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Basics of doing any procedure
Steps to perform a procedure:
1.Review Patient Chart & Clinical Indications:Prerequisite Phase.
Review the patient's full medical chart, including all diagnostic investigations, treatment indications, and potential contraindications before proceeding.
2.Counsel Parents & Obtain Written Consent:Informed Consent Phase.
Discuss the procedure's benefits, potential risks, and alternatives with the parents or legal guardians. Obtain signed informed written consent.
3.Pre-Procedure Preparation & Analgesia:Baseline & Safety Setup.
Obtain baseline pre-procedural vital signs.
Administer appropriate measures for analgesia/sedation as indicated.
Perform hand hygiene and don appropriate Personal Protective Equipment (PPE: gloves, gown, mask/visor as needed).
Prepare and arrange all necessary sterile equipment.
4.Execute Procedure & Collect Specimens:Procedure Phase.
Perform the procedure adhering strictly to aseptic technique. Collect and properly label any required laboratory samples/specimens immediately.
5.Post-Procedure Monitoring & Documentation:Follow-Up Phase.
Take and record post-procedural vital signs.
Write complete procedure notes in the chart (including procedure details, findings, complications, and patient tolerance).
Inform parents/guardians about the outcome (success/failure) and outline immediate post-procedure care or warning signs.
How to counsel parents/care takers
Do not miss an opportunity to counsel parents or care takers if they come to you to know the status of the baby. If there has been a sick event or improvement in the condition of baby, do counsel parents. Try to make points of the points once you have counselled them. Urdu terminologies:
For a baby who is nothing per oral, tell parents that, bacha doodh nhi pi rha lekin bachay ko glucose ki drip say sahara dy rhay hain takeh sugar kam na ho, iske ilawa protein ki drip (aminovil) bhi ja rhi hai if giving aminovil)
Baby on inoptropes (bachay ka blood pressure low ho jata hai jiske liyay blood pressure barhanay wali dawai ja rhi hai, bacha icu mei dakhil hai aur her tarah ki ngahdasht ki ja rhi hai takeh yeh behtar ho skay)
Early onset sepsis/ Late onset sepsis ( bachay kay jism mei jaraseem honay ka shubah hai jis kaye liyay test bhaij diay gaye hain, ya bhaijay jayengay ya reports agai hai aur un mei infection aya hai, iske liyay dawai yani antibiotic shuru kera di gayei hai)
Birth asphyxia: Bacha paidaesh per late roya hai aur bachay kay demagh ko oxygen kam gayei hai jiske liyay bachay ko oxygen say aur machine say sahara dey rhay hain. bachay per nazar rkhi ja rhi hai keh gurday, anntriyan aur dil sahi kaam kertay rhain.
Preterm baby (bacha waqt say pehlay paida huwa aur iskay phaiphray kamzor hain jin ko taiz oxygen say sahara diya ja rha hai, bachay ka jigar, antriyan , gurday, dil sb kuch waqt say pehlay ka hai aur chota hai, aur in sb cheezo per nazar rkhi ja rhi hai, hum dekhain gay keh kab bachay ko nali kay zariyay doodh dena hai)
Here is a clear and structured framework summarizing the complete step-by-step clinical counseling protocol:
Phase 1: Pre-Counseling Preparation
Chart Review: Thoroughly study the patient’s medical case file, diagnostic results, and history prior to entering the counseling area.
Phase 2: Environment & Communication Setup
Environment & Appointment: Select a quiet, private space with minimal interruptions and schedule sufficient uninterrupted time.
Greeting: Warmly welcome and greet the patient and their accompanying party.
Attendance Limit: Limit accompanying attendants to a maximum of two (or as designated by the patient) to prevent room overcrowding, maintain privacy, and avoid unnecessary interruptions.
Seating Positioning: Arrange seats so the healthcare provider, patient, and attendant form a 60 degrees cone arrangement at approximately 1.5 arm lengths distance.
Phase 3: Uninterrupted Active Listening & Assessment
Open-Ended Initiation: Begin by giving the floor to the patient/attendant. Ask open-ended questions such as:"What is your understanding of your condition so far?"
"What have you been told about the procedure we are planning?"Active Listening ("Listen, Listen, Listen"): Do not interrupt while they speak.
Observational Assessment: While listening, evaluate:
The patient/attendant’s health literacy and level of understanding.
Their current perception and emotional weight regarding the illness/diagnosis.
Empathy & Reflection: Validate their feelings using reflective statements and explicit empathy before transitioning to your portion.
Phase 4: Structured Information Delivery
Boundary Setting (Transition): Softly set the expectation for uninterrupted delivery using a clear, gentle statement:"Thank you for sharing that. Now, I will explain the situation and details step-by-step. Please hold any questions until I finish, and I will make sure we address every single one."
Communication Style: Use non-jargon language, everyday analogies, visual diagrams, and evidence-based clinical information.
Framing Strategy (Prognosis & Outcomes):
Present favorable outcomes, benefits, and positive prognostic factors first.
Present risks, complications, side effects, and guarded prognostic factors last.
Content Coverage:
For Disease Management: Outline available medicinal, surgical, or conservative treatment pathways alongside their respective advantages and drawbacks.
For Procedures: Detail why the procedure is recommended, how it aids diagnosis or treatment, evidence-based success rates, and potential procedural risks/complications.
Phase 5: Guided Decision-Making & Autonomy
Shared Decision-Making: Present options clearly without making the final choice for the patient.
Unbiased Guidance: Assist their decision based strictly on medical logic, patient benefit, and the principle of non-maleficence (primum non nocere), keeping personal bias out of the discussion.
Phase 6: Documentation & Next Steps
Chart Documentation: Record the discussion, treatment options presented, patient/family understanding, and the final decision in the patient’s medical record.
Procedural Follow-Through: Execute standard clinical protocols following the decision (e.g., obtaining formal written informed consent, recording baseline pre-procedural vital signs, and scheduling next steps).
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