Your Feet, Your Fit - SingHealth

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2016 A SPECIAL EDITION ON NURSING BY SINGHEALTH DUKE-NUS ACADEMIC MEDICAL CENTRE MCI (P) 049/05/2016 www.sgh.com.sg | www.singhealth.com.sg

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How a supportive mentor makes a difference in a nurse’s career

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Meet the nurses who help and cheer patients and caregivers on

Nursing runs in the family

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stand out from the crowd Photo: alvinn lim

Two Singhealth scholars reveal why they chose nursing and love it P3

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Nowhere is too far when it comes to helping those in need

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Nurses: the pride of singhealth

2016

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Group Chief Nurse, SingHealth

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For editorial enquiries, please e-mail [email protected] For advertising enquiries, please call 6319-3022 or e-mail [email protected] All rights reserved. Copyright by SGH (registration no: 198703907Z). Opinions expressed in Singapore Health are solely those of the writers and are not necessarily endorsed by SGH, SingHealth Group and/or SPH Magazines Pte Ltd (registration no: 196900476M) and their related companies. They are not responsible or liable in any way for the contents of any of the advertisements, articles, photographs or illustrations contained in this publication. Editorial enquiries should be directed to the Editor, Singapore Health, 168 Jalan Bukit Merah, #13-01 Surbana One, Singapore 150168. Tel:+65 6222 3322, Email: [email protected]. sg. Unsolicited material will not be returned unless accompanied by a self-addressed envelope and sufficient return postage. While every reasonable care will be taken by the Editor, no responsibility is assumed for the return of unsolicited material. ALL INFORMATION CORRECT AT TIME OF PRINTING. MCI (P) 049/05/2016. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).

2016

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The road to nursing

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casual chat with a platoon mate during his national service (NS) days led Mr Muhammad Imran Ahmad to nursing. “He told me about his nursing studies and hospital attachments, which really sparked my interest in the profession. He said that nursing isn’t glamorous and won’t bring fame, but that the sense of satisfaction you get from seeing patients get well is immense.” Mr Imran, now 29, did not expect that conversation to take him anywhere, but after finishing NS in 2008, he found himself applying for a SingHealth scholarship to study nursing at the National University of Singapore (NUS).

Nursing can really keep you in touch with humanity. mr muhammad imran ahmad, senior staff nurse, ward 64 (renal), SGH

He got the scholarship, which eased the financial burden on his parents and more importantly, helped him chart clearer career goals. He found life as a student nurse far from dull. “We volunteered to do community health screenings and often went door-to-door to help elderly patients. I also organised trips to Medan in Indonesia, to bring basic health

education to the community there.” Now a Senior Staff Nurse at Ward 64 (Renal) of the Singapore General Hospital (SGH), he is convinced that nursing will be his career for life. “Nursing lets me experience all of life’s emotions. I’m full of joy when my very sick patients get well and walk out of hospital. My heart aches when I see patients’ relatives break down or cry. Nursing can really keep you in touch with humanity.” In the renal ward, he cares for patients with chronic kidney diseases and kidney failure, some of whom need to return for tests and procedures every three to four months. “My patients are like family to me. Bonding with them makes me understand their needs and helps me develop personal care plans that can help them manage their conditions,” said Mr Imran. Having completed an Advanced Diploma in Nursing (Medical-Surgical) last July, he hopes to broaden his skills by pursuing a Master in Nursing or Public Health in the future. He is glad to have found a job he loves. The job, meanwhile, has brought him another love – his wife, a fellow nurse he met while working at SGH.

No change of mind

Ms Angela Kirk, 27, had wanted to be a nurse for as long as she could remember. As a child who was often in and out of hospital due to asthma attacks, she was inspired by the nurses who took care of her, wanted to be like them, and help others when she grew up.

Photo: ALVINN LIM

Two SingHealth nursing scholars found their way to nursing through different routes but what they have in common is a great love for the job. By Esther Au Yong

Senior Staff Nurse Angela Kirk, who received a SingHealth scholarship to study in Australia, is happy to be making a positive difference in her dream job.

When it was time to choose a career, her mind was unchanged. And though her parents objected, she remained firm. “We were still arguing hours before my application for the nursing course at Nanyang Polytechnic (NYP) closed. They believed that studying business had better prospects than nursing. But I wanted to follow my heart,” she said. She won and her nursing journey began. She graduated in 2009 as NYP’s top nursing student and joined the Children’s Intensive Care Unit (CICU) at KK Women’s and Children’s Hospital (KKH). Shortly after, she received a SingHealth scholarship to pursue a nursing degree at the University of Sydney in Australia. While there, she was exposed to research activities that she said “really sharpened (her) investigative and critical thinking skills”. When she returned in 2011, she resumed work at the CICU as a Senior Staff Nurse and wasted no time in putting her research skills to use. “For my final semester’s research project, I did a systematic review of research papers and found that following bundles (set procedures) could help

reduce the rate of ventilator-associated pneumonia in the ICU,” said Ms Kirk. She discovered that following standard protocols, such as brushing a patient’s teeth at set intervals to prevent bacteria build-up, or propping patients up 30 to 45 degrees to prevent reflux of gastric content, can help lower the incidence of ventilator-associated pneumonia. Six months after her return, with the help of a team of respiratory specialists and nurses, she implemented a bundle at the CICU. She has also presented her research findings at international conferences in countries such as South Korea and Netherlands. In 2014, she obtained an Advanced Diploma in Nursing (Paediatrics) and will be pursuing her Master in Nursing (Paediatrics) at NUS later this year, under a KKH sponsorship. “For nurses, the learning never stops. I hope to be a better carer and advocate for my patients, and a bridge between nurses and our multi-disciplinary health care teams,” she said. As for her parents, they are now extremely happy and proud of her work.

Nursing scholarships and sponsorships Photo: ZAPHS ZHANG

Calling all aspiring nurses!

Senior Staff Nurse Muhammad Imran Ahmad, who received a SingHealth scholarship to study nursing at NUS, says his patients are like family to him.

If you have a passion for helping people, and are looking for a dynamic job that allows you to interact with people from all walks of life, consider nursing as a career! Visit SingHealth’s website to find out more. (www.singhealth.com.sg/Careers/scholarships-sponsorships/nursing)

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2016

Happy Nurses’ Day Nurses are at the frontline of patient care. They act with kindness and compassion during the crises of illness; they give medications and treatments to heal and relieve suffering; and they uphold the highest standards to protect our patients from falls, errors, pressure injuries and infections. It has been said, “Save one life and you’re a hero. Save 100 lives and you’re a nurse!” We celebrate our nurses today and every day – you are the PRIDE OF SINGHEALTH! Prof Iv y Ng Group CEO, SingHealth

In the many heartfelt letters of appreciation from patients, almost all invariably thank our nurses. They are touched by the high standard of care delivered with warmth, compassion, thoughtfulness and the human touch – and often, these are things which really matter to our patients. Our nurses provide the true essence of healing and are the faces of humanity in health care. Prof Kenneth K wek CEO, KK Women’s and Children’s Hospital

Nurses help patients heal with their amazing commitment and care, working tirelessly both at the forefront and behind the scenes. With warmth and humility, you quietly care for each patient, healing them with your gentle touch. Thank you for always giving your best and inspiring all of us with your dedication! Prof Terrance Chua Medical Director, National Heart Centre Singapore

The high quality of care our patients receive is to a large extent a reflection of your professionalism and tireless commitment to comfort and heal. Present day demands on public health care can be challenging, but you help to ensure our patients’ needs are met by working on the frontline alongside other health care staff. This Nurses’ Day, we take a moment to show our appreciation for your dedication. Thank you for your kindness and compassionate care. You deserve to be honoured. Happy Nurses’ Day! Prof Soo Khee Chee Deput y Group CEO (Research & Education), SingHealth & Director, National Cancer Centre Singapore

Our nurses are incredibly committed and loyal to their calling. Many of them have seen me grow from a junior MO, and it is awesome, comforting and humbling working alongside some of these nurses who have been in service for 30, 40, even 50 years. Thank you, nurses, for staying the course. Prof Christopher Cheng CEO, Sengk ang Health

Your professionalism and skills shine through as you attend to the needs of our patients tirelessly every day without fail. Wonderful stories abound about your kindness and compassion as you go the extra mile for our patients. Thank you for bringing smiles to our patients. Assoc Prof Poon Choy Yoke Director, National Dental Centre Singapore

Nursing comes from the heart. Your work can be stressful and tiring but you are never short on care and compassion. Thank you for being at the heart of health care. Happy Nurses’ Day! Assoc Prof Ng Wai Hoe Medical Director, National Neuroscience Institute

My dear nursing colleagues, you are the pillar of strength at SingHealth. Your expertise, your empathy, your care and concern exemplify the important work that we do for all our patients. May we continue in this meaningful work and scale new heights of excellence. Prof Ang Chong Lye Deput y Group CEO (Clinical Services & Informatics), SingHealth & CEO, Singapore General Hospital

Nurses are key partners of the health care team. Your professionalism, dedication and excellent care for our patients are unparalleled. We are very proud of you! Prof Fong Kok Yong Deput y Group CEO (Regional Health & Medical), SingHealth

Nurses play a critical role in our care for patients at SNEC – we are grateful for their compassion, tireless contributions and personal sacrifice. Prof Wong Tien Yin Medical Director, Singapore National Eye Centre

Our nurses are the pride of SingHealth. You are strong in the face of challenges, yet always gentle when caring for patients. You are resolute in matters of patient safety; yet compassionate when managing patients’ concerns. You embody the essence of health care and we thank you for being you. Dr Adrian Ee CEO, SingHealth Polyclinics

On this day, we celebrate you, your selfless service and compassion for all who are sick and vulnerable. For giving so much of yourself to offer comfort and healing to someone else, for being so caring even when not looking after the sick, you are our heroes and the pride of BVH. Mr Chua Puay Hian CEO, Bright Vision Hospital

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A guiding hand More than just helping a novice navigate the first few months on the job, a good mentor provides guidance and support throughout a nurse’s career. By Rachel Chan heart and lung functions. On my first day of work, I was daunted by the number of these machines. Thankfully, my seniors guided and looked out for me,” she said.

The best advice that my mentor has given me is to follow my passion and plan for it! Ms lim leng shan, senior staff nurse, CTICU, national heart centre singapore

Under the nursing preceptorship programme, all new nurses are paired with a senior nurse (preceptor, who is often looked upon as a mentor) from the same depar tment for at least six months. Ms Lim’s preceptor was Nur se Clinician Chia Tat Jin, 34, a 14-year veteran in the CTICU, known for his nurturing and good-natured personality. Like Ms Lim, he had started off as a staff nurse, and had worked his way to becoming a nurse manager overseeing a team of 12. Af ter her six-month probation, Ms Lim continued to look to Mr Chia for career advice and guidance.

Photos: alvinn lim

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xcited and nervous – that was how Senior Staff Nurse Lim Leng Shan, 25, felt when she first became a nurse three years ago. She had then just graduated from the National University of Singapore with a nursing degree, and joined the Cardiothoracic Surgery Intensive Care Unit (CTICU) at the National Hear t Centre Singapore. As a newbie, her biggest challenge was putting theory into practice when caring for critically ill patients. She also had to familiarise herself with the different life support systems. “I was overwhelmed by how complex the CTICU was. Patients there need intensive care and depend on life support machines to maintain their vital

Senior Staff Nurse Lim Leng Shan (right) was initially daunted by the many machines in the CTICU, but soon learnt to master them with the help of Nurse Clinician Chia Tat Jin.

Sharing their experience How does mentorship work?

Mr Chia: During her probation, I taught her the ropes and assessed the competency of her skills. After that, my role became more of a facilitator, to provide guidance on career development, give emotional support, and serve as a good role model. She is very inquisitive and always has questions about work. Rather than always giving her the answers, I sometimes turn the questions around to encourage her to think and come up with her own solutions. Ms Lim: It’s sometimes not possible to ask questions at a patient’s bedside. So, I jot down them down in a notebook and ask him later at the end of our shift or when we have time to catch up. He’s helped me become more independent and to think on my feet. It’s amazing how he’s always so patient, approachable and generous in sharing his knowledge.

What was your most memorable work experience with your mentor?

Ms Lim has learned a lot from Mr Chia and continues to look to him for career advice even after her six-month probation.

Ms Lim: During my first month at work, I was taking care of a critically ill patient on advanced life support who needed frequent resuscitation. I didn’t have much experience doing this, and was anxious when the patient’s condition turned worse. Mr Chia noticed my fear and calmed me

down with encouraging words, while at the same time taking instructions from the doctors. It was a highstress situation but he was calm and composed, and resuscitated the patient. He could have chided me for being anxious but instead, he later told me that he appreciated my ef for t s . That wa s a huge morale booster. Mr Chia also patiently answered quite a few questions I had after the situation was resolved.

What’s the hardest thing to teach a mentee?

Mr Chia: It can be hard inculcating a good and positive attitude in a mentee. It’s a personal choice whether someone is “just doing a job” or “proud to be a nurse”. You can teach them the A to Zs of nursing, but without a positive and receptive attitude, something will be missing.

What’s the best advice your mentor has given you?

Ms Lim: The best advice that my mentor has given me is to follow my passion and plan for it! Mr Chia knows I’m interested in becoming a nurse educator and he’s been encouraging me to work towards this goal. I also learnt from him that there’re bound to be good and bad days at work. However, I should just focus on doing my best and have some work-life balance in my days. In these ways, I can stay happy on the job every day.

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2016

The mind matters

Technological advancements and new tools have improved health care delivery but they can never substitute the human touch of a nurse. American poet Maya Angelou once said: “As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients and their families. They may not remember your name but they will never forget the way you made them feel.” Indeed, care and compassion will always be the essence of nursing practice.

Photo: ZAPHS ZHANG

To serve in the operating theatre, nurses need skills, stamina, emotional control and a very focused mind. By Rachel Chan

Nurse Clinician Ng Siew Fong (second from left) shares that mindfulness techniques and cross-training are important factors that help her team of 20 operating theatre nurses excel in their work.

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ome surgeries CAN last 10 to 12 hours. Staying focused is critical because the multiple tasks and procedures require precision,” said Nurse Clinician Ng Siew Fong, who heads a team of 20 nurses at Alexandra Hospital’s Anaesthesia Unit, Perioperative Services. The hospital, currently run by Sengkang Health (SKH), started offering general and orthopaedic surgery services this year. Its Operating Theatre (OT) nurses care for patients before, during and after operations. They assist anaesthetists and surgeons during surgeries, and monitor patients’ conditions in the intra-operative and post-operative stages. These nurses are also continually improving their levels of concentration with mindfulness techniques, something the hospital has incorporated into its staff training programmes. Mindfulness is said to help one focus through present moment awareness, improve empathy and job satisfaction, and reduce psychological and physiologic stress, emotional distress, and burnout. “The practice of mindfulness helps nurses have active and open concentration on the tasks at hand. The operating theatre environment is very dynamic and we can’t afford to have any distraction because it can compromise patient safety,” said Ms Ng.

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Cross-training

Another way OT nurses are honing their skills is through rotation of duties, or cross-training. Previously, they used to specialise in a specific area of care such as perioperative, anaesthesia or recovery. Now, by allowing them to rotate through these areas, SKH h a s d ev e l o p e d a n i n - h o u s e t ra i n i n g programme that equips them with skills in both anaesthesia and recovery care. The programme includes classroom lessons, on-the-

job training, and simulated experience of working in a multi-disciplinary team. They are also assessed on how competent they are in these skills. “More than just empowering them to be allrounders, there are benefits to having the same nurse take care of a patient before, during and after surgery. It sets the patient’s mind at ease to see a familiar face when he wakes up after surgery,” said Ms Ng.

The operating theatre environment is very dynamic and we can’t afford to have any distraction because it can compromise patient safety. Ms ng siew fong, nurse clinician, sengkang health

One nurse who underwent this crosstraining is Staff Nurse Kamalia Kamis, who joined SKH this year. With four years of experience as an anaesthesia nurse already under her belt, she went on to learn recovery care skills, and said it was an eye opener. “I realised there’s so much to learn in perioperative nursing. My role has expanded beyond supporting the anaesthetists in the OT, and I am more involved in different aspects of care management for patients,” said Ms Kamalia, who will be taking her Advanced Diploma in Nursing (Perianaesthesia) at Nanyang Polytechnic in October.

Ms Tan Soh Chin Chief Nursing Officer, Ministry of Health

The challenges we overcame in the past year have reinforced my pride in SingHealth nurses. I am so grateful to work with an excellent team of resilient nurses who strive to create a caring and healing environment for our patients and their loved ones; who as respected members of the health care team, balance expertise with empathy and compassion. Thank you for all that you do and for always giving so much of yourselves.

Dr Tracy Carol Ayre Group Chief Nurse, SingHealth & Chief Nurse, Singapore general hospital

Happy Nurses’ Day Ms NG Gaik Nai Deput y Group Chief Nurse, SingHealth & Chief Nurse, KK Women’s and Children’s Hospital

Ms Christina Lim chief nurse, Sengk ang Health

Ms Stephanie Teo Chief Nurse, SingHealth Polyclinics

Ms Ho Ai Lian Chief Nurse, National Heart Centre Singapore

Ms Lian Siew Bee chief nurse, National Cancer Centre Singapore

Ms low siew ngim Director, Nursing, Singapore national eye centre

Ms Ng Wai May Senior Nurse Clinician, National Neuroscience Institute

Ms Leow Suat L ay Senior Nurse Manager, National Dental Centre Singapore

Ms Magheshwari R K Sabapathy ASST Director, Nursing, bright vision hospital

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fter 70-year-old Mr Tan (not his real name) was discharged from Singapore General Hospital (SGH), he continued to receive care from a medical team under SGH’s Transitional Home Care (THC) programme. This was a great relief to his daughter, who had worried about not being able to look after her father properly at home. “It is very reassuring to have the care team visit him at home, especially nurse Stephanie who taught me and my helper how to tube feed him and how to transfer him from the bed to the wheelchair safely. She also calls us regularly to find out how he is doing,” Ms Tan said. Mr Tan is one of 40 patients whom Ms Stephanie Lam, Senior Staff Nurse, Office of Integrated Care, is caring for under the THC programme. Set up by the Department of Family Medicine and Continuing Care, the ser vice helps patients with sub-acute medical conditions and limited mobility receive care at home. The multi- disciplinar y team comprising doctors, nurses, medical social worker s, pharmacis t s and therapists meets weekly to discuss patients and their follow-up care. In addition to stroke patients, the programme also benefits those who suffer from Parkinson’s disease and endstage organ failure. “There are daily tasks that patients and caregivers need help with. For instance, inser ting feeding tubes properly to ensure food reaches the

stomach. If not done properly, this can affect a patient’s recovery. During home visits, I observe how well caregivers perform these tasks and train them if needed,” Ms Lam said. “The programme usually lasts about three months post-discharge. When a patient’s condition is stable, we discuss the next care plan in detail. If necessary, we will arrange for the patient to continue receiving care from community partners such as the Home Nursing Foundation or NTUC Eldercare.” Ultimately, the aim of providing transitional home care is to empower b oth patient s and caregiver s to successfully manage their medical conditions at home, and avoid having to be admitted back into hospital.

Connecting the dots

Working closely with nurses from the transitional care programme are Patient Navigators who help to assess, plan and coordinate care for patients from admission to discharge. They connect patients with the wider health care teams, community hospitals, hospices, and other external agencies in the community. One Patient Navigator is Nurse Clinician Xu Yi, who works with cancer patients in Ward 48 in SGH. A key part of her daily work is to review the medical records and social backgrounds of patient s due for discharge, and to understand their medical, functional and psychosocial


As part of her role in the Transitional Home Care programme, Senior Staff Nurse Stephanie Lam (middle) teaches a patient’s helper how to better care for him at home.

From hospital to home Patients continue to receive hospital-standard care at home or in the community after discharge under the Transitional Home Care programme. By Audrina Gan

Ms Lam (left) and Nurse Clinician Xu Yi, both from SGH, work together to care for patients post-discharge.

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PhotoS: ALVINN LIM

2016

needs. Together with a multi-disciplinary team, she then crafts a plan that ensures a patient’s care isn’t disrupted or changed too dramatically when he returns home. She refers the more complex cases, including patients who are admitted repeatedly, to the THC team for additional support. Ms Xu recalled a patient with latestage cancer who had fractured her pelvis after a fall at home. “She came to us with severe pain and was unable to undergo surgery due to her pre-existing condition,” said Ms Xu. As the patient, who is in her late30s, wanted to be cared for at home, the health care team met with her family to discuss her needs af ter her discharge. “To receive care at home, she needed a trained caregiver, pain-relieving devices, and community support,” said Ms Xu, who arranged f o r co lleag u e s f r o m S G H’s Pain Management Centre to train the

What’s in her bag?

Ms Lam totes a small suitcase with medical supplies such as: • stethoscope • blood pressure monitor • thermometer • bladder scanner (when needed) • medication • wound dressings • disposable gloves • hand sanitiser • disinfectant wipes

hospice home care team and the patient’s caregiver. For instance, they were taught to handle and monitor an intrathecal device, which delivers medication directly to the spinal cord. “The patient navigator’s role benefits patients and the health care system. For me, the oppor tunity to better understand my patients has helped me to grow professionally and personally,” said Ms Xu.

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2016

Welcome to the group Many support groups are initiated by nurses and fellow health care staff to help patients and their caregivers cope with neurological diseases like Parkinson’s disease and dementia. By Celine Asril

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very month, Mr Tan Tian Seng travels 90 minutes by bus and train from his home in Marsiling to attend Parkinson’s disease support group meetings at the National Neuroscience Institute (NNI). But the long journey doesn’t bother 60-year-old Mr Tan. “I really look forward to coming to the support group. I get to learn more about my condition and also share my experiences with those who are newly diagnosed and unsure of what to expect,” said Mr Tan, who has had the disease for a decade.

the sessions are also a time for caregivers to relax and enjoy themselves. Ms evelyn poh, resident nurse, sGH, and brain empowerment support group co-lead

Photo: alvinn lim

it’s very fulfiLling to hear how they feel more empowered and enjoy the activities we plan for them.

Resident Nurse Evelyn Poh (second from left) and Advanced Practice Nurse Usanee Chotphoksap (third from right) enjoying a craft activity together with dementia patients and carers who attend the Brain Empowerment Support Group.

mdm ng hwee lan, nurse clinician, nNI, and parkinson’s disease support group co-lead

Organised by NNI nurses and allied health professionals, the suppor t group meets every second Thursday of the month and is attended by over 30 patients and their caregivers. Patients experience tremors, stiffness in the limbs and problems walking, as well as depression and anxiety. Though joining the support group is free and all are welcome, most members

the first Thursday of each month. Par ticipants learn about different aspects of dementia, and participate in arts and crafts activities, dance, and simple games to improve their memory. They have also made mooncakes together and gone on an outing to Gardens by the Bay. “During the activities, we chat with the participants to find out how they are doing,” said Ms Usanee. “If we learn that a participant needs help, we refer them to other health care experts such as psychologists or medical social workers.”

began as patients at the NNI. Mr Tan is one such patient, having undergone deep brain stimulation surgery in August 2015. The nurses supported him before and during surgery, and also during his recuperation period.

You are not alone

“The support group sessions allow our patients to connect with people who are facing similar challenges. Many find such psychological support important

for them to better manage and cope with their condition,” said Advanced Practice Nurse Li Wei. The 48-year-old has been leading the support group with Nurse Clinician Ng Hwee Lan, 51, since 2010. In addition to sharing sessions with patients and their carers, the nurses organise bimonthly talks in English and Mandarin by neurologists, neurosurgeons, therapists, acupuncturists and other health care experts. Topics range from the latest treatment s to music therapy and traditional Chinese medicine. The planning of and preparation for the group’s activities are often done outside the nurses’ working hours. But the positive response from participants makes their efforts worthwhile. “We’re happy to see patients and caregivers coming every month to learn and interact with one another,” said Mdm Ng. “It’s very fulfilling to hear how they feel more empowered and enjoy the activities we plan for them.”

Photo: VEE CHIN

You are not forgotten

Nurse Clinician Ng Hwee Lan (left), Senior Staff Nurse Yvonne Chew (fourth from right) and Advanced Practice Nurse Li Wei (far right) co-lead a Parkinson’s disease support group at NNI, in which participants share their experiences candidly.

Singapore General Hospital’s (SGH) Brain Empowerment Support Group offers a cozy and relaxing environment for dementia patients and their carers. Advanced Prac tice Nurse Usanee Chotphoksap, 35, said that when the group was set up in 2011, “We wanted to provide an informal platform for them to share their personal experiences.” Health care experts are invited to lead the sessions, which are held on

Understanding how the condition can be stressful for both patient and carer, Resident Nurse and support group co-lead Ms Evelyn Poh, 27, said: “The sessions are also a time for caregivers to relax and enjoy themselves.” Mr Leong Chan Kay, 78, who looks after his wife Mdm Grace Wong, 76, has been attending the sessions for the past two years. “One of the most beneficial sessions was a talk by a law yer about the lasting power of attorney. We also went to Gardens by the Bay, which we would never have thought of doing by ourselves,” he said. Members of the group have also formed strong bonds with the nurses. “(The group’s members) really treat us like family,” said Ms Poh. For example, Mr Yong Chong Hiong, 89, one of the suppor t group’s longest-attending caregivers, holidays with his wife, Mdm Chan Yeow Mei, 84, every year; upon returning, they show their holiday pictures to the nurses, Ms Poh added.

Learn from videos

It’s not an easy task taking care of loved ones with Parkinson’s disease or dementia – it helps to have a reliable guide at hand. Learn more about symptoms and treatment options, useful tips and simple exercises from SingHealth health care experts! Visit SingHealth’s YouTube channel to view videos related to Parkinson’s disease and dementia, as well as useful information and health tips on a wide range of health conditions (www.youtube.com/ user/SingaporeHealth).

2016

Nurses: the pride of singapore health

A day in the life of…

7.05am

Start of the day

Ms Leong gets in an hour before the busy day begins to get paperwork done and to reply e-mails that came in during the night. This morning, she is going through her staff roster before approving staff leave requests to make sure that each shift has enough people to keep the ward running smoothly.

...Senior Nurse Manager Leong Siew Teing of Ward 64, Singapore General Hospital. By Rachel Chan

7.45am

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rom juggling patient caseloads to monitoring ward cleanliness and ensuring nurses’ welfare, no detail is too small for Senior Nurse Manager Ms Leong Siew Teing. Two decades of nursing experience has armed her with a no-nonsense but compassionate and friendly approach to managing 180 nursing and patient care staff in Ward 64. The 109-bed ward is for renal, rehabilitation, orthopaedic and general surgery patients.

Reviewing patients’ progress Ms Leong gets an update from Ms Usha Rani, the nurse clinician on morning duty. They review patients who require special attention such as those with high risk of falling, as part of the hospital’s risk management strategy.

8.10am

10.18am

On her feet

Conducting rounds with Environmental Services colleagues allows Ms Leong to survey ward corridors and rooms to ensure that they are kept clean and safe for patients and staff. As she walks around the ward, she checks that all trolleys, equipment and surfaces are thoroughly disinfected.

12.05pm Lunchtime

WARD ROUNDS

During her ward rounds, Ms Leong checks that hygiene standards as well as patient safety protocols, such as the proper administration of injections and infusions, are met. For instance, she ensures that Ms Tang Qui Huan, Senior Staff Nurse, puts on a protective gown correctly. Protective equipment is necessary when attending to Isolation Room patients.

Lunch is usually a sandwich or noodles from the cafeteria. Eating with colleagues in the staff pantry gives her a chance to catch up with them. Over a lunch of stir-fried bee hoon, they unwind and chat about their families and where they will go on holidays this year.

1.30-5.30pm Running like clockwork

1pm

Photos: ZAPHS ZHANG

Roll call

At 1pm sharp, Ms Leong gathers 30 afternoon shift nurses in a tutorial room to update them about the morning’s happenings. She also highlights policy and protocol changes, and other matters they need to note, as they go into their shift.

Throughout the day, Ms Leong discusses patients’ treatments with doctors, gets updates on the ward from her nurses, and speaks with patients and their caregivers. She attends workgroup meetings involving doctors, allied health professionals and nurses, and concludes the day by writing reports, clearing paperwork and emails. As her day draws to an end at 5pm, she catches up with the nurse clinicians on afternoon duty to make sure that everything in the ward continues to run like clockwork at night.

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2016

Small ideas, big impact

It’s about consistency Bright Vision Hospital

Photos: ALVINN LIM

Nurses show how small ideas can improve the quality of care and patient experience. By Celine Asril and Rachel Chan

Through their efforts, Nurse Manager Maureen Mok (second from right), SNEC, and her team cut about an hour off waiting times for intravitreal injections at the centre’s Clinic F.

Better, faster, easier

Singapore National Eye Centre Patient s ne e ding an intr avitreal injection at Clinic F at the Singapore National Eye Centre (SNEC) used to spend about three hours at the centre, going from one location to another. In the past, they had to go to various places during one visit – to the clinic to consult the doctor, pharmacy to collect medicine, treatment room for the injection, and front counter to pay and fix the next appointment. This has changed with an improvement project by staff to locate all services within Clinic F itself. A satellite pharmacy was set up next to the treatment room in the clinic, where patients would then be able to consult the doctor and also get their injection. The injection is to maintain vision or prevent fur ther vision los s in patients with eye diseases such as age-related macular degeneration and diabetic retinopathy. There is also a dedicated payment and appointments counter in the clinic, for patients who have had the injection. The changes were spearheaded by a multi-disciplinary team from the medical retina depar tment, made up of frontline staff, nurses, doctors, pharmacists and clinical audit staff. They spent three months intensively studying the various touchpoints and key areas with long waiting times. “We observed that elderly and less mobile patients found it hard to move

from one location to another. The wait at each location was also stressful and frustrating for the patients and their caregivers,” said Nurse Manager Maureen Mok, who was in charge of collating patient feedback and data for the project. The team brainstormed to find possible solutions and introduced the changes to make the overall experience more seamless and less time-consuming for patients. Situating all services in a single place has cut about an hour off waiting times and saved the elderly a walk between locations. What is more, the clinic, which previously did 800 injections a month, now does 23 more a day.

Nectar, honey and pudding. To the layman, these are sweet treats, but to those with dysphagia (difficulty in swallowing), they are the three most common consistencies of thickened fluids that they can swallow. Dysphagia is common in patients whose nerves and throat muscles have been affected by stroke, head injuries, or cancer treatment such as radiotherapy. They cannot swallow clear f luids like soup and water, and need thicker consistencies. About 14 per cent of Bright Vision Hospital’s (BVH) elderly and chronically ill patients have dysphagia. “Any fluid that is too watery or thick can also enter their airways and lungs, and potentially cause a chest infection. This is dangerous, especially for elderly patients,” said Mr Errol Jay Kwek, Speech Therapist Assistant, BVH. He was part of a quality improvement project team, consisting of nurses and speech therapists, who studied ways of standardising the consistency of the fluids served to patients. One move was to standardise the preparation of the thickened fluids. Staff were trained to prepare and check the consistency of the fluids. “Previously, my definition of ‘puddingthick’ could be different from another nurse’s definition. With the standardised routine, ever yone’s understanding is more consistent,” said Mr Sakkara Narayanasamy, Senior Staff Nurse, BVH, who conducts the training. Another move was to pre-thicken the drinking water placed at patients’ bedsides instead of thickening the water each time the patient asks for it. This saves the nurses time and effort from mixing drinks several times a day, and improves accuracy. Water jugs for dysphagia patients were also changed to jugs with markings to indicate when the water should be changed. And bedside signs, which previously carried only a patient’s name and preferred language of communication, now also include the fluid consistency the patient requires. The initiatives have been adopted as mainstream practice across all wards at BVH since August 2015.

Senior Staff Nurse Sakkara Narayanasamy (middle) and Senior Enrolled Nurse Yin Nwe Nwe Win (right) were part of a team at BVH that came up with ways to effectively standardise the preparation of pre-thickened fluids.

Preventing falls in clinics

National Neuroscience Institute More than 350 patients are seen at the National Neuroscience Institute’s (NNI) clinics every day. These include elderly patients, with conditions such as movement disorders, stroke and dementia, who are prone to falls. To improve patient safety and reduce falls in the clinics, NNI nurses developed a falls assessment protocol to screen those aged 65 and above. Patients found to be at risk are identified with an orange sticker while they are in the clinics. Benefits: • Nurses and clinic staff keep a closer watch on those at risk of falls. • While patients wait to see a doctor, nurses share fall prevention tips with patients and caregivers. Many caregivers have said that this has helped them better care for the elderly at home. • Falls in the clinic, on average, have decreased from one per month to one every six months.

Shorter is better for diabetes care KK Women’s and Children’s Hospital

Diabetic patients need daily insulin injections to control their blood glucose levels. To ensure optimal drug efficacy, insulin should be injected into the fat layer under the skin, and not into the muscles. Nurses from KK Women’s and Children’s Hospital (KKH) researched insulin needle lengths and found that shorter needles more effectively deliver insulin. Benefits: • KKH inpatients now get insulin injections with 8mm needles instead of 12mm needles. Many have said that the shorter needles are less painful. • From 2017, KKH will be introducing 6mm needles to further improve both insulin delivery and patient experience.

2016


She also remembers the time her elder son had febrile (fever-related) fits as a baby. “When my son had febrile fits, I would’ve panicked if I wasn’t a nurse. But I knew exactly what to do,” she said, adding with a laugh, “My husband was pretty impressed with my nursing skills too.” What drives her now is the fulfilment she gets from seeing patients recover after their operations. “We always make a follow-up call the day after an operation to see how a patient is doing, and the best response for us is, ‘I’m good!’”

Photo: ZAPHS ZHANG

No regrets

Staff Nurse Anne Goh was working in a bank before she joined nursing, where she now finds great fulfilment in seeing her patients recover well from dental surgery.

Following a calling They were in good jobs, but something happened to make them stop, turn around and make a switch to nursing. By Desmond Ng and Esther Au Yong

rather routine, my day revolves around different tasks such as assisting surgeons and anaesthetists, preparing patients for their operations, and taking care of them after their procedures,” she said. Ms Goh’s nursing know-how has also come in handy at home.

Now a Senior Staff Nurse at the Children’s Intensive Care Unit of KK Women’s and Children’s Hospital, Ms Poh, 36, said: “I didn’t want to have any regrets in life. I knew I had to give nursing a try.

It’s the best decision I’ve ever made. I’ve never felt happier and my family members are also proud of my job and what I do. Ms Poh Ya Nee, Senior Staff Nurse, Children’s Intensive Care Unit, KK Women’s and Children’s Hospital

“I’ve always felt that nursing is noble. I’m in such a privileged position now to have a direct and positive impact on the lives of my young patients and their families.” On her decision to switch careers, she said: “It’s the best decision I’ve ever made. I’ve never felt happier and my family members are also proud of my job and what I do.”

Ms Poh (left) was inspired to make the leap into nursing after volunteering at a Club Rainbow camp.

When my son had febrile fits, I would’ve panicked if I wasn’t a nurse. But I knew exactly what to do. Ms Anne Goh, Staff Nurse, Operating Theatre (General Anaesthesia), National Dental Centre Singapore

“When my dad was bedridden during his last days, after a stroke, I was able to help my mother understand his condition better. I taught her techniques in looking after him, like how to transfer him to and from the bed without injuring herself, and how best to prevent bed sores,” she said.

Photo: ALVINN LIM

M

s Anne Goh, 44, was working in operations in a local bank when she felt the calling to join nursing. She was greatly inspired by how well the nurses had cared for her late father in hospital. Ms Goh was impressed by their competence and moved by their compassion. At that time, she was also having second thoughts about her job at the bank and she was yearning for a more fulfilling career. So, she quit her job and went for an accelerated diploma course in nursing from 2005 to 2007. The decision shocked her relatives. “Some of them tried to dissuade me but I was determined to make the change. Since then, nursing has opened many doors for me,” said Ms Goh. Now, with close to 10 years of nursing experience in public hospitals and private dental clinics behind her, Ms Goh is a Staff Nurse with the Operating Theatre (General Anaesthesia) at the National Dental Centre Singapore. She enjoys the teamwork and camaraderie in the operating theatre, where procedures such as wisdom tooth surgery and implants are done. “Unlike a desk job which can become

Her career path became crystal clear the day she volunteered at Club Rainbow and helped a cancer-stricken child have fun. Ms Poh Ya Nee, then 25 and armed with a degree in Business Administration (Marketing) from Nanyang Technological University, had a bright future working in a training and consultancy firm. It was a job with prospects, although she did have a small nagging thought... that perhaps she was in the wrong industry, and that perhaps her passion lay elsewhere. Volunteering at Club Rainbow – an organisation which helps children with chronic and life-threatening illnesses, and their families – was an eye-opener. At a three-day camp, she befriended a wheelchair-bound eight-year-old girl with bone cancer. “I helped her take part in activities and games. I also helped her when she needed the toilet and during bath time. It was a short volunteering stint but life never felt more meaningful to me. The happiness I got from helping her and the other children was immediate.” The experience inspired her to take the leap into nursing. She quit her job and returned to school to pursue an accelerated diploma in nursing from 2006 to 2008, under the Workforce Development Agency’s Healthcare Professional Conversion Programme.

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Senior Staff Nurse Poh Ya Nee has a Business Administration degree but has chosen to pursue a career in nursing.

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2016

Bridging the gap Alice Chua, Advanced Practice Nurse, SingHealth Duke-NUS Head and Neck Centre, who has more than 16 years’ experience as an oncology nurse, talks about her role.

…usually starts in the ward. I’m part of a multi-disciplinary team made up of doctors, nurses and allied health professionals who do daily morning ward rounds. I serve as a communication bridge between the team and patients. After rounds, I run clinic sessions with surgeons at the Head and Neck Centre. I am also involved in the continuing education of nurses and do bedside teaching at the National Cancer Centre Singapore’s Ambulatory Treatment Unit. Some of the courses I conduct include health assessment and problembased learning.

If there is an analogy for what I do in the multi-disciplinary team, I’d be...

…engine oil. I imagine the team as a car, in which all parts function independently. But for the whole to function optimally,

all the parts need to be interdependent. My role in the team is to act like engine oil, helping the parts run smoothly, reducing friction and ensuring that the engine lasts.

I love patients who...

…smile in the face of adversity. I learn so much from them and appreciate life a lot more as I reflect on their journeys. One valuable lesson I’ve learnt is the value of living each day to the fullest.

Photo: ALVINN LIM

A typical day for me…

Advanced Practice Nurse Alice Chua uses a head-and-neck model to explain a condition.

I wouldn’t trade places for the world because...

...I feel privileged to journey with my patients and their families during the most difficult time in their lives. Every patient is somebody’s loved one, so I respect and treat them as if they are my own family. In times of need, sometimes just holding a patient’s hand or lending a listening ear is good enough.

From nursing to consulting

“Cancer cannot spread from person to person.” While it is true that you cannot catch cancer from someone who has it, some forms of cancer are caused by viruses, and viruses can be transmitted through contact. For example, the Human

W

Photo: ALVINN LIM

Trained to manage common rheumatic diseases, Advanced Practice Nurse Yee Sow Ling runs a clinic independently at the Singapore General Hospital. By Audrina Gan

Advanced Practice Nurse Yee Sow Ling independently examines and helps manage the condition of patients with inflammatory arthritis.

A myth debunked...

HEN MS YEE SOW LING decided to take up the challenge of working as a specialist nurse at Singapore General Hospital’s (SGH) Depar tment of Rheumatolog y and Immunology back in 2004, little did she know that she would one day run her own clinic. Since completing her Master in Nursing at the National University of Singapore in 2013, Ms Yee has been running the Rheumatology Monitoring Clinic (RMC) at SGH ever y Friday afternoon. She sees 10 to 12 patients with inflammatory arthritis at each session. “We manage patient s whose conditions have stabilised. Instead of seeing the rheumatologist once every three months, they see us at the RMC, and only need to see the doctor every six months. This has helped free up more appointment slots for new patients and those with more complex needs,” said Ms Yee. The nurse-led RMC was set up in 2009 to care for patients with stable inflammatory arthritis such as rheumatoid arthritis and spondyloarthritis. These conditions affect young adults in their early 20s to the elderly in their 80s. Ms Yee carries out some tasks normally done by doctors, such as examining patients, monitoring adverse drug reactions and issuing repeat prescriptions for medication when needed. “We also order blood tests for patients and evaluate the results to ensure that their liver function and blood count are

Papillomavirus (HPV), a common sexually transmitted infection, is one of the main contributors in the development of head and neck cancers. The virus can be transmitted through intimate skin-toskin contact, including oral contact, and can cause cancer years later.

normal. In some cases, there can be a drop in blood count or elevated liver enzymes after taking the medication,” she said. When adver s e dr ug reac tions or complications occur, Ms Yee alerts the relevant rheumatologist, and they work together to implement care interventions. In addition to the RMC, Ms Yee also runs the Virtual Monitoring Clinic every Monday for patients with stable rheumatoid arthritis or spondyloarthritis. As the name suggests, patients discuss their conditions over the phone instead of having to travel to hospital for their consultations. Both clinics have been well received by patients and their caregivers. According to a survey of RMC patients, more than 90 per cent said they were satisfied or highly satisfied with the overall service provided. Many patients also found that the patient education and counselling given at the clinic gave them more confidence in managing their conditions. “Inflammatory arthritis is a chronic condition and medication must be taken over the long term. But some patients think that medication is to relieve pain, so they stop taking it when there’s no pain. This will cause their conditions to worsen,” said Ms Yee. Ms Yee, who has been a nurse for more than 20 years, said the most rewarding aspect of her job is seeing her patients learn to manage their conditions and improve under her team’s care.

2016


13

Nursing is in their blood Three young nurses are inspired by their parents to join the profession. By Esther Au Yong In mum’s footsteps

Photo: alvinn lim

It should have been an easy decision to ma ke . B ot h h e r m ot h e r a n d younger sister were already in nursing, a profession that she had always been drawn to. Yet, it was only when she was halfway through her economics and management degree studies at SIM University that Ms Kwan Xiu Ling decided to make the switch and pursue a nursing diploma at Nanyang Polytechnic. Now a Senior Staff Nurse at Singapore General Hospital’s (SGH) Medical Intensive Care Unit, 30-year-old Ms Kwan said: “I saw how my sister, who was then in her third year in poly, had gone through clinical attachments and derived great satisfaction from caring for and helping others.” Senior Staff Nurse Kwan Xiu Ling (right), SGH, was inspired by the positive experiences of her mother and sister to join nursing.

Ms Kwan Xiu Ling, Senior Staff Nurse, Medical Intensive Care Unit, SGH

Her sister, Ms Kwan Xiu Xian, Staff Nurse, Intensive Care Unit (ICU), Farrer Park Hospital, became a nurse shortly after the SARS pandemic in 2003. “I’ve always admired my mother for being knowledgeable; people are always asking her for health and medical advice,” the younger Ms Kwan, 28, said. “I saw the impact the SARS outbreak had on the health care profession, especially on the nurses who stepped up despite the risk s and dif f iculties they faced.” Their mother, Senior Staff Nurse Woo Yuen Kau, 63, from SingHealth Polyclinic (Bedok), was thrilled to have both her daughters follow in her footsteps. “Both of them love to hear stories about my student days in nursing school and how nursing has changed over the last 40 years. What I love most about this job is being able to make a positive difference in people’s lives. I also treasure the great camaraderie among my colleagues. I am very happy that my daughters have found their calling in nursing too,” said Mdm Woo. The elder Ms Kwan said that having a sister who had “walked the path before” was a great help when she was studying nursing. In part, she had her

“drill master” sister to thank for her good grades – she was on the Director’s List in Nanyang Polytechnic and received a scholarship to study nursing at the National University of Singapore. “Xiu Xian was my ‘trainer’ and ‘mannequin’. To prepare for my clinical as s e s sment s , I pr ac tis e d t ak ing blood pressure and did simple health assessments on her. She would point out areas where I could do better and coach me on them,” she said. Her mother has also been a pillar for her during challenging times. Once, the elder Ms Kwan returned from work looking troubled and palefaced. “When I saw her, I knew that something was wrong,” said Mdm Woo.

“I found out that she had just performed ‘last offices’ procedures on a deceased person for the first time. As a nurse, I understand well that it’s never easy to deal with death but it is something that we must overcome, and learn to cope with. She cried as I hugged and comforted her.” Now, all three women in the Kwan household are called upon whenever there is a need for medical advice. The elder Ms Kwan said: “My dad always jokes that he never has to worry about health matters since he has not one, but three personal nurses at home!”

Like father, like daughter

Ms Annabelle Neo is another daughter

Now, I can understand why my dad made nursing his lifelong career. i love the challenges and excitement that each day brings. Ms annabelle neo, nurse clinician, nursing informatics, sGH

Photo: zaphs zhang

My dad always jokes that he never has to worry about health matters since he has not one, but three personal nurses at home!

who admired one of her parents’ chosen professions. But unlike the Kwan sisters, she wasn’t so sure that the parent in question would welcome her decision to quit her job in the private sector to train to be a nurse. “She hid her job from me!” retired nurse manager Michael Neo said. I n r e s p o n s e , h i s da u g h te r, a Nurse Clinician specialising in Nursing Informatics at SGH, said: “I didn’t want him to worry. I fell sick quite often when I was growing up so I knew he would worry if I joined nursing, as the work can be physically demanding given the long hours and shifts.” Ms Neo, who is in her mid-30s, made her mid-career switch to nursing in 2007. “He eventually found out from his peers that I was working in the or thopaedics ward!” Ms Neo said. “Instead of being upset, he was very supportive, especially after seeing how well I was managing my patients and how much I was enjoying work.” In what might be the best compliment from a father to his daughter, Mr Neo said: “I think Annabelle is a better nurse than me. She is very thorough and efficient in her work and is able to anticipate and understand patients’ needs.”

Nurse Clinician Annabelle Neo, SGH, is praised by her father, retired nurse manager Michael Neo, as a “better nurse than me”.

The 71-year-old Mr Neo was a nurse for more than 40 years. Ms Neo, however, credits her dad for helping her do well in her job. “My dad has a wealth of nursing experience and is very familiar with the hospital’s operations, having worked with staff from different departments in SGH. His deep understanding of patient care and people management helped me to not only provide better care for patients, but also manage my working relationships.” Like her father, she has found great fulfilment in nursing. “Now, I can understand why my dad made nursing his lifelong career. I love the challenges and excitement that each day brings,” said Ms Neo.

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2016

Lessons from abroad

Two SingHealth nurses, who went on overseas training stints as part of the Ministry of Health’s Health Manpower Development Plan (HMDP), discuss what they learnt. By Shermaine Wong Indiana, United States

provided for every endoscopy procedure. These kits contain items such as sponges, special cleaning lotions and gauze for the patients. “Having such kits enhances patient safety. The kits also save us preparation time before each procedure,” Ms Naranderjit said. She was delighted to discover that such kits were already in the works at SGH and will be introduced at the new SGH Endoscopy Centre when it opens in August 2016. She described her HMDP experience as highly rewarding. “It was daunting to be away from home. It was my first time travelling alone and my maiden trip to the US, but I’m glad I took up the opportunity. I’ve returned refreshed and energised with new ideas on how we can do our work better,” Ms Naranderjit said.

Ms Naranderjit Kaur, 43

Assistant Nurse Clinician, Endoscopy Centre, Singapore General Hospital (SGH)

Photo: ALVINN LIM

G

oing to the US last year on a six-week clinical attachment wa s a n e ye - o p e n e r f o r M s Naranderjit, who has been working at the SGH Endoscopy Centre for the past seven years. At the renowned Glen Lehman General Endoscopy Centre at Indiana University Medical Centre, she noticed differences in the practice and diploma courses in endoscopy for nurses. She said that at the SGH Endoscopy Centre, where up to 150 procedures are done a day, nurses are all-rounders and generalists. “We’re trained to take care of patients from when they’re admitted, to when their procedures are done, and right up to discharge. In the US, endoscopy nurses specialise and focus on honing their skills in a particular area.” At the SGH Endoscopy Centre, Ms Naranderjit assists doctors in exploring the human body with scopes, and carrying out minor procedures, like removing stones from gall bladders. Her job al so involves helping doctors in biopsies, screening patients before procedures, and monitoring them

Assistant Nurse Clinician Naranderjit Kaur is energised and inspired by her clinical attachment, under the HMDP, at a renowned endoscopy centre in the US.

after to ensure that they are well enough for discharge. In the US, she was also impressed by the detailed and comprehensive training for nurses doing the endoscopic retrograde cholangiopancreatography (ERCP) procedure. This is a specialised technique to study the bile duct,

Pennsylvania and Colorado, United States Ms Yeo Guat Hoon, 59

Nurse Clinician, Nursing Administration, SingHealth Polyclinics

Photo: ALVINN LIM

A

fter a six-week clinical attachment in the US in 2012, Ms Yeo returned with new ideas about community case management for patients with chronic conditions. She had been in Pennsylvania and Colorado on attachment, and had visited patient-centred medical homes run by the Geisinger Health System and Kaiser Permanente. She saw how elderly patients there enjoyed well-coordinated and sustained health care in the community. She noticed that part of this success hinged on the use of technology, and a robust and integrated electronic medical records system. Patients were monitored virtually – to

Nurse Clinician Yeo Guat Hoon came back from her clinical attachment in 2012 in the US with new ideas that have since been implemented.

pancreatic duct and gall bladder. Since returning, she has been working with two colleagues to update the hospital’s ERCP training manual and incorporate what she has learnt into the training programme. Another takeaway from the US has been seeing pre-packed bedside kits

both reach out to them and empower them to manage their condition at home. In doing so, it minimised their need to travel to hospital. There was also a team of case managers on standby round the clock to take calls, give advice and offer support. “For instance, at Kaiser Permanente, a patient who needs travel vaccinations can just call his case manager for advice. The case manager will assess the patient’s condition based on his records and refer him to a pharmacist who will provide the jab or medication needed,” said Ms Yeo. “It’s really convenient for the patient.” Since her return, Ms Yeo has been part of a primary care team that introduced case management protocols to guide community health care teams in designing personalised care plans based on patients’ health and social needs. The team works closely with community welfare organisations and care agencies, to ensure patients with chronic diseases are well supported in their community and homes. Ms Yeo finds her learning relevant

Ms Naranderjit (centre) came back to Singapore not only with new ideas, but also new friends.

because of Singapore’s growing number of elderly people with chronic diseases. “Nurses doing this work can build rapport with patients, and their personalised care plans can keep patients’ conditions stable and prevent hospital admissions,” she said.

Ms Yeo (second from left) spent time learning and picking up tips from colleagues at two patient-centred medical homes.

2016


Project Light

was actually available to us. When setting up our mobile clinic, for example, school desks were used to create a makeshift examination table and old bed sheets served as curtains for some privacy.” The nurses hope to make more trips. “We plan to increase our visits to twice a year so that we can provide more consistent care for the communities there,” said Ms Hong.

Photo: VERNON WONG

Travelling to remote villages in the mountains of northern Thailand to provide medical care is no walk in the park. But knowing how welcome their presence would be to the villagers was more than enough for Singapore General Hospital (SGH) Senior Staff Nurse Felicia Ho to keep making that arduous trip to reach out to these communities with little or no access to regular health care. In January, Ms Ho co-led a team of seven nurses and two doctors on a medical mission to the country, the second such trip she has undertaken for Project Light, which was started by some alumni nurses from the Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore. “In addition to the pre-trip preparation, which involved seeking funding and support, it was also a challenge to coordinate our leave schedules as we all work at different institutions,” said Ms Ho. “But the tough preparation was worth it. It was a great opportunity for us to be able to make a difference in the lives of those in the Hmong community.” Ms Ho also worked with Radion International,

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Senior Staff Nurses Ms Felicia Ho (left) from SGH, and Ms Hong Yan Qi from NCCS, are glad they can make a difference to the lives of others through Project Light.

a Singapore relief and development organisation based in Thailand, to plan the trip. The team saw patients at a mobile clinic, but also ventured often to homes when the elderly or infirm were not able to make the journey to their clinic. They also distributed warm clothes and food to the villagers.

Operating in such a remote area meant that resources were limited and the team often had to make do with what was available. Said Senior Staff Nurse Hong Yan Qi, Department of Ambulatory Treatment Unit, National Cancer Centre Singapore (NCCS): “Even though we were mentally prepared to have limited resources, we were still surprised by what

At the mobile clinics, Ms Ho (above, right) and Ms Hong (below, left) perform health screenings and give medical advice to the villagers.

Touching lives across the gl be

Through humanitarian and medical mission trips, these inspiring nurses make a positive impact. By Esther Au Yong Medical missions

She said: “While we have designated roles, everyone is always looking out for one another and ready to offer help when the need arises.” It was also back to basics when Ms Junaidah went on teaching trips to countries like Laos, Cambodia and India, where she helped hospitals set up standard protocols to deal with maternal post-partum haemorrhage and neonatal emergencies. “I taught my foreign counterparts to have two emergency kits, complete with all the required instruments and premeasured drugs, in their delivery rooms,” Ms Junaidah said.

Photo: ALVINN LIM

Many nurses go the extra mile in their jobs. But two veteran nurses of KK Women’s and Children’s Hospital (KKH), Nurse Manager Lim Lee Ngoh and Nurse Clinician Junaidah Nawi, have literally travelled thousands of miles to offer much-needed medical care to people in disaster-hit areas. On many of their 10 medical missions to seven disaster-hit countries, they worked with local hospitals to set up training programmes and standard protocols in areas like the management of obstetric emergencies. Going to Pakistan in 2010 was particularly memorable for Ms Lim. “I was part of the SingHealth medical aid team formed in collaboration with Mercy Relief to help flood victims there,” she said. “We were based in Sukkur, on the west bank of the Indus River. We set up a clinic from scratch. Similar to a hospital’s A&E, we had a registration counter, triage area, areas for consultations, procedures and dressings, as well as a pharmacy.” “Basic” took on a new meaning on that trip. “Armed with the bare necessities, we had to improvise and work with what we had. For instance, we used cardboard pieces as splints to secure intravenous cannula for infants prior to

“These are mandatory in managing high-risk obstetric conditions such as post-partum haemorrhage (post-delivery bleeding) and severe pre-eclampsia. These kits help to save time in an emergency and increase the chances of survival for the mother. This is what we practise in KKH too.” When training nurses, she looks out for potential master trainers, giving them extra coaching to enable them to pass on skills and knowledge to other nurses. Ms Junaidah feels privileged to be part of these mission trips. She said: “In sharing my knowledge with others, I also learn and benefit from the interaction.”

Nurse Clinician Junaidah Nawi (left) and Nurse Manager Lim Lee Ngoh, both from KKH, have been on a total of 10 medical mission trips.

transportation to the local hospital,” said Ms Lim. “Used sharps and needles were discarded into empty mineral water bottles to prevent injury.” In hospitals, used sharp instruments that can cause injury and contamination are thrown into biohazard sharps containers. Ms Lim added that one of the “perks” of going on mission trips is the strong camaraderie formed with fellow nurses.

Ms Lim (fourth from left, in blue vest) and her team in Sukkur, Pakistan.

Ms Junaidah (in blue) helping a patient in Cambodia.

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2016

What can you do with a Nursing education? Depending on your aspirations and strengths, you can pursue your nursing career along different professional tracks. Find out how an education in nursing can be fulfilling in more ways than one. No. of nurses in Singapore

20%

increase 40,000

Healthy job outlook 20,000 more healthcare professionals needed by 2020

30,000

Source: www.moh.gov.sg

2011

2013

2015

Year

Where will a nursing education take you? Everywhere! Different Care Settings Acute general hospitals and national speciality centres

Community hospitals

Long-term care facilities

Polyclinics and private clinics

Clinical

Education

Research

1. You’re reading a novel and come across a word that you don’t know. What do you do? A. Look it up on the spot – it bothers you not to know. B. Ignore it and keep reading. 2. Which statement best describes you? A. I am a people person and enjoy talking to new people. B. I work best alone and don’t enjoy interacting with people. 3. How do you react to changes in routine? A. I love trying out new things and just roll with the punches. B. I panic and find it hard to get anything done.

5 Professional Career Tracks At SingHealth Management

Is nursing the right career QUIZ for YOU?

Informatics

A World of Possibilities: 30 Nursing Specialities

Perioperative Nursing Infection Control Palliative Care Ophthalmology Breast Care Diabetes Urology Medical Nursing Wound Management Renal Orthopaedic Paediatric & Neonatal Osteoporosis & Bone Metabolism Pain Management Oncology Surgical Nursing Critical Care Stoma Care Midwifery & Gynaecology Transitional Care Infectious Diseases Haematology Cardiac Nursing Emergency Rheumatology & Immunology Neurology & Neurosurgery Rehabilitation Radiology Nursing Mental Health Nutrition Support

4. How would you describe your organisational skills? A. I make lists of things I have to do and I am rarely caught off guard. B. I tend to put things in random places and usually am a “play it by ear” person. 5. What’s your goal in life? A. To constantly learn and make a difference in the lives of others. B. To work independently and be your own boss.

Results

If you scored mostly As: Congratulations! You can connect with people and enjoy making a difference in the lives of others. Nursing may just be the perfect career for you! If you scored mostly Bs: You have some attributes required of a nurse but it is not the best job fit for you.

Visit SingHealth’s website to find out more about a nursing career with us - www.singhealth.com.sg/Careers/scholarships-sponsorships/Nursing/Pages/Home.aspx