AHA magazine Jul-Aug 2019 + Nurses' Day Special: Adding value through collaborations by Yishun Health

aha

ISSUE 4: July-August 2019

ADDING VALUE THROUGH COLLABORATIONS

NURSES’ DAY SPECIAL Honouring our nurses who have the courage to ‘Dream. Dare. Do’

MCI (P) 101/04/2018

Putting our patients at the centre of care through integrated team-based partnerships

A HELPING HAND IN TIMES OF NEED

SHOULD I EXERCISE WHILE I AM ILL?

EATING WELL WITH DYSPHAGIA

PUBLISHER

ontents

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

30 FIT & FAB Should I exercise while I am ill? Our Sports Medicine doctor shares an aboveand below-neck check to decide 32 DAILY DOSE Eating well with dysphagia For those with dysphagia, diet modification ensures that food can be enjoyed easily and safely

COVER STORY Collaborating towards value-based care Yishun Health adds value to care through integrated teambased partnerships, transdisciplinary training and new models of care that put patients first

THE VALUE SERIES 2 |

HEALTH HIGHLIGHTS Healthcare news and updates

34 MIND & HEALTH Fill in the blanks Can you deduce what these five incompletely spelt words are?

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

35 NURSES’ DAY 2019 Read about the journeys our nurses have taken in caring for their patients

14 SPOTLIGHT A helping hand in times of need Our medical social workers support patients on the road to back to wellness and everyday life 18 EVERYDAY HEROES Plugging the health gap in the community The founders of TriGen share their inspiration for the programme, and how it’s grown

26 5 THINGS ABOUT… Blood donation Here’s why you should donate if you can

28 LIVE WELL Bridging the generation gap Reconnecting through TriGen, volunteer Praiselyn Tan and her former teacher now bond over stories and mutual support

Part 2 of 3 In this second instalment of our three-part series on value-based healthcare, we explore how we have put patients at the centre of our integrated transdisciplinary efforts. The goal is to optimise not just clinical outcomes, but more importantly, patient’s functional abilities and quality of life.

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 Chia Kwee Lee Fatimah Moideen Kutty Shirley Heng Teresa Foong

ktph.com.sg/aha aha@ktph.com.sg

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg M A N AG I N G D I R E C T O R

Christopher Tay

E D I TO R I A L D I R E C TO R

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 A R T D I R E C TO R

Melissa Poon

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.

S E N I O R M A N AG E R , 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

Justin Loh Kelly Loh Lee Lily

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) 101/04/2018

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ealth Highlights

Upskilling Nurses for the Future

New 2+2 Diploma in Nursing for ITE Upgraders A new accelerated progression pathway will allow enrolled nurses who did well during their ITE training to progress to become registered nurses. They will be able to graduate in two years instead of two-anda-half years, with the same diploma as the three-year diploma course.

More Skills Frameworks for Healthcare Professionals Competency and training programme maps and online courses are available on the MOH Healthcare Professionals portal for:

More is being done to equip nurses and allied healthcare professionals with the skills to support a sustainable healthcare system. Upgrading initiatives and new skills frameworks will bolster the healthcare sector and achieve the goal of providing accessible and affordable care that is of good value. NURSES

PHYSIOTHERAPISTS

Community Nursing Competency Framework In May 2019, the Ministry of Health launched a skills framework that more deeply defines the skills and competencies required of nurses who wish to be involved in community nursing.

SPEECH THERAPISTS OCCUPATIONAL THERAPISTS

Investing in Nursing An online platform is being developed for nurses and nursing leaders. It will provide them easy access to courses, and offer a way to recognise skills and competencies attained at the workplace.

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PHARMACY TECHNICIANS

PATIENT SERVICE ASSOCIATES | 5

hat’s Up

Healthcare Humanity Awards

Recognition for Yishun Health at the 2019 NHG Awards T

The award winners (holding bouquets) with top executives from Yishun Health: A/Prof Pek Wee Yang, Chairman, Medical Board (extreme left); Mrs Chew Kwee Tiang, CEO (3rd from right); and Ms Magdalene Chai, Chief Human Resource Officer (2nd from right)

he Healthcare Humanity Awards (HHA) builds on the legacy of the heroism shown by healthcare workers during the outbreak of Severe Acute Respiratory Syndrome in 2003. Today, it recognises and honours healthcare professionals for their commitment to patients. On 25 April 2019, five members of the Yishun Health family were honoured at the 2019 HHA.

Dr John Chua

Dr Ramaswamy Akhileswaran

Manjit Kaur

Senior Consultant, Geriatric Medicine, KTPH Dr Akhilesh is known among his colleagues for being an exemplary model of empathy and care. Apart from supporting patients and families in addressing end-of-life issues, he has also been instrumental in helping to develop palliative care services in Indonesia and Myanmar through Singapore-based non-governmental organisations.

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Senior Staff Physician, Acute & Emergency Care Centre, KTPH Dr Chua not only provides clinical oversight in the emergency care environment, but guides junior doctors in their medical training and professional growth. He also goes beyond the call of duty to take part in overseas humanitarian relief missions.

Senior Nurse Manager, Ward B55, KTPH Manjit is a nursing leader who exemplifies steadfastness, dedication and compassion, not just for patients, but her team and colleagues as well. Apart from being a mentor, she also contributes to the community by taking part in charity fundraisers and community health programmes.

Noor Aiyshah Binte Abdul Raman

he National Healthcare Group (NHG) held its annual NHG Awards on 24 May 2019. Among the 41 individuals and 13 teams honoured, Yishun Health won 14 awards. The top award, the Lee Foundation-NHG Lifetime Achievement Award, was presented to Prof Pang Weng Sun, Deputy Group Chief Executive Officer (Population Health), NHG, and a Senior Consultant in the Department of Geriatric Medicine at KTPH and YCH. Prof Pang was honoured for his critical role in building capacity for his pioneering work in developing geriatric medicine and palliative care services in Singapore. He set up the Society for Geriatric Medicine and developed the curriculum for the two fields in postgraduate medical education. Today, he continues to

work at a national level in population health and eldercare-related committees, and on Advance Care Planning in Singapore. A respected clinician, leader and teacher, Prof Pang is also well regarded for his empathy for patients. Other members of Yishun Health also won awards across both the individual and team categories.

Distinguished Senior Clinician Award A/Prof Chin Thaim Wai, Senior Consultant, Orthopaedics, KTPH

Distinguished Achievement Award A/Prof Lim Su Chi, Senior Consultant, Diabetes Centre, AdMC, and Clinical Director, Clinical Research Unit, KTPH

Outstanding Citizenship Award Ms Low Beng Hoi, Director, Nursing, Population Health & Community Transformation Dr Wong Sweet Fun, Chief Transformation Officer and Deputy CMB (Population Health), Yishun Health, and Clinical Director, Population Health & Community Transformation

Educational Leader Award A/Prof Yip Chee Chew, Medical Director, Admiralty Medical Centre, Head & Senior Consultant, Ophthalmology & Visual Sciences, and Education Director, KTPH Lee Yoke Kee, Senior Nurse Educator, Nursing Administration, Yishun Health

Senior Assistant Nurse, Isolation Ward, KTPH Aiyshah brings a high level of attention and care to her patients in the isolation ward. She is also a strong team player who supports her colleagues in the face of the many challenges faced at work. In her personal time, Aiyshah gives back to the community, the underprivileged and those in need.

Mr Daniel Ho Caregiver, KTPH Mr Ho has been the main caregiver and pillar of support to his mother, who suffered a heart attack and severe brain damage. Juggling the responsibilities of being a father, husband and son, Mr Ho ensures that he spends time daily caring for his mother’s needs and comfort. His tenacity, filial piety and resilience are an inspiration to others. | 7

hat’s Up

Supporting Patients with a More Caring Commute

Young Achiever Award Dr Geraldine Cheong, Consultant, Anaesthesia, KTPH Phyllis Tan, Nurse Manager, YCH Sharon Toh, Principal Occupational Therapist, Rehabilitation Services, YCH

Debbie Do Nguyen Ngoc Thuy, Senior Pharmacist, Pharmacy, KTPH

NHG Team Recognition Award: Gold Award Excellence through Collaboration — KTPH Multidisciplinary Trauma Team Critical Haemorrhage to Operation Room Patient (CHOP) protocol identifies at-risk trauma patients early, activates the multidisciplinary team (Medicine, General Surgery, Orthopaedic Surgery, Anaesthesia, and Interventional Radiology) in a timelier manner and initiates early resuscitative measures such as blood transfusions to address and arrest severe bleeding as quickly as possible.

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Silver Award

Bronze Award

Less is More: Lean Cataract Surgery Care Path The Ophthalmology & Visual Sciences and Anaesthesia departments, as well as the Day Surgery Centre and Nursing Team, collaboratively transformed the cataract surgery process to do away with unnecessary fasting and non-critical pre-operative investigations. Patient bills have also been reduced through the reduction of unneeded consumables and a more streamlined combination eyedrop regime.

Campus Flow and Care Integration Team The Campus Flow team has streamlined the processes within the campus so that patients can be transferred smoothly, efficiently, and in a hassle-free manner anywhere across Yishun Health, as well as into and from the community. For instance, transfers from KTPH to YCH are now done in an average of 1.17 days instead of three to five days.

n 3 May 2019, Yishun Health, together with the Public Transport Council (PTC), Land Transport Authority (LTA) and SMRT Trains, launched Heart Zone @ Yishun. Heart Zones are a way for people to promote a caring community and commuter experience, while also enhancing convenience and safety for patients. Under the Heart Zone initiative, six touchpoints have been created at Yishun MRT station, Northpoint City and the KTPH Main Lobby to nudge the general public and Yishun Health staff to look out for commuters in need, particularly the elderly, frail or those with limited mobility. These signs encourage commuters to assist patients and visitors going to KTPH and YCH from Yishun MRT Station. Commuters are encouraged to walk with patients or provide them with directional assistance to the shuttle bus pick-up point. The official launch was graced by Mr Baey Yam Keng, Senior Parliamentary Secretary for Transport.

Guest-of-Honour Mr Baey Yam Keng (5th from left) was joined by A/Prof Muhammad Faishal Ibrahim (3rd from left) and KTPH CEO Mrs Chew Kwee Tiang (6th from left) as well as representatives from PTC, LTA and SMRT at the launch of Heart Zone @ Yishun

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hat’s Up

A Spotlight on Heart Matters

Empowering Patients Towards Active Health

ishun Health’s Cardiology department held its first Cardiology Symposium on 6 April 2019 for over 300 members of the public. This inaugural symposium was aimed at increasing the public’s awareness and knowledge of various cardiac conditions, such as heart attack, chest pain, heart failure, high blood pressure and heart blockages. Beyond informative sharing sessions by cardiologists, there was also a multidisciplinary aspect to the event event, where Nutrition and Dietetics, Pharmacy, and Rehabilitation Services set up educational booths to raise awareness of how to maintain good heart health.

ctive Health Lab at Admiralty Medical Centre (Active Health @ AdMC) was launched on 25 May 2019. Housed within a community medical facility, Active Health @ AdMC is a collaboration between SportSG and Yishun Health that aims to help residents in the North to take greater ownership of their fitness. Under this unique effort, patients will be referred to Active Health experts for fitness and health assessments as well as a personalised wellness plan. This may also involve medical referrals from Active Health to AdMC doctors, as well as AdMC physiotherapists to Active Health. These two-way medical referrals will integrate the overall medical and physical needs of each person. For patients, this means they will gain the skills and knowledge to transit from medical care to self-care.

Arming Primary Care for the Battle Against ‘Diabesity’ T

Senior Parliamentary Secretary, Ministry of Health, Mr Amrin Amin (in red) toured the Active Health @ AdMC with the heads of Yishun Health and SportSG

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The organising committee for the inaugural Cardiology Symposium held at KTPH auditorium and Learning Centre

he AdMC Diabetes Centre organised the Diabetes and Metabolic Symposium 2019 on 6 April at Sheraton Towers Singapore. Focusing on the association between diabetes and obesity, this year’s event was named ‘Diabesity Revisited — A Primary Care Focus’. The symposium was attended by over 300 healthcare professionals, including general practitioners, nurses and allied health professionals. A transdisciplinary team comprising Yishun Health doctors, dietitians and psychologists highlighted the complications, risk stratification and management options of diabesity. For more in-depth learning, participants moved on to attend breakout sessions in more specific areas, such as nutrition, psychology, therapeutics and surgery.

Members of the transdisciplinary Diabetes Centre team formed a panel, speaking on the topic of ‘diabesity’

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hat’s Up

Taking Steps for Better Elder Foot Care

Celebrating Our Kaizen Culture Y

o celebrate Podiatry Day 2019, the Yishun Health Podiatry team set up an exhibition on 16 April. This year’s focus was on nail and skin management in the geriatric population and persons with diabetes. To educate the public, the team put up posters on various conditions, such as calluses and corns, warts, and bacterial and fungal infections. These were complemented by interactive games and quizzes. To support colleagues and raise skills in foot care, the team also conducted a workshop for Healthcare Assistants and Geriatric Nurses. During this workshop, participants were taught how to safely trim the nails for elderly persons with foot conditions, and how to manage nail and skin issues in people with diabetes.

Kaizen award winners pose for a group photo (top); participants also attended hands-on kaizen workshops (left & bottom)

The podiatry team celebrated Podiatry Day with a public education showcase and a healthcare professional-focused skills workshop

Shedding Light on the Work of Medical Technologists Y

Members of the public had a chance to literally ‘take a look’ at the work that medical technologists do during Medical Laboratory Professionals Week

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ishun Health’s Laboratory Medicine department marked Medical Laboratory Professionals Week with an exhibition that ran from 22–26 April 2019. The showcase was a chance to reveal the behind-thescenes work of medical technologists, who play a critical role in supporting doctors in making timely diagnoses. To highlight the work they do, the team put up posters on the various job scopes, including haematology, chemistry and dealing with body fluids. The public also had a chance to experience some aspects of the work, such looking through the lens of a microscope to try and identify different types of cells.

ishun Health celebrated its spirit of continuous improvement at the fourth Kaizen Festival, held on 17 April 2019. This annual event recognises the good work done by staff across our institution, and reinforces our commitment to doing better each day. Kaizen, or continuous improvement, has been part of our organisation’s DNA of since the days of Alexandra Hospital. Some 176 projects were submitted this year. Of this, 96 were shortlisted and 28 won an award. This is an affirming nod to Yishun Health’s ‘Think think do, think do, think do’ mantra. In his opening address at the Kaizen Festival Award Ceremony, A/Prof Tan Kok Yang, Deputy CMB (Service Development), and the Head of General Surgery, Yishun Health, rallied staff to own the care they provide and renew their conviction and passion.

Quality Convention: The Value Question O

n 26 April 2019, Yishun Health held the first Quality Convention of 2019. Themed ‘Adding Value to Quality: How Do We Get There?’, the timely event touched on how to deliver more meaningful outcomes to patients. The co-founders of Homage, which provides ondemand caregiving for the elderly in Singapore, were present as guest speakers. Ms Gillian Tee, CEO, and Ms Lily Phang, COO, spoke on tackling challenges, such as an ageing population, rising healthcare costs, and how to deliver value to their patients through technology

and mobile applications. More importantly, they focused on what dignified care means from the patient’s point of view, and the importance of covering the wide range of complex functional, emotional and social needs.

Yishun Health Senior Management together with Homage co-founders Ms Gillian Tee and Ms Lily Phang (8th and 9th from left) and guest panellist, Dr Lim Zilian, Deputy Head, Yishun Polyclinic (2nd from right)

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potlight Lim Li Ying, Senior Medical Social Worker (right), and Kimberly Lim, Senior Staff Nurse, visiting Mr Toh at home

Movement for the Intellectually Disabled of Singapore (MINDS). A solution was soon arranged. In July 2018, Mr Toh was admitted

A HELPING HAND IN TIMES OF NEED 14 |

Medical care is more than addressing health crises; it also requires support on the road back to wellness and everyday life, a role Medical Social Workers play.

r Toh Ah Seng’s osteoarthritis was getting worse. It was increasingly difficult for him to walk, get around, and give all-round care for his 38-year-old son, who has intellectual disabilities. The 71-year-old unemployed widower knew he needed help, and treatment for the painful degenerative joint disease. But without any other form of support, the elderly man was at a loss as to who would look after his son. Yishun Health’s Ageing-in-Place Community Care Team (AIPCCT) learnt of his plight and the urgency of the situation. Stepping in to help was Lim Li Ying, Senior Medical Social Worker (MSW). She listened to Mr Toh’s concerns and needs, and reviewed his coping and care plans. Tapping on various community resources, funding and partnerships, she contacted the Ang Mo Kio-Thye Hua Kwan Hospital (AMKH) and highlighted the situation to the

to AMKH for almost a month so he could receive treatment. His son was homed for the same duration at the MINDSville@Napiri Hostel. With the reassurance that his son was well cared for, Mr Toh could focus on his recuperation and rehabilitation. His dedication and hard work paid off; soon,

Ill health and hospitalisation can lead to difficulties, especially after patients are discharged back into the home. Medical Social Workers help to assess these care challenges, as well as social, financial and other needs so that patients are supported every step of the way. LIM LI YING SENIOR MEDICAL SOCIAL WORKER | 15

potlight he was discharged after making significant improvement, and reunited with his son. Li Ying’s work did not end there. She made sure Mr Toh received additional support and care by working closely with the AMKH social worker prior to his discharge, enrolling him in a Day Rehabilitation Centre so that he can continue to walk independently at home. Various community partners, such as Care Corner Cluster Support, NTUC Health Community Befriending, SWAMI Home Nursing, SWAMI Home Help (Medical Escort & Transport), and Handicaps Welfare Association (HWA) are currently supporting him. At the same time, SG Enable is now working to help him secure a long-term placement for his son at a hostel. To help Mr Toh move more freely in the community, Li Ying also activated the Senior Mobility Fund to purchase a motorised scooter at a subsidised fee. The scooter not only helps Mr Toh conserve

energy, but makes it easier for him to remain engaged in life outside his home.

SOLUTIONS FOR HOLISTIC CARE Li Ying’s efforts to help Mr Toh in a holistic way represent the work of MSWs. They are an important aspect of multidisciplinary care as they see to the emotional, psychological, social and practical needs of patients and their families. “Ill health and hospitalisation can lead to difficulties, especially after patients are discharged back into the home,” Li Ying explains. “We help to assess these care challenges, as well as social, financial and other needs so that patients are supported every step of the way.” This often means connecting patients and families to necessary resources and support in the community, helping them access financial assistance, or even linking them up with services such as counselling and caregiver training.

ISMAWANTY ABDUL RAZAK SENIOR MEDICAL SOCIAL WORKER

Ismawanty, Senior Medical Social Worker (third from right), works with a multidisciplinary team to engage in care planning, helping patients and families adjust to acute conditions, and following through with discharge and community support

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Andrew Swee, Medical Social Worker, and Ho Hui Qi, Physiotherapist, encouraging a patient during his rehabilitation session at the YCH ward gym

We work closely with various community partners and government agencies to extend support to patients and their families beyond the healthcare setting.

“We work closely with various community partners and government agencies to extend support to patients and their families beyond the healthcare setting,” says Ismawanty Abdul Razak, Senior MSW. This helps patients and their families transition back to life in the home and community with greater ease. It takes more than a kind heart to be a medical social worker, shares Andrew Swee, MSW. “We also have to be empathetic and sensitive to the needs of patients and their families. Based on this understanding, we intervene as necessary,” he shares. The job requires resourcefulness and a good understanding of the wide variety of health and social care services, support systems and subsidies available. Most importantly, it is about activating resources and services to empower patients and families, equip them with the right skills, tools and support, and help them stay as well and healthy as possible.

MSWS CAN ASSIST IN THESE SOCIAL CIRCUMSTANCES • Individuals and families with limited social support • Family estrangement • Homelessness or poor living conditions • Support for physical/ intellectual disabilities

THE MANY ROLES OF MSWS • Discharge planning and home care arrangements

• Mental health conditions • Terminal/chronic medical conditions • Financial constraints

• Counselling and mediation

• Family violence

• Groupwork

• Caregiver stress

• Financial assessment and assistance

• Suicidal intent

• Illness education • Risk/crisis assessment and intervention • Care coordination and referral to relevant community resources

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veryday Heroes

PLUGGING THE HEALTH GAP IN THE COMMUNITY As medical students, Ms Angeline Tey and Mr Kennedy Ng observed that patients from closeknit families tended to recover better. Wanting to extend this support to those who were more isolated, they decided to activate students who could act as care advocates.

here is power in feeling cared for. It not only supports patients in daily care and recuperation, but also helps them to comply better with care regimes. However, not everyone has a family or support system. It was this awareness that led Angeline and Kennedy to start Tri-Generational HomeCare @ North West (TriGen) in 2014. “We wanted to bring the care and love of a family to elderly people in the community,” explains Kennedy, 28. “It was partly inspired by the idea of Singapore’s kampung spirit.

While we did not experience it ourselves, we know it is about strong community bonds, where neighbours chip in to care for whoever needs help.” TriGen brings students and the elderly together. This promotes intergenerational learning and builds

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Founding student heads Angeline Teh and Kennedy Ng (in red T-shirts) at the launch of the TriGen programme in 2014

a network of care for vulnerable people in the community, adds cofounder Angeline, 26. Starting with university students, the programme has grown to comprise secondary school students as well.

CASCADING CARE THROUGH THE AGE SPECTRUM Under TriGen, National University of Singapore (NUS) students from the Medicine, Nursing, Pharmacy and Social Work faculties are trained by Yishun Health’s Ageing-in-Place Community Care Team (AIPCCT) and North West Community Development Council (NWCDC) in healthcare and social service skills, as well as proper responses to emergency situations. The university student volunteers then lead and organise the programme themselves, passing on knowledge to new and junior

volunteers. Mentorship is an important aspect of the project, notes Kennedy. Each team consists of at least two university student leaders and four to five secondary school students, who are in turn supported by a community nurse who provides support and advice. They form teams, assign schedules, and conduct fortnightly home visits to at-risk elderly patients who are under the AIP-CCT programme. During these visits, the students conduct routine health checks and evaluate medical, social and financial issues. “They act as an extension of community nurses, helping to keep a look out for the elderly, and raising potential issues or red flags,” says Kennedy. Kennedy and Angeline have since graduated from university, and have passed the baton to the next batch of leaders. One of these is volunteerturned-leader Ms Ong Yan Ling, who is now Project Director. Having

witnessed the impact TriGen has had on elderly residents, she sees the programme as a way to build intergenerational bonds and provide holistic care in the community. “It has also given me the opportunity to develop further as a future healthcare professional, a leader, and an active citizen,” says the medical student. Her co-Project Director, Ms Kuah Poh Kah, notes the value in making a long-term contribution to the community for sustained impact and change, as the programme also engages younger students. Secondary school students augment the visits from university volunteers, visiting as befrienders and running interactive activities to keep the seniors engaged (turn to page 28 to read about a special friendship arising from this activity). “This allows the university students to experience interprofessional collaboration

Current student heads Ong Yan Ling (left) and Kuah Poh Kah hold the Asian Elderly Care Awards plaque presented to the TriGen programme

and build their own professional readiness, while secondary school students learn values and develop character through empathy and compassion,” Angeline elaborates. Poh Kah adds that the programme is an important platform for learning. “I have learnt to appreciate the importance of good interprofessional relationship, and how various allied health professions can contribute to keep the elderly healthy and active within their community.”

GROWING THE POOL OF HOLISTIC HELP Over the years, the programme has grown significantly in number and capabilities. To fill the gap for an increasing pool of patients requiring medical care and rehabilitation support, two other universities have come on board. Students from Nanyang Technological University (NTU)’s Medicine faculty and Singapore Institute of Technology’s Occupational Therapy and Physiotherapy faculties started home visits with TriGen in

They act as an extension of community nurses, helping to keep a look out for the elderly, and raising potential issues or red flags. January 2017. Overall, the collaboration increases the number of home visits that can be conducted, and complements the work of community nurses with resources and manpower. The programme also now

includes food and nutrition training by community dietitians. The first training session, held on 30 March 2019, enabled and empowered team leaders to provide appropriate and realistic dietary recommendations. It is encouraging that TriGen pioneers who have graduated have volunteered to come back as alumni to further contribute as mentors since they are now armed with a little more professional experience. Plans are underway to make the most of this to raise the capacity of the volunteers and improve the development and execution of care plans. Going forward, Yan Ling and Poh Kah hope to grow the service further. It has gained recognition and won the Singapore Patient Support Group/ Volunteer Group Award in 2016, and a Gold award in the Most Creative Community Partnerships Category at the Asian Elderly Care Awards 2019. It is also currently being considered a model for community engagement in the medical schools of both NUS and NTU. Yan Ling hopes that the impact can be widened. “It is a project with potential that goes beyond service learning,” she says. “It shows the impact that the younger generations can have on the future of healthcare in Singapore, regardless of whether they become healthcare professionals.” By nurturing a sense of responsibility and capability to care for the elderly, it develops a community of care that goes beyond the treatment of illness to the building of health. She notes how the simple act of receiving care and attention had led beneficiaries to make positive changes. “Many elderly residents who had initially given up hope of good health have changed their perspective. They are willing to lead a healthier lifestyle, which includes a healthy diet and regular exercises, as well as complying with their medications and follow-ups”

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Cover Story

THE VALUE SERIES PART 2 OF 3

ishun Health’s Unified Care Model (UCM) organises and integrates care around a person as a whole. Underpinned by our mission to deliver value-based care, the UCM represents our aspiration to co-create with all staff and our communities the highest form of integrated care: care that is person- and community-centred, and built upon collective strengths, shared goals, trust and relationships. Under the UCM, all patients come under a “One Care Plan” that supports them in living a healthy and fit life. This is by ensuring hassle-free access to dignified and safe care by collaborative teams and networks. This is our approach to deliver value-based healthcare. Working together, our healthcare teams have taken a critical look at their own healthcare delivery processes to identify gaps and opportunities for improvement. Through increased partnerships, capacity building and, in some cases, restructuring models of care, various teams across Yishun Health have improved their processes to enhance outcomes, patient care, and experience. One of the most important shifts needed to drive value is to move away from reactive, episodic or organ-specific treatment. Instead, adopting a value-based healthcare means first understanding what people want before, during and after their care, and providing appropriate treatments and services that support them in these goals. It also means treating patients as a whole person — beyond their conditions — and journeying with them.

COLLABORATING Towards

Value-Based Care 20 |

Value-based care is about broadening the definition of what good healthcare means. It goes beyond achieving clinical excellence and ‘sickness care’ to take a holistic, integrated, long-term and person-centred view of a patient’s needs and wants. Yishun Health adds value to care through integrated teambased partnerships, transdisciplinary training, and new models of care that put patients first. | 21

Cover Story

THE VALUE SERIES PART 2 OF 3

As such, building such relationships is what value-based healthcare is premised on, says A/ Prof Tan Kok Yang, Deputy CMB (Service Development), Yishun Health, and Head of General Surgery, KTPH. Take one of his long-time patients, Mr Wong, whom A/Prof Tan first treated 10 years ago. The gentleman underwent surgery for advanced cancer and experienced many complications. Despite the challenges of the treatment and developing other illnesses over the years, they forged a friendship. To this day, Mr Wong, who lives in the west of Singapore, still prefers to consult A/Prof Tan at KTPH, even though the hospital is located in the north of Singapore. “In medicine, many things can go wrong,” says A/Prof Tan. “But we should strive to be the right person with the right mindset, doing the right thing for the patient — even if all the other circumstances are wrong.” This, he emphasises, is relationship-based, patient-centric care. And this is where value resides. What really helps to establish ties with patients, notes Ms Eileen Cheah, Assistant Director, Nursing, is seeing things from their perspective, rather than just seeking to ‘solve’ a problem. “We have to take a less paternalist view and consider their individual

challenges,” she advises. For example, when patients are not in the controlled environment of the ward, such as when they are discharged back home, they may face difficulties in complying with certain treatment regimes. “How do we then activate our community resources to close the gaps, offer assistance, and consider their personal preferences and circumstances so that they can continue to take care of themselves beyond the hospital?” she probes. Mr Jazimin Haron, Senior Physiotherapist, also adopts this broader consideration of a patient’s personhood in his work. Rather than take a prescriptive approach, he takes the time to understand his patients’ chronic diseases and lifestyle. This adds value to the treatment process, and helps him to better discover their motivations and goals. “I ask them ‘How can I help you?’ Then I design exercises that work around their limiting factors that also meet their needs.” These examples point to the most important factor in enabling a culture of value-based care: empathy. Empathy helps the medical team understand what patients value most, so that treatment approaches can be designed around what is most important to them. It is the ethos that underpins Yishun Health’s definition

In medicine, many things can go wrong. But we should strive to be the right person with the right mindset, doing the right thing for the patient — even if all the other circumstances are wrong. A/PROF TAN KOK YANG DEPUTY CMB (SERVICE DEVELOPMENT), YISHUN HEALTH HEAD OF GENERAL SURGERY, KTPH 22 |

of value-based care: the delivery of the best possible clinical, physical, emotional, functional and social outcomes for patients at the most affordable cost.

MAKING TRANSITIONS SMOOTHER One of the ways that value is delivered to patients is through ensuring hasslefree transitions from the acute to community hospital setting and back home. This is all part of an overall integrated care model to right-site patients, while also caring for them seamlessly regardless of where they are in the healthcare continuum. Each month, about 245 patients who are stable and no longer acutely ill, but still require on-going rehabilitation and treatment, are transferred to various community hospitals from KTPH, with 90% of them admitted to YCH. In the past, administrating the transfer took three to five days. To help patients receive rehabilitation sooner, the process was reviewed and made more efficient [see box story].

Under the GSS, Senior Physiotherapist Lam Xin Yi initiates rehabilitation with her patient in the ward after surgery.

LESS HASSLE TO TRANSFER PATIENTS BETWEEN KTPH AND YCH • Financial counselling is activated as soon as patients are deemed suitable candidates for continuation of care in YCH by the primary team

• The vetting time was shortened

• The referral form was reduced to one page from three, as a shared clinical system meant that information could be automatically and easily retrieved

• A Joint Clinical Governance Model was established between KTPH and YCH

This new expedited process, which takes one day on average, was fully rolled out in May 2019 together with an enhanced electronic referral system. More significantly, the new seamless flow between KTPH and YCH means patients can receive appropriate care in an environment that is more suited to their needs. In addition, transferring patients efficiently from KTPH allows it to free up beds for sicker patients coming from the A&E department. The Joint Clinical Governance Model has also streamlined the transfer of patients back to acute hospital. A Code Blue Team attends to all emergency cases across Yishun Health, including YCH, and these cases are sent directly to KTPH’s Intensive Care Unit or High Dependency Unit. For cases where YCH patients deteriorate and become acutely ill again, they are moved back to KTPH via a ward-toward transfer as soon as an acute bed is available. Furthermore, KTPH primary teams will also consistently render specialist consult services to YCH patients.

FROM START TO FINISH: A HOLISTIC APPROACH TO GERIATRIC SURGERY What counts as a ‘successful’ surgery? According to A/Prof Tan, it is more than a safe procedure. “Ultimately, we have to be accountable for all short-term and longer-term outcomes,” he states. Surgeons, he says, should also consider the concerns of geriatricians and therapists, in addition to those of the patients. “We must plan the patients’ treatment as a team, especially to ensure patients retain their ability to walk or eat on their own,” he emphasises. “If patients cannot return to their previous level of functionality, or are disabled, or lose their independence after surgery, we are not achieving anything for them.” To address these concerns, A/Prof Tan and his transdisciplinary surgical team started KTPH’s Geriatric Surgery Service (GSS) Start-to-Finish (STF) programme. The model deploys an enhanced team-based approach to specifically cater to the unique needs of elderly surgical patients.

Compared to younger patients, elderly patients face a relatively higher risk of developing complications after major surgery. This may be due to their existing health conditions, functional disability, and/or frailty. To better care for this group of patients, help them recover well, and avoid complications for an improved quality of life, selected elderly surgical patients undergo a period of pre-habilitation prior to surgery. To improve their functional outcomes, elderly patients undergo an exercise and nutritional programme two weeks before surgery. This regime helps them withstand the stress of surgery and recover faster. After discharge, patients continue to undergo rehabilitation either at the outpatient clinic or at home. Through this programme, the service was able to reduce major complication rates and improve functional recovery despite dealing with an increased percentage of frail patients [see diagram on page 24]. | 23

Cover Story

THE VALUE SERIES PART 2 OF 3

COMPARISON OF MODELS OF CARE: TRADITION VS KTPH

Health & Function

Frailty Begins

Transdisciplinary Team-Based Care Symptomatic Disease

Discharge

Surgery

Diagnosis Diagnosis

Independence Minimal Loss of Function

Reduced Incidence & Severity of Complication

At home

At home more frequently than Community Hospital Enhanced Rehabilation Recovery Dependence Recovery

Surgery

Complication Acute Hospitalisation

Community Hospitalisation

Shortened Hospitalisation

Prehabilation Patient Education Cardiovascular Training Physical Strengthening Nutritional Optimisation

Time Traditional model of care for elderly surgical patients

LEVERAGING NURSING CAPABILITIES FOR CATARACT SURGERY To bring more convenience to patients undergoing cataract surgery, the Department of Ophthalmology & Visual Sciences (OVS) has developed new care models by expanding the roles and responsibilities of its nurses. Empowering nurses with the skills to take on more clinical roles brings more value to patients, as it enhances the patient experience, increases touchpoints for patient care, and raises patient safety. 24 |

KTPH’s Geriatric Surgery Service’s model of care

To save time and cost for patients, OVS started its Cataract Surgery Under Topical Anaesthesia (CSUTA) initiative. Suitable patients are identified for topical rather than regional anaesthesia. This does away with the wait for pre-operative appointments (POAs) at the Anaesthesia Clinic. Instead, a trained nurse does a POA on the same-day at the Eye Clinic, so there are no additional appointments and diagnostic tests. Apart from saving patients the cost and time taken for preoperative diagnostic tests, topical anaesthesia has faster post-

operative recovery, and eliminates anaesthetic injection complications. In a second nurse-led model, trained nurses provide peri- and postoperative anaesthetic care under the supervision of an anaesthetist. Nurses are trained to deliver special eye drops to dilate and numb the eye. Instead of four different eye drops given over 40 minutes, a new combination drop is given instead. This streamlines the process and halves the time needed to prepare patients for cataract surgery. It also frees up anaesthetists for more complex cases, while improving the nurse-patient experience.

Together, these models have improved the resource efficiency of cataract surgeries and improved patient convenience and safety. For patients, their appointment lead time for cataract surgery has dropped from between four and six weeks to just two. The elimination of at least two appointments also saves them time and almost $200 in fees. At the same time, the Day Surgery Centre has an improved operating theatre utilisation, meaning patients have a shorter wait for surgeries.

IMPROVING GERIATRIC PATIENT CARE IN A&E Taking a similar nurse-led person-centric approach to acute and critical care for the elderly, Yishun Health’s Emergency Department (ED) designed a specialised unit to cater specifically to the unique care needs of older adults. “Triage, diagnosis and discharge in the ED environment can be more challenging in older patients as they may have subtle clinical symptoms, multiple existing chronic conditions, multiple medications, as well as functional and cognitive impairments,” explains Dr Ranjeev Kumar, Consultant, A&E Care Centre. To better address the needs of older patients and extend more holistic and right-sited care, the ED began to train geriatric nurses to take on a broader role in 2017. Equipped to identify patients with early geriatric syndromes, these nurses can then recommend appropriate and effective plans.

To build on this, the ED started the Acute Geriatric Assessment Unit (AGAU) in 2018 to offer more holistic team-based geriatric care in an acute setting. The AGAU provides full multidisciplinary assessment and management for geriatric patients who would otherwise be admitted to acute wards. Dedicated geriatricians, supported by a multidisciplinary team, review patients with the aim of attending to geriatric issues in a timely and targeted matter to reduce admissions and re-attendances [see box story].

PUTTING THE PATIENT AT THE CENTRE OF CARE These approaches create value by delivering care that considers factors beyond clinical outcomes. Above and beyond specific results that matter to medical teams, these initiatives take a multidimensional approach to outcomes that include what matters from a patient’s perspective. This comprehensive and long-term view broadens the idea of healthcare from that of just ‘sickness care’ to ‘wellness care’, and looks after a holistic spectrum of needs of a person, not just a patient.

DEDICATED GERIATRIC PATIENT CARE IN THE A&E HAS...

Avoided unnecessary hospitalisation and related complications without compromising patient care

Saved an average of 8.4 bed days per patient

Led to the safe discharge of elderly patients from the ED, with appropriate referrals and follow-ups to an Early Review Clinic, the geriatric specialist outpatient clinic, Ageing-In-Place Community Care Team (AIP-CCT) or community hospital

How else are our nurses making an impact on patient care? Turn to our Nurses’ Day special, beginning on page 35. | 25

Things About...

EVERY LITTLE BIT HELPS!

Blood donation takes only about an hour of your time, but each bag of the precious fluid could potentially save up to three lives. It is used not only in emergencies and surgery, but also sustains the life and wellbeing of people with medical conditions such as leukaemia and thalassaemia.

A short rest and plenty of fluids after donation will see you back to normal in a day or two. Your body is amazing, and can produce new cells after blood donation. Red blood cells need about four to six weeks for complete replacement. Your body takes a little longer to restore the iron lost, which is why at least 12 weeks are required between whole blood donations.

4 2

5 Things About

Blood Donation

Blood donation saves lives. Here’s why you should donate if you can! In consultation with Jesse Boyer Godfroy, Principal Medical Technologist, Laboratory Medicine, KTPH, and the Singapore Red Cross

26 |

ALL BLOOD TYPES ARE USEFUL

Think your blood is ‘too common’ or ‘too rare’ to be needed? Think again. All blood types are useful. Even common blood types such as O-positive and B-positive are needed by patients all the time.

YOUR BODY WILL REPLENISH ITSELF WITH FRESH, NEW BLOOD WITHIN A FEW WEEKS

YOU HAVE MORE THAN ENOUGH BLOOD TO GIVE

At each donation session, 450ml (slightly more than a canned drink) is drawn; that is about 10–12% of the total volume of blood in an average adult. It is safe for a healthy adult to give blood every three months.

REGULAR DONATION SAVES LIVES, ESPECIALLY AS DEMAND IS INCREASING Every hour of every day, 14 bags of blood are used in Singapore. About 120,000 units of blood are needed to meet the transfusion needs of patients every year, equivalent to more than 400 units of blood a day. An ageing population and the rise of more advanced life-saving medical procedures mean more blood will be needed every year.

WHERE TO DONATE

There are four bloodbanks in Singapore, and they are open six days a week. If you live in Yishun, the closest bloodbank is at Bloodbank@Woodlands. For more information, visit giveblood.sg or call Singapore Red Cross at 6220 0183.

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ive Well

hen Praiselyn joined TriGen in July 2018, it was to help in a good cause and to have opportunities to learn interesting new skills. Little did she realise the impact it would have. As part of the programme, the Orchid Park Secondary School student attended a two-day course at the National University of Singapore, where she learnt basic healthcare skills, such as taking blood sugar and blood pressure readings. It was also during this time that she was assigned to her TriGen team. Imagine Praiselyn’s surprise when she came face to face with her former teacher, Mr Tam, a TriGen beneficiary. Currently on long medical leave, the long-time sufferer of rheumatoid arthritis was not in the best of health. He was still mobile despite undergoing a knee replacement surgery in 2014, and continues to be in good spirits. However, recurring bouts of TRIGEN is an initiative that cellulitis, a type of skin infection, encourages student in his left leg resulted in swelling volunteers from medical and pain, affecting his ability to and secondary schools walk and balance. to visit seniors to extend social and “My left leg got weaker and health advocacy weaker after each bout,” shares support. Mr Tam, who lives alone. Eventually, he developed issues with his spine and the nerves in his legs. It was in 2018, when Mr Tam was hospitalised in KTPH, that he heard about TriGen. When he was discharged, he received follow-up home visits from the Ageing-In-Place Community Care team (AIP-CCT) and later, TriGen. “I feel that the programme is good for the beneficiaries as it provides an additional avenue for social interactions,” he affirms.

BRIDGING THE GENERATION GAP A 40-year gap separates 15-year-old Praiselyn Tan and 56-year-old Mr Tam, but the former student and teacher now share a friendship — formed through the TriGen programme — that brings them joy.

28 |

RECONNECTING AND BONDING Praiselyn only realised 15 minutes before the visit that she would be seeing her teacher again. “I was

shocked as I never expected that I would be familiar with the patient to whom I was assigned; at the same time, I was excited since I have not seen Mr Tam for quite some time,” she recalls. As for Mr Tam, meeting Praiselyn again was a pleasant but not too big of a surprise, as it was very much in the character of his former student. “I have always known that she was a kind person, always willing to help those around her. As a teacher, it is heartening that my student has grown up and is still helping people,” he says. Over the fortnightly visits, Mr Tam and his TriGen team got to interact and know each other better, and ended up supporting each other as friends. This opportunity for bonding is valuable and necessary, as it enhances understanding between the generations, explains Mr Tam. Students also learn practical life skills, such as interacting with people from different backgrounds and age groups, team communication, leadership, as well as organisational and negotiation skills. Beneficiaries such as Mr Tam can view the world through the perspectives of people of different age groups and worldviews — and vice versa. Though strangers at first, interacting with more sensitivity and sensibility becomes natural over time, bridging the age and generational gaps. And in sharing his life, perspectives and challenges with Praiselyn and her team, Mr Tam is a living example of resilience. “Being with Mr Tam has taught me to hang in there and do my best. Mr Tam has always tried his best and remained positive,” says Praiselyn. From teaching English, Mathematics and Social Studies,

Mr Tam and his TriGen friends, including Praiselyn (standing), sharing a joke

Mr Tam now imparts other kinds of knowledge to his young TriGen friends. “He is very knowledgeable and understanding, and will share news and stories with us,” describes Praiselyn. And when they don’t get to meet as often, they keep in touch via group chat, sending each other jokes and stories.

The TriGen programme provides a safe platform for the students to discover and develop their abilities to help those in need, such as myself. It also creates an opportunity for cross-generational friendships, letting them work with people who may not usually be within the locus of their daily lives.

BRIDGING THE AGE GAP As Singapore’s population ages, programmes such as TriGen help to build bonds between people of all ages in the community, Mr Tam notes. “There will be more of those who are not so healthy, who are lonely and bored. It is meaningful to have clusters of youngsters looking out and providing company for older folks.” The support and encouragement of his befrienders have made an impact on Mr Tam. The team has not only showed him that he can move beyond his physical limitations to enjoy a new world of experiences, they also reinforced his motivation to eat and live better. “I believe it is human nature to be kind and reach out to others,” reflects Mr Tam. “The TriGen programme provides a safe platform for the students to discover and develop their abilities to help those in need, such as myself. It also creates an opportunity for cross-generational friendships, letting them work with people who may not usually be within the locus of their daily lives.” | 29

it & Fab

should I exercise while I am ill? Exercise is part of a healthy lifestyle, but how safe or healthy is it to do so when one is down with a cough, sore throat, or runny nose?

DOCTOR’S ORDERS

Dr Teoh recommends that people conduct two checks to determine whether they should exercise when feeling unwell:

AN ABOVE-NECK CHECK:

A BELOW-NECK CHECK:

If symptoms are located above the neck (a stuffy or runny nose, sore throat), then exercise is probably safe. Start at half your usual effort for the first 10 minutes, and gradually increase the intensity to 80% if you feel good. If you feel bad, stop.

If there are symptoms such as muscle aches, fever and chills, skip the workout.

In consultation with Dr Teoh Chin Sim, Clinical Director and Senior Consultant, Sports Medicine Centre, KTPH

ome of us worry when we read, from time to time, stories about individuals who collapsed or even died while exercising or taking part in competitions. The question of whether or not we should exercise if we’re sick boils down to listening to our body and being sensible about its limits. According to Dr Teoh Chin Sim, Clinical Director and Senior Consultant, Sports Medicine Centre, KTPH, while missing a workout or derailing a training routine can be frustrating, it is important to understand that exerting the body — such as when doing high-intensity exercises — while nursing an infection puts us at risk of heat illness, inflammation of the heart muscles, as well as other complications. “Deciding whether or not to train or exercise when feeling unwell is largely common sense,” she says. “Listen to your body; how well or sick are you really feeling?”

30 |

FEVER AND CHILLS SORE THROAT

MUSCLE ACHES

STUFFY OR RUNNY NOSE

EXERCISE IS PROBABLY SAFE

She also recommends that, for every day of sickness, do two days of a lower-thannormal intensity workout when resuming your usual workout routine. To recuperate fully and reduce the risk of infection, it is important to get adequate sleep

SKIP THE WORKOUT, HAVE ENOUGH REST

and drink plenty of fluids, and avoid overtraining. Practise basic infection control, such as not sharing utensils, towels and water bottles, and stay away from people who are also nursing symptoms of illness, especially the first few hours after strenuous exercise.

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aily Dose ENJOYING MODIFIED FOOD

EATING WELL WITH DYSPHAGIA

It is a common misconception that patients with dysphagia have limited food options, such as porridge and baby cereal. Modified meals can be tasty, varied and pleasurable! Just as parents would go to great lengths to modify meals to make them healthy and appetising for their toddlers, we can do that for family members with dysphagia without needing to cook separate dishes for them (see box story).

Dysphagia, a medical term for swallowing difficulties, can cause problems with eating and drinking. For most people with dysphagia, diet modification is needed to ensure that food can be enjoyed easily and safely.

EATING SAFELY WITH DYSPHAGIA Food can be modified to minimise the risk of choking, and make swallowing safer and easier. The extent of food modification depends on the severity of the dysphagia, which is determined by a swallowing assessment carried out by a speech therapist. There are three types of food modification:

CAUSES OF DYSPHAGIA

SIGNS OF DYSPHAGIA

Swallowing, like many other bodily functions, is an unconscious act. However, the mechanics of swallowing can change due to weakness or changes in the muscles that enable swallowing, leading to dysphagia. There are many causes of dysphagia, including dementia, stroke, Parkinson’s disease, and prolonged use of certain medications.

Common signs of dysphagia include coughing, choking, throat-clearing, and regurgitation of food or water during eating and drinking. There may

also be a sensation of a ‘lump’ of food or liquid stuck in the throat or chest, which indicates that the muscles are not working properly to bring the food or fluid down into the stomach.

Normal Swallowing

Disordered Swallowing

WHEN SWALLOWING BECOMES DIFFICULT AND RISKY The weakness or lack of coordination of the muscles involved in swallowing makes chewing, moving food around in the mouth, and transferring food to the ‘food pipe’, or esophagus, difficult. It can lead to an increased risk of food, fluids, or even saliva entering the windpipe and lungs instead of the food pipe, which leads to the stomach. This may cause choking and infections such as pneumonia. People with dysphagia may also become malnourished as eating becomes a challenge. 32 |

Food/ Drink

In disordered swallowing (right), food and drink may enter the airway, causing choking.

Soft: Food that is cooked for a bit longer so that it can be easily broken up with a fork.

Minced: Food that is soft, moist, and can be easily mashed with a fork. Food should be small enough to fit between the prongs of a fork. Little chewing is required.

Pureed: Food that is smooth and lump-free so that no chewing is required. It should flow off the spoon easily without leaving much behind.

Minced food Cook the food for a longer time so that it is softer. Remove bones and crunchy ingredients, and chop it finely. • Mash carrot cake with a fork • Use scissors to flake sambal stingray into a fine floss • Mince well-cooked noodles into small bits that fit between the prongs of a fork Pureed food Opt for foods that are already thick and smooth, and do not contain any lumps or hard additions. • Almond, sesame or walnut paste • Avocado, papaya or banana milkshake • Hummus and other thick dips • Whipped potato Anything that can be blended (including stir-fried meat and non-leafy vegetables!) Tips to puree food: – Use a strong blender – Add a little oil or gravy when blending vegetables and meat to give a smooth texture – Consider adding porridge or cooked rice for a thicker and smooth texture

TO LEARN MORE ABOUT MODIFYING LOCAL FOOD, WATCH THIS VIDEO!

Tinyurl.com/ MinceandMash

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ind & Health

FILL in the BLANKS

Can you make out what these five incompletely spelt words are? They all appear somewhere in this issue. If that’s not enough, we’ve given clues to help you achieve those ‘aha’ moments!

ord games are a fun way to maintain mental acuity. They activate parts of the brain that deal with language and word finding. The brain is thus forced to exercise and keep its gears lubricated and moving. Try the puzzle below!

CLUE: Inflammation of the joints (page 28)

R 2

CLUE: another word for kampung (page 4)

CLUE: Administration of a drug that blocks sensation (page 24)

T H 4

CLUE: Cared for as a whole person (page 25)

S T 5

34 |

H R

CLUE: To restore to a condition of good health (page 15)

Nursesâ&#x20AC;&#x2122; Day special 2019

Read about the journeys our nurses have taken in caring for their patients

urses’ Day 2019

THE COURAGE TO DREAM, THE CONVICTION TO DO T his year’s theme, ‘Dream. Dare. Do.’ consolidates my aspirations for our nurses, not just as professionals seeking to improve, but as people actualising their life’s goals. It means having the internal motivation to look beyond our profession as a job and seeing it as a meaningful calling and a way to self-actualise. ‘Dream. Dare. Do.’ speaks to the need for tenacity, conviction and courage to take on the hard tasks, ask the tough questions, and speak up even when it is difficult to do so. It is also a call to action, for us to rally our individual and collective strengths towards enhancing care delivery, improving ourselves, and elevating the nursing profession. Being able to dream big is an important aspect of keeping our heart for nursing alive. It awakens the passion for our work and injects purpose into our days. Dreaming is about seeing the potential not only in ourselves, but in others, and being aware of the possibilities before us. It stems from a deep conviction in knowing that what we do as nurses makes a difference in the lives of others. But our dreams must be matched with strong, strategic and sincere actions. Leveraging mutual strengths and insights, we must embrace change and take on challenges to find better ways of doing things to improve care and patient outcomes. Beyond dreaming, we must act and take the initiative — be it to learn a new skill, voice a concern or start a kaizen project. These efforts should be nurtured through a supportive leadership that is unafraid to give nurses the autonomy to ‘just do it’. Of course, to realise our dreams and be the change we want to see, we need courage. Courage underpins and gives life to our dreams and actions. In the routine and hectic nature of our day-to-day work, I recognise that there are many barriers to speaking up and driving change, particularly among more junior nurses. However, we must take it upon ourselves to step up, make ourselves heard, do what we are trained to do — more so during difficult and challenging times, and especially when it comes to patient safety.

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This courage and confidence should be fostered by the nursing profession as a whole. We have what it takes: sound professional capabilities, knowledge, skills, experience and insight on the ground put us all in good stead to speak up, share opinions and participate. Beyond our technical abilities, we should also drive courage as a fraternity. At every level, we can do our part to support the confidence that drives courage. As leaders, we can impart confidence to our juniors through active listening, mentorship and giving others the space to build their sense of autonomy. As team members, we can bolster each other through open and honest communication, and treating everyone as a valued and respected member. As younger nurses, we can learn from the experience of others and embrace a proactive learning mind-set. I am confident that, together, we can live out this year’s theme. This Nurses’ Day, I urge all of us in the nursing profession to build each other up, leverage our collective strengths, and foster a culture that gives us the space to dream, the will to do, and the tenacity to brave challenges head-on and rise above. Happy Nurses’ Day!

MS SHIRLEY HENG CHIEF NURSE YISHUN HEALTH

NURSING: EMBRACING A BRAVE NEW WORLD T he nursing profession has come a long way. In the last few years, the transformation of our healthcare systems has translated to an expansion in the roles and responsibilities of nurses. More is being asked of us, and it is with great pride that we heed this call. ‘Dream. Dare. Do’ is a timely motto for us as the nursing profession evolves. It helps us as nurses to reflect on why we do what we do — and how we can develop ourselves so that we can better contribute to a healthier, more resilient community that lies beyond the hospital and in homes. ‘Dream. Dare. Do’ is a reminder that we can look beyond the confines of tradition to creatively think about solutions that improve the way nursing is performed, that we have the ability to make these improvements happen, and we are capable of meaningfully contributing to new and rising aspects of nursing. Many of these changes can be seen in the expansion of our roles in the transitional care and community nursing arenas. Nurses at YCH care for patients with subacute and rehabilitation conditions to help them convalesce before their transition back home. Compared to the acute setting, nursing in a community hospital is not about doing everything for a patient, but to engage and empower them to self-care, and equip them and their caregivers with the skills and knowledge to manage when they are discharged. It takes a different mindset and requires a more sustained level of rapport building, motivation, guidance and supervision. This is what we call a strength-based approach. And we see this increasingly in the communitynursing sphere as well. Instead of being top-down and paternalistic, strength-based nursing is based on building relationships and trust to partner patients and families to promote autonomy, self-efficacy and empowerment. It focuses on the strengths of patients and families (what they can rather than cannot do) that can help them independently deal with problems in the home. This de-medicalises

care and, instead, looks at personhood rather than ‘patient-hood’. As nurses, it means we are learning new skills and broadening our understanding of meaningful healthcare and nursing. By co-creating with patients an environment that bolsters their own ability to self-care, strength-based nursing affirms our goals of promoting health, facilitating healing, and alleviating suffering. This evolution of nursing care reinforces the importance of lifelong learning, which goes beyond professional proficiencies to encompass general knowledge, soft skill sets, and personal development. From communicating better and listening more effectively to resolving conflict and getting better acquainted with social support and community resources, we must arm ourselves with the tools to holistically meet the multitude of patient needs. Building up the capabilities of the nursing profession will help us achieve our goal of being the ‘spine’ of the community. As a the strong but unseen infrastructure, we can do more to support people to maximise their own reserves, resources and innate capabilities to make better choices, manage their health, and live the best life they can.

MS LOW BENG HOI DIRECTOR, NURSING POPULATION HEALTH & COMMUNITY TRANSFORMATION

MDM CHUA GEK CHOO DIRECTOR, NURSING YISHUN COMMUNITY HOSPITAL

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urses’ Day 2019 Ms Low in her various roles and functions over her years in nursing

A Tribute to Ms Low Beng Hoi

I have worked with Ms Low for a good 20 years. She is one of my great inspirations. Two things have made lasting impressions on me: 1. She quietly carries around a book at all times. This is no ordinary book. If you happen to appear before her for any dispute or complaint, she will religiously record all proceedings in this special book. And in her distinguished style, she will proceed to amicably resolve the issue at hand. 2. Her trademark way of speaking — ever so calm and gentle, yet firm and full of conviction. In fact, her tone is so soothing and convincing that even birds in the trees are moved to fly down to listen to her. This is a Ms Low skill that I have not yet been able to master, but hope to one day!

I was a newly promoted Nurse Manager when Ms Low came on board at Alexandra Hospital as Nursing Director. It was a time of great change for the hospital. From new staff and processes to realigning our culture and strategies, we faced audits, attrition and the arduous task of building not only a brand-new culture, but also planning and designing medical facilities. Then, we had to deal with the deadly SARS attack. Through it all, Ms Low was our steadfast leader, working alongside us from early in the morning to late at night. I admired her courage and conviction in building a new nursing administration team and nursing workforce. She encouraged and trusted us, giving us the autonomy to do what we believe is best, while also sharing invaluable advice. Ms Low’s dedication, close mentorship and ongoing and open dialogue through the years have built a strong relationship with nursing administration. She empowers us to develop forward-looking nursing policies and practices, and continuously encourages us to have a life-long learning mindset to keep abreast of healthcare trends, models and practices. Importantly, Ms Low often reminds us to know our purpose, values and principles when we are faced with making tough decisions. I am grateful to have experienced her exemplary leadership and to have worked, learned, developed and grown together in our calling.

SOH LAY SEE ASSISTANT NURSE CLINICIAN, KTPH

ALICE LEONG DEPUTY DIRECTOR, NURSING YISHUN HEALTH

Known for her warmth and nurturing spirit, Ms Low Beng Hoi has served as a nurse for over three decades. Today, we honour her for her leadership and contribution as Yishun Health’s first Chief Nurse.

arly in her career, Ms Low trained and worked in the United Kingdom for 16 years as a midwife and intensive care nurse before returning to Singapore in 1985 to continue her nursing journey. Over the years, she has worked in both specialist outpatient and intensive care, overseeing and managing operations in these settings. Joining Alexandra Hospital in April 2001 as Director of Nursing, Ms Low was among the pioneering team that saw the hospital through its restructuring and transformation into Yishun Health. Beyond growing the nursing team, her hard work and conviction inspired and motivated her colleagues towards the new vision and mission of the hospital. A well-respected mentor, she has fostered in many nurses a willingness to try new things and a culture of learning. Serving as Chief Nurse for Yishun Health from 2017 to 2019, Ms Low not only demonstrated leadership, but has groomed and guided numerous nursing leaders in their careers. Through one-on-one chats, she takes time to catch up with her staff to get to know them and their aspirations. She is also supportive of nurse-led

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initiatives, events and improvement projects, and is a highly visible leader who walks the ground. Since stepping down from her post, she has ventured into one of her passions — community work. Now Director of Nursing for Population Health & Community Transformation, she brings her energy, empathy and experience to the work of building healthcare resilience and an empowered and self-managing populace. Working collaboratively across the organisation, she also plays a critical role in building the culture and capabilities of community nurses. This broadening of the nursing role takes an upstream approach to focus on health promotion, disease prevention, and building patient and caregiver autonomy. This goes towards developing hassle-free, high-quality and holistic person-centred care and services that keep people healthy and out of hospital.

WORDS OF GRATITUDE AND PRAISE Here are some heartfelt thoughts from nurses who have been touched by Ms Low’s dedication to healthcare:

Ms Low is a nursing leader who combines utmost professionalism with humility. Through the decades that she has served at Alexandra Hospital, KTPH and Yishun Health, she has been an example of commitment and leadership, and a pillar of support for over 2,000 nursing staff. Ms Low truly cares for us. As a leader, she has created a conducive working and learning environment for us; as a mentor, she takes the time from her busy schedule and many responsibilities to talk with us one-on-one; as our biggest supporter, Ms Low never fails to grace ceremonies and events that recognise nurses. Through all her interactions, she is warm and sincere. She also has a clear and gentle way of articulating her thoughts and ideas that never fails to make an impact. Her commitment to the nursing profession, to us nurses, and to patients motivates us. And her leadership has made a difference to us — it has touched our lives and inspires us to greater things.

THERESA EE SENIOR STAFF NURSE, KTPH

I have worked with Ms Low since I was a very young nurse, and she has been such a role model for me. Ms Low has never had any airs, whether she was a Director of Nursing or when she was Chief Nurse. Her office door was always open, just like her heart. Ms Low takes the effort to understand the issues on the ground and always listens to our ideas and inputs, even from junior nurses. I remember that whenever I approached her with issues or frustration, she had this magical ability to calm me, turn the tables around and inspire me to face the challenges and find ways to manage. Most importantly, she motivates and coaches us to do better, to grow and try out new ideas, urging us to view nursing in different perspectives so we can grow in the profession. YVONNE YAP NURSE MANAGER, KTPH

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TOGETHER IN ASPIRATION & ACTION 40 |

Yishun Health’s Nursing Leaders include Chief Nurse, Nursing Directors, Nurse Managers, Nurse Clinicians and Nurse Educators

ach year as we commemorate Nurses’ Day, we look back on a rich tradition of care. Even as we celebrate our triumphs, we also take time to address the challenges before us and envision the future that we want to craft for the profession. Some of these goals include growing the profession, improving patient safety and care, nurturing nursing leaders, and playing a broader role in care delivery. Increasingly, it also means partnering patients, families and communities to build a resilient, self-managed population.

This evolution of nursing requires us to think beyond the confines of what has been done before. It behoves us to step outside our comfort zone. And it means believing not just in the value that we can bring to the table as nurses, but the strength and abilities that come from our patients as well. Together, buoyed by our conviction and courage, we can collaborate towards better, safer and moreaccessible person-centred care.

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Nurses’ Merit award 2019

When I was 14, my grandmother was admitted to the hospital. I became her caregiver back then, and I could see that she was satisfied with my company. At the same time, I felt that my presence was valued. This kickstarted my interest in helping the sick. One day, my classmate invited me to go with her for a job interview, and that led to the beginning of my nursing career. I am now 38 years into nursing, and have never been prouder to be a nurse. I see nurses as superheroes for the needy — we help relieve our patients of their suffering and make them feel comfortable; we help ease the anxiety of patients and their families. Personally, I feel a great sense of achievement and satisfaction in being a nurse when my patients and their family members recognise the part I play in their care journey.

The MOH Nurses’ Merit Award recognises individuals for their outstanding performance and contribution to the nursing profession. These stories provide a peek into what motivates this year’s batch of award recipients to continue giving outstanding care to their patients.

YU LEE HOON SENIOR NURSE CLINICIAN, INPATIENT WARDS KHOO TECK PUAT HOSPITAL

I am now 38 years into nursing, and have never been prouder to be a nurse. I see nurses as superheroes for the needy.

I’ve learnt that in prioritising safety, we must have utmost integrity in our work, a humble attitude, and always strive to be better.

CHAN HOI SUM

JOYCE LEE

NURSE MANAGER, WARD B96 KHOO TECK PUAT HOSPITAL

NURSE MANAGER, CARDIOVASCULAR CENTRE KHOO TECK PUAT HOSPITAL Nursing has been my ambition ever since I discovered the meaning of the word ‘nurse’ in primary school. Since fulfilling that dream in 2003, I have been living out my passion to provide care for those who need it most. As a junior nurse in 2004, I missed highlighting a patient who did not stop antiplatelet medicine and proceeded for an ultrasound-guided liver biopsy. As such, the patient went into a bleeding episode; thankfully, the doctors and senior nurses were able to respond to the situation immediately. The patient had to be hospitalised and incurred extra costs. Because of my carelessness in this incident, I nearly gave up on nursing. However, rather than blaming me, the doctors and nurses gave me nothing but encouragement. They showed me that, in prioritising safety, we must have utmost integrity in our work, a humble attitude, and always strive to be better. Through this, I’ve learnt the importance of a good healthcare team, so that we can serve our patients in the best way possible.

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This incident emphasised that I should always trust my intuition, knowing that my patients’ safety is always of utmost priority.

After 12 years as a nurse, I still can recall a case during my first year of nursing, when I was posted to a medical-surgical ward. Upon fetching one of the patients under my care after a procedure in diagnostic radiology, I realised the patient was pale and less responsive than before. I had a strong intuition to check the procedure site; in doing so, I noted that it was swollen. When I took my concerns to the proceduralist, who was the team consultant, he assured me that nothing was wrong and requested that I send the patient back to the ward. Upon arrival at the ward, I alerted the HO and MO of my observations, and we checked the patient’s blood pressure — it was not detectable. Within the next 30 minutes, the patient collapsed and was transferred to the ICU. This incident emphasised that I should always trust my intuition, knowing that my patients’ safety is always of utmost priority. | 43

urses’ Day 2019 For me, the satisfaction I seek as a nurse is making that difference in someone else’s life at their most critical time, and that’s why the A&E is the right place for me.

SITI NOR ILYANA BINTE KAMSOL NURSE CLINICIAN, ACUTE AND EMERGENCY CARE CENTRE KHOO TECK PUAT HOSPITAL

As an A&E nurse, I’ve encountered a spectrum of cases. They range from a flu or a headache to unforgettable incidences involving trauma and death. One incident that I will never forget is an unknown patient who was brought in after playing basketball. He was soon pronounced dead and sent to the mortuary. Witnessing the moment when the deceased’s face was exposed for the family to identify was so surreal — it felt like something out of the movies. I will never forget the sadness that filled the mortuary that evening. As clichéd as it may

When I was young, becoming a nurse was a thought that never crossed my mind. However, when SARS struck Singapore in 2003, I was deeply inspired by the stories of nurses who toiled around the clock, working tirelessly to care for patients. Eleven years on in this profession, choosing nursing has been one of the best decisions of my life. During my attachment as a student nurse, I encountered a patient who was critically ill, and saw how her family struggled to come to terms with the inevitable. Although I was still

sound, being a nurse gives opportunities for individuals to make a difference in someone else’s life. Our touch, words, and intent to help is already half the job done. For me, the satisfaction I seek as a nurse is making that difference in someone else’s life at their most critical time, and that’s why the A&E is the right place for me.

inexperienced at that time, I provided them with the comfort and support within my means. After the patient passed away, the family shared with me how I had helped them through the difficult times. Their gratefulness and appreciation have constantly reminded me to look beyond my primary role of giving care to the patients, and focus on building relationships with my patients and their family members.

Because the team was focused on a common goal, I felt energised and was able to persevere through such a long surgery without feeling tired.

FAN XIULAN ASSISTANT NURSE CLINICIAN, PERI-OPS KHOO TECK PUAT HOSPITAL

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In 2004, Singapore was recruiting nurses, and even provided scholarships for a Diploma in Nursing. I decided to seize this opportunity to relieve my parents of their financial burden. In Singapore, I worked in a surgical ward for six months. However, I wanted to challenge myself to try different nursing roles and, as such, requested to work in the Operating Theatre, where I have been for the last 10 years. I really enjoy it as I am able to play the important role of the patients’ advocate, ensuring their safety and preserving their rights throughout the surgery. I have also assisted in a surgery that lasted more than 10 consecutive hours. Because the team was focused on a common goal, I felt energised and was able to persevere through such a long surgery without feeling tired. This memorable experience has been my source of strength and resilience in overcoming many other challenges and obstacles in my nursing life.

Eleven years on in this profession, choosing nursing has been one of the best decisions of my life. KOH PEI PEI ASSISTANT NURSE CLINICIAN, WARD A82 KHOO TECK PUAT HOSPITAL

Life as a nurse is not a bed of roses, but it is one that leaves no regrets. KATHY LAM NURSE EDUCATOR, NURSING ADMINISTRATION YISHUN COMMUNITY HOSPITAL My passion is to help others, especially the underprivileged. Against the will of my parents, I chose nursing after completing my ‘O’ levels and have never looked back. Six months after graduating, a patient under my care passed away. It was my first patient death. Although she suffered from end-stage renal failure, she had refused all treatment. Both her legs were infected and subsequently amputated. I was her nurse in the last few days of her life. She was a strong lady, and always had a smile for me despite her pain. I can still remember the peaceful smile on her face when she passed on. Her fighting spirit inspired me deeply. I vowed to be a better nurse so I can bring more happiness into the lives of my patients. Life as a nurse is not a bed of roses, but it is one that leaves no regrets.

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IN PURSUIT OF A CALLING Nursing called out to them when they were young. Living their dream each day as a nurse takes commitment and a willingness to grow personally and professionally. Although not always an easy path, they have stayed the course, sustained by one simple thing — the satisfaction of knowing they have made a difference in someone’s life. We have grouped their stories into three sections, according to this year’s theme.

Living my childhood dream CRISTLYNNE GRACE SARMIENTO ABERGOS STAFF NURSE, WARD D98, YCH I HAVE ALWAYS BEEN INSPIRED BY THE LADIES IN WHITE UNIFORMS WHO TOOK CARE OF ME AND SPOKE SO CHEERFULLY TO ME WHENEVER I HAD A DOCTOR’S APPOINTMENT. “When I grow up, I want to be a nurse,” I vividly remember saying onstage at my preschool graduation ceremony. And I have pursued this dream ever since. When I was older, my grandmother died of a heart attack. I’ve always wondered what I could have done to help her had I the skills to do so. The pieces all fell into place when I started nursing school and could finally dress in the white uniform. Two years into my career, I decided to apply for a job overseas to better provide for my family. That decision was a leap of faith; it took a lot of courage to leave my comfort zone, family and loved ones. Coming to Singapore to work was very challenging, having to deal with the diversity of people and culture, and language barriers. Slowly but surely, I fell in love with this new life and career path. Despite the many difficulties, one of the reasons I have stayed on this road is the people I work with. As Helen Keller once said, “Alone we 46 |

can do so little; together we can do so much.” I am truly blessed to have such great colleagues. We work well together, look out for one another, and encourage each other in our ups and downs. Of course, the main reason why nursing has been so rewarding is because of my patients. There is so much joy and satisfaction when they appreciate the care we render. One of my favourite patients is an auntie who always waves and says “hi” whenever she sees me. However, she wasn’t always so cheerful. In fact, she used to be quite bad-tempered. Over time, she came to appreciate our work and gained an understanding of everything we do for her. It was through our knowledge, skills and, most importantly, our attitude and affection that won her over. It has been seven years since I started working as a nurse. As I get ready for work each day, I still cannot believe I am living my childhood dream — my life has been enriched with so many people and experiences. I am thankful that my profession allows me to help people, not just heal from illness but also support them in living their best quality of life. | 47

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Passing the mark to be a nurse

Nursing, my all-in-one career achievement

RYAN TAN

NOR SYAFAWATI BTE JUMAAT

I FEEL LUCKY TO HAVE KNOWN SINCE I WAS 17 THAT I WANTED TO BE A NURSE. I still remember visiting the Health Sciences (Nursing) booth at a polytechnic open house. My peers all laughed; one even said that nursing was for those who did not do well in the ‘O’ levels. I was crestfallen to learn that I did not meet the minimum ‘O’ level requirement for a Diploma in Nursing. I enrolled in ITE to pursue a NITEC in Nursing instead. My father, a Senior Officer with the Singapore Police Force, was keen for me to follow in his footsteps and was not in favour of this, but my mother was supportive of my dream. After two years in ITE, I more than made the grade to enroll for a Diploma in Nursing in a polytechnic. Those first two years of nursing education truly cemented my desire to pursue my dream. Today, seven years into my nursing journey, I am glad I stayed on my path. Even my father has come around and can see my passion for the job. It proved that it takes more than just grades to be a nurse — it also takes conviction and fortitude, qualities that help us overcome the challenges of our chosen career. Nursing is not always rainbows and butterflies. What also keeps us going are our amazing patients. One of them is Mr J. He had been admitted for a fever, and wanted to go home after several days. However, as his temperature had recently spiked, his doctor advised against this. As such, before my shift ended, I reassured and encouraged him. The next day, I was shocked to learn that his condition had deteriorated overnight, and was now in the ICU. When I saw Mr J again several days later, he cheerily asked me how I was despite having been so ill. His greeting touched me — after all that Mr J had been through, it should have been me enquiring after him! When we spoke again later, Mr J said, “Remember to treasure every moment in life because life is such a fragile thing; one moment you are ok, the next, you are not.” This simple statement made me realise the fragility of life. This thought has helped me to appreciate the simple and sometimes mundane things in life. Seeing Mr J again several months later, I recalled his observations, and felt happy knowing he was back on his feet. It is small but meaningful experiences like these that continue to fuel my passion for nursing, and the continued pursuit of learning and growing to make my mark as a nurse.

WHEN I WAS YOUNG, I WANTED TO BE SO MANY THINGS: TEACHER, DOCTOR, ECONOMIST, LAWYER — EVEN A BUS DRIVER! BUT NOT NURSING. In fact, after taking my ‘A’ levels, I settled on the idea of becoming a teacher. However, that did not pan out as I was not able to further my studies in university. So I worked as a preschool and tuition teacher, waitress, and even in retail before settling in an office job. Three years in, a friend suggested that I join nursing after sharing his experience in that vocation. I was reluctant because of a bad experience as a child: a nurse had raised her voice at me for not bringing my glasses, making me cry. I’ve been apprehensive of nurses since. I also had a fear of seeing dead bodies, and of going back to school and being older than my classmates. However, my friend’s enthusiasm gave me the push to take the first step. Honestly, it was a hard decision to make as I was filled with so much fear and uncertainty. But I am so glad I took that detour in my life, and have never looked back in regret. There is so much more to nursing than dispensing medication and cleaning up the patients. Just as I had wanted to be so many things as a child, I get to take on multiple roles as a nurse! I care for patients, counsel them, act as their advocate, and even educate them. My career as a nurse has been a rich one, full of memories and experiences. There has been frustration and joy, sadness and hope. As a student nurse, my days were filled with unending interesting incidents and experiences as I was attached to different departments. As a working nurse, I got to be involved in medical standbys and career fairs. As a graduate nurse, I even achieved my dream of getting a degree and teaching nursing to others. As a mother, I had the great joy of having my second child born on Singapore’s Nurses’ Day in 2015. I have met and been inspired by so many different people — patients, colleagues and supervisors alike — and gained an abundance of experience, skills and knowledge. All these have made my better-late-than-never calling such a memorable and meaningful journey. I am so glad that I found my way to this path. I feel I have achieved much, but look forward to many more exciting adventures in nursing ahead!

STAFF NURSE, WARD B96, KTPH

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SENIOR STAFF NURSE, NURSING ADMIN (EDUCATION), KTPH

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COMFORT IN DARK TIMES Finding the push to go on from heartbreak

Sickness, trauma, death. Sadness, anger, grief. These are the inescapable downsides of nursing. But amid the darkest of times and the burden of human suffering, nurses find it in themselves to journey with patients and families, stepping in to light the path and lighten the load. In daring to do so, they provide compassion, care and comfort that can mean the world to those undergoing tough times.

HUI WEI XIONG

STAFF NURSE, A&E CARE CENTRE, KTPH WHAT DOES IT MEAN TO BE A NURSE? This experience from three years ago remains deeply etched in my memory. I was barely three months into the start of my nursing career and assigned to the Emergency Department’s resuscitation room. Like any rookie, I was idealistic, excited and bursting with anticipation to put my skills to good use. But I was little prepared for what I know now — that Monday afternoon shifts are one of the most intense. That day was no different. The first patient came in with a heart attack, with blood oozing from the mouth. In this stricken state, the patient had released both bladder and bowels. We worked in a frenzy to try and stabilise the patient; unfortunately, not all battles can be won. It was my first cardiac-arrest case, and my first loss. Though a thousand questions flooded my mind, I had no time to process the experience. Another team was already attending to a new patient, this time a casualty of a road traffic accident. I was tasked to perform the last offices for the first patient so that my team leader could help out in this second case. Together with a colleague, we cleaned the patient up before presenting the deceased to the family. It was a heart-rending task. I tried to be sensitive and empathetic to the grieving family. However, when I brought up the need to process the death certificate and arrange for casket services, the deceased’s spouse lashed out at me, calling me “heartless”. My heart froze. I was stung, dejected, and feeling out of my depth — how could I have handled the situation better? But there was no time for despair; after all, work had to go on. 50 |

I went on to help my colleagues with the traffic accident victim and other cases, but also took the time to keep the family of the first case updated so that the body could be transferred to the mortuary. Throughout the day, the word “heartless” kept haunting me, even during my break and throughout the back-to-back resuscitation cases that streamed in. Due to these critical cases, manpower in the A&E had to be redeployed from less-urgent needs. This meant some walk-in patients had to wait for more than 30 minutes before being attended to. When I had the bandwidth to attend to one of these patients, I was berated soundly for the long delay in treatment. The patient, who was experiencing pain in his leg, was clueless to the fact that, just beyond the wall, a father of three was close to dying from serious injuries. It was another blow to my already fragile heart. This was only my first rotation in the emergency ward, and I had already lost my spirit. This feeling of hopelessness stayed with me throughout my shift and lingered long after — I was not sure I would last my probation period. Soon after this traumatic day, someone waved at me while I was having breakfast. He introduced himself as the son of patient who had died from cardiac arrest, and apologised for his parent’s harsh words. He also thanked me for the care and guidance during their initial period of loss. “Continue what you are doing. You are a great nurse and will be a greater nurse in the future,” he said. I was touched beyond words. As nurses, we don’t work for moments like these, but these gestures reaffirm our conviction that what we do is a higher calling — helping those who cannot help themselves. | 51

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Journey’s end: letters to my patients HENRY KONG

SENIOR STAFF NURSE, GERIATRIC CLINIC, KTPH AS A PALLIATIVE NURSE, I WORK WITH PEOPLE REACHING THE END OF THEIR LIFE’S JOURNEY. Each time a patient passes away, it takes an emotional toll, but it also enforces the humanity of my work in the geriatric field. We feel because we care. We grieve because we give of ourselves. I’ve learnt from each patient and grown — as a person and a nurse — to be a better version of myself. These are some Thank You and Goodbye letters that I’ve written to some of the patients who have made their mark in my life. MDM A: LOVE AS A PARENT, PATIENT AND FRIEND Dear Mdm A, I remember pushing you in your wheelchair, oxygen tank and all, to the bank and the HDB office to settle your financial affairs and housing issues. Though the journey was challenging and rather arduous, it was quite an adventure that we had together! That was the day that you promised me that you would quit smoking — and you kept your word. We organised a birthday party for your daughter. It was one of your greatest wishes to celebrate her 11th birthday, and we helped you plan the whole thing — decorations, food, a beautiful personalised cake, and all. I will never forget the look on your face as you sat on your wheelchair, sweating but with a smile, bright as can be, as you encouraged your daughter to “eat more, eat more”. So thank you, Mdm A, for teaching me what it means to love and forgive others unconditionally. Thank you for teaching me the immeasurable love of a parent, which transcends all circumstance, be it sickness or health, riches or poverty. Most importantly, thank you for allowing me to take care of you. You will always be remembered, not only by me, but by the others whose hearts you have touched. MDM H: STRENGTH EVEN IN THE TOUGHEST OF TIMES Dear Mdm H, I nursed you from the beginning, from the time you entered our care through the A&E. Despite your pain and illness, you were unfailingly joyful. Even though we could not communicate very well due to the language barrier, 52 |

you communicated through your smiles, jokes and bubbly personality. I remember sitting with you that one time when you were in so much pain. Though it was a dark period, it connected us. The rapport I built with you and your lovely family made me sad — yet happy at the same time — when you were eventually discharged. Little did I realise then that the next time I saw you, you wouldn’t be able to recognise me as just staying alive was taking so much out of you. It was hard seeing you and your family suffer at that moment. I think the deepest regret I had was not having the chance to say “goodbye”. I have since visited your final resting place, and hope that you are in a better place. Thank you for allowing me to take care of you, for sharing with me your love of music, and for teaching me how to remain strong even in the toughest of times. MR T: GIVING TILL THE VERY END Dear Mr T, Just thinking about you makes me smile. It was through your frequent admissions to hospital that we got to know each other and subsequently became friends. The first time we met, you had arrived at the clinic after being discharged from the A&E. You told us not to trouble the home care team — it was just one example of your consideration towards others. It took you several times to remember my name, and when you eventually did, you mispronounced it! That became our little inside joke: my name rhymes with a famous song, ‘Xiao Wei’, which we would sing together spontaneously, much to the amusement of others. The day before you passed on, I remember dropping by your ward. Unfortunately, I didn’t get the chance to say “hi”, and regret that I will never have another chance to do so. The only solace to me is knowing that you passed on peacefully in the company of your sons. Thank you for teaching me to be considerate to others, no matter how bad our own situation is. You also taught me the importance of humour, especially in the darkest of times. Lastly, thank you for allowing me to take care of you so many times, and for always appreciating my care for you. | 53

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Finding meaning and healing at life’s end ONG WEI WEI ASSISTANT NURSE CLINICIAN, POPULATION HEALTH & COMMUNITY TRANSFORMATION IT WAS MY TURN TO COVER NIGHT CALLS. My mind was on high alert even as I tried to rest. Before long, I was awakened by a phone call at 1am. “Hello? I’m the wife of Mr Ahmad. My husband is feeling breathless now. What should I do?” Hearing wheezing and coughing in the background, my mind raced: was it COPD, asthma, an infection, or just an exacerbation? I would need to check on this tomorrow. In the meantime, I gave advice on what to do even as I began pull out Mr Ahmad’s records. Here was another patient I would be walking with as they traversed the final leg of their life’s journey. Patients like Mr Ahmad and many others across the range of care settings have been my greatest teachers — their journeys always leave an impact on me. Each patient’s story is different; every individual tackles illness,

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discomfort and death in his or her own way. It was from a paraplegic that I learnt gratefulness; I witnessed grief from a mother whose daughter never woke from surgery; I learnt strength and grace from a woman who lost her battle with breast cancer. Today, as a community nurse, I am sometimes on call after-hours to support terminally ill patients. I translate my knowledge into achievable actions that empower patients and their loved ones for as long as life permits. To me, palliative care is a beautiful, delicate piece of work. The end of life can bring out every complex emotion. I have begun to see how this time is life’s final chance for us to reconcile relationships, to forgive, and be forgiven; to love and be loved again in the face of the inevitable. This is when I play my part in a team, racing against time to help our patients and their loved ones attain this goal. Though at times emotionally draining and physically taxing, nursing has been rewarding and therapeutic for me. In caring for the sick, I find healing; in tending to the dying, I cherish life.

SERVICE TO MANKIND While nursing was not a childhood calling, these nurses developed their passion for the job nonetheless, building a meaningful career through compassion for others. This dedication to give back to society has seen them overcome uncertainty to become the excellent nurses they are today.

Serving those in need WONG SOOK CHENG

SENIOR NURSE MANAGER, WARD B46, KTPH I BECAME A NURSE OUT OF NECESSITY. Coming from a poor family, I accepted the first job offer I received, and started my nursing training when I was 16. In those days, nursing training could be quite harsh and strict. My first assignment was as a feed nurse. One memorable patient was an elderly gentleman with advanced liver disease. He was very thin, had a bloated stomach and a yellow pallor. As I helped to spoon food into his mouth, I realised it was coated with blood and clots, making it difficult for him to swallow. I wiped his mouth with gauze and cotton wool, making it easier for him to eat. He clasped his hands in thanks. The next day, I did the same, and ended my shift feeling pleased that he seemed on the mend, but he unexpectedly died after throwing up a lot of blood. I was shocked by the sudden turn of events, and kept wondering what I could have done to help him. It made me feel inadequate. In fact, I toyed with the idea of giving up, and even applied for other jobs. I went for many interviews, but something held me back. I came to realise that not every illness can be cured, and my responsibility is to be there for my patients, especially when medical science has done all it can. That is when I step in to play a bigger part. With my training and experience, I can help make patients feel cared for. I can make them comfortable and reduce their suffering. This is really why I have continued to be a nurse. I believe that nursing, as much as it is about supporting patients to get back to health, is also about seeing to their needs when they are at the end of life. In caring for the poor, the sick, the lonely and the dying, I serve the people who need it most. | 55

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The many faces of nursing

Nursing: my evolution

JOSEPH CHEONG

DACUG KIM GARCIA

SENIOR CARE COORDINATOR, CASE MANAGEMENT, KTPH MY VERY FIRST TASTE OF NURSING WAS WHEN I WAS IN SECONDARY SCHOOL. Rejected from the National Police Cadet Corps, I decided to join the St John Ambulance Brigade instead. Their mission to serve mankind by relieving pain and suffering resonated with me. As I spent my teenage years rising through the ranks from recruit to officer, I learnt basic first aid, discipline, leadership and teamwork, skills that have primed me for my chosen profession. I guess it was only natural that I decided to join the healthcare sector after I finished my national service. Apart from my personal interest in nursing, I also felt that the skills I would gain would equip me well to take care of my parents when they became older. I have now been in nursing for over two decades. It has been full of interesting experiences — not all of them pleasant! The job can be dirty, challenging and tiring. We work long hours and late shifts. Often, we have to contend with bodily fluids and waste. There is sickness and death… but there is also recovery, renewal and new life. There is much more to nursing than ‘sickness care’. In fact, there are so many ways to serve as a nurse today. For instance, nursing plays a great role in the prevention of illness and the empowering of patients, as well as in the development of better care plans for patients. This led me to pursue another nursing path as a case manager. This gives me the opportunity to help and educate people to manage their chronic diseases better through awareness, capability building, and lifestyle modification. These days, as a care coordinator, my role is to help deliver integrated and holistic care to patients and their families. I identify their care needs, coordinate services, educate, advocate and empower them; all this with the aim of enabling them to remain in the appropriate care setting, and to age well in place. Though my nursing career has broadened and I have taken on many roles, my core duty has always remained the same — to serve.

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STAFF NURSE, WARD D98, YCH SOME CALLINGS REVEAL THEMSELVES ONLY LATER IN LIFE. As a nursing student, I remember four years’ worth of endless books, frantic sleepless nights and stressful exams, but cannot honestly say that I was driven by an inner fire to be a nurse. I began my career in the Philippines in a public hospital that served the poor. Beset by political complications and a lack of resources, the work was challenging and often disheartening. It was especially difficult because my first rotation was in a paediatric ward. Witnessing the death of young children — one eight-month old girl’s passing was particularly hard — made me question my fortitude for this career I had chosen. But I stayed and did my ‘tour of duty’ through all the different wards and specialties. From the frenzied rush of the emergency department and the precision of the surgical to the extraordinary privilege to witness the birth of new life in the obstetrics and gynaecology ward, I began to appreciate each unique experience and the opportunity to serve. My patients — sick, suffering and

poor as they were — extended their thanks in small but immeasurably valuable ways. Five years into my career, I realised that being a nurse was truly what I was meant to do. My calling had finally found its way into me and I had a strong desire to further my path. This led me to Singapore, where the stark differences in culture and practice meant I had to begin my career all over again. To be frank, this was a humbling move that almost doused my passion for nursing. But the experience of stepping out of my comfort zone to learn and challenge myself has made me a better person and a better nurse. Although many things were different, one thing remained the same — the desire to be of service to others. Another five years have since passed. Each step in my journey has come with its ups and downs, but, at the end of the day, it is the people I care for who keep me going. Each person whom I have taken care of has added to the richness of my nursing career. As nurses, we use our knowledge, experience, instinct and compassion to heal and comfort, and I am thankful and grateful to be part of this healthcare community. It is in serving them that I reinforce my calling in nursing.

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urses’ Day 2019

Giving my all for my patients THILAGAVATHY MUTHUSAMY SENIOR STAFF NURSE AGEING-IN-PLACE COMMUNITY CARE TEAM, POPULATION HEALTH & COMMUNITY TRANSFORMATION WHEN I WAS PURSUING MY DIPLOMA, NURSING WAS ACTUALLY MY LAST OPTION — I had debated with myself whether it was the right path and whether I was up to the challenges. While my father encouraged me, saying that nursing was a noble profession, and that it was a blessing to help others, it was through the many rigours, heartache and pressure of nursing work that I developed my passion for nursing. Even though it was tough, giving my all to help save lives strengthened my motivation. I have worked in the high-pressure environment of acute and intensive care, and only recently moved to the community nursing setting. Supporting patients and family members after their discharge back home is an extension of the work I did in acute care. This continuity keeps patient stable and prevents readmission to the hospital. One important aspect of my work is palliative care, an area that I have become more involved in. One of my patients passed away suddenly at home, and this badly affected the family. Witnessing the complicated bereavement, I realised I can do better if I can support patients and their families by preparing them early and exploring Advanced Care Plans (ACPs) to guide them better during crisis. I began volunteering for palliative cases in my community care team. This work is meaningful because it can bridge the gap between patients and their family’s expectations to help patients achieve their wishes at the end of life. It also means supporting families in preparing for and accepting the loss in order to find comfort and closure.

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