Mapping the Adult Comfort Promise

Pain is a barrier to gynecological procedure completion. Best practices recommend pharmacotherapy and assessment techniques (e.g., trauma-informed history) to manage pain. Non-pharmacological interventions, including distraction techniques (e.g., heat and breathing), demonstrate minor effectiveness, low side effects and low cost. However, there is a paucity of evidence exploring the implementation of pain management interventions into gynecological services. The purpose of this paper is to map a pain management intervention in order to increase our understanding of how to create environments supportive of pain management and patient safety for adults receiving gynecological procedures.

We applied Intervention Mapping to the development and implementation of a pain management intervention known as the Adult Comfort Promise. We used informant conversations with healthcare providers, identified as pain champions, to complete the six steps of Intervention Mapping. We completed the following Intervention Mapping steps: 1) conduct a needs assessment, 2) create change objectives, 3) select theory-based interventions, 4) design the intervention, 5) plan for adoption and implementation and 6) evaluation. This included a barriers and facilitators assessment, mapped to the Inside out socioecological model by Golden et al. We used member checking to confirm the accuracy of our findings.

From August 2023 onwards, healthcare providers in an Ambulatory Care Clinic, within a tertiary-level healthcare center for women, youth, children and gender diverse individuals in the Maritime Canadian provinces, designed and implemented an intervention to improve the assessment, prevention and treatment of procedural pain for in-office gynecological procedures. Creating supportive environments for comfort and pain management required multiple factors, including policies, pain champions, ongoing monitoring, and support from leadership. Future research will evaluate the intervention's effectiveness, acceptability and fidelity.

Intervention Mapping was a valuable method for identifying opportunities for patient empowerment and implementation strategies for the Adult Comfort Promise. These findings may be transferable to other procedures or settings (e.g., primary care, student health, or community clinics). Intervention Mapping offers a guide to designing and implementing other pain management interventions to improve procedure completion. It may be useful for nurses as they implement pain management interventions into practice.