AHA Magazine Jan-Mar 2022 by Yishun Health

aha

ISSUE 1: JAN–MAR 2022

BETTER SUPPORT TO LIVE & LEAVE WELL

MCI (P) 047/07/2021

At Yishun Health, a person-centred mode of palliative care seeks to improve quality of life, no matter the stage of illness

UNDERSTANDING UTI

INCONTINENT? HOLD ON, THERE’S HELP

LIFT FOR MORE STRENGTH!

ontents

COVER STORY Better support to live & leave well At Yishun Health, palliative care is not limited to patients who require terminal care, but even at earlier stages in the disease trajectory

WHAT’S UP Community events, outreach efforts, and more

16 Q&A Understanding UTI Your health and wellness questions regarding urinary tract infection (UTI) asked and answered! 18 LIVE WELL Giving back through listening YCH Befriender Mdm Jenny Ng gives patients the valuable feeling of being heard 21 EVERYDAY HEROES A career of devotion & professionalism K Vasantha Devi is our recent Tan Chin Tuan Award for Enrolled Nurses recipient. Read her story here!

24 SPOTLIGHT Incontinent? Hold on, there’s help Interventions are available to manage the condition and improve confidence, well-being, and quality of life 28 5 THINGS ABOUT… Telehealth in the community As we make care more accessible, here are five tips to help you understand what our telehealth service entails 30 DAILY DOSE Making wonderful festive memories Celebrating CNY during the pandemic can be just as meaningful!

Part 3 of 3

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Palliative care is not just for the end of life. After all, its concepts — to improve quality of life, alleviate suffering, and care for a person’s physical, psychosocial and spiritual needs — are universal, regardless of the stage or type of disease. To this end, Yishun Health is taking steps to integrate these holistic principles into our care plans across different settings, including in the emergency, critical, surgical and rehabilitative arenas.

PUBLISHER Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. It comprises Admiralty Medical Centre, Khoo Teck Puat Hospital and Yishun Community Hospital. It also includes community extensions such as Wellness Kampung.

EDITORIAL TEAM

32 32 MAKAN TIME Ratatouille This French-inspired recipe is veggie delightful and vitamin-rich 34 FIT & FAB Lift for more strength! Strength training plays a critical role in preventing injuries; we share some tips on doing it right!

Hannah Wong Sabrina Ng Sharon Ng Albert Foo

EDITORIAL COMMITTEE

The editorial committee — made up of clinical, nursing, allied health, population health & community transformation, and administrative heads of department — advises aha’s direction. A/Prof Tan Kok Yang Bastari Irwan Caroline Tan Fatimah Moideen Kutty Shirley Heng Teresa Foong

www.ktph.com.sg/ about-us/media/publications aha@ktph.com.sg

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg Maskless photos in this issue were taken before COVID-19 or with safe management measures in place

aha

ISSUE 1: JAN–MAR 2022

BETTER SUPPORT TO LIVE & LEAVE WELL At Yishun Health, a person-centred mode of palliative care seeks to improve quality of life, no matter the stage of illness

M A N AG I N G D I R E C T O R

Christopher Tay

H E A D, E D I TO R I A L

Chua Kim Beng

C O N T R I B U T I N G E D I TO R

Sheralyn Tay E D I TO R

Dang Hui Ling MCI (P) 047/07/2021

H E A D, C R E AT I V E UNDERSTANDING UTI

INCONTINENT? HOLD ON, THERE’S HELP

LIFT FOR MORE STRENGTH!

hy aha? The name aha holds much significance for us at Yishun Health. In part, it is a nod to our history; it also stands for ‘Advocates for Health in Action’. Through these pages, we hope to empower you to take charge of your own health and discover those ‘aha!’ moments that lead to a healthier, happier you.

Sean Lee

H E A D, C L I E N T R E L AT I O N S H I P

Jessie Kek

C O N T R I B U TO R S

Lee Lily Vivienne Looi

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 047/07/2021

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hat’s Up

Co-creating a healthier, more active Sembawang O

n 11 December 2021, Yishun Heath’s Regional Health Office organised a dialogue session with Minister for Health & Member of Parliament for Sembawang, Mr Ong Ye Kung. Together with Members of Parliament for Sembawang Ms Poh Li San and Ms Mariam Jafaar, Sembawang grassroots partners, National Healthcare Group

(NHG), Yishun Health, Woodlands Health and NHG Polyclinics, the session was a valuable platform to engage stakeholders and discuss how to support and empower residents towards healthy lifestyles, pro-active health behaviours, and self-management. At this inaugural meeting, healthcare organisations presented

key strategies for community health and primary care, and proposals for collaborations with partners in the Sembawang community. This marked an important milestone, with Minister Ong leading a collective effort with Yishun Health, working hand-in-hand to co-create a healthy, happy, active and resilient Sembawang neighbourhood.

Minister for Health & Member of Parliament for Sembawang, Mr Ong Ye Kung (in light blue top), led a productive dialogue with Yishun Health and other stakeholders on building a healthier Sembawang neighbourhood

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Recognition for our S.A.F.E programme A

fter a long hospital stay, the elderly and frail are at risk of functional decline. To address this issue, a multidisciplinary team of clinicians, nurses, occupational therapists, and the Patient Experience Office designed the S.A.F.E (Stimulating Activities for Frail Elderly) programme. S.A.F.E ropes in trained volunteers to run a wide range of stimulating activities to engage elderly patients who are frail physically and/or cognitively with dementia and delirium. These include communal dining, art therapy, horticulture therapy, befriending, and more. Not only have these efforts made hospital stays more comfortable, the volunteers also act as an extra set of eyes and hands to help watch over high-fall risk patients. Patients have also been observed to be happier and more compliant with medical instructions. With the pandemic, these activities have moved into the virtual realm, where the S.A.F.E team connects with volunteers by conducting Zoom trainings on caring for patients with dementia, and sharing their experiences of caring for their loved ones.

Giang Thuy Anh, Senior Occupational Therapist, Rehabilitation Services; and A/Prof Philip Yap, Senior Consultant, Geriatric Medicine, and Director of Integrated Care for Dementia in the North, received the award on behalf of the S.A.F.E team

The efforts of the S.A.F.E team were recognised at the Singapore Patient Action Awards 2021 on 20 November 2021 with the Singapore Patient Engagement Initiative Award (Team-Based).

Mind games for better cognitive improvement D

ementia is a growing concern, especially among older adults. To better maintain cognitive ability, KTPH has developed games specially designed to help patients with dementia improve their memory. While it is

Games, such as See Shape, help to meaningfully engage patients with dementia

unclear whether dementia can be reversed, some studies indicate that domain-based cognitive training may help in the pre-dementia stage or in very mild dementia. The games address specific domains of cognition — such as memory, logic, focus and spatial reasoning — for more targeted training, which aims for improvements in these areas. More importantly, they also provide a way to meaningfully engage dementia patients as they embark on purposeful activities. The four games developed — each focuses on a key aspect of cognition — are available for sale at KTPH’s ABLE Studio: • See Me: Exercises memory capabilities with shapes and colours • See Speed: Trains mental processing speed, concentration and focus • See Logical: Trains logic reasoning and problem solving • See Shape: Trains visual-spatial and visual-constructional abilities

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hat’s Up

Senior Research Nurses Su Jialei and Qi Xiaoge (third and fourth from left respectively), with Ms Shirley Heng, Chief Nurse; Keven Ang, Manager, CRU; A/Prof Lim Su Chi, Clinical Director, CRU; and Prof Chua Hong Choon, CEO, Yishun Health

Recognition for our Clinical Research Coordinators K

TPH’s Clinical Research Unit (CRU) conducts important studies in the quest to drive better understanding of diseases so as to improve patient outcomes and safety. At its heart are Clinical Research Coordinators (CRCs), two of whom were recently recognised by the Singapore Clinical Research Institute for their contributions to the profession and the clinical research community. One of them, Su Jialei, received a Distinguished Contributor Award (Merit) for her outstanding contribution in building a collaborative ecosystem and supporting quality clinical research. Originally trained as a nurse, she

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made the switch 11 years ago, and has since supported clinical trials across a wide range of medical specialties, including endocrinology, cardiovascular, renal, and ophthalmology. She also set up key CRC capabilities in three clinical departments, and has mentored more than 10 junior CRCs. During the COVID-19 Circuit Breaker, Jialei and her team also overcame many challenges while implementing mitigation plans for ongoing clinical trials to concurrently balance study requirements, patients’ needs, and safe management measures. The other award recipient, Qi Xiaoge, received a Finalist

Award in recognition of her contribution to clinical research while providing a high standard of person-centric care to her patients. She is one of the lead nurses in the SMART2D diabetes cohort study team, which studies commonly encountered complications of type-2 diabetes. Since the opening of Admiralty Medical Centre (AdMC) in 2017, Xiaoge has stepped up as the lead coordinator on-site to coordinate CRU’s research activities with colleagues from the clinical laboratory, diabetes centre, eye clinic, and operations, thus ensuring the smooth conduct of research at AdMC.

Staying Clean and Green Y

ishun Health marked Singapore’s Clean and Green Week on 13 December 2021 with our very own slew of programmes and events. The Green and Sustainability Committee virtually launched the programme with a major milestone — the installation of a Solar Photovoltaic system on the roofs of KTPH and YCH. This has enabled the whole campus to generate renewable electricity to offset our carbon footprint. The clean energy generated by the new Solar Photovoltaic system generates 456,000kWh of clean energy — this is equivalent to the electricity needs of 98 four-room HDB flats, and saves around 184.2 tonnes of carbon footprint annually. To chronicle Yishun Health’s sustainability journey, Senior Management launched the Green & Sustainability Achievement Wall to mark the awards and achievements attained along the way. In the spirit of the week, Yishun Health also held a tree-planting session to add even more lush greenery to our grounds, and conducted a litter-picking session in the neighbourhood.

CEO Prof Chua Hong Choon took part in the tree-planting session and added new trees to the Yishun Health garden

Senior Management, together with the Green and Sustainability Committee, launching the Solar Photovoltaic system in Yishun Health (main photo), and showing their support for the day (top right)

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Cover Story

BETTER SUPPORT TO

Dr Laurence Tan, Lead and Consultant, Palliative and Supportive Care Service, Geriatric Medicine, KTPH, ensuring one of his patients feels comfortable during his ward round

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FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 3 OF 3

LIVE & LEAVE WELL Contrary to public perception, palliative care is not synonymous with dying or terminal care. It is, in fact, a person-centred mode of care that seeks to improve quality of life, no matter the stage of illness. With this understanding, Yishun Health is taking steps to integrate this universal healthcare mission — even at earlier stages in the disease trajectory — so as to optimise outcomes and quality of life for all our patients and their loved ones.

or many years now, the paradigm of care has shifted to a more preventive and proactive approach. From a focus on treating diseases and their related complications in late stages, healthcare has moved upstream to screen and prevent illness, as well as manage them better at earlier stages. This evolution holds true for palliative care as well. Traditionally associated with the end of life, palliative care is now being introduced at earlier stages of disease management so that patients, families and healthcare providers can benefit from its holistic approach, including post-death support, such as grief counselling and risk-factor identification of familial propensity for illnesses.

TYING IN PALLIATIVE CARE WITH HOLISTIC DISEASE MANAGEMENT Dr Laurence Tan, Lead and Consultant, Palliative and Supportive

Care Service, Geriatric Medicine, KTPH, explains, “Palliative care is an approach where we consider the bigger picture of care, including the well-being of patients and their families.” This means supporting the physical, psychological, social and spiritual needs of patients and their families who are facing challenges associated with a lifethreatening illness. Proactively introducing these considerations as part of disease management — and not just at the terminal stages of an illness — paves the way for early identification and assessment, and treatment of pain and other problems. “We can prepare people for future needs such as symptom avoidance, understand their preferences, manage expectations, and alleviate anxiety,” he elaborates. Compassionately helping patients accept their diagnoses, persuading them to enjoy dignity

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Cover Story

Dr Mansha Khemlani (right), Senior Consultant and Deputy Head, Palliative Care Services, Geriatric Medicine, shares her thoughts at one of the Palliative Care team group huddles

and quality of life in their remaining days, and providing them with the knowledge and support to make informed care decisions can provide much-needed support and guidance during the last stage of these patients’ life journey.

“Palliative care is an approach where we consider the bigger picture of care, including the wellbeing of a patient and their families.” Dr Laurence Tan Lead & Consultant, Palliative and Supportive Care Service, Geriatric Medicine, KTPH

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Studies have shown that this early integration of palliative care in the inpatient setting improves patient comfort, reduces length of stay, and lowers the cost of care, as it has the potential to limit unnecessary tests and non-beneficial treatments. Importantly, this approach also alleviates moral distress for healthcare staff and suffering for both families and patients without worsening outcomes of care. This wider scope and applicability of palliative care has been encapsulated in a new ‘bow tie’ model of care: instead of employing palliative care only as a last resort, palliative care is introduced at earlier stages in the disease trajectory and across different scenarios. Depending on the area of care and patient needs, the appropriate treatment and resources can be allocated to improve the quality of life of patients and their families.

This model, explains Dr Tan, is useful in providing a better understanding of palliative care and integrating it across the spectrum of disease management. “It is not synonymous with dying or giving up,” he emphasises. Rather, it is all-encompassing, and accommodates all necessary and relevant aspects of treatment and care while also preparing patients and families for the worst.

COLLECTIVE PALLIATIVE APPROACH: MANY ARENAS At Yishun Health, the palliative care approach is being introduced across the spectrum of care under an integrated care plan. Under this plan, palliative care doctors build connections with various specialties, equip healthcare providers with an understanding of what the palliative approach entails, and support decision-making to align

FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 3 OF 3

goals with a single care plan that matches the needs of patient and family, and improves their quality of life. According to Dr Tan, the core principle is the patient being cared for by staff that unites as one team across sites to improve timely access to palliative care using an all-somefew approach. This involves rolling out competencies in three ascending levels of expertise of palliative care practice (refer to chart). The goal is to instil the principles of the palliative care approach into as many settings as possible — and not just in wards or hospices. This helps healthcare teams to provide quality of life at all stages of an illness, and achieve the maximum potential for the relief of suffering. This approach was used to roll out palliative care competencies to Yishun Health’s allied health professionals. Their goals of optimising function and well-being by assisting individuals to be as active and independent as possible within the limitations of their progressing illness dovetails neatly into the palliative care approach. As Melissa Ng, Senior Physiotherapist, Rehabilitation Services, YCH, points out, “Our care goals can take the form of preventive, restorative, supportive and palliative (comfort) care while respecting values, choice and autonomy.” Thus, she adds, rehabilitation in palliative care is about enabling people to live fully until the end of life. Regardless of the stage of disease, allied health professionals have an important role to play in complementing care, she states, working together with both patients and their families to affirm life while managing symptoms. By

FEW

SOME

ALL LEVELS OF EXPERTISE

TEAMS INVOLVED

FEW Intensive specialist-level training for staff who are predominantly involved in providing palliative care for patients with complex and persistent care needs.

Teams involved in care • Palliative Specialist team • Palliative Nursing team • YCH Palliative team • Long-term care team for nursing homes • Palliative Rehabilitation team • Palliative Social Workers • Palliative Pharmacists • Palliative Psychologists

SOME Specific competencies for staff who are partly involved in providing care for patients with palliative needs. Confers a generalist level of palliative care knowledge and skills.

Teams involved in collaborative practice • Acute & Emergency Care Centre • Intensive Care Unit • General Surgery Department • Haematology Department • Renal Department • Population Health & Community Transformation

ALL Universal training to cover the foundations of the palliative care approach for all staff who are occasionally involved in providing care for patients with palliative needs.

Team involved in palliative approach • All clinical teams • Advance Care Planning team

looking beyond the disease to the restoration of personhood and the creation of moments, the aim is to support patients to live well and eventually leave well. “Rehabilitation comes into play by improving mobility, exploring activity modification, and empowering caregivers to enable the participation in activities of daily living as fully as possible,” advises

Melissa. With the Rehabilitation Services team, a support system is provided, creating an important avenue for individuals to fulfil meaningful goals while adapting to their new state of being with dignity. To raise the level of understanding and the confidence of the team, a work group consisting of key representatives from physiotherapy, occupational therapy, and speech

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Cover Story

therapy was formed under the guidance and leadership of Dr Tan. The goal was to raise awareness of the principles and increase the skills and knowledge in palliative care for all therapists. Over six months in 2021, all therapists were trained to gain a basic awareness of the palliative approach. Those partly involved in providing care for patients with palliative needs were trained in a more generalist level of knowledge and skills. At the top of the pyramid, therapists who are predominantly involved in providing palliative care were trained at a more specialist level to gain competency in managing patients with complex and persistent care needs. A survey conducted before and after the training period found a significant increase the level of confidence and an enhanced positive attitude among

those therapists who are partly and predominantly involved in providing palliative care. “Building a palliative-ready rehabilitation team helps us to prepare for the surging demands,” Melissa asserts. “This strengthens our roles in the multidisciplinary team and improves the standard of palliative care delivery in our campus.”

Another example was YCH’s HOPE and CARE programme, which has won multiple awards for its blending of the deep skills of each multidisciplinary staff into a transdisciplinary model that integrates assessment, physical rehabilitation, mental well-being support, and nutritional interventions, thus illustrating the ‘one team’ concept.

RESTORING DIGNITY & PERSONHOOD After a prolonged hospital stay due to progressive multiple-organ failure, Mdm H was in a poor functional state when she was admitted to the YCH Palliative Ward for symptom management while waiting to be placed in a nursing home. She could hardly move or turn in bed independently, and had intermittent back pain. She called for nurses repeatedly and insisted that her requests were met. Behind her fractious demands was a woman with many fears and anxieties, struggling to come to terms with her mortality. The palliative care team continuously engaged her to build rapport and understand her better, which was how they learnt that she feared losing control and dying alone. They also gained insight on what mattered to her: the company of others, looking presentable, and food. The allied health team began to explore meaningful activities that could bring Mdm H and her son joy and purpose. Her physiotherapist assisted

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with range-of-motion exercises and supported sitting whenever possible, while her occupational therapist helped her in personal grooming, painting her nails, and dyeing her hair. To enable her to enjoy regular food again, her speech therapist taught her and the nursing staff strategies to facilitate safer eating in view of her swallowing deficits. These efforts restored her personhood, and significantly uplifted her mood. As Mdm H’s symptoms became more controlled, the team brought her out to the hospital garden via a reclining wheelchair. After months of being cooped up in the hospital, spending time outdoors made her so happy that joy radiated from her face. She laughed, reminisced about her life, and shared pearls of wisdom. On the day of her transfer to St Joseph’s Home, she repeatedly called for the nurses and staff again — but this time, it was with an outpouring of gratitude and appreciation.

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EMERGENCY CARE WITH A DIFFERENCE At the Acute & Emergency Care Centre (A&E), steps have been taken to improve care delivery through clinician and nurse education, as well as the implementation of pathways, protocols and improvement of spaces. Dr Ranjeev Kumar, Consultant, A&E, points out that the A&E is at the forefront of crisis healthcare delivery, and is particularly important for the provision of appropriate end-of-life (EOL) care. “A majority of EOL patients use emergency services in the last month of their lives due to symptoms of distress, poorly controlled symptoms at home, or caregiver stress during this steep decline of their EOL path,” he describes. However, the A&E is not traditionally regarded as an optimal place for palliative care due to its inherent environment. The need to be prepared to quickly reverse serious conditions focuses on aggressive resuscitation measures, which necessitates an agile mindset shift to meet the needs of the palliative care approach. There is also a lack of tranquil areas for families to spend meaningful time with their loved ones during their last moments. This led to several enhancements within the A&E, such as the creation of a ‘quiet room’ to allow family members to spend time with the dying patient in a private area. Steps have also been made to support A&E patients at their EOL to fulfil their preferences. In one case, the team worked urgently on a terminal discharge for a patient who was actively dying. Due to

“It enables the A&E to provide comfort and relief of burdensome symptoms for terminally ill patients, while maintaining patients’ dignity and respect for the family members.” Dr Ranjeev Kumar Consultant, Acute & Emergency care centre, ktph visitor-restriction policies, his family could not be by his bedside. To help him carry out his previously expressed wish to pass away at home surrounded by loved ones, the A&E team worked closely with their palliative colleagues to prepare discharge medication, arrange transportation, explain the dying process to his family, and provide caregiver training — all in a short span of time so that he was able to pass away at home in comfort and dignity. In another instance, Dr Ranjeev worked with Dr Tan and Dr Mansha Khemlani, Senior Consultant and Deputy Head, Palliative Care Services, Geriatric Medicine, on a patient who came into the A&E on a weekend because her oxygen concentrator was faulty and her oxygen levels were dropping. Instead of warding her, they lent her one such unit from their donated

stock to tide her over at home until her oxygen concentrator was repaired. “These initiatives serve to enhance the quality of care delivered to our palliative patients,” says Dr Ranjeev. “It enables the A&E to provide comfort and relief of burdensome symptoms for terminally ill patients, while maintaining patients’ dignity and respect for the family members.”

SURGICAL INTERVENTIONS FOR QUALITY OF LIFE A palliative care approach is also useful when considering the usefulness of certain surgical procedures, says Dr Ruth Chua, Consultant, Palliative Care Services, Geriatric Medicine. She notes that, in some cases where curative surgery may not be possible, certain surgical measures can still be beneficial to help alleviate symptoms and improve quality of life for the patient. “Palliative surgery in oncological surgery is not uncommon, comprising about 10–20% of all surgeries,” she points out. The main aim of palliative surgery is the relief and/or prevention of symptoms, improvement in quality of life, and the maintenance of functional status, not just based on the consideration of oncological or survival benefits alone. It may involve removing obstructions, decompressing or stabilising areas to alleviate pain, or reducing the size of large tumours. Collaborating with the Tumour Board, Perioperative Team, and in consultation with patients to understand their values, preferences and goals, a shared decisionmaking process is utilised to

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Cover Story

determine whether an intervention is appropriate. “It is thus key to know what is truly important to patients and their families,” reveals Dr Chua. “Only in doing so are we able to advocate for our patients and recommend interventions that are concordant with their goals of care.” In one instance, a patient with advanced breast cancer had a bleeding wound on her breast that needed to be dressed three times a week. The bleeding also meant that she had to stop her anti-coagulation medications. She did not want to trouble her daughter for the thrice-weekly wound dressing, and was also worried about suffering a stroke due to the cessation of her medication. Presented with various options, she decided on a palliative mastectomy. The surgery, while not curative, has given her back her independence. Eight months on, she does not need any wound dressing, remains stroke-free and on preventive medications. . Another patient, with an intestinal obstruction due to advanced colon cancer, was only able to have a liquid diet. She expressed to her surgeon that she wished to eat solid food again, and was also worried for her cats, the sale of her flat, and her relationship with an estranged parent. After discussions with her care team, she decided against any surgical interventions, but managed to settle her practical matters. With support from the team, she wrote her will, reconciled with her father, and found a home for her cats before she passed away. These examples illustrate that, while there are standards, the palliative care approach is highly individualistic; most importantly, it puts the patient first. “The goal is to

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In Yishun Health, Palliative Care is advocated by staff champions in different areas and stages, even beyond the inpatient wards. Pictured are (L–R) Dr Ranjeev Kumar, Consultant, A&E; Sim Lai Kiow, Nurse Clinician, Nursing Administration; Dr Ruth Chua, Consultant, Geriatric Medicine; and Melissa Ng, Senior Physiotherapist, Rehabilitation Services

capture outcomes that matter to patients,” Dr Chua emphasises.

POWER FACTS FOR NURSING HOMES Palliative care training has been rolled out to our nursing home partners under the Yishun Health GeriCare@North programme since 2010. GeriCare provides access to specialised geriatric care via teleconsultations, and direct training and supervision to raise the level of palliative and geriatric expertise to eight nursing homes in the northern region of Singapore, benefitting some 1,600 nursing home residents. To further enhance the understanding of the palliative care approach, the team created Power Facts, a series of 12 short animated videos. They offer essential knowledge on palliative care in a

modular and easily accessible way. Learners then take a post-course assessment to validate their learning. Lim Yujun, Assistant Manager, Gericare@North, who was part of the Power Facts creation team, shared that a survey thereafter concluded that the Power Facts videos proved to be effective and raised levels of interest and expertise in nursing home staff. “Given how resource-intensive palliative training can be, our aim to improve access and equity to palliative training can be met with use of Power Facts, which helps to bridge these gaps.”

ACPS GO VIRTUAL As part of the ongoing work to enhance EOL care and bring care-planning upstream, Yishun Health’s Advance Care Planning (ACP) team and Geriatric Medicine department have also commenced

FRAILTY, DIGNIFIED CARE & LEAVING WELL PART 3 OF 3

teleconferencing for ACP discussions and family conferences. At the same time, training is being rolled out to equip nursing home providers with the skills to facilitate these over Zoom. ACP conversations are aimed at eliciting, understanding and documenting patients’ view on their future healthcare plans, and guide their medical or personal preferences and decisions in line with their values and goals. It seeks to provide an opportunity for them to express their choices, thus providing their respective medical teams and families peace of mind that the care they are providing is in accordance with the patients’ wishes, values, beliefs and preferences. This removes the need for family members to secondguess what their dying loved one would prefer when crisis strikes, and safeguards a patient’s best interests by making their final wishes known. According to Sim Lai Kiow, Nurse Clinician, Nursing Administration, “Teleconferencing is ideal to accommodate families with various commitments and who may not be physically in the same place.” More family members can also be part of the discussions, especially in times of restricted visitation. Ultimately, says Dr Tan, these moves build into Yishun Health’s overarching vision of a Unified Care Model. “It will drive us towards our envisioned model of care, where the healthcare team can function as one to follow through a patient’s care journey from one setting to another, working with them and their families to achieve what truly matters to them, regardless of their stage of disease.”

RESPECTING CHOICE & DIGNITY AT LIFE’S END A staff seminar titled ‘Leaving Well: Choice & Respect’ was held in April 2021 to better understand the experience of patients and caregivers in their end-of-life journey so as to more efficiently support their care and needs. During this session, Dr S shared about her journey caring for her mother, Mrs M, who was a patient at Yishun Health. Mrs M had been an active 94-year-old in spite of a long-standing ankle injury and her well-controlled chronic diseases. However, after a fall in December 2020, her function and health started to decline. Her son became an increasing presence to support her at home; many of her close friends also took turns to check on her daily. Mrs M had always been clear about her end-of-life preferences. She made her Preferred Plan of Care in the presence of her son and her two close friends, expressing her wish to pass away at home if it was clinically possible. Dr S flew in to live with her mother as the primary caregiver in the final stages of her life journey. At the end of March 2021, Mrs M passed away with her symptoms under control, just as she had hoped. It was a valuable first-person voice that generated deeper understanding among palliative care staff and provided insights into the complexities of care, remaining gaps, and the assistance needed by patients, their families and caregivers. Dr S revealed that she felt “incredibly supported” by the care team during this period, and that caregiving was not easy. Despite the best attention, medications, nutrition and assistive aids, caregiving tasks such as skin care, bowel and bladder management, and medicine administration triggered pain and side effects in her mother. The session highlighted important learning points for healthcare professionals — not least of which is recognising caregivers’ strengths, and understanding how to affirm and empower them. This means regular care planning with the caregivers, and equipping caregivers with relevant information at an appropriate pace to reduce the anxiety generated from not knowing what to expect in the dying trajectory. Care teams can be more anticipatory to prepare the caregivers and family — to offer a sense of agency and control, reassurance, confidence and compassion — while ensuring that the patient is always at the centre of care.

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understanding

UTI

Yishun Health experts answer your frequently asked questions about health, well-being and medical conditions. In consultation with Dr Yeow Siying, Consultant, Urology, KTPH, and Priscilla Chng, Assistant Nurse Clinician, Infection Control, YCH

How common is UTI, and what are some of the symptoms to keep an eye out for? What are some ways to reduce the risk of UTI? A urinary tract infection (UTI) occurs when there is an infection caused by bacteria that has made its way up the urethra (urinary tube) and into the bladder. This causes the urethra and bladder to become inflamed and irritated, which can cause discomfort during urination. UTIs can happen to anyone at any age, but is generally more common in women than in men. This is because women have a shorter urethra, which makes it easier for bacteria to enter the urinary tract. It is estimated that at least 40% of women experience a UTI at least once in their lives; women are also more likely to have UTIs after menopause. Older adults are at risk of UTI if they are bed-bound, have problems emptying their bladder, experience urinary incontinence, or are fitted with a urinary catheter.

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A UTI CAN CAUSE SYMPTOMS SUCH AS: • A burning or stinging sensation while urinating • A frequent and strong urge to urinate • Lower abdominal discomfort • Blood in the urine • Cloudy, foul-smelling urine • Fever TO PREVENT UTIs, YOU CAN TAKE THE FOLLOWING STEPS: • Drink plenty of liquids, especially water, as this helps to flush out bacteria from the urinary tract before infection can occur • Avoid holding in your urine; empty your bladder when you feel the urge to do so • For women – Wipe from front to back – Avoid using potentially irritating feminine products, such as douches and powders, on the genital region – Empty your bladder soon after sexual intercourse

My elderly mother was recently diagnosed with a UTI and given antibiotics. The doctor advised her to seek further medical help if her symptoms do not improve, and that she may even require hospitalisation. Why is this the case?

cases, hospitalisation is necessary. During a hospital stay, there will be investigations, such as a urine culture to identify the bacteria causing the infection, to determine the antibiotics that are most appropriate. Your mother’s doctor may order imaging scans to evaluate her urinary tract as well.

Most UTIs affect the lower urinary tract and bladder; sometimes, there is a risk that the infection travels up the urinary system and into the kidneys. This can result in back pain, nausea or vomiting, and can become life-threatening. However, this can be prevented by timely and appropriate antibiotics. As such, it is important to seek prompt medical attention for a UTI and complete the course of antibiotics as prescribed by your doctor. If the infection is serious, or if your mother has other underlying medical conditions, oral antibiotic treatment may be inadequate, and intravenous antibiotics may be required. This is why, in some

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ive Well

GIVING BACK THROUGH LISTENING Despite having no experience in volunteering before, Mdm Jenny Ng took the plunge to become a Befriender at Yishun Community Hospital as a way to give back to the community. With her gentle and empathetic manner, she provides a listening ear to patients — and in doing so offers others the simple but valuable feeling of being heard.

s a mother, wife, daughter, working professional, and more, Jenny has spent so much of her life caring for others. As she starts to plan for her retirement years, she looks forward to doing even more — such as extending her efforts to volunteering. “Due to time constraints, I have not been able to do it,” she says. “But now that I am thinking of my retirement plans, volunteering seemed like a good way to do something meaningful.” However, she was unsure of how to start. Knowing just how much love Jenny had to share, Jenny’s daughter,

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Michelle, introduced her mother to the Yishun Health Befriender programme, and encouraged her to give it a chance. “I’ve always found joy in talking to people and bringing them some happiness in their time of need,” shares Jenny, who is in her 60s. Two main factors enticed her to sign up: the proximity to home, and the personalised setting. The Yishun resident felt that the convenience would save on travelling time, time that she could channel into impactful work rather than on commuting. It also meant she could make a more regular commitment to build relationships at the hospital. “As a volunteer, I want to give my

best when I’m there interacting with patients. So I make sure I’m ready for each day, and also take care of myself before I help others,” she reflects. Naturally shy and introverted, Jenny also liked how the Befriender programme was structured. “The personalised one-on-one interaction appealed to me, because it allows me to relate better to patients and facilitates deeper connections in small groups,” she explains. Nonetheless, she admits feeling a little apprehensive during the first session and how she would be received. But her fears were alleviated when she met the patients for the

With her quiet warmth and friendliness, Mdm Jenny Ng (in brown top) easily puts patients at ease

first time. “They were very nice and welcoming,” she shares with a smile. It was also reassuring to have support in the form of Linda Ong, Yishun Health’s Volunteer Coordinator, and Rosli bin Hadi, the team leader of the Befriender programme. Under this programme, they help volunteers like Jenny feel comfortable, and offer tips on how to start conversations and handle interactions. They also give guidance on how to establish rapport and hold debriefing sessions so that the volunteers have an opportunity to reflect on the engagement. “It felt reassuring that they are always there in the background, ready to help

us,” says Jenny, recounting her early volunteering days. After a few sessions, Jenny became more confident and looked forward to each Saturday, when she visits patients, spending about an hour with them each time. During these sessions, Jenny often just offers a listening ear — it may not seem like much, but it is a gift to those who feel sad, restless or alone. Being listened to helps people feel heard, seen and cared about — and develop human connections that matter. Patients, too, looked forward to her visits; some of them have become familiar faces to her. Linda explains that some patients do not

have many visitors; for them, social interaction is a valuable part of their rehabilitation and transition back to their home and community. Such interactions are important in an intermediate setting such as Yishun Community Hospital, where it is not just about physical recovery, but social and emotional wellness as well. Linda says, “As our community hospital patients are long stayers, activities run by these volunteers are an integral part of bringing the feeling of home to the hospital so that patients do not feel so lonely.” However, not all patients are so receptive. Some carry heavy emotional burdens with them

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ive Well

during their stay, including suicidal thoughts. Jenny recalls one gentleman who refused to talk. But over time, with her quiet warmth and friendliness, the soft-spoken Jenny managed to put him at ease. He relaxed, came out of his shell, and even started to share some of his personal memories about losing his loved ones. Having someone there to listen and simply give him the space to express his feelings was cathartic. For Jenny, knowing that people trust her gives her a sense of privilege. “Most of the time, people just need someone to listen,” she reveals. “Seeing him warm up to me was very encouraging.” Not all interactions are so emotional; many of them are quite joyful, and she usually leaves with a sense of happiness and fulfilment, treasuring

“Most of the time, people just need someone to listen. Seeing him warm up to me was very encouraging.” each interaction as a learning moment and every sharing as a gift. Jenny realises that, through her volunteering, she too has emerged a little from her own shell — the experience has given her perspective on her own life and reinforced her gratitude for the life

DID YOU KNOW? Yishun Health volunteers help support the emotional and psychological well-being of our patients by giving them the gift of a listening ear and engaging them by doing activities together. These activities include: l Rooftop gardening l Virtual sing-along l Virtual Bingo games l Virtual arts & craft l Virtual befriending It takes patience, active listening, and a genuine interest in people to be a good befriender. It is also important to be comfortable with silence, as some patients do not like interaction, but simply enjoy quiet company. An ability to converse in your mother tongue or dialect also helps!

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she has. She hopes to be able to give more of her time towards volunteering in the years to come. It will be a meaningful way to stay active and complement her other hobbies, such as taking nature walks, cooking and baking, as well as tending to her plants and flowers. “I am very contented and blessed,” she states. As to what keeps her so optimistic and calm, Jenny smiles and says, “Don’t think so much. Keep your mind in the present, smile a lot, and find something that you enjoy and surround yourself with it!” Interested to become a volunteer with Yishun Health? Contact volunteers@ yishunhospital.com.sg to register your interest or to find out more!

veryday Heroes

A CAREER OF

DEVOTION & PROFESSIONALISM Steadfast in her duties and deeply committed to her work, Principal Enrolled Nurse K Vasantha Devi is a pillar of reliability to her colleagues and a comfort to her patients. For her unwavering devotion, she was conferred the Tan Chin Tuan Nursing Award for Enrolled Nurses in 2021.

lood-taking can be, at best, an inconvenience for patients and, at worst, a stress-filled necessity. But in the calm and steady hands of Vasantha, the procedure is almost always an uneventful one. In fact, patients often shower her with praises for her ability to turn this routine test into a pleasant patient experience. Taking the lead in blood taking for the General Medicine Specialist Outpatient Clinic (SOC), Vasantha also multitasks in many other arenas.

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veryday Heroes

This makes her an asset in the highly demanding setting of the General Medicine Clinic, which hosts multiple specialties. Quick to step up to the plate, her initiative and quietly cheerful manner make her a joy to work with. When she is not in the bloodtaking room, she offers assistance to her colleagues wherever it is needed and is quick to volunteer to stand in for her peers whenever they call in for unplanned absences. She also often assists in the SOC rooms, helping in complex clinics and guiding new colleagues into the job as well. Joining KTPH in 2010, Vasantha moved from an inpatient setting to an outpatient one as she saw many learning opportunities with job rotation in the outpatient setting. She explains, “Being in the inpatient setting during my early years, I joined KTPH’s SOC so that I could extend my nursing skills and serve patients in many more ways.” One of these is the Outpatient Parental Antibiotic Therapy (OPAT) Clinic. In 2012, when the OPAT Clinic started operating, Vasantha approached her supervisors and requested to work in this area even though it is traditionally a role for registered nurses. This required her to undergo training

in intravenous (IV) medication administrations, but she took it on with enthusiasm, going through a cannulation course and classroom learning. In just three months, she achieved the competencies required for the skills, making her the first Principal Enrolled Nurse to work in the KTPH OPAT Clinic. Since then, Vasantha has participated in many areas of patient care. Aside from regularly rotating to cover the OPAT Clinic over weekends and public holidays, she also helps in other clinic duties, such as assisting dermatologists in performing specialised procedures to dressing central venous catheters. And that is not all. In 2015, she took on an additional skill of financial counselling duty. Despite her selfadmitted limitations in technology literacy, she nevertheless challenged herself to become more comfortable with the technicalities and intricacies of the role. “I wanted to be able to explain to patients and caregivers about their admission options, and help them to make informed choices for hospitalisation,” she says. It is a task she performs with patience and compassion. According to her Nurse Manager Fan See Wai, Vasantha often stays late to accompany patients till they are sent to the ward. “Late

“I am grateful for the opportunities given to develop the capabilities and attributes to be an outstanding nurse. With passion and determination, my contributions to nursing continues.” K Vasantha Devi Principal Enrolled Nurse

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admissions can be common, and she would go the extra mile to ensure her patients do not wait in hunger,” See Wai explains. “On some occasions, she would even buy food for these patients out of her own pocket.” Over the years, Vasantha has established strong relationships with these patients when they return to the clinic for their follow-ups. Her devotion to her duties met their strongest test yet in late 2020, when her husband was critically ill and was admitted into the Intensive Care Unit (ICU). Although it was a trying period for her and her family, Vasantha continued to work as scheduled and did not take time off. In fact, she juggled her time between caring for her husband and own work so well that none of her peers realised that she was undergoing such a challenging period in her life. Barely a week after her husband passed away, Vasantha was already volunteering at the Acute & Emergency Clinic (AEC). See Wai speaks of Vasantha’s strength with high praise. “Despite her pain, she responded to the higher calling as a nurse practitioner and meet institutional needs. She selflessly volunteered to work in a new department with rotating shifts so that her colleagues with young families could continue to stay in the clinic. This kind gesture earned her a high level of respect among her peers, and I personally salute her for that.” Even with the long hours and sacrifices, Vasantha has never once regretted her decision to be a nurse. “Caring for each patient like a friend or loved one brings me joy and warmth,” she shares, adding that a simple “thank you” or a warm smile from her patients is all it takes to brighten her day

It’s a thumbs up from CEO Prof Chua Hong Choon and Chief Nurse Ms Shirley Heng, as they rejoice with Vasantha, Yishun Health’s Tan Chin Tuan Award for Enrolled Nurses recipient for 2021!

and drive her onwards. “Knowing that I am working with a great team motivates me to make meaningful contributions to my patients. I am privileged to be given the opportunities in this rewarding career; to learn, to experience exciting moments, and to serve my patients and colleagues,” she says. Despite already giving 31 years of service, she still enjoys the dynamic nature of the work and the many opportunities for professional growth. Even amid the pandemic, she has found many learning points. Explaining her decision to work in AEC, she says, “I saw this as an opportunity to update my bedside nursing skills and to learn something new, because learning never ceases.”

“We rejoice with Vasantha for receiving this prestigious award. We are extremely proud of her as we share her glory. Congratulations on your well-deserved success! Great work, Vasantha!” Fan See Wai Nurse Manager

This, she hopes, will be an example to new generations of nurses. “This attitude of consistent learning is important for nursing to progress as a profession. Being part of this profession, I am responsible for expanding my skills so as to serve and touch more patients’ lives.” For Vasantha, being able to take on more than expected of an enrolled nurse is a way to showcase the many areas of growth that nursing can present. “I never expected to be able to administer intravenous medication via a central line as an enrolled nurse. This teaches me that, as long as one is willing, opportunities are abundant. I wish I could influence more nurses with this lifelong learning spirit and contribute to nursing in more ways.”

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potlight

INCONTINENT? HOLD ON, THERE’S HELP Urinary incontinence is an issue that many are ashamed to talk about, but there is no need to suffer in silence. A range of interventions is available to help overcome the problem and improve confidence, well-being, and quality of life.

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ver feel like you need to visit the bathroom all the time? For Mdm Tan, this urge would occur all too frequently, and she would feel the need to urinate every half an hour or so, or else she would ‘leak’. She turned to using incontinence pads, which are similar to sanitary napkins, to keep herself dry. When she needed to go out for a longer duration, she would use adult diapers. However, most of the time, she preferred to stay at home because of the inconvenience and anxiety about potential embarrassment. This meant she no longer joined her sisters for their weekly long walks; she has also reduced the frequency of outings with friends. For many older adults such as Mdm Tan, urinary incontinence is more than a medical issue — it also has a negative impact on their well-being. According to Dr Lawrence Tan, Senior Consultant, Geriatric Medicine, the problem is usually under-reported and diagnosed. “Many of our patients think this condition is part of ageing, so they don’t really tell us about it,” he shares. “It’s only when we dig deeper and ask very specific questions that we find out that they’re experiencing incontinence.”

Even so, some people will deny the problem, which is only discovered because caregivers report it. “There’s a stigma attached to it.” Other times, the problem is only discovered incidentally as part of other assessments. “Lots of people just try to live with it. But it may impact their lives in other ways,” Dr Tan points out. This can affect quality of life because it can lead to social isolation, depression and low self-esteem.

UNDERSTANDING INCONTINENCE There are various types of incontinence. Urge incontinence is most common in older adults. This is when the bladder is overactive, and creates an overwhelming need to urinate even when it is not full. “The bladder can hold about 500–600ml of urine, and most people feel the urge to urinate when about 50% of the capacity is reached,” Dr Tan explains. For people with urge incontinence, the bladder contracts even before this capacity is reached. This overpowering urge to void means that urine may leak after drinking a little water or even after hearing the sound of running water!

The second most common form of incontinence is stress incontinence. This is when exertion such as coughing, sneezing, laughing, exercising or lifting something heavy causes involuntary leakage. It is most common among women, especially in those who have given birth. Another form of incontinence is overflow incontinence. This happens when the bladder cannot be emptied adequately. It commonly affects men with prostate conditions, those with diabetes, and older adults. Incontinence can also be due to a mental or physical limitation that makes it hard to get to the toilet in time (functional incontinence), or a mix of factors mentioned above (mixed incontinence).

YOU’RE IN GOOD HANDS Urinary incontinence affects at least one out of 10 people aged 65 or older. However, it is not a natural part of ageing. “Contrary to popular belief, it is possible to treat the causes of incontinence,” Dr Tan reveals. At KTPH, a Continence Team is at hand to help manage the problem. Comprising geriatricians — including Dr Tan — and a specialist nurse, they hope to not only help people cope better with their condition, but raise awareness of it. The team works to design a care plan that addresses the root causes.

“Many of our patients think this condition is part of ageing, so they don’t really tell us about it. It is important to demystify and remove stigma about the condition. Help is available and they do not have to suffer in silence.” DR LAWRENCE TAN SENIOR CONSULTANT, GERIATRIC MEDICINE, KTPH

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potlight

The Continence Team is led by (L–R) Dr Lawrence Tan, Senior Consultant, Geriatric Medicine. Pictured with him are Dr Tay Poh Peng, Associate Consultant, Geriatric Medicine; Tan Lay Choon, Senior Staff Nurse, Geriatric Medicine SOC; and Dr Marrero Leynard Manuel, Resident Physician, General Surgery, Woodlands Health Campus

The first line of treatment is to educate patients on lifestyle changes and initiate rehabilitation. Patients are advised to avoid or limit beverages that encourage urination, such as drinks that contain alcohol or caffeine, both of which increase the production of urine. Those who are overweight are also encouraged to lose weight, as excess fat can exert pressure on the bladder and weaken the pelvic floor muscles. Exercises are also helpful to strengthen the muscles in the pelvic area. This can include bladder training, which involves lengthening the intervals between urinating. For instance, when the urge to urinate is felt, patients are taught to wait another few minutes before going. This biofeedback practice helps patients understand how their body behaves, and thus exert more control over their urges. Pelvic floor exercises — such as Kegel exercises, which contract the muscles of the pelvic floor — help to strengthen the muscles that support the bladder, uterus and bowels. “If these

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EXERCISES TO STRENGTHEN THE MUSCLES OF THE PELVIC FLOOR

“PTNS is a relatively non-invasive outpatient procedure performed in the clinic. This inhibits bladder contractions and stops the urge to urinate, preventing leaks.” DR YEOW SIYING CONSULTANT, UROLOGY, KTPH techniques do not work, there are medications that can be prescribed to control bladder spasms, or tighten the urinary sphincter muscles,” shares Dr Tan. Dr Tan adds that several drugs have been used for many years for overactive bladder syndrome; they suppress the contraction of the bladder muscle and alleviate the desire to void. “However, these drugs can cause confusion and memory loss, so they are not suitable for those with dementia.” More recently, help has come in the form of a new class of drugs called beta-3 agonists. “Unlike previous drugs, these do not cross the blood-brain barrier and therefore do not exacerbate confusion and memory loss,” he explains. “This opens up treatment options for more patients.” However, the drug is currently quite expensive and can cause hypertension, so close monitoring is advised.

INTERVENTIONS FOR QUALITY OF LIFE In addition to these treatments, the Continence Team works closely with their medical colleagues at the

Department of Urology. Dr Yeow Siying, Consultant, Urology, shares that surgical and other clinical procedures form the third line of treatment. The type of intervention will depend on the form of incontinence. For stress incontinence, sling surgery is the most common procedure. During the surgery, a sling is used to lift and support the urethra (urinary tube) and the neck of the bladder (where it connects to your urethra) like a hammock to help prevent leaks. In more severe cases of leakage in men, an artificial urinary sphincter may be considered for suitable candidates. For urge incontinence caused by overactive bladder, KTPH has recently introduced Percutaneous Tibial Nerve Stimulation (PTNS). “This is a relatively non-invasive outpatient procedure performed in the clinic,” Dr Yeow says. During treatment, a small needle electrode is placed in the tibial nerve located in the ankle. This needle is connected to a stimulator that runs impulses up the tibial nerve to the spinal nerves, which control bladder function. “This inhibits bladder contractions and stops the

urge to urinate, preventing leaks,” Dr Yeow elaborates. A treatment plan consists of about 12 weekly sessions, each lasting about 30 minutes. “Results are promising,” asserts Dr Yeow. “And efficacy has been validated through several studies.” Another treatment for urge incontinence is to inject botulinum toxin (Botox®) into the bladder to weaken the muscles so that they contract less. This is an endoscopic procedure, where a small camera is inserted up the urethra into the bladder, and Botox® is then injected into the bladder wall. This can improve the condition without the need for medications, and the effect can last for six to nine months. Ultimately, Dr Tan and Dr Yeow hope that more people become more aware about incontinence and the interventions available to alleviate the problem. “It is important to demystify and remove stigma about the condition,” Dr Tan emphasises. “Many of the causes can be reversed. More importantly, people should know that they are not alone; help is available and they do not have to suffer in silence.”

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Things About...

Telehealth in the Community

Community nursing has adapted to the times with new telehealth initiatives that make services and support more accessible. Here are five things to expect when you next ‘visit’ your community nurse.

CONTINUED CARE AND SUPPORT

Residents in Yishun and Sembawang can access care services offered by community nurses and connectors conveniently with telehealth monitoring and consultations — no disruptions even during the pandemic.

‘SEE’ US FOR CHRONIC DISEASE MANAGEMENT

We offer telemonitoring for hypertension, hyperlipidaemia and/or diabetes. You can also seek help for asthma, stroke, heart conditions, chronic kidney disease, and chronic obstructive pulmonary disease.

DIFFERENT MODEL, SAME HOLISTIC SUPPORT

Telehealth consults are similar to consultations held at any of our Community Health Posts. During each session, you can speak to our community nurses about healthy lifestyle choices, build a personalised

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care and support plan, and ask questions about your medication, risk of falls, or memory loss. Our nurses also guide residents in monitoring their health metrics, such as blood pressure and blood glucose.

NO DEVICE? NO WORRIES!

Residents who do not have smart devices at home will be provided with a telehealth toolkit, which consists of a tablet computer, blood glucose monitoring device, blood pressure meter, weighing scale, oximeter, and thermometer (see photo on opposite page). The goal is to empower residents with the habit of self-monitoring.

SMILE FOR THE CAMERA

Telehealth sessions use videoconferencing technology. Besides improving communication, this allows our community nurses to effectively demonstrate how to use the monitoring devices.

The team from Population Health & Community Transformation will ensure proper guidance is given to residents, especially those not IT-savvy

If you wish to make an appointment with our Community Health Posts, please call our hotline at 9236 6573 (Mondays–Fridays, 9am–5pm).

Items in the telehealth toolkit

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aily Dose

MAKING WONDERFUL

FESTIVE MEMORIES With the pandemic restrictions still in place this Lunar New Year, we share some meaningful activities that you can do. In consultation with Lisa Choo, Principal Clinical Psychologist, Psychology Service, KTPH

he Lunar New Year marks the beginning of the new lunar cycle and the coming of spring. Historically, it is a time of rest for farmers and labourers before the work year begins; importantly, it is also a time for celebrating family and our connections with each other. While pandemic protocols may mean a quieter festive period for yet another year, you can still stay true to the spirit of the occasion by focusing on gratitude, self-care, sustainable practices, and maintaining strong

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relationships. In this way, the Lunar New Year can be equally joyous, memorable and meaningful as those celebrated pre-COVID-19.

GET TOGETHER IN CREATIVE & NOVEL WAYS Every day, we can be easily caught up in the hustle and bustle of daily life and living. The pandemic has also robbed us of social connectedness. This Lunar New Year, instead of doing separate tasks, why not spend time with

your loved ones? There are many recreational activities that allow us to bond with others, such as a walk, picnic, or movie marathon. For more challenging occasions, consider an Escape Room experience or rock climbing. With limitations to group size for in-person gatherings, quality time could just take a different form this year. You can organise virtual catch-up sessions over Zoom with extended family and friends based overseas, to play games, have a meal, or simply share family stories. While there may be fewer physical visits, embrace the quality time together that is guaranteed to bring fun and laughter.

PRACTISE GRATITUDE

Practise the act of being grateful rather than just feeling grateful. Gratitude is a virtue and skill that leads to action. We can choose to be grateful in any situation — pleasant or difficult — that we find ourselves in. Being grateful can be an alternative resilient response to life’s stressors. The Lunar New Year is the perfect time to practise gratitude in the form of: • Expressing gratitude: Say “thank you”, give (virtual) hugs, and write notes of appreciation • Practising gratitude imagery: Visualise a recent memorable Lunar New Year celebration with your extended family and friends, and focus on the sense of appreciation • Set a ‘gratitude alarm’: Pause what you are doing, and acknowledge and appreciate the things that are meaningful to you — even the small things. Extend this to your own achievements • Start a gratitude journal: Write and reflect on three things to be thankful for each day. Gratitude journaling leads to greater happiness and resilience, and can help to manage your stress level • Gratitude breathing: Take deep breaths while telling yourself, “I am deeply grateful for...”

THE GIFT OF SELF-CARE Spring cleaning is not just for your home, but yourself as well! Many people have been negatively impacted by the pandemic, and it is important to practise self-compassion and care during this time. Find time to rest and recharge. Techniques for stress management, mindfulness, and relaxation arm you with greater strength to face challenges in life. Make pledges to yourself to avoid over-eating, over-scheduling your routine, or stressing out about crowds and long queues during this festive season.

GO GREEN Instead of using good-as-new bank notes for red packets, e-gifting or e-hongbaos are sustainable alternatives to this tradition. Other eco-friendly ideas include making your own decorations with recycled materials, reusing plastic containers for CNY snacks, and purchasing just enough goodies to minimise food wastage. Overwhelmed with gifts of food? Donate them to the needy.

A SEASON OF GIVING The Lunar New Year is not just about red packets — you can give back in kind as well. Why not volunteer to spring clean a charity home, organise a virtual or pre-recorded festive sing-along session for the residents of such a home, or pack festive food items and care packs for donation? These activities pivot our focus onto others; furthermore, they can be done at any time of the year!

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akan Time

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cut & keep

Ratatouille

Taste the rainbow in this colourful and vitamin-rich casserole. Easy to throw together in just one dish, this French-inspired recipe is veggie delightful. Recipe provided by Demi Chef De Partie Loo Tzy Siong, and Cooks Chua Wei Jie & Iskandar Bin Abdullah, Food Services, KTPH, in consultation with Nutrition & Dietetics, KTPH

INGREDIENTS SERVES 4 • • • • • • • •

350ml ‘lower in salt’ pasta sauce /2 onion, chopped 1 medium eggplant, thinly sliced 1 green zucchini, thinly sliced 1 yellow bell pepper, thinly sliced 3 tomatoes, thinly sliced 2 tbsp olive oil 1 tbsp thyme

METHOD 1. Pre-heat oven to 190oC. 2. Pour pasta sauce into a 11 x 8” baking dish. Sprinkle chopped onion and garlic, then mix until thoroughly combined. 3. Arrange alternating slices of eggplant, zucchini, yellow bell pepper, and tomatoes by starting at the outer edge of the baking dish and working across horizontally. Form three lines of vegetables. 4. Drizzle vegetables with olive oil and sprinkle with thyme. 5. Cover vegetables with a piece of parchment paper cut to fit the dish. 6. Bake for 45 minutes or until the

Optional • 4 garlic cloves, chopped (to taste) • black pepper, to taste • sprig of rosemary (as garnish)

NUTRITIONAL INFORMATION (PER SERVING) Energy

170kcal

Carbohydrates

14.7g

Protein

Fat

14g

• Saturated

2.1g

• Polyunsaturated

>0.8g

• Monounsaturated

>9.6g

Cholesterol

0mg

Dietary Fibre

7.2g

Sodium

258mg

Potassium

>669mg

Phosphate

>9.3mg

vegetables are roasted and tender. Serve hot. | 33

it & Fab

Lift for more

strength! Strength training is one of the best ways to improve your ability to do everyday activities; it plays a critical role in preventing injuries. Like any sport, there is a small risk of injury, so here’s how to stay safe as you get strong. In consultation with Dr Ong Joo Haw, Clinical Director and Consultant, Sports & Exercise Medicine Centre

trength training is a major component of overall fitness. In fact, no matter the sport, all elite athletes include resistance training as part of their in- and off-season conditioning programmes. This is because strength training can improve fitness and performance. It is not just beneficial for athletes, but everyone young and old. It aids in our functional ability for daily tasks, improves balance and metabolic (energy-burning) rate, and helps keep our muscles toned and strong.

ON THE QUESTION OF INJURY For some people, strength training can be perceived as intimidating, while some are worried about getting injured. However, studies show that the risk of injury in strength training is actually lower than in endurance-type sports. In fact, strength training is a major component of prevention and rehabilitation of injuries. Enhancing tendon strength, muscle balance, load-bearing ability

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on tendons, bones and ligaments, and increasing bone mass — all these can reduce the chances of skeletal injury. Having said this, injuries can still happen, just like in any sport. • Lower back injuries are by far the most common type of injury, and are usually due to poor lifting mechanics and chronic postural issues • Shoulders, too, can be affected; this is largely due to the complex nature of the ball-and-socket joint. Designed for mobility, it is inherently less stable and can suffer from tears, strains and impingement • Knee injuries are the least common, but issues may arise from overuse or atypical biomechanics. Usually, knee pain is often the easiest to address and fix in those who lift

TRAIN SMART, TRAIN SAFE For those who lift, there is a saying that the goal is recovering from training, not from injury. This means taking several precautions when training.

•

• •

Environment and equipment: Wear the right shoes and clothing, and ensure that your equipment is properly loaded and stable. Ensure a conducive environment, with good lighting, dry floors, and sufficient space.

To protect the back, maintain a neutral spine from neck down, hinge from the hip, learn proper bracing techniques, and work on pelvic stability For the shoulder, it is important to know your maximum range and avoid hyperextension Proper stretching and strengthening of supporting muscles can help to prevent knee injuries

Generally, to keep safe and strong when weight training, one should prioritise learning about proper form and your appropriate mobility-to-stability balance. If you are new to strength training, ask for professional advice to develop a good programme that gradually increases the intensity at a pace where you can progress safely. However hard you intend to train, remember that the best way to get stronger is to take enough time to recover — and focus on sleep and good nutrition. Strength training is best complemented with lots of mobility work, foam rolling, and even yoga. Most importantly, enjoy the exercise and honour your body and its wonderful ability to move and get strong.

Awareness and focus: Be intentional and aware about every movement, especially if you are working with heavier weights. Have a spotter if needed, and listen to your body to know when it is right to keep going or time to back off. Posture and movement: The right techniques and the quality of movement are more important than weight or speed. This is especially important to prevent common injuries in the back and shoulder.

WHAT TO DO IF INJURY STRIKES WHILE STRENGTH TRAINING • Do not train through pain • Rest and ice, especially if there is swelling • If there is swelling, or if daily activities are painful, see a sports doctor early. If not, take a week off or train around the injury, not on it • Start with gentle mobility work and unloaded movements once pain subsides and progressively work back up • In general, most low-grade strains or sprains should resolve within 3–4 weeks. If the issue persists even after a month, consult a sports doctor

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Community Nurse Post

Wellness Kampung

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the North. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting. Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)*

115 Chong Pang

260 Nee Soon East

765 Nee Soon Central

Blk 115 Yishun Ring Road #01-495, Singapore 760115

Blk 260 Yishun Street 22 #01-87, Singapore 760260

Blk 765 Yishun Street 72 #01-366, Singapore 760765

6257 4702

6257 4802

6257 4842

*In light of COVID-19 safe management measures, please check the KTPH website for the centre schedule and call in advance to see if there are vacancies for group activities.

Admiralty Medical Centre (AdMC) AdMC is a one-stop medical centre for specialist outpatient consultation, day surgery, rehabilitation and diagnostic services, as well as community health outreach activities.

Khoo Teck Puat Hospital (KTPH)

KTPH is a 795-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore. It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.

Yishun Community Hospital (YCH)

YCH provides intermediate care for recuperating patients who do not require the intensive services of an acute care hospital. Situated beside KTPH, the two hospitals provide an integrated care experience for patients.

676 Woodlands Drive 71, #03-01 Kampung Admiralty, Singapore 730676

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800