Self-care promotion of the intact (non-circumcised) patient: A review of available recommendations.

PURPOSE: With routine infant circumcision rates declining in the United States, nurses are likely to encounter more intact (non-circumcised) male patients requiring genital hygiene, nursing interventions, and education accessing the health system. To date, a little emphasis has been placed on the care of the intact male patient in the nursing literature, resulting in ambiguity in care recommendations. The vagueness is problematic, as improper intact care, particularly in the pediatric patient, can result in forced retraction injuries, bleeding, scarring, and unnecessary intervention. In addition, with nurses conducting many of the tasks of hygiene and education for self-care, there is potential for impaired patient self-care and harm if nurses are not knowledgeable in intact care. Utilizing Orem's self-care theory as a framework, the aim of this effort is to perform a review of current recommendations on intact care to inform nursing practice with this population. As no evidence was found in the scientific literature, readily available consumer website resources were reviewed. CONCLUSION: Themes of hygiene and age of retraction emerged. While recommendations for hygiene practices were variable, all review sources (n = 12) were clear in advising against the premature retraction of the intact foreskin and identified this as a route for injury. PRACTICE IMPLICATIONS: With no current literature available to summarize current nursing clinical or educational practices, dissemination of these recommendations is necessary to prevent patient injury and promote appropriate patient self-care.

Non-surgical adult male circumcision using the PrePex device: task-shifting from physicians to nurses.

The Republic of Rwanda is implementing a program of voluntary male circumcision (MC) to reduce HIV transmission but lacks the infrastructure for conventional surgical MC on a nationwide scale. Nonsurgical MC using the PrePex device was first assessed in 5 subjects on an inpatient basis. Subsequent procedures were on an outpatient basis. Physicians performed 100 outpatient procedures (Phase 1 of this study) and trained nurses in the technique; the nurses then independently performed 47 procedures (Phase 2). All subjects achieved complete circumcision and healing within 6 weeks. There were no cases of infection or bleeding. In Phase 1, one case of transient moderate diffuse edema occurred. In Phase 2, no adverse events were reported. Thus, outcomes of MC performed by nurses using the PrePex device were not inferior to outcomes achieved by physicians, suggesting that task-shifting MC by this method from physicians to nurses is feasible in Rwanda.

Cost Analysis of Adult Male Circumcision with the PrePex Device versus Surgery in Rwanda.

In this study from Rwanda, voluntary adult male circumcision costs 33% less with trained nurses using the PrePex device compared with physician-nurse teams performing dorsal-slit surgery. These cost savings and the documented safety, speed, and efficacy of the PrePex procedure, serve Rwanda's HIV prevention program.

To circ or not: a reappraisal.

Routine circumcision remains a topic of controversy. The most recent male circumcision policy from the American Academy of Pediatrics argued that data were insufficient to recommend routine circumcision. Recent trials in Africa evaluating male circumcision for the prevention of sexually transmitted diseases have, however, revived the circumcision controversy.

Circumcision care.

Though circumcision can be a debatable topic, the American Academy of Pediatrics (AAP) in 1999 determined that scientific evidence demonstrated potential medical benefits of newborn male circumcision. However, there was insufficient data to prove neonatal circumcision is medically essential. The opinion of the AAP was reaffirmed in 2005.1 Therefore, nurses in the postpartum units often address questions about circumcision. Moreover, learning about circumcision's standard of care is a great opportunity to add to evidence-based clinical knowledge for the nursing profession.

A unique service in UK delivering Plastibell circumcision: review of 9-year results.

Muslim infants undergo circumcision for religious reasons and Bradford has a high Muslim population. The National Health Service in UK does not provide religious circumcision, so in 1996 a nurse-delivered circumcision service led by consultant urologists was set up at a no-profit and cost-only basis. Plastibell circumcision was offered to all infants between 6 and 14 weeks old and performed under local anaesthesia. Information leaflets and videotapes about the procedure were available to parents prior to the procedure. A three monthly audit of the service was undertaken. Between July 1996 and June 2005 (9 years) 1,129 circumcisions were performed. The common complications were problems with the ring (3.6%) and bleeding (3%). Overall, there was 96% satisfaction rate among the service users. The Plastibell technique for circumcision is a simple method and can be safely performed by trained nurses with acceptable complication rates.

Pain management for newborn circumcision.

PURPOSE: To describe current newborn circumcision pain interventions and to identify which forms of analgesia were most effective. METHOD: Each male newborn was assessed for pain during the circumcision procedure and at 15-minute intervals after the procedure using the FLACC pain scale. The type and combination of analgesia was also recorded on the pain assessment record. RESULTS: Pain scores were highest for newborns receiving no analgesia during circumcision. Newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores. The sucrose alone did not provide sufficient analgesia; however, it did reduce the FLACC score somewhat when used in conjunction with other analgesics/anesthesia. CONCLUSIONS: Information obtained from this project facilitated a change in policy wherein newborn circumcision is performed only with the use of analgesia and not concentrated oral sucrose alone.

A pictorial and video guide to circumcision without pain.

3 Despite the 1999 American Academy of Pediatrics (AAP) policy statement indicating that routine neonatal circumcision is not medically necessary, circumcision continues to be the most frequently performed surgical procedure in the newborn period in the United States. Further, many health care practitioners routinely perform this procedure without the use of any or with inadequate or ineffective analgesia and anesthesia. Multiple studies have evaluated the safety and efficacy of specific pharmacologic and nonpharmacologic interventions to relieve circumcision pain and discomfort. Penile nerve blocks, local anesthetics, various operative instruments, acetaminophen, sweet oral solutions, pacifiers, a physiologic restraining device, intrauterine sounds, and music all have been evaluated. This article synthesizes these studies and highlights their significance for current clinical practice. The article provides a detailed pictorial and video guide to circumcision with an emphasis on the use of multimodal strategies to ensure adequate anesthesia, analgesia, and infant comfort before, during, and after the procedure.

Circumcision: a consideration of some of the controversy.

This article considers the procedure known as male circumcision. This is practised throughout the world for a variety of reasons, including medically essential reasons, health promotion, health protection, cultural, religious and aesthetic. It has been estimated that approximately one-third of the male population has been circumcized. As with some other surgical interventions its use is controversial, and there are a number of ethical and moral issues that are of interest to the children's nurse. The anatomy and physiology of the prepuce is summarized and the practice of circumcision and some of the risks and proposed benefits of the procedure are considered. This article is intended to be culturally sensitive and it is hoped that it will inform others and provoke discussion. It may enable the children's nurse to raise awareness of the issues among the general population.

An evidence-based multidisciplinary protocol for neonatal circumcision pain management.

Pain experienced in infancy may have effects later in life. Neonatal circumcision is a common painful procedure. In addition to dorsal penile nerve block, interventions that may have a role in minimizing pain and distress in neonatal circumcision include use of a sucrose pacifier, buffered lidocaine, small needles, acetaminophen, swaddling, and environmental modification. The evidence for each intervention is presented and evaluated. Implementation of a comprehensive evidence-based circumcision pain control standard of practice is discussed.

Neonatal circumcision. Benefits, risks, and Family teaching.

Neonatal circumcision is a frequently performed elective surgical procedure, and is one of the oldest known surgical procedures. Neonatal circumcision may be performed for medical, cultural, or religious reasons. This article provides current information from the literature regarding the risks, benefits, and concerns about neonatal circumcision.