AHA Magazine Jul - Sep 2022 by Yishun Health

aha

ISSUE 3: JUL–SEP 2022

SPECIAL

SEE PAGE 30

CARE CONTINUITY FOR

TOTAL KNEE REPLACEMENT

MCI (P) 062/07/2022

Enhancing and consolidating care flows for patients undergoing knee surgery

FOCUSING ON FOOT HEALTH

BURN INJURIES

EXERCISE, THE FORGOTTEN MEDICINE

ontents

COVER STORY Care Continuity for Total Knee Replacement Enhancing and consolidating care flows for patients undergoing knee surgery

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

16 Q&A Health and wellness questions asked and answered! 18 SPOTLIGHT Focusing on Foot Health A deep dive into the allied health specialty of podiatry 22 5 THINGS ABOUT… Burn Injuries Types of burns that can occur around the home, and what to do about them

18 24 DAILY DOSE Seeing a Clearer Picture Our radiographers explain the different types of scans that produce images of diagnostic quality 26 MAKAN TIME Seabass with Mango Salsa & Mesclun A refreshing fish dish that can be prepped in under 30 minutes!

Part 2 of 3

PUTTING PATIENTS IN THE CENTRE OF CARE 2 |

As we move towards greater levels of collaborative team-based initiatives, the ongoing challenge is to ensure that — despite bringing in more players — the patient care journey remains streamlined and convenient. To this end, various Yishun Health teams have made a concerted effort to structure their care flows so that patient care is as seamless as possible. In the area of elective joint replacement surgery, the total knee replacement team worked with the Care Integration and Flow Office to develop a structured patient journey, resulting in greater care consolidation, shorter stays, and enhanced patient satisfaction.

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

EDITORIAL TEAM

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.

28 FIT & FAB Exercise, The Forgotten Medicine Exercise brings physical benefits, mental wellness, and longevity! 30 NURSES’ DAY 2022 We dedicate an entire section to celebrate our nurses, the people who form the backbone of our health system

A/Prof Tan Kok Yang Bastari Irwan Caroline Tan Fatimah Moideen Kutty Shirley Heng Teresa Foong

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

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

aha

ISSUE 3: JUL–SEP 2022

S P ECI A L

SEE PAGE 30

Maskless photos in this issue were taken before COVID-19 or with safe management measures in place

Christopher Tay

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

Chua Kim Beng

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

Sheralyn Tay E D I TO R

Dang Hui Ling CARE CONTINUITY FOR

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

TOTAL KNEE REPLACEMENT

Sean Lee

MCI (P) 062/07/2022

Enhancing and consolidating care flows for patients undergoing knee surgery

FOCUSING ON FOOT HEALTH

BURN INJURIES

EXERCISE, THE FORGOTTEN MEDICINE

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.

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

Jessie Kek

C O N T R I B U TO R S

Lee Lily Gina Ang Justin Loh Mark Lee Vivienne Looi

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 062/07/2022

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hat’s Up

Recognising our Super Mentor and Research Extraordinaire

Some members of Yishun Health’s Senior Management and Union gathering for a shot after the CEO handover ceremony

Dr Sharon Pek and A/Prof Sum Chee Fang, Senior Consultant, General Medicine, giving a thumbs up at the awards ceremony!

rincipal Research Officer Dr Sharon Pek, Clinical Research Unit, KTPH, was honoured with the Super Mentor Award at the 2021 Lab Tech of the Year Awards on 18 March 2022. She was one of 15 winners who were chosen among hundreds of nominees. Organised by Asian Scientist magazine, this is the second run of the Lab Tech of the Year Awards, a national competition that recognises outstanding laboratory technicians making an impact in research and innovation. The Awards shine a light on the lab and research work that furthers Singapore’s STEM (Science, Technology, Engineering and Mathematics) capabilities and healthcare ecosystem. Since joining KTPH as a fresh PhD graduate in 2010, Dr Pek has gone on to contribute towards many of Yishun Health’s research collaborations. These include her leading involvement in a pilot study on Familial Hypercholesterolemia (FH). This study paved the way

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for Yishun Health to start Singapore’s premier FH national registry, which has received grant funding support and is gaining ground in its research findings. Dr Pek continues to support the study as Principal Investigator and administrative manager, going beyond this work to also mentor the team running the in-house next-generation sequencing. Apart from her research work, Dr Pek has guided many junior staff and student interns in their academic and professional journey as well as career; some of them have gone on to win awards for research best practices in benchmarking, data documentation, and analysis. She has also trained many research nurses and coordinators in biobanking and DNA extraction. For her work in nurturing and developing the research skill sets of so many under her, Dr Pek is well deserving of her ‘Super Mentor’ status!

Singapore’s first co-located NKF dialysis centre opens at YCH O

n 10 April 2022, the National Kidney Foundation (NKF) officially launched its new dialysis centre at Yishun Community Hospital (YCH). The centre, which started operations on 23 November 2020, is the first in Singapore to be integrated within a hospital compound. Built with a $2 million donation from Keppel Corporation — through its philanthropic arm, Keppel Care Foundation — this centre will offer fully integrated and seamless dialysis care for both haemodialysis and peritoneal dialysis patients. The goal of intentionally colocating the centre within YCH is to offer smoother care flows to patients.

This is in line with Yishun Health’s mission to provide hassle-free healthcare and more seamless care delivery between the acute and community hospital settings. More than 100 patients who have made around 400 visits have benefited from the centre’s unique shared care model services since it started operations.

Guest-of-Honour Minister for Health Mr Ong Ye Kung took a tour of the new facilities

Building new competencies in Smart Health Leadership

n inaugural batch of 22 Yishun Health colleagues from Operations, Allied Health, Human Resource and Corporate Development completed the final module for their Professional Diploma in Smart Health Leadership on 8 April 2022. This programme is the culmination of a Master Collaboration Agreement

signed on 5 January 2021 between Yishun Health and NUS Institute of Systems Science, and features a curriculum customised by Operations, Quality and Risk Management, and Corporate Development teams. The goal is to develop in-house talents to become change agents for systems, service transformation, and digitalisation.

The cohort will go on to embark on their chosen Capstone Projects, which comprise initiatives to improve healthcare delivery in areas such as discharge turnaround time, patient experience, resource optimisation at clinics, and collaborations with the primary care sector.

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hat’s Up

The value of Advance Care Planning in the new normal O

n 8 April 2022, the Yishun Health Advance Care Planning (ACP) Office and Agency for Integrated Care held a collaborated symposium with the theme, ‘ACP in the Age of COVID-19’. The highlight of the session was an insightful and thought-provoking roundtable discussion by a panel of speakers from the population health, infectious diseases, and palliative care arenas. This segment emphasised the value of ACP, especially for those who are at higher risk, and gave helpful perspectives on overcoming challenges in this new normal. Some 250 attendees — including ACP facilitators and healthcare teams from different organisations — joined the Zoom session.

TGIF: It’s time to learn!

he Kaizen Office hosted the inaugural The Good Improvement Forum (TGIF) on 5 May 2022. This session welcomed over 100 participants across Yishun Health’s job families who were enthused to learn from Ms Denise Bennett, CEO of Lean

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Enterprise, Australia, and Yishun Health’s Dr Benjamin Chang, HOD and Senior Consultant, Ophthalmology and Visual Sciences, KTPH. The session also introduced our new kaizen partner, the National Centre of Excellence for Workplace Learning from

Singapore Institute of Technology (NACE@SIT). This workplace learning centre aims to develop business capabilities by empowering businesses with best-in-class practices, expertise and networks to support workplace learning efforts.

No safety, know injury; know safety, no injury

o educate the public on exercise safety and injury prevention, the Sports and Exercise Medicine Centre held a webinar on 23 April 2022. Called ‘Exercise

During the Pandemic’, this session shared ways in which people could avoid sports-related injury while still keeping active and fit as part of a healthy lifestyle.

The session was presented by Dr Teoh Chin Sim, Senior Consultant, Dr Benjamin Soh, Registrar, as well Yeo Boon Kiak, a national cyclist.

Reinforcing our focus on safety Y

ishun Health conducted Safety & Security Week for the first time in two years with a range of activities in the week leading up to a funfilled event on 26 May. Themed ‘Think Safe, Work Safe’, the week’s events included Zoom sessions on ergonomics, radiation safety, cybersecurity, and mental wellness. There were also fire drills, unannounced security exercises, and other simulation exercises to test staff responsiveness. The week’s activities were aimed at raising awareness of workplace safety and security, emergency readiness training, community preparedness, and the importance of continuing the focus on other forms of safety beyond the pandemic. On 26 May, CEO Prof Chua

Yishun Health presented guests with our signature homegrown vegetable baskets as a token of appreciation

Hong Choon gave an opening address to a full auditorium, and even more staff via Zoom, that touched on the significance of the week as a milestone that marked the collective journey of overcoming the challenges of COVID-19. He urged everyone to learn from the experience.

Following that, guest speakers took centre stage. That day, partners from Singapore Police Force and Singapore Civil Defence Force, as well as teams from the organising committee, set up booths at the KTPH Learning Centre to engage attendees and promote the various aspects of safety.

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hat’s Up

Moving towards an Epic milestone

Yishun Health’s first batch of certified Specialist-Training-Specialists and Credentialed Trainers

ishun Health is making good headway in the adoption of the Next Generation Electronic Medical Record (NGEMR) system, slated to go live on 25 February 2023. The NGEMR — an integrated electronic health record software application known in whole as Epic — will fully consolidate all patient care functions end-to-end, including: • Registration; • Scheduling; and • Clinical documentation.

This will have the benefit of: • Saving on cost and necessity for repeat tests when patients switch care providers; • Providing consolidated patient information that will harmonise workflows; • Enabling healthcare practitioners to deliver care in a more organised and effective way; and • Allowing for better reporting of healthcare data across healthcare clusters for a consistent patient experience.

It will also track all patient information, including medical and administrative data, from the time of admission through discharge, and outpatient appointments. Acting as a centralised, shared electronic medical record system for Singapore’s population, the implementation of NGEMR will improve care delivery and management. This will result in a single patient health record that can be accessed across institutions (using the same system).

For example, authorised members of the patient’s care team from different NGEMR institutions will be able to view the results of any recent blood tests, x-rays and investigations online without having to specifically request the records from another institution. According to CMB A/Prof Pek Wee Yang, “This system we are adopting will be future-proof and flexible. It will enable seamless data transfer across

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hospitals and healthcare clusters, and caregivers will benefit as well.” Yishun Health embarked on implementing the NGEMR on 1 July 2021. Since then, the team has worked towards achieving numerous project milestones crucial for a successful go-live. Some significant milestones have been reached, including: • The completion of two rounds of Integrated testing for Epic, with more than 100 scripts tested; • The deployment of the 671 powered Computeron-Wheels (pCOWs) to all clinical areas; • Starting the Technical Dress Rehearsal, an activity to verify that all NGEMR End-User Devices are deployed and configured correctly; • Starting the Medical Device Integration testing to ensure that patient data from medical devices will flow seamlessly into Epic; • Preparing training areas for all 5,000 Yishun Health staff;

• Creating ‘Learning Spaces’ across the Yishun Health campus for staff to practise using the new system; • The certification of our first batch of 79 staff from different family groups as Specialist-TrainingSpecialists and Credentialed Trainers; • Starting demonstration sessions with departments; and • Organising engagement activities such as webinars, roadshows, Learn and Lead Forums, Super RO Bootcamp sessions, Fortnightly ‘Ask-All-You-WantFridays’, Principal Trainers Orientation.

Testing medical devices at the Major Operating Theatre

The NGEMR team behind-the-scenes at the Outpatient Workflow Roadshow

Deploying pCOWs to Admiralty Medical Centre

Principal Trainers participating in an onsite orientation

Yishun Health CEO Prof Chua Hong Choon points out that these many months of intensive work will serve a greater end. “We are investing in a future-ready electronic system to enable our mission of better care and better health for our patients and the population we serve.” He adds, “The NGEMR will bring people closer together — and together, we can build a much stronger healthcare system.”

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Cover Story

CARE CONTINUITY FOR

TOTAL KNEE REPLACEMENT Restoring function and mobility, knee replacement surgery is one of the most common orthopaedic surgeries in developed countries with ageing populations. As Singapore is seeing a rise in demand for this procedure, Yishun Health has embarked on consolidating care flows for these patients for a better experience, shorter stay, and improved overall recovery.

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PUTTING PATIENTS IN THE CENTRE OF CARE PART 2 OF 3

ust hours after coming out of surgery for knee replacement, 70-year-old Mdm Lau was ready for her rehabilitation exercises. In fact, thanks to a pre-operative class, she had been practising her exercises at home prior to the operation. Just three days after her surgery, Mdm Lau was back home, where she continued with her prescribed exercises. Her family members supported her in her recovery, accompanying her on walks, during which she was aided by a walking frame. Within a month, Mdm Lau was able to walk independently, and kept up her mobility and fitness with regular sessions on a static bike. Mdm Lau’s experience with total knee replacement (TKR) surgery is indicative of how far this form

of orthopaedic procedure has come. According to Dr Alvin Tan, Consultant, Orthopaedic Surgery, changes have been made to improve the pain management and recovery process for TKR surgery. “In the past, TKR surgery would require a hospital stay of five to six days. And, because of the type of anaesthesia used and the lack of pre-operative conditioning, there was also the challenge of pain and muscle weakness, which would delay the rehabilitation process,” he shares. Recognising the downsides to a surgery aimed at restoring function, mobility and freedom, Dr Tan and his team looked into enhancing their TKR practice. In 2019, they came together to implement several initiatives to improve this surgical service.

“Early discharge planning helps to expedite our discharge process and right-site patients so that they need not stay longer than necessary at the acute care hospital, while also ensuring their recovery is monitored.” Dr Alvin Tan Consultant, Orthopaedic Surgery KTPH

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Cover Story

PREPARATION, PREHABILITATION AND PARTICIPATION One of key additions to the programme is a pre-operative class, where Case Managers such as Huo Hui Jiao provide patient education and counselling. “I give

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them information about how they can prepare and what to expect before and after surgery, as well as the expected length of stay in the hospital,” Hui Jiao explains her role. She also teaches patients and their caregivers how to move around after surgery, what fall precautions

to take, as well as the management of pain, swelling and wound. This pre-operative class helps patients and their families better understand the care journey. Importantly, it includes a session with physiotherapists, such as Ng Su Yee, who begin reinforcing the

PUTTING PATIENTS IN THE CENTRE OF CARE PART 2 OF 3

“No one person is smarter than all of us combined. It is satisfying to see how, when all of us come together, we can make a huge change to improve our care and impact the lives of our patients.” Ng Su Yee Senior Physiotherapist KTPH

message about the importance of strengthening exercises before and after surgery. “We explain that, if they prime their muscles and improve their general conditioning, it will help them with their recovery,” Su Yee says. “It also pre-empts them that we will come around for their simple exercise sessions to get them moving once they come out of surgery.” During these pre-operative sessions, the team also begins to do early discharge planning. This, Hui Jiao says, helps greatly in ensuring that patients receive adequate post-operative support. “We find out about their home care situation to ensure that they have someone to help them during the recovery period.” If patients do not have sufficient support at home, Hui Jiao plans for discharge to an intermediate care facility such as Yishun Community Hospital, where patients can stay to receive rehabilitative care. “This helps to expedite our discharge

see how they are coping, and arrange for follow-up appointments. Knowing what the care journey would be like alleviated a lot of anxiety in Mdm Lau and her daughter, Ms Kathy. Compared to another TKR surgery she had gone through years ago, Mdm Lau and her family felt more prepared this time around. They are also glad for the faster discharge and postoperative care delivery.

GETTING THE CARE FLOWS RIGHT process and right-site patients so that they need not stay longer than necessary at the acute care hospital, while also ensuring their recovery is monitored,” explains Dr Tan. For patients like Mdm Lau who are discharged home, Hui Jiao will follow up with phone calls to check on their well-being,

Outcomes such as these are the culmination of what started in August 2020, when the Care Integration and Flow Office (CIFO) approached Dr Tan and his team to collaborate on improving the TKR service. CIFO’s role is to facilitate the improvement of value for patients through better patient outcomes and experience. They work with various teams across Yishun Health

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Cover Story

to translate the organisation’s mission of integrated care under a Unified Care Model (UCM). This means implementing actionable steps to meet care needs and ensure that care continuity is smooth across different aspects of the spectrum, from the hospital to its care partners, at home and in the community. “CIFO brought structure to what we’ve been doing,” shares Dr Tan. “Using their tools, they guided us in establishing our goals, tracking these goals, and identifying what works and what

we can improve on.” “Working with CIFO helped us to tie everything together,” adds Su Yee. “We already knew that there were studies to show the importance of prehabilitation and patient engagement. Working with CIFO, we saw how each one of us in the care spectrum could contribute.” Due to the COVID-19 pandemic, not many elective surgeries have been conducted in the last two years. But for patients who have undergone this new care flow, the response has been promising and

positive. Already, the average length of stay has dropped to 2.94 days in FY2021, compared to 3.34 days in FY2020. The average total cost before government subsidy also fell by 2.61% in FY2021 compared to the year before. Significantly, Dr Tan notes that — thanks to improved discharge planning, pain management and prehabilitation — more patients are being discharged within one to two days after surgery. The number of patients being discharged

Members of the multidisciplinary TKR team include (L-R): Siwat Bhunlapiwat, Assistant Manager, Care Integration and Flow Office; Nur Ashida Binte Rahim, Senior Patient Service Associate, Specialist Outpatient Clinics; Dr Alvin Tan, Consultant, Orthopaedic Surgery; Huo Huijiao, Senior Staff Nurse, Case Management; and Ng Su Yee, Senior Physiotherapist, Rehabilitation Services

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PUTTING PATIENTS IN THE CENTRE OF CARE PART 2 OF 3

TOTAL KNEE REPLACEMENT SURGERY

Total Knee Replacement (TKR) surgery — also called knee arthroplasty — is a surgical procedure to ‘resurface’ a knee that has been damaged. Metal and plastic parts are used to cap the ends of the bones that form the knee joint and the kneecap. Replacing the damaged knee helps to relieve pain, restore function, and impart a better quality of life. Most people can resume daily activities about

within the first and second day post-TKR increased from 1% and 29% in 2018 to 12% and 51% in 2021, respectively. Dr Tan and his team are optimistic that more improvements will surface as the

four to six weeks after surgery. To gain the full benefit of the operation, rehabilitation is very important. As part of Yishun Health’s TKR service, patients and caregivers will be guided on wound care, diet and exercise to improve recovery. Most knee replacements can last more than 15 years, and many patients go on to pursue an active lifestyle.

service grows. “Importantly, patient satisfaction has gone up,” Dr Tan reveals. The team has also gained a sense of fulfilment from this deeper collaboration. Su Yee reflects, “I like to say that no one person

is smarter than all of us combined. It is satisfying to see how, when all of us come together, we can make a huge change to improve our care and impact the lives of our patients.”

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WOUNDS, FALLS &

FRACTURES Yishun Health experts answer your frequently asked questions about health, well-being and medical conditions. I recently had surgery to remove a small, non-cancerous growth on my arm. What can I do to take care of the wound? Wound care after surgery is important to prevent infection. Good care will also help the incision heal well so that it does not scar excessively. If you have had your wound closed using stitches, medical glue or Steri-Strips, you must keep your wound dressing clean and dry. Continue to use the dressing prescribed upon discharge to prevent infection. Do not use waterproof dressing unless advised by your doctor. Before showering, use other waterproof materials — such as a plastic bag or film — to prevent the wound from getting wet. If it does get dirty or wet, proceed to the nearest polyclinic or GP to get your dressing changed. After your dressing is removed, gently massage the area with an unscented, pH-balanced skin moisturiser three times a day to encourage good wound-healing. As our body needs nutrients such as protein, zinc and vitamin C to help wounds caused by surgery or injury to heal faster, do maintain a balanced diet. Always follow your medical team’s advice on how long to keep the wound dressing on for. Importantly, look out for any pain, swelling, and yellow or green discharge on the wound site — these are signs of infection and require medical attention.

In consultation with Kathy Lam, Senior Nurse Educator, and Wound, Ostomy and Continence Nurse, YCH, and the YCH Wound Specialty Team

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My 70-year-old mother is recovering from a hip fracture. As her primary caregiver, what can I do to help on her road to recovery? Surgery is only one aspect of recovery from a hip fracture; another is helping your mother regain her strength, function and confidence. A hip fracture can be traumatic, especially for older adults, as it may cause them to reduce or completely stop being active and mobile because they are afraid of falling and injuring themselves again. It is important that you provide reassurance, motivation and encouragement so that you can help your mother gradually regain her confidence and function. As you care for your mother, keep a look out for signs or symptoms that could indicate that her condition is getting worse, and seek medical help when necessary. Such signs include increasing pain, sudden instability of the hip, and a noticeable difference in leg length or misalignment. While she is recovering, ensure that she follows the precautions prescribed by her medical team, such as making sure that she does not: • Bend her hips beyond 90 degrees • Bend her body forward to reach for objects or tie shoelaces • Lie on the affected side • Cross her legs when lying or sitting While your mother will have to limit some movement, it is important that she does the prescribed exercises recommended by her physiotherapist. These exercises are tailored for her specific needs and aimed at helping her regain mobility, so ensure she follows these movements and avoids other generic exercises.

As your mother recovers, it is normal for her to experience some difficulty in getting around and with movements such as walking, sitting or standing. Where needed, provide her with physical support and help her move around. Do encourage her to be as mobile as much as possible as this will help in her recovery.

In consultation with Lim Nasrul Hakim, Physiotherapist, Rehabilitation Services, YCH

How do I fall-proof my elderly parents’ new flat so as to prevent them from having a fall at home? A majority of falls among older adults happens at home. Fall-proofing the home starts with identifying danger areas, which tend to be poorly lit, cluttered, or have a slippery surface. To prevent tripping, remove hazards, such as loose rugs, electric cables, and wires. Make sure these are attached firmly to the ground or along the walls with tape. Where necessary, install grab bars and other assistive aids in the bathroom and shower. You can consult an occupational therapist to identify which of these are most suitable for your parents’ needs. Good lighting is helpful in preventing falls at night and in dim corners of the house. Ensure switches are within easy reach, and consider motion-sensor lighting to make moving around at night safer. It is also useful to organise the house such that commonly used items are within easy reach, so that your parents do not need to use step stools or have to bend excessively to retrieve items.

In consultation with Teoh Ai Lin, Occupational Therapist, Rehabilitation Services, KTPH

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potlight

FOCUSING ON FOOT HEALTH

Our feet contribute greatly to our well-being, especially when it comes to mobility and function. For people living with diabetes, foot health is critical to prevent complications. Podiatry is an allied health specialty that focuses on maintaining foot health, thus ensuring that our feet keep us moving and living well.

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dmit it: we hardly give our feet much thought, even though they support us — quite literally — in all that we do! It is only when our feet hurt that we begin to recognise just how important it is to keep them in good shape. For the allied healthcare specialty of podiatry, feet are the focus. As Chelsea Law, Senior Principal Podiatrist, explains, podiatrists are specialists in the management of foot and ankle conditions. The work involves assessing, diagnosing and treating foot and ankle problems, such as: • Managing skin and pathological nail conditions of the feet • Assessing the foot’s biomechanical function and abnormalities • Prescribing functional orthoses that support the feet to improve function • Managing and treating diabetic foot ulcers Podiatrists play an especially important role in the management of diabetes. This is because poor blood sugar control can affect blood supply to the feet. Diabetes can also cause nerve damage that impairs sensation. This means that small sores and cuts can be overlooked and thus progress into more serious conditions — such as ulcers and non-healing wounds — that can become infected; in severe cases, they may lead to gangrene and require amputation.

A TEAM APPROACH TO ADVANCING FOOT CARE At Yishun Health, a podiatrist team is on guard to prevent such complications from happening.

Working as an integral part of a long-standing multidisciplinary diabetes management approach, the team of podiatrists, podiatry assistants, and diabetic foot care coordinator maintains regular follow-ups with patients to deliver foot assessments and treatments, as well as educate patients and family members on self-care and foot care practices. Over and above this, the team is always exploring ways of delivering new treatments. Over the last decade, Chelsea points out that advancements in podiatry have improved the management of foot wounds. This includes negative pressure wound therapy, maggot debridement therapy, total contact casts, and more (see box story). Importantly, as patient numbers grow due to an ageing population and increasing burden of chronic illness, the podiatry team has innovated to improve its care approach. For instance, it has started joint-consult clinics to better manage more complex and challenging cases, especially for patients who may need expertise from multiple disciplines due to the complexity of their health status. These joint-consult clinics help to consolidate care so that patients attend fewer medical appointments in this one-stop concept. This team-based approach also means that the patient, clinician, podiatrist and other allied health professionals get together

Alexandra Foo, Podiatrist, explaining the mechanics of the foot using a model

to discuss the best way to achieve shared care goals. Apart from outpatient services, the podiatry team has also started an initiative with the Acute and Emergency Care team to offer treatment in the Extended Diagnostic Treatment Unit (EDTU). Patients seeking help for a foot wound are treated here so that there is no need for hospital admission. “We stabilise and manage the presenting problem and subsequently organise a follow-up visit to the appropriate discipline after assessment,” Chelsea explains. Apart from managing diabetes, podiatrists also play a role in geriatric and palliative care, as well as sports medicine.

BUILDING RAPPORT, STEP BY STEP Senior Podiatrist Nadiah Raman highlights that the job is not all about feet — it is also about connection, empathy and personhood. It is this sense of

potlight

fulfilment from interacting with patients that led her to join the profession in the first place. “In our job, we spend quite a bit of time with patients, and we use that time to get to know them better and find out how they are coping emotionally and functionally,” she shares. This insight is important, as it helps the team to identify specific areas where patients need support. “We look after more than just medical issues,” Nadiah emphasises. “Where needed, we escalate cases to medical social workers or recommend referrals to other doctors.” This proactive, person-centred approach is also something that has come to greatly characterise how podiatry has evolved. “Rather than being reactive and purely focused on treatment, the specialty has shifted from firefighting to a preventive stance. Education, awareness, and stronger patient empowerment are important components of care,” adds Wong Wan Mun, Senior Podiatrist. For instance, the team takes time to educate patients and caregivers on self-care and management, especially on how to do basic foot checks and nail care, which are critical in preventing issues from arising. The team has also trained community partners, such as nursing home staff, on how to manage toenails for geriatric clients. “This helps to better allocate care so that podiatrists can focus on more challenging and complex cases that need more attention and technical handling blood, pus and dead skin. clinical expertise,” she adds. “You need a really strong stomach PUTTING OUR BEST and a diminished sense of smell to stay in this job!” Chelsea jokes. Jests FOOT FORWARD Podiatry is often challenging and can aside, nothing beats the sense of be viewed as ‘dirty’. Many diabetic gratification that comes from saving a foot wounds take a long time to foot from gangrene and amputation, heal and require frequent cleaning or successfully treating a non-healing and care. There is also the matter of ulcer. “The satisfaction is incredible,”

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Nadiah reveals. “We don’t really think about them, but our feet are the keys to freedom.” And as our population ages and the chronic disease burden grows, the team hopes that its work continues to support people’s goals for quality of life, active ageing, and living well

With the advancement of technology, 3D foot scans help podiatrists like Wong Wan Mun care for patients in a more efficient and productive way!

HEALING ADVANCEMENTS

Treatment modes have come a long way to improve the outcomes for hard-to-heal wounds common in people living with diabetes. Here are three treatments that podiatrists may use to address such issues. Negative pressure therapy is an advanced wound therapy that encourages healthy tissue growth and enhances wound closure. This treatment allows for better wound fluid management and provides a better environment for wound healing.

with illness. “We will continue to strive towards empowering people to take better care of their foot health and avoid complications,” assures Wan Mun. This underscores the team’s ultimate goal: walking with patients on their personal journey towards a life of dignity, health and wellness.

Maggot debridement therapy is an advanced wound therapy used in the inpatient setting. It utilises the secretion of laboratory-sterilised maggots to help remove unhealthy or dead tissue. The secretion from the maggots has a special antimicrobial property, which helps prevent infection locally. This enables healthy tissue in the wound to have a better chance of growing, which in turn aids wound healing. Total contact cast is a custom-made, well-moulded, below-the-knee cast that helps to remove pressure at the bottom of the foot. It is used for patients with insensate diabetic foot with ulcerations, and acute diabetes Charcot arthropathy (similar to multiple fragmentations and fractures of bones in the foot and ankle). It is reapplied weekly till wound healing is achieved.

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Things About...

burn injuries Things About...

Burns are kitchen and household injuries that require immediate first aid. Dr Jerry Goo, Head and Senior Consultant, General Surgery, and Dr Jolie Hwee, Associate Consultant, General Surgery, talk about some of the most common types — and what to do about them. 22 |

THERMAL BURNS

Thermal burns refer to injury from a fire, hot surface, steam or hot liquids. If you are burnt or scalded, remove any coverings to expose the burnt area. Cool with clean running tap water (but not cold water or ice) for 20 minutes to reduce tissue damage and scarring.

Small burn wounds can be cleaned and covered with sterile, non-adhesive dressings, but you should seek medical attention for: • Burns that are deep or larger than the size of your hand • Burns of any size that cause white or charred skin • Burns on the face, hands, feet or genitals that cause blisters • Signs of infection

DIABETES-RELATED BURNS

Importantly, if you have diabetes and neuropathy (nerve damage), be careful when using hot water to soak your feet or when using heat packs, as burns can happen without you realising. Seek early medical attention if a burn occurs and the wound is not getting better.

INHALATION BURNS

In the event of a fire, there is a risk of inhalational harm if you breathe in hot smoke, which contains carbon monoxide. During a fire, move away from the heat source and to a wellventilated area far from smoke and fire. Call 995 and seek medical attention if there is shortness of breath. Other symptoms of inhalational injury include coughing, a hoarse voice, singed nose hair, and soot in the saliva or phlegm.

CHEMICAL BURNS

While household bleach is at a lower concentration than industrial or factory bleach, it can still cause irritation and potential chemical burns. In case of a spill, uncover the affected area, wipe it off and flush the skin with clean running water. If any bleach gets in the eyes, or if the burn wound is large and severe, seek medical attention.

PREVENTION Burn injuries can be prevented by following a few safety tips: Do not leave lit cigarette butts or candles lying around the house Do not leave cooking fires and open flames unattended Do not use appliances with damaged electrical cords Engage a licensed electrician to install new appliances and fix faulty wiring and broken insulation If you have a personal mobility device or electric bicycle, ensure that it has the UL2272 fire safety certification; never leave it charging overnight or unattended, and check the battery regularly for damage or deformity

ELECTRICAL BURNS

For electrical burns, call 995 immediately. It is very important to ensure the environment is safe and the electricity has been turned off before helping. If you are unsure, do not touch the affected person. In cases of severe electrical shock, be mindful that there may be serious neck injury, and the person should not be moved without first protecting the neck. If you are able to move the injured person safely from the scene, remove any affected clothing and flush the wounds under clean running water while waiting for help.

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aily Dose

seeing a clearer picture

Radiation is an important diagnostic tool that helps doctors and medical teams make more timely and accurate diagnoses, as well as inform optimal treatment plans. Here are several types of scans that use radiation to produce images of diagnostic quality, as explained by Yishun Health’s radiographers. In consultation with Jasmine Lee, Senior Radiographer, Diagnostic Radiology, and Mervyn Liang, Physicist, Diagnostic Radiology

CHEST X-RAYS A chest X-ray produces images of the heart, lungs, airways, blood vessels, and the bones of the spine and chest. Used to: Diagnose shortness of breath, persistent cough, fever, chest pain or injury. It is also used to help diagnose and monitor treatment for a variety of lung conditions, such as pneumonia, emphysema and cancer. Procedure time: About five minutes. How to prepare: There is no special preparation necessary. You may eat, drink and continue with any medications as usual.

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BONE MINERAL DENSITY (BMD) / DEXA SCANS Bone Mineral Density (BMD) / DEXA scans are a special form of X-ray technology that determines bone strength and measures bone loss. It is usually used to scan the lower back, hip and wrist bones. Used to: Diagnose osteoporosis, a disease where there is loss of bone tissue, thus causing bones to be brittle and more prone to fracture. Procedure time: 15–20 minutes How to prepare: There is no special preparation necessary. You may eat, drink and continue with any medications as usual.

CT ABDOMEN AND PELVIS SCAN A CT scan is a non-invasive, painless examination that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Used to: Detect and diagnose diseases of the small bowel, colon, bladder, uterus or prostate, and liver. X-ray dye may also be injected intravenously to enhance blood vessels and better outline abnormal tissue and organs. Procedure time: About 30 minutes How to prepare: Before the procedure, you must fast for three hours, but you may take prescribed medications with small sips of water.

GASTROSTOMY

FLUOROSCOPY (BARIUM SWALLOW) Barium studies are specialised X-ray procedures that use barium (a white mixture) to provide contrast so that the gastrointestinal system can be viewed. Used to: Examine the oesophagus (food pipe) and, to a smaller extent, the stomach. During the procedure, you will be asked to stand and drink the barium mixture. Several pictures will be taken during swallowing. Procedure time: About 30 minutes How to prepare: Before the procedure, you can continue to take prescribed medications, but must abstain from solid food and smoking for six hours prior to the scan.

Gastrostomy is the insertion of a tube through the abdomen wall and into the stomach. This minimally invasive procedure is done under local anaesthetic by an interventional radiologist who is guided by X-ray. Used to: Provide temporary or permanent feeding directly through a tube in the stomach. This is mainly for patients who have difficulty swallowing food or drink due to illness such as stroke or cancer. Procedure time: 30–45 minutes How to prepare: Do not take any anti-blood clotting medications. You will need to fast for six hours prior to the procedure.

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akan Time

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SEABASS WITH MANGO SALSA & MESCLUN Low in sodium but full of fresh flavours, this elegant yet easy-to-make dish can be prepared in under 30 minutes! Recipe provided by Nge Aik Tee, Executive Chef, Food Services, in consultation with Nutrition & Dietetics, KTPH

INGREDIENTS

cut & keep

Serves 4 • • • • • • • •

360g mango, diced 200g capsicum, diced 150g cucumber, diced 60ml cider vinegar 60g honey 6g lower-in-sodium salt 480g seabass (4 fillets) 90g mesclun

METHOD: 1. To make the salsa, combine the mango, capsicum, cucumber with cider vinegar and honey. Mix well to combine and set aside 2. Season the seabass fillets with salt 3. Pan-sear the seabass till it is cooked through 4. To serve, plate the seabass with

NUTRITIONAL INFORMATION (PER SERVING) Energy

229kcal

Carbohydrates

27g

Protein

25g

Fat

1.5g

• Saturated

0.5g

• Polyunsaturated

0.2g

• Monounsaturated

0.3g

Cholesterol

10mg

Dietary Fibre

2.9g

Sodium

459mg

Potassium

554mg

Phosphate

>39mg

the mango salsa and mesclun

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it & Fab

EXERCISE,

THE FORGOTTEN MEDICINE We all know that a healthy lifestyle must include regular exercise and activity. More than its inherent physical benefits, exercise is akin to a ‘vaccine’ for good health, mental wellness, and longevity! By Dr Pay Leon Han, Medical Officer, and Dr Ong Joo Haw, Clinical Director and Senior Consultant, Sports and Exercise Medicine Centre, KTPH

xercise has been known to promote health, even as far back as 1953, when Scottish epidemiologist Professor Jerry Morris published a paper in The Lancet showing that active stair-climbing conductors had a much lower risk of heart disease and around half the mortality rate than sedentary drivers. All these findings led Dr Robert Butler, a former director of the National Institute on Aging, to famously state, “If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.”

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Unfortunately, exercise is not conveniently available in pill form, so there remains the challenge of trying to develop strategies that will convince the public to engage in greater levels of physical activity.

THE LONGEVITY FACTOR Physical inactivity is a growing problem that requires urgent intervention. In 2009, WHO declared that physical inactivity is the fourth-highest independent risk factor for death, behind hypertension, tobacco and diabetes, and has

been shown to cause heart disease, diabetes, as well as breast and colorectal cancers. A 2012 study published in The Lancet revealed that, if inactivity were decreased by 10% or 25%, 533,000 and 1.3 million deaths respectively could be averted every year. Exercise is also proven to especially delay death due to cardiovascular disease, as it impairs the key disease processes, such as: • Atherosclerotic process: the build-up of fats, cholesterol and other substances in and on your artery walls • Thrombotic process: the formation of a blood clot (a thrombus) within a blood vessel • Ischaemic process: the restriction of blood supply to any tissue, muscle group or organ in the body, resulting in tissue death In fact, if you have already suffered a heart attack, embarking on an exercise programme can reduce your mortality risk by 8–35%, which is about the same level of benefit as medications.

FITNESS BENEFITS Surprisingly, exercise is not all about losing weight! It is also important for our overall wellness. In fact, physical activity and obesity are two distinct factors in the argument for exercise. It may be better to be fat and fit rather than skinny and unfit, as low levels of fitness may be a greater risk factor for mortality than mild-moderate obesity. Apart from physiological benefits, exercise also has psychological benefits, such as increased assertiveness, confidence, memory, self-control, and well-being; it also decreases anger, depression, headaches, work errors, as well as delays the onset of dementia. The barrier to physical activity may seem daunting, but small steps — literally — can be taken to overcome this. Any level of physical activity is better than none, and it has been proposed that the simple act of walking can lead to improvements in diabetes control, body composition, lipid profiles, and cardiorespiratory fitness. National guidelines suggest that we should aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week. These should be performed in episodes of at least 10 minutes, and should ideally be spread throughout the week. Additionally, muscle strengthening activities targeting all eight major muscle groups (shoulders, arms, chest, abdominals, back, buttocks, thighs,

Apart from physiological benefits, exercise also has psychological benefits by increasing assertiveness, confidence, memory, selfcontrol, and well-being; it also decreases anger, depression, headaches, work errors, as well as delays the future onset of dementia.

calves) should also be performed as part of a balanced exercise programme. This does not necessarily involve going to the gym — alternatives include using bodyweight exercises or simple pieces of equipment such as resistance bands. Although the risk of such acute cardiovascular events are momentarily increased during vigorousintensity exercise compared to rest, exercise is generally safe for most people. If you do not experience warning signs and symptoms, such risks are extremely low. In fact, these risks associated with exercise lessen as individuals become more physically active and fit. In summary, exercise is a form of medicine, a vaccine that can prevent multiple chronic and mental diseases, as well as improve and extend our quality of life. The choice is up to us — better late than never!

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Nurses’ Day Special

urses’ Day 2022

ABOUT THIS YEAR’S THEME T

hroughout the COVID-19 pandemic, our nurses have been steadfast in their duty of care. Despite the unprecedented challenges and uncertainties that have come their way, they have strived hard to protect our communities, be the voice of patients, and deliver quality care that prioritises the holistic well-being of our patients. They deserve immeasurable gratitude for their commitment, compassion and dedication to their craft. As we celebrate Nurses’ Day on the 1st of August, we take the opportunity to thank our nurses — both past and present — for their important contributions to Yishun Health and public healthcare. It is fitting that the theme for this year’s Nurses’ Day is ‘Shine Like a Diamond’. Our nurses are indeed like diamonds, a brilliant and luminous symbol of purity, perfection and strength, as well as a representation of commitment and faithfulness. Just like diamonds, which are forged under extreme conditions, our nurses have emerged stronger from the tough conditions of the recent healthcare crisis. To our precious Yishun Health nurses, let’s take time this Nurses’ Day to recognise and celebrate your contributions to the nursing profession! Continue to shine bright like a diamond! Happy Nurses’ Day!

DR TIMOTHY TEO CHAIRMAN NURSES’ DAY 2022 ORGANISING COMMITTEE

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OUR Shining examples

his Nurses’ Day, we shine a light on the strength of our nurses, and how — like diamonds — you have been forged through great pressure and deft honing to become the brilliant gems of the healthcare frontline. Our theme for 2022, ‘Shine Like a Diamond’, encapsulates the fortitude you have shown. As you may know, diamonds are formed from carbon deposits deep within the earth’s mantle. Under temperature and pressure so intense, the carbon atoms bond together to form a crystal. These crystals, hidden in the depths of the earth, are brought to the surface through violent volcanic eruptions. This transformation — from soft black rock to one of the world’s hardest, naturally occurring materials — is an apt metaphor for how our nurses have been strengthened through adversity. This strength has been shown in so many ways, and we recognise and thank you for the hard work and many sacrifices you have made over the past two-and-a-half years. And even as we start to see light at the end of the tunnel, and begin to cautiously envision life in a postpandemic world, we hope that we carry forth the many lessons and new mindsets that we have gained from the COVID-19 experience. As Winston Churchill once said, “Never let a crisis go to waste.” In the same way, let us make meaningful advancements from our recent challenges. While it is only natural to sink back into the comfort of old ways, we should push ourselves to embrace some discomfort. Let us lean into how we can grow and improve even more with the new-found strengths that have surfaced during the recent crisis. These have ranged from breaking our old mental models of silos, taking

MS LOW BENG HOI Director, Nursing, Community Transformation Office, Yishun Health

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on wider responsibilities, expanding our professional scope of practice, and deepening our collaborations with our healthcare peers. Take how YCH nurses converted six out of seven wards to support the nation’s battle against the COVID-19 pandemic at its onset. Two of these wards were converted from sub-acute and rehabilitative care to take on higher-acuity patients with COVID-19 in a matter of two weeks. Our nurses showed adaptability, speed under pressure, and great resilience to care for patients — geared in full PPE, no less!

MS SHIRLEY HENG Chief Nurse, Yishun Health

urses’ Day 2022

“

The more we build on our innate strengths and learn new skills, the more we will shine. And we will do so together, reflecting the many colours and cuts of the precious gemstone. From our backgrounds and skills to our specialisations and experiences, we come together to illuminate the dark times, offer hope, and represent integrity and grit.

Many of you stepped up in other ways. We now see nurses taking on a broader set of professional skills — from Enrolled Nurses learning medication management, administration and taking charge of patients independently, to A&E triage nurses who order medicatons and investigations based on protocols, to SOC nurses managing A&E P3 patients. During the pandemic, ward nurses also accepted the challenge to undergo ICU training so that they could bolster manpower in the intensive care units to support their peers and deliver care where it was needed.. Our community nurses, too, worked hard on the ground to ensure that residents and patients who were at home continued to receive the care they required. When COVID-19 cases soared and strict lockdown measures were implemented, most follow-up cases were changed to tele-consult via phone or video call. And as the Wellness Kampung and Senior Activity Centres slowly opened their doors again, tele-consult satellites were set up for residents to seek medical support and assistance from the community nurses. For diagnosed or suspected COVID-19 cases who needed a face-to-face home visit, nurses would also don full PPE outside the resident’s homes before entering. These initiatives ensured that no one fell through the cracks. We also appreciate the initiative all of you took to become role models and mentors to those who were new to healthcare — students, graduating nurses, locum nurses, and healthcare assistants, as well as our Patient Care Officers. These are the shining examples of your diamond-like brilliance. And as we move into the future, we must continue to grow these traits. Just like how a diamond is cut to create facets to bring out their sparkle, we as nurses must continue to hone and expand our capabilities. The more we build on our innate strengths and learn new skills, the more we will shine. And we will do so together, reflecting the many colours and cuts of the precious gemstone. From our backgrounds and skills to our specialisations and experiences, we come together to illuminate the dark times, offer hope, and represent integrity and grit. Thank you all for your hard work and continued strength. We wish you a very happy Nurses’ Day!

“

MDM CHUA GEK CHOO Director, Nursing, Yishun Community Hospital, Yishun Health

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Forging ahead with

commitment & compassion

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urses’ Day 2022

his Nurses’ Day, we take the opportunity to recognise the brilliance and bravery of our nurses, whose efforts have truly shone a light in the darkness of recent times. As we navigate with cautious optimism towards brighter days ahead, we advance — emboldened and inspired — with the knowledge that, together, we have done well and will continue to do so.

The recent challenges of the pandemic have tested our sense of vocation and strengthened our professional calling. It has been heartening to see how our nurses have stepped up to the plate so as to ensure that our patients and communities continue to receive safe, quality care. Going forward, we will continue to strive and reach greater heights, spurred by the simple but meaningful knowledge that we can — and have — made a difference.

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PURSUING PASSION & EXCELLENCE TO CARE FOR OTHERS For Senior Staff Nurse Nanthiniy V, nursing has been an ongoing pursuit of improvement. From hands-on skills to academic qualifications and on-the-ground experience, she embraces all paths that expand her knowledge so she can pursue her passion of helping people. 36 |

anthiniy was a little girl when her younger sister was born, and she still recalls visiting her in the hospital. Born with special needs, her sister required intensive care. “My sister was on the ventilator for three months in the neonatal intensive care unit,” Nanthiniy recounts. “I remember watching the nurses teach my mother to insert the feeding tube and comfort my sister when she cried.” Nanthiniy did not realise then that she would one day be bringing comfort to patients and caring for them in their time of need. It was only during a two-year gap after she had finished her A-levels that she began to seriously consider nursing as a career. Working as a camp facilitator and first aider, she realised just how much she enjoyed helping people. Students found her comforting and reliable, and would seek her out when they needed support. “That was when I realised that I gained satisfaction from caring for people, and knew then that I wanted to join the medical profession,” she says.

LEARNING AND GROWING Nanthiniy decided to follow her calling, and applied for the nursing programme at Nanyang Polytechnic in 2014. Juggling studies and part-time work, the determined Nanthiniy applied for and received a Healthcare Merit Award offered by MOH Holdings (the holding company of Singapore’s public healthcare institutions). This eased the financial burden she had to bear. Nanthiniy did well enough to earn an internship at the Hospital of the University of Pennsylvania, and completed a module at the Ivy League university. It was quite an experience for her as a student nurse. “I got the chance to visit many wards, which we don’t get to do in Singapore,” she shares. “I was attached to the heart transplant unit, where I interacted with patients and

veryday Heroes learnt about how they viewed life and their second chance at it. The experience built my confidence in caring for different kinds of patients with varying needs.” She also went on medical missions to Cambodia, where she started a project to enhance the diagnostic skills of nurses stationed in rural areas. This ensured better assessments of their patients’ conditions before they sent them to bigger hospitals for treatment. Nanthiniy went beyond her diploma in nursing studies to obtain a degree jointly offered by the Singapore Institute of Technology and the University of Glasgow. As part of the course, she spent four weeks overseas, where she was posted to clinics and major hospitals. This experience, and her drive to help, led her to develop a prototype that contains secretions from the tracheostomy in the neck in order to control infections. This innovation won the Singapore Healthcare Management 2019 Poster Competition Merit Award under the Risk Management category.

ASPIRING TO BE BETTER EACH DAY Today, Nanthiniy is a Senior Staff Nurse at KTPH specialising in airway and pain management during and just after surgery. She continues to contribute to her unit, team and the profession beyond her core functions. During the pandemic, she volunteered to be trained to care for ICU patients. This new skill set boosted her confidence for her own work in the operating theatre. Her love for helping people, especially students, continues unabated. To better guide and mentor student nurses, she proactively developed a structured programme for them during their routine one-week attachment to the anaesthesia unit.

Always striving to better herself, Nanthiniy is currently enrolled in the Advanced Diploma in Perianaesthesia Nursing. This course will equip her with more clinical skills, allowing her to carry out specific medical procedures related to her field of work; it is also a boost to her aspiration to be an Advanced Practice Nurse. Nanthiniy’s nursing leaders commend her commitment to her duties and passion for professional improvement. “Through her nursing journey, Nanthiniy has demonstrated dedication, perseverance and resilience,” observes Ms Alice Leong, Deputy Director, Nursing, PeriOps. Ms Loo Gaik Lee, Assistant Director, Nursing (Education), Nursing Administration, agrees, noting that, more than a story of resilience, Nanthiniy’s is a tale of finding oneself and one’s calling. “Her passion for helping people led her right into her purpose.” For Nanthiniy, her journey has not just been something for her own personal and professional growth, but one where she hopes to inspire new generations of nurses. “I hope to become an all-rounded practitioner who can not only do well clinically, but also teach juniors to be equally passionate about caring for people.”

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Embracing beauty, variety and living life to the max 38 |

ive Well

A familiar face around Yishun Health, Jamilah Binte Hussin is known for her deep knowledge of the organisation and ability to get things done, as well as her always-onpoint outfits and stylish appearance. The single mother has risen above personal tragedy to become a positive force for good in the lives of her family and her colleagues.

ften, if something needs to be organised for the nursing department, one name always comes up: Jamilah. And given her decade of experience at Yishun Health, it is no wonder. But it is more than longevity that makes Jamilah the go-to person for matters big and small; her attitude and vibrancy have made her a reliable resource and friend to her colleagues. “I have been through so many of the changes at the hospital!” Jamilah declares, recalling her early days at Alexandra Health working under former CEO Mr Liak Teng Lit and former Chief Nurse Ms Low Beng Hoi. Journeying with the hospital through its many milestones over the years has been challenging and interesting, to say the least, and Jamilah has loved every minute of it. Though her formal designation is Executive Secretary, Nursing Admin, Jamilah has taken on a lot more than just her job description. “Saying ‘yes’ to every given task is not just about pleasing people; it gives me the opportunity to learn, experience new things, and get to work with many people,” she says. “Being helpful to others brings purpose to my life.” This can-do mindset has been key to keeping things interesting, and is part of the reason why she loves her work. From coordinating schedules to keeping track of projects, from giving a hand in event planning and execution to doubling up as the makeup artist for major hospital festivities, Jamilah has done it all. “I am the type who cannot keep still!” she admits. This positivity and forward momentum were traits that have also helped her overcome personal

adversities. In 1995, her husband was diagnosed with cancer and he passed away in 1999. Widowed at just 36, Jamilah has had to keep strong and resilient for her two sons, who were only nine and 12 years old then. “I am blessed that I had a few years to prepare to say goodbye,” she shares. Though this did not lessen the grief, she feels lucky to have had time to process the sad eventuality. While the loss was devastating, she focused on staying the course for her children. “I wanted to show my children that I was strong and will keep going on for them.” In fact, she still sees a lot of joy and beauty in life, and wholeheartedly embraces all things that make life worth living. “I am lucky my children are independent, and I’ve had so much support from my colleagues.” Today, she is proud that her sons — now in their 30s — have made their own way in the world, and are in the midst of settling down and starting families of their own.

“Saying ‘yes’ to every given task is not just about pleasing people; it gives me the opportunity to learn, experience new things, and get to work with many people.”

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ive Well

“I believe in selfcare; it keeps me happy and youthful!”

As her children leave the nest, Jamilah is embracing her next chapter. “It’s something I knew I always had to accept,” she says. “I know they are mature and capable adults.” Highly engaged in her community, family life and organisation, Jamilah is just as busy outside of work. The active 60-year-old’s zest for life truly belies her age. She keeps fit by taking part in all manner of activities, such as Zumba, yoga and hitting the gym. During the pandemic, she even volunteered to help out with swabbing, mask fitting, and vaccination exercises. When she switches off, she indulges in salon treatments and self-care regimens. “I believe in self-care; it keeps me happy and youthful!” she says with a chuckle. Her zest for life is boosted through travel, and she looks forward to her upcoming planned trip to New Zealand. These holidays with her children are precious to her, as they are a chance to spend quality time with her sons, slow down, and step out of her routine. “Life is beautiful if you just stop and count your blessings.”

Proud mum Jamilah all glammed up with her two sons and their spouses

Jamilah posing with the Yishun Health Nursing Administrators at one of the annual Nurses’ Day celebrations

A throwback to one of the Nurses’ Day walks during Jamilah’s Alexandra Health days

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urses’ Day 2022

Merit Award Winners

The MOH Nurses’ Merit Award recognises nurses who have performed exceptionally in their duties and made their profession proud. Congratulations to the seven winners from Yishun Health! Read what what drives them to constantly have a caring spirit.

AISYAH BINTE NASIR

ASSISTANT NURSE CLINICIAN, WARD B86, KTPH

I’ve been in nursing for the past decade, and I feel fortunate to have cared for all types of surgical patients. They inspire me and from them I have learnt so much about strength, resilience, fear, anger and love. It’s a privilege to be allowed into their lives. It’s this that drives me to provide them with the best possible nursing care.

TAN SOK KENG

NURSE CLINICIAN, ACUTE & EMERGENCY CARE, KTPH

My 26-year journey as a nurse has had its share of challenges. In the A&E, I’ve witnessed births, deaths, healings and heartaches; it’s where I learnt what it means to be truly vulnerable. In these moments, I’m privileged to have teammates who are truly dedicated to caring for our patients and supporting one another.

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LOW SING EE

NURSE MANAGER, COMMUNITY NURSING, KTPH

I never expected, despite 11 years of nursing, to find myself facing caregiver stress when my grandmother suffered a stroke. This experience deepened my empathy for the patients and caregivers I care for as a community nurse. I can only imagine the weight of caregiving as a layperson that was already heavy for me as a nurse! This understanding drives me to look out for issues and do my best to alleviate them for my patients and their caregivers.

MERIANI CHEN

NURSE CLINICIAN, WARD B85, KTPH

Though I’ve been in nursing for 16 years, it’s a calling that still fills me with fulfilment and joy. I still derive great satisfaction to see our patients recover and get discharged. Today, I’m continuously expanding and enhancing my knowledge and clinical skills. This passion for caring enables me to make a positive impact in the lives of our patients and their loved ones.

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urses’ Day 2022

YVONNE TAN SIOW LIN

SENIOR NURSE MANAGER, NURSING ADMINISTRATION, YCH

Nursing is not just a job, but an opportunity to help people through difficult times. Of all my treasured interactions with patients — of which there are many — my favourite one was with an elderly patient who held my hands and cried thankfully when I helped to feed her dog while she was warded. Such moments — knowing that I have the ability to make a difference in someone’s life — motivate me to do my best.

GOH SOON PANG

NURSE CLINICIAN, APN & SPECIALTY NURSES, KTPH

Though pursuing nursing as a career is never an easy journey, I’ve never once regretted my decision. Though you may sometimes feel you have reached a plateau, don’t be discouraged! Take a step back, count your blessings, and you’ll realise that the grass you are stepping on is as green as that on the other side.

SREEVIDYA D/O JAYACOPALAN

PRINCIPAL ENROLLED NURSE, WARD D87, KTPH

As a nurse in the Geriatric ward, I gain satisfaction from looking after my patients with dementia, despite its unique set of challenges. It’s rewarding to play a role, however big or small, in supporting patients in their recovery. Beyond a job, nursing is a passion that stems from your soul and mind. This experience becomes even more meaningful when I see patients recovering well under my care.

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Nurses’ Profiles

Our nurses shine bright in their workplace and beyond — read on to find out more!

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urses’ Day 2022

Caring for the community in more ways than nursing Low Min Hui STAFF NURSE, C54 GENERAL SURGERY CLINIC, SPECIALIST OUTPATIENT CLINICS, KHOO TECK PUAT HOSPITAL There’s so much to love about nursing despite its challenges; it remains a calling that I am glad to have followed. I joined the profession in 2015, driven by the need to help people. It’s especially rewarding for me to serve my patients, as it gives me a great sense of accomplishment seeing them get well and going back to their homes and community. I think this love for people is something that also drives my passion for community service. I started volunteering in earnest some time in 2018 and, since then, I’ve been involved in a number of projects in my neighbourhood. For example,

celebrating Chinese New Year with community dinners and ang bao presentations, helping out during the Mid-Autumn festivities, and taking part in fun Christmas activities. With the demands of nursing, some people may wonder why I spend whatever little personal time I have to volunteer. For me, it’s how I recharge and do something different from my usual routine. I also find community service to be very meaningful, as it’s a great way to meet more people and develop stronger interpersonal skills in areas outside of my work competencies. I think having a life outside of work makes me a better nurse. It’s another avenue for me to grow strengths and passions that complement my job. These experiences also broaden my horizons and allow me to learn from different challenges. Because of these, I have a wider perspective, which trains me to think of alternatives to better solve problems that I face in my daily life.

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A love for people, a passion for service Zhou Ming Lan SENIOR STAFF NURSE, DAY SURGERY CENTRE, PERI-OPS, KHOO TECK PUAT HOSPITAL

Medicine has always been of great interest to me. Even though I had the chance to pursue university studies in China, the cost would have been quite a burden on my family; it also would’ve meant depriving my younger sister of a tertiary education. Instead, I came to Singapore to study nursing. Some 20 years on, I don’t regret my decision, as my career in nursing has been very fulfilling. I’ve also made Singapore my home. In fact, I’ve been very active in my neighbourhood and was a volunteer at Nee Soon East Resident’s Committee (RC) Zone 4, and eventually took on the role of Treasurer and was in charge of financial matters. I was also the lead of the Brisk Walking Club, which started with just a few people and has gradually grown to over 100 residents! It was fun to organise walks around the neighbourhood and to various scenic places around Singapore. Apart from brisk walking, I also hosted block parties and seasonal celebrations for residents. With my nursing background, I’m also able to advise the residents on a healthy lifestyle and keeping fit for wellness. I love being part of my RC; through the course of my service there, I gained better insight into my community. For example, I got to know a number of first-generation grandparents who migrated to Singapore to care for their grandchildren. Being in a new country and environment, some of them felt lonely and isolated. I’m so happy that the community activities have benefited them through the building of friendships and community harmony. Besides improving my management skills, such experiences have taught me to better listen to, learn from, and appreciate the people I meet. This is also applicable in my nursing work, when it comes to person-centred healthcare delivery. These are the traits that help me in my work, as they teach me to be flexible, adaptable and to always prioritise personhood for my patients. Even more so, these experiences have built my self-confidence, my passion in nursing, and my love for serving the community.

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urses’ Day 2022

Juggling expectations and the art of empathy Max Toh Shang Ming SENIOR STAFF NURSE, THINK CENTRE, KHOO TECK PUAT HOSPITAL In my 13 years as a nurse, I’ve had the chance to work in many areas, and have learnt to be a nurse who wears many hats. Apart from caring for patients in the wards, I’ve also taken on roles as a clinical instructor, mock resuscitation trainer, and more. I am grateful to have been given the chance to take on so many job scopes and responsibilities; it’s thanks to the support and guidance of all my colleagues that I can grow in my profession and juggle many duties over the years. Being a good ‘juggler’ is also important to me for other reasons. As both my wife and I are nurses at KTPH, we always find ourselves trying to find the right balance between family and work. We make the best of it and try to schedule our days off together, take time to eat together, and whenever possible, catch each other even when we have opposing shifts. During these times, we share the highlights and — truth be told — even the lowlights; but most of all, make the best of each other’s company. These days, my nursing journey has taken me to the ThINk (Telehealth Integrated Network) Centre, a new telehealth programme in Yishun Health that provides accessible, 24/7 care to Yishun Health’s patients and their caregivers. I started in October 2021, and my role comprises providing care coordination, case management, tele-triage, as well as chronic disease education and health coaching services. While all these responsibilities are varied and take place in different settings, they share similarities, such as the ability to empathise, understand the needs of people, and communicate well. These are skill sets that I think nurses should nurture and continually enhance as they grow into their careers. For one, they help us overcome the difficult times when we have to make unpopular decisions or encounter challenging scenarios with patients and their family members. These are times when we should remain calm, try our best to empathise, and think broadly to find a reasonable solution that prioritises patients’ safety. Even as we juggle work pressures, the demands of our duties, and the expectations of patients and their families, as a leader sometimes we have to make a choice between ‘doing things right’ and ‘doing the right thing’. Nursing is by no means easy, but it’s rewarding and can teach you to face challenges and overcome them with love and compassion.

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Always look for the light Escala Marie Eugenie Edang SENIOR STAFF NURSE, ICU WARD B26, KHOO TECK PUAT HOSPITAL I had always wanted to be a nurse, and pursuing this career is the realisation of a childhood dream. Over the last 13 years, it’s had its ups and downs, but I’ve always clung to the core values of nursing — extending care to my patients and their families, and to look out for them in their difficult times. The recent pandemic has been a long and dark road. The world stopped momentarily, and everything changed. One of the hardest challenges for me was not being able to visit my family in the Philippines like I usually do. It made me sad and worried for my loved ones. Thank goodness for technology that allowed me to talk to them regularly and ease some of my longing and homesickness. When things have been difficult, being able to connect with them strengthened my mental health and spiritual core. Digital technology also helped me to pre-book slots for church and regularly attend masses online, so I could say prayers of guidance and courage to face the battles of physical and emotional hardship from the long work hours and missing family. It helped me to keep the faith that there will always be light at the end of the tunnel. I believe that everything happens for a reason, and that reason will make us strong in life. Though things have been tough, I think these experiences have shaped me to develop optimism, faith and resilience. I’ve come to appreciate the beauty and importance of being a nurse and contributing value to people through my skills and my care. There is great satisfaction in helping people in their time of need, providing emotional support, and journeying with them in the hope that, just like me, they will also see light in the darkness.

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urses’ Day 2022

Stronger, together Kartina Binte Ismail PRINCIPAL ENROLLED NURSE, A&E CARE CENTRE, KHOO TECK PUAT HOSPITAL When the COVID-19 pandemic hit Singapore, I had flashbacks to 2002, when we battled SARS. The fear, anxiety and weight of responsibility felt all too burdensome at the start. We were clueless about how severe this pandemic would be and how long it would last. But one thing I was sure of — if we stuck together as a team, applied our skills and training, and remained steadfast, we would weather the storm. Drawing on my 30 years of service in nursing, many of them in the Acute and Emergency (A&E) department, I resolved to do my best in this fight. There were so many challenges to cope with, and there were times when I was just so tired and drained. Thankfully, I had my family and

colleagues to rely on; their emotional support and hard work kept me strong and still motivates me to do my best each day. I pulled together all my lessons from SARS to step up to face the challenges each day brought, and I embraced every chance to learn and contribute where I could. I am thankful to have had the opportunity to assist in the implementation of the A&E tentage, conduct training for personal protective equipment and powered air purifying respirators, ensure that nurses complied with infection control standards, and even conduct orientation for agency nurses. While it has been a lot of work, these activities have helped to enhance my organisation and leadership skills. Importantly, I learnt to accept change and worry only about what I can control. I am also grateful that my nursing team and I have solidified our bonds through this experience. Having survived and thrived through the pandemic, I know we will always have each other’s backs.

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Work from the heart Norizan Binte Salahudin SENIOR STAFF NURSE, WARD D87, KHOO TECK PUAT HOSPITAL Working with geriatric patients living with dementia in Yishun Health’s non-restraint ward, my job is more than the act of ‘doing nursing’, but tending to humanity and supporting the dignity of people. Beyond medical needs, I believe that my role as a nurse is to touch the lives of my patients, their family members, and even the younger generations of nurses. This lesson was instilled when I witnessed the dedication of the nurses who cared for my late grandfather. I was really impressed by their passion. It made me think about what I wanted to do with my life — did I want to live a ‘normal’ life, or did I want to make a difference in the lives of others?

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This conviction about putting my heart into what I do also extends to my hobbies in art, which is my second passion. I perform Malay cultural dance and love to make and create. Even though my work takes up most of my time, I still continue to do the things that I love, such as drawing and painting, doing henna art, sewing, dancing and even baking! I learnt to do many of these activities on my own through online research, but I have also gone further to attain certifications in them. I think pursuing professional growth and artistic endeavours go hand in hand — it’s all about embracing learning, finding solutions, practising patience, and paying attention to detail. Whether it’s sewing clothes, making art, delivering care, or lending a listening ear and helping hand, I know that hard work and a passionate heart always lead to success and satisfaction.

urses’ Day 2022

There in their hour of need Sebastian Orumbadayil Prince SENIOR ENROLLED NURSE, WARD B85, KHOO TECK PUAT HOSPITAL One of the most rewarding aspects about nursing is that it gives me immense opportunity to help people at their most vulnerable moments — it’s a privilege to be there to uplift people in their time of need. Nursing is also a profession where there are many different roles, so you can choose how best you can serve people. For me, this has been in emergency care, an area I’ve worked in for some 12 years now. This role is all about overcoming crisis, adapting and working as a team. And all these aspects came into play when the COVID-19 pandemic hit. It was a truly difficult time for healthcare workers. As nurses, we had to go above and beyond to step up to the frontline. On a personal level, it also meant sacrificing my twice-yearly visits to see my family in India. It was a very stressful situation for me, as I had never been separated from my family for more than six months in my entire life. I had to dig deep inside myself to find my strength and courage. It made me realise that nursing is not only a physically and mentally demanding job, but one that sometimes requires us to put service before self. To cope with the stressors of my work and keep myself emotionally and physically strong, I keep fit and use exercise as a way to recharge. I also love to cook delicious yet healthy meals; they don’t just fill my time and inspire me, but also nourish my body and soul. Most importantly, what keeps me going is my team. I am a great believer in the power of groups. During the pandemic, it was inspiring to see how strongly we collaborated for the greater good. As a team, we worked, evolved and solved problems. In doing so, we grew in unity and skill to take our mission of care further and provide the best for our patients.

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Fighting the good fight Zhang Shufang SENIOR STAFF NURSE, DIABETES CLINIC, ADMIRALTY MEDICAL CENTRE After many years working in the orthopaedic and ENT wards, I moved to a slightly different setting, taking on the role of a Diabetes Nurse Educator at Admiralty Medical Centre. This outpatient setting allowed me to take a ‘slow’ approach, building rapport with patients and supporting them in sustained chronic disease management and self-care. More recently, with the pandemic, I was deployed to the KTPH Acute and Emergency Centre (AEC), another arena of care where treatment is at a much faster pace, and where the patient volumes and turnover rate is higher. I knew that moving from the outpatient setting to the acute setting would be challenging, but I also wanted to do my part and contribute to help my healthcare colleagues in areas that were short on manpower. I’m proud to say that, working hand-in-hand, we made it through a very difficult period. I remember one afternoon when there were only two of us nurses running the AEC, as the rest of my colleagues were down. Both of us were exhausted, but we tried our best to attend to patients without delaying their treatment, keeping in sight our mission to prioritise patient safety and well-being. The deployment to AEC was truly eye-opening and re-invigorated my love for nursing. During this time, I went out of my comfort zone and acquired new medical knowledge and procedures — such as performing bladder scans — and also managed to re-visit and hone some nursing skills that I had not put into good use for some time. If you were to ask me what the most valuable experience was during this deployment, I’d have to say it was the terrific teamwork among my colleagues. From nurses across different specialties, doctors, counter staff, porters and cleaners, we all banded together to fight the good fight. The friendships we forged during this time will always be special; this challenging period cemented my reason for being a nurse.

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urses’ Day 2022

Food for the soul Ummu Kharr Unais Binte Abdul Rahman SENIOR STAFF NURSE, WARD D48, YISHUN COMMUNITY HOSPITAL I am a strong believer in karma, and that we should always pay it forward with kindness and service. It’s one of the reasons I chose nursing as my profession. I’m truly appreciative of the blessings I’ve received in life, and what better way to practise gratitude than working with people with dementia. This work not only aligns with my values and beliefs, but affords me countless opportunities to be of service and to bring joy and comfort to others. I believe that we can practise gratitude in many other ways; for me, I also do it through my passion for hosting and cooking. Food brings people together on many different levels. It nourishes the body and the soul, and I think people who give you their food are also giving their heart. More than just a hobby, cooking has helped shape my character. It has taught me about imperfection, resilience and perseverance. There are two simple lessons I’ve learnt from my cooking adventures that have added value to my nursing work. Firstly, it can be hard and messy, and things do not always turn out the way I expect. I just have to push on and adapt, the same way that I need to be open to new ideas in the fast-paced healthcare landscape. And, just as in life, cooking has also taught me that it’s okay to make mistakes sometimes. It has trained me to think on my feet, be more flexible, and think out of the box whenever I’m faced with difficulties or challenges. Through this, I’ve learnt how to bounce back from mistakes, learn from them, and turn failures or setbacks to opportunities for improvement, then carry on with joy in my heart.

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Being a beacon for others Zarina Binte Kamis SENIOR STAFF NURSE, COMMUNITY NURSING, POPULATION HEALTH & COMMUNITY TRANSFORMATION Nursing has been quite a journey for me. In fact, I had actually set my sights on travelling the world as a cabin crew. But life had a different plan for me, and I ended up pursuing a different calling. Part of the reason was my father, who had a stroke and needed tube feeding. As his caregiver, nursing became the logical choice for me. And, 30 years on, looking back on my varied career in the private and restructured hospital settings, I’ve come to realise that this path has been right for me all along. I love my nursing journey and all the knowledge that I’ve gained through the years. And I’m still learning. In 2019, I started a new chapter by joining the Yishun Health community nursing team. While I am still involved in care delivery, it’s a very different experience from the hospital setting. My interactions with residents and patients in the

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community have opened my eyes, and I now better understand the challenges and realities of caring beyond the hospital walls. As a community nurse, I’m in a special position, as I get to learn more about my patients and their everyday struggles. I’m also up close enough to see their strengths and their resilience even in the most difficult of times. It’s been a meaningful, purposeful and gratifying experience that has added to my sense of satisfaction in being a nurse. While I don’t jet around to far-flung countries, I still journey with my patients on their many different paths, and get to listen to their stories and experiences, which are filled with much descriptive detail — as much as any travelogue! Having gone through major surgery and being a patient myself, I am better able to empathise and extend compassion; it has made me a better nurse and friend. I hope that, with my support, I can be a beacon for patients along the way, too.

urses’ Day 2022

Finding rhythm through practice and passion Vanessa Natalia Sutristio STAFF NURSE, A&E CARE CENTRE, KHOO TECK PUAT HOSPITAL Music has always been a big part of my life. I learnt to play the piano at a young age; in school, I was in the military band, where I played the flute and various percussion instruments such as the marimba and snare drum. Learning music is not unlike picking up technical nursing skills. There are many missed notes and mistakes at the start, but each misstep is a stepping stone towards success. With focus, determination and lots and lots of practice, I know I can become not just competent but confident in the skill, be it a challenging score or a slippery vein. This is the mindset I take whenever I am learning a piece of new music or taking up certification in venepuncture and cannulation, and it has motivated me to continue persevering through all the difficult times at work and in my personal life. This mindset has also helped me to stay the course in a challenging work environment such as the A&E. Armed with my skills and practice, and supported by my colleagues and mentors, I find my rhythm every day and keep on scaling new heights. I view my team and I as an orchestra. Teamwork is vital as everyone contributes their own part to make up the whole piece of music. Even playing the accompaniment instead of the melody is crucial, because it builds the harmony. Just as how every note in the musical score is important, everyone in the healthcare industry plays a vital role. Even as a new nurse, I know that I matter in my team as an advocate for my patients. This empowers me and gives me the confidence to raise any concerns when it comes to patient care, because I know my voice is valued!

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