aha
Nurses’ Day special 2018
Nurses’ Day 2018
MCI (P) 101/04/2018
Celebrating nursing: a lifelong journey of learning
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FOSTERING
KNOWLEDGE SHARING
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t is an interesting and exciting time to be in the healthcare profession. While the changing healthcare landscape, ageing population and rise in complex chronic diseases have made healthcare sound like a challenging industry to be in, it has also opened up many new avenues for professional development and pursuit of passion, with all hands on deck. For us nurses, we have at our fingertips a wealth of learning opportunities that go beyond formal qualifications, and a plethora of scholarships and grants to support these endeavours. Learning, training and upgrading have become a part of everyday practice and being on-the-job.
AN EVOLUTION OF CARE Shifting paradigms of care have not just expanded our roles as nurses, but the breadth and depth as well. We are already seeing this in the rise of empowered nursing — Advanced Practice Nurses, Nurse Clinicians, Nurse Researchers and, most recently, our Community Nurses. This expanding range of job scopes and specialties illustrates the ‘3 Beyonds’ of nursing that are transforming healthcare: Beyond Hospital to Community; Beyond Quality to Value; and Beyond Healthcare to Health.
KEEPING UP AND STAYING AHEAD While nursing continues to evolve to take on new care approaches and job roles, we must also keep learning from each other. Our nurses come from all walks of life, making a vibrant and varied workforce. From supervisors to fresh graduates, everyone has something to learn and something to give. We come together to form a unique confluence of experience, innovation, academic knowledge and practical skill, and it is through this that we can embrace the diversity of perspectives and competencies to find synergy for ever-better patient care. We encourage nurses at all levels to be open to this culture of knowledge sharing. There
(left to right) Ms Shirley Heng, Deputy Chief Nurse, Khoo Teck Puat Hospital & Yishun Health Mdm Chua Gek Choo, Director of Nursing, Yishun Community Hospital Ms Low Beng Hoi, Chief Nurse, Khoo Teck Puat Hospital & Yishun Health
are many opportunities for formal and informal mutual learning, mentorship and coaching, be they from seniors to juniors, juniors to seniors, or among peers. Only through making the most of these opportunities will we be in good stead to meet the challenges ahead. We are confident that our nurses’ tenacity, passion and commitment can take the profession to new heights of excellence. At this juncture, we would like to take this opportunity to thank all nurses for their dedication to this calling. Happy Nurses’ Day!
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senior management acknowleDgementS
PROF PHILIP CHOO
MRS CHEW KWEE TIANG
DR PAULINE TAN
GCEO, NHG Not everyone can become a nurse — you need to have dedication and a selfless attitude. Nurses don’t just help patients heal physically; they also help them to become stronger and more resilient. Every day, nurses help someone smile, relieve pain, and make a difference to his or her life. Happy Nurses’ Day!
CEO, KTPH & YISHUN HEALTH Mother Teresa said, “It is not how much you do, but how much love you put in doing.” Our nurses not only put much love into what they do, they also do so much! The ‘3 Beyonds’ to building a sustainable healthcare system have spurred our nurses to acquire new skills and reinvent themselves to meet these future challenges with initiative, resilience and tenacity. You are an inspiration to us all. Happy Nurses’ Day!
CEO, YCH Even as healthcare and health services continue to evolve, nursing remains the constant denominator of our healthcare system 24/7, for 365 days a year. Thank you for being the heart and soul of our healthcare system. Wishing you all a happy Nurses’ Day!
A/PROF PEK WEE YANG
DR LEE KOK KENG
MS YEN TAN
CMB, KTPH & YISHUN HEALTH Nurses are a crucial pillar of healthcare. Besides nursing care, your role has expanded to include health promotion and illness prevention, health advocacy for a safe healthcare environment, education and research. You also have to keep pace with rising healthcare needs. But with these challenges come opportunities for development and improvement. I am confident you will rise to the occasion and continue the good work. Here’s wishing you a very happy Nurses’ Day 2018.
MEDICAL DIRECTOR, YCH A salute to all of you who work tirelessly for patient care, taking extra time to do a good job or adding the finishing touches to a task while wishing you could go home to your waiting families. Thank you for being there when we and our patients need you most. Your selflessness and unwavering support indeed bring pride to your profession. Happy Nurses’ Day!
COO, KTPH & YISHUN HEALTH Every year, on Nurses’ Day, we celebrate your achievements. I would like to dedicate this poem to all of you: Your duty starts at sunrise and stretches beyond dawn; Your love extends beyond care and yearns no crown; Your work heals patients and collects no credence; Your role bears fruit and inspires generations.
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GROWING FROM
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Our Nursing Directors (in dark blue suits, front row, from left): Ms Velusamy Poomkothammal, Deputy Director of Nursing, KTPH; Ms Audrey Saw, Deputy Director of Nursing, KTPH; Mdm Chua Gek Choo, Director of Nursing, YCH; Ms Low Beng Hoi, Chief Nurse, KTPH & Yishun Health; Ms Shirley Heng, Deputy Chief Nurse, KTPH & Yishun Health; Ms Yiap Pok Ling, Deputy Director of Nursing, KTPH; Ms Alice Leong, Deputy Director of Nursing, KTPH; alongside senior nurses from Yishun Health
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very year on 1 August, we celebrate Nurses’ Day to commemorate the dedication and passion of those who have chosen to dedicate their lives to the welfare of those who need care. Beyond bringing comfort and healing, nurses today are playing an even bigger role in the healthcare system. They advocate for patient wellness and safety, empower patients and their families with knowledge and skills, and develop programmes to bring care closer to home. As Singapore’s healthcare landscape evolves, the
nursing profession too is transforming in tandem. It is heartening to see so many of our nurses step up to take on more leadership roles, broader job scopes, and build up specialised skills. Be it through formal training, on-the-job mentorship, self-directed learning or personal reflection, our nurses have embraced a culture of lifelong learning. This puts us in good stead to continue to support each other, our healthcare colleagues and, most importantly, the health of our nation, families and friends.
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Merit award
winners 2018
The Nurses’ Merit Award recognises individuals for their outstanding performance and contribution to the nursing profession. The personal stories here are but just a glimpse of what motivates this year’s award recipients to care selflessly for their patients.
It is my honour and duty to give my elderly patients the best nursing care. NG HUOY LING NURSE MANAGER, POPULATION HEALTH, YISHUN HEALTH After losing my grandma when I was 13 years old, my passion for geriatrics grew, and I decided I wanted to serve the elderly as a nurse. My patients remind me of my grandparents; I respect them for their rich life experiences and want them to live gracefully and to the fullest. Once, I encountered a patient’s daughter who was very distressed during her father’s end-of-life care. Being his nurse allowed me to provide clinical expertise and psychosocial support to both him and his family — a role I felt honoured to take on. I am thankful for my own family, bosses and colleagues for journeying with me. As nurses, we have the opportunity to heal the heart, mind, soul and body of our patients and their families. They may not remember your name but they will never forget the way you have made a difference in their lives. 6 |
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I chose nursing as a vocation because it is a profession that never stops giving. Nursing is the intersection of humility, knowledge and compassion, and the practice involves both art and science. There is tangible satisfaction when I am able to make a difference in the lives of others through my daily work. Having practised nursing for seven years, I have come to realise that there is always room for professional and personal growth. The nurses of today are empowered and equipped with evidence-based practices and clinical reasoning skills. This has definitely helped me provide high-quality patient care to those I meet. It is a journey of continuous learning, reflection and self-discovery of what we are capable of offering to our patients. Nursing is a dynamic and exciting profession that I am proud to be in!
Every nurse is drawn to nursing because of the desire to care, serve, and help. NG SIOK QI NURSE MANAGER, WARD B95, KTPH
Nursing is special because it can make the extraordinary, ordinary; and the ordinary, extraordinary. CHERIE KOH NURSE MANAGER, WARD B86, KTPH
When I was young, I had to take many medications to alleviate the symptoms caused by my childhood asthma. The multiple trips to the clinics and hospital sparked my interest in pursuing a career in healthcare. To find out more, I took up a clinic assistant job in an outpatient cancer centre during the holidays while waiting for my exam results. Over time, I found myself drawn to the rapport that the nurses built with their patients. The nurses’ caring nature eventually inspired me to become a nurse myself. The most impactful episodes in my nursing career have been when I was together with my patients during their last moments. These experiences truly humble me, especially when I am performing last offices for them. If you possess a head to think, hands to warm and a heart to care, I encourage you to join us on this rewarding nursing journey! | 7
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You will find the purpose, joy, happiness, courage and satisfaction when your work and passion come together.
LAI FOON WAN NURSE MANAGER, DAY SURGERY CENTRE, KTPH
Nursing is something I am passionate about. It gives me great satisfaction as I make a meaningful difference in the lives of my patients. My most memorable event was my first time assisting a caesarean section. I felt privileged to have the ability to help bring life into the world. Having been a nurse for 21 years now, I just want to tell everyone that nursing is simply awesome. We are not in it for the riches, but much more than that — being able to shine a light in people’s lives. I would like to thank my loved ones, bosses and colleagues for supporting me, and walking with me through this journey. One of the biggest challenges in nursing is to persist in doing what is of value to our fellow humans, even amidst the rapidly changing environment. Thank you for reminding me to “do what is right, and never give up”.
Sometimes it feels like all you do is give, but the impactful moments make it all worthwhile. XU SHUHUI ASSISTANT NURSE CLINICIAN, WARD A61, KTPH When I was 16, my uncle was admitted to the hospital. I remember taking note of the nurses who took care of him before he passed away. It was their dedication that inspired me to become a nurse. Throughout my 10 years of being a nurse, I find the most joy when patients recover under our care, and when they are appreciative of what we do for them. Being a nurse places us in a unique role as we spend the most time with our patients. This allows us to better understand and care for them in every aspect, ranging from their physical health to how they are mentally and emotionally. No matter the designation, all nurses commit themselves to ensure the best patient care for those they meet; that, to me, is the most gratifying thing about being in this profession. 8 |
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It is the experiences as a nurse that inspire me to be courageous. PAMELA FOONG SENIOR STAFF NURSE, ICU 2 (SURGICAL), KTPH
Throughout my seven years as a nurse, I have come to understand this profession as one driven by the passion and dedication to help others. Whether faced with futile efforts or meritable feats, our motivations should remain unchanged as it is a great privilege to serve those in need. An event that impacted me greatly was during one of my night shifts as a junior nurse. I responded to my first call to assist another ward in the resuscitation of a young patient. While we busied ourselves, the room was filled with heartbreaking cries of the patient’s loved ones. Eventually, we had to prepare ourselves to break the news to the grieving family. It was then that I truly felt a sense of duty as a nurse, and it has spurred me to do my best to help those I meet, especially when precious lives are at stake under my care.
The support from my supervisors and peers has been invaluable in my nursing journey. They keep my passion strong. LEE YEN EIN ASSISTANT NURSE CLINICIAN, WARD D68, YCH Nurses witness life’s first and final moments; we see the entire spectrum of life. I joined nursing to help others after losing my grandfather to a heart attack and uncle to renal failure. My 16-year journey is now coloured with powerful memories, such as assisting in the unexpected birth of a newborn in an ambulance, as well as poignant moments of making last wishes come true. My vocation is a combination of art and science: art in communicating, being supportive, and managing emotions of others and self; and science from my nursing training to give care we would give to our loved ones. Throughout this journey, my supervisors and nursing peers have been of tremendous support. My greatest satisfaction is seeing a patient recover, or for one at an end-of-life stage to pass on peacefully and comfortably. | 9
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A CULTURE OF
CARING & LEARNING
Today, the nursing role has broadened greatly to keep pace with growing demands, an ageing population, and more complex medical needs. As highlighted in these inspiring profiles, the pursuit of excellent patient care is supported not only by a culture of care, but a mindset of lifelong learning.
HOSPITAL-BASED STAFF: CARE AT KEY TOUCH POINTS FAZIRA BTE ZULKIFLI STAFF NURSE, WARD A71, KTPH
BEING ONLY ABOUT ONE YEAR INTO THE JOB, Fazira still has a long way to go in her nursing career. She welcomes the challenges ahead with optimism and excitement. “The nursing journey is a series of many steps, and we must continue to grow and learn so we can care for patients better,” she says. She recognises that many of these steps will test her resolve and commitment. After all, simply transitioning from student to staff nurse has been one of the most intense and difficult moves she has ever experienced. But Fazira sees it as a necessary rite of passage. “When I became a Staff Nurse, I had to take on more responsibilities and make independent decisions. I am grateful to have had the support of my seniors and older sister, who is also a nurse.” She relies on a lot of selfstudy, going back to her textbooks, and searching for credible ‘how-to’ videos online. Nursing, Fazira adds, is also about learning mental resilience. There were many times when she faced difficult situations but she kept calm and tried to understand the root of the problem. This is one of the most critical lessons she has learnt so far. “It is important to rise above the challenges. When the going gets tough or when I am tired, I think back to why I wanted to be a nurse in the first place: to help, to bring comfort, and to offer a human connection to those in need.”
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LIN XIAOYAN SENIOR STAFF NURSE, UROLOGY CLINIC, KTPH
FROM DOING BASIC CARE AND RUNNING UROLOGICAL SCANS AND BLOOD TESTS, to counselling and patient advocacy with care planning and coordination, the nursing role can take many forms. In some cases, it even includes setting up clinics. This novel opportunity has been presented to Xiaoyan not once, but three times. Most recently, she was in charge of relocating KTPH’s Urology Clinic. The experience was intense, complex, sometimes frustrating, but ultimately rewarding. With every clinic she sets up, Xiaoyan feels a great sense of pride and belonging. “There is a feeling of ownership,” she shares. To her, the work of setting up a clinic is not beyond the scope of nursing, but actually a part of it. It uses
many of the same skills, such as having a comprehensive understanding of clinical requirements, and meeting people’s needs — be they patients, other healthcare professionals or fellow nurses. It is all about embracing every chance to improve oneself personally and professionally, she adds, even if the process of change can be challenging initially. “I like to ask new doctors from different institutions to identify ways we can improve our practices.” This is central to growing in the profession. “Nurses today take a more active role in care,” she notes. “We need to practise on a higher level — we have to be more proactive, open to change, take more initiative, and ask more questions. We must also learn from mistakes and past experiences.”
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GOH SOON PANG NURSE CLINICIAN, CASE MANAGEMENT, KTPH
WHEN IT COMES TO LEARNING AND GROWING PROFESSIONALLY AND PERSONALLY, Soon Pang believes in the power of reflection, self-awareness and a ‘you never know until you try’ mindset. This approach, she says, has helped her keep pace with the many changes in the nursing landscape — such as in the expansion of the nursing role. As a Nurse Clinician, she is involved in ward rounds, does consultations, and plays an important role in designing care plans for patients. “Increasingly, nurses have to multitask and expand our roles as the complexity of illnesses escalates. To keep up, it is important to ‘power up’ and build our knowledge.” To do so, Soon Pang has not only gone through formal training — the Advanced Practice Nurse holds a Master’s degree — but also engages in self-directed learning. “Reflection is a process of improvement,” she advises. “I evaluate what I am doing and how I can do better.” This awareness opens her mind to learning from others, finding ways to adapt techniques, and being more proactive in solving problems. She also believes in having the courage to identify personal flaws or weaknesses in established processes. “It helps me to step up and be solution-focused.” This is one of the reasons why she appreciates the learning culture within Yishun Health. “The organisation is very open to change and learning. We have the autonomy to initiate projects and try new things.” However, staying updated need not be so formal, she adds with a laugh. So while she reads journals and scientific papers, the occasional gossip magazine and tabloid newspaper are useful tools as well. “It helps me communicate and connect better with some of my patients!”
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KARTINA BTE ISMAIL PRINCIPAL ASSISTANT NURSE, ACUTE & EMERGENCY CARE, KTPH
A DOER BY NATURE, Kartina enjoys the exciting, handson work that she does in the A&E. She first became a nurse after her O-levels — knowing nothing about the job but applying herself to the training anyway. It was in learning about anatomy during her first attachment as a student nurse in the old Alexandra Hospital that she grew to truly appreciate nursing as a meaningful profession. Then, she shares, nursing education was more skillsthan theory-based, so there was a lot more practical work and assessments. Whatever the case, Kartina enjoys that the profession is always evolving, so there is always something new to learn. One has to balance practical and theoretical learning, Kartina says. As a preceptor, she tells students to grab
every chance to “just do” as learning through doing builds confidence. Theory builds a foundation for mindful practice. For instance, doing her advanced surgical and medical course played an invaluable role in cementing her years of practice. “It was quite difficult at the start, but once you have the practical skills to back up theory, it offers clarity and you do things with understanding, not just out of habit.” Kartina, who was conferred the Tan Chin Tuan Award in 2012, continues to embody this spirit of learning by taking up numerous continuing education programmes. “They help me make better decisions and be a better team player in the delivery of safe and timely care.”
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LEE YOKE KEE SENIOR NURSE EDUCATOR, NURSING ADMINISTRATION, KTPH
NURSING FOR YOKE KEE IS NOT A JOB BUT A PASSION. However, it is interesting to note that she had not always wanted to be a nurse. When she was a teenager, her ambition was to be a teacher. But life had other plans — and a funny way of bringing her full circle. Today, as a Senior Nurse Educator, Yoke Kee is both a nurse and teacher. She teaches and develops continuous education curriculums for nurses in various patient care settings. In this role, Yoke Kee believes she is able to give back to the profession she loves because she can empower new generations of nurses with the essential skills required for good and safe patient care. She confesses that, while her first love remains bedside care, her current role is fulfilling from a long-term perspective, such as imparting critical skills and nurturing a learning mindset in nurses
across the organisation, and thus supporting the delivery of safe, patient-centric and quality care on a wider level. “Education is part of what being a nurse is all about,” she reflects. After all, nurses play an important role in teaching patients, their families and caretakers, and also in training younger nurses and other healthcare staff. The dynamic nature of healthcare also requires nurses to continually upgrade themselves and keep pace. Yoke Kee has found herself embracing this lifelong learning through all her various pursuits as an ICU nurse, a Nurse Manager, a Nurse Educator, and a Master’s student. “I think nursing, and life in general, should be a journey of learning. To me, lifelong learning is not just a catchphrase but something to live by every day.”
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ONG LI DAN SENIOR STAFF NURSE, ACUTE & EMERGENCY CARE, KTPH
WHEN EVERY SECOND COUNTS AND LIFE PRECARIOUSLY BALANCES on every action and decision, it takes a great measure of skill and confidence to make swift decisions. This surety must be backed up by a firm footing in evidence-based knowledge, and a practised eye. It is what makes working in the A&E so challenging and yet rewarding, says Li Dan. “From sore throats to heart attacks, we see all the extremes and everything in between. Being in a more specialised area of nursing, Emergency Department nurses need to know these scenarios well to be able to give value to the team and save lives.” The work requires her to have a cool head and the ability to think on her feet. But more than that, it takes a dedication to training and learning. Li Dan attends trauma conferences at least twice a year, and frequently refreshes her skills through life support and other lifesaving courses. These opportunities to learn and grow are, to her, a significant job benefit. “It is a perk that as a nurse you are expected to keep learning,” she affirms. She observes that she works differently each time she returns from a course or training programme. “I work better,” she insists. “There is a sense of satisfaction putting my new skills into practice. No one can take the learning away from you, and you become better each time you practise and apply it.”
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JASON TAN SENIOR STAFF NURSE, INTENSIVE CARE UNIT, KTPH
THE PACE OF CHANGE IN NURSING IS INCREASING QUICKLY in the healthcare landscape. For Jason, this dynamism is a lived reality every day in the high-octane environment of the Intensive Care Unit (ICU). “All areas of nursing are fast-paced. In frontline medicine, this is even more clearly seen,” he describes. “One of the biggest challenges is not knowing what to expect and the severity of what comes.” However, Jason revels in the daily challenges. Intensive care nursing is his dream job — even with its tough situations and high-pressure environment. To thrive in this area of work, it is important to take an interest in everything and to embrace every chance to learn. “In nursing, we need to take ownership of our own learning.”
This is especially the case in the ICU, where there is no time to slow down, show or explain. Here, one has to learn on the job, be observant, take the initiative, and do one’s own background learning. Apart from the deep sense of reward that comes from seeing critically ill patients get better, this continual learning, teaching and professional development is what Jason particularly loves about the job. There is satisfaction when he applies what he learns to his patients’ recovery. “This is what drives me to improve. In nursing, there is no full stop to professional growth. You get to apply what you learn every day.” Jason takes the time to train preceptors and junior nurses, and shares his passion through action.
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KOH FANG QI STAFF NURSE, NURSING RESEARCH, KTPH
EMPATHY, PATIENCE AND AN OUTGOING PERSONALITY are not the only traits that make for a good nurse. It also helps to be curious and a little thickskinned. To Fang Qi, an appetite for knowledge is a big motivating factor in her professional growth. Not one to be afraid of asking questions or admitting ‘I don’t know’, she is open to expanding her horizons. For instance, as a pioneering member of KTPH’s Nursing Research Unit, she has embarked on several research projects despite not having any prior research experience in school. She has found the work — done in addition to her core nursing duties — compelling. Nursing research provides evidence-based support for nursing practices that promote good health outcomes. “Compared to
research in university as part of an honours degree, doing it now has enabled me to identify relevant areas to study,” she points out. Beyond this, Fang Qi has opted to extend her nursing skills by pursuing her Advanced Diploma in Nursing. This is especially important as patient needs get more complex, and expectations rise. “By upgrading, we can gain more skills, credibility and autonomy, so that we can be better advocates for our patients,” she adds. Returning to school has revealed even more unexplored realms for her, a prospect that excites her and fuels her love for nursing. “There are always more questions and more skills to discover, and I like to find out more. I apply what I learn to my practice, and my practice to what I learn.”
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NG GEK LING SENIOR STAFF NURSE, DAY SURGERY CENTRE, KTPH
PREPARE, ANTICIPATE, AND ALWAYS HAVE A BACK-UP PLAN — these are the skills Gek Ling says are essential to a surgical nurse. Her job scope requires her to maintain a sterile environment, monitor safety procedures, and ensure that equipment and tools are ready, among other responsibilities. “My job is to anticipate problems and ensure a smooth-sailing surgical procedure,” she explains. “We need to be alert and ensure everything a surgeon needs is available at hand. For instance, when I do equipment checks, I will also have on standby the tools that are not essential but related, should the need arise.” It boils down to a comprehensive knowledge of various surgical procedures and taking the effort to understand each surgeon’s particular preference and working style. Gek Ling reads up thoroughly before every procedure so she is well prepared. She does a lot of self-study and goes on at least two training courses a year to stay abreast. “Selfstudy is a way of life. We have to learn fast and keep pace with technology.” She finds great satisfaction in being able to anticipate the needs of each surgeon and being ready for unforeseen problems. “It is very satisfying every time a surgery goes smoothly,” she shares. As a Clinical Instructor, Gek Ling instils this learning mindset in her students and nurtures their eye for detail. She encourages them to use their intuition, cultivates their inquisitiveness, and urges them to embrace the intensity of the operating room.
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THAM JUNCHENG STAFF NURSE, WARD D97, YCH
AS A STUDENT NURSE, JUNCHENG THOUGHT OF WORKING IN THE EMERGENCY DEPARTMENT. However, the opportunity to join Yishun Community Hospital (YCH) presented itself, and he seized it. He enjoys his work at YCH’s stroke-dedicated ward. Patients stay an average of 21 days, so he is able to build stronger relationships with them, he shares. Each patient is unique. “Stroke affects each person differently, depending on which part of the brain is affected,” he explains. He works hard to expand his knowledge, researching and reading up on each type of stroke to better understand his patient’s needs. His approach to self-improvement has opened up more than new roles and on-the-job training. Juncheng has
finished his Advanced Diploma, done preceptor training, and gone on a team learning journey under the Healthcare Manpower Development Plan. They went to the United Kingdom to learn about their stroke programmes there, and are developing a stroke rehabilitation unit at YCH. Outside of work, he has a black belt in taekwondo, and is a coach and avid volunteer. His hobbies teach him to be a better mentor to his juniors, he says. Meanwhile, his volunteering work — with the SCDF Civil Defence Auxiliary Unit, at a migrant worker clinic, and on the editorial board with the Singapore Nurses Association — offers learning opportunities in other ways. “It allows me to grow my medical knowledge as well as give back. It all builds back into my development as a nurse.”
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COMMUNITY NURSING: BRINGING CARE CLOSER TO YOU
LAURA THAM & NG HUOY LING NURSE MANAGERS, POPULATION HEALTH, YISHUN HEALTH
IN LIGHT OF AN AGEING POPULATION AND THE INCREASING PREVALENCE OF CHRONIC DISEASES, healthcare systems are relooking the way care is being delivered to create a more sustainable, accessible and prevention-focused healthcare system. This has led to the rise of community nursing.
Social Determinants of Health In the community, the goals of care are not necessarily medical. Social, functional, emotional and psychological wellness are clear influencers of behaviour, and even physical wellness. For some patients, the answer is not more medicine or more trips to the hospital, but simply to maintain mobility, quality of life and happiness.
Evolution of Community Nursing The concept of community nursing is not new. In the past, we have always had nurses and midwives who went into homes to do basic care. With the advancement of medicine and healthcare facilities, nursing has evolved to become more concentrated in acute settings. Today, we know that hospital-based healthcare does not fully tackle the management of chronic diseases and other long-term conditions. Community nursing has thus come back into focus as a way to address health, wellness and quality of life in a more holistic way. With community nursing, we are going back to basics: teaching people how to take care of themselves, bringing care to homes, and working with the community and its resources.
The Hospital to Home (H2H) programme is a transitional care programme. Specialised teams visit homes of recently discharged patients to ensure they are coping well. This prevents unnecessary hospital re-admissions. With the Self-Managed Autonomous Regional Team (SMART; see page 22) initiative, nurses develop their own workflow, processes and clinical protocols to manage those in the community who have health issues. The Population Health nurses offer readily accessible health advice at Community Nurse Posts, and conduct health screening in community settings, such as markets.
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KANAGA SUNDARY SOMASUNDARAM SENIOR STAFF NURSE, POPULATION HEALTH, YISHUN HEALTH
WHAT SUNDARY LOVES MOST ABOUT HER ROLE AS A COMMUNITY NURSE with the Population Health team is the ability to truly be part of her patients’ everyday lives. Compared with her early days of practising ‘fast nursing’ in a hospital where patients only stay for a few days, her work today sees her building long-lasting relationships with residents. Apart from raising awareness and conducting health screenings, she also identifies those in the community who need a little more support — be it in the form of a pharmacist, home care nurse, or a specialist referral. “In my job, I get to meet a lot of people from all walks of life, take time to get to know them, hear their stories, and connect with them on a more personal level,” she shares. This rapport helps her to be more effective in her work as she better understands their care needs and circumstances so she can support them in managing their illnesses and living a healthy lifestyle. She counsels residents on their health screening results and uses this as a chance to share simple recipes or tips for small but healthier lifestyle changes. This approach makes health goals seem more achievable, which motivates people. It always pleases her when her health screening participants seek her out to proudly show off improvements in their health. “I always feel very happy for them. I can see that they are encouraged to do better,” she says. Such upstream work is meaningful to her. “What we do is more preventive. If we can pick up conditions such as prediabetes early, we can prevent it. If not, at least we can manage it and prevent complications.”
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BEVIN TANG STAFF NURSE, SELF-MANAGED AUTONOMOUS REGIONAL TEAM (SMART), YISHUN HEALTH
BEVIN HAS ALWAYS LOVED WORKING WITH THE ELDERLY — her initial training in nursing was in dementia and palliative care. She enjoys the holistic approach, where a person’s pyschosocial and even financial circumstances influence the design of medical care. This passion led her to take a Master’s in Gerontology. Today, her experience and studies equip her well for her work as a community nurse with Yishun Health’s new SMART. Here, nurses are given more autonomy to customise care for clients in the community, such as reviewing their medications and streamlining their appointments. Patients are also encouraged to be more active in their own care so they know how to manage their own conditions, what to do if a problem comes up, and who to look for. “We
are de-medicalising healthcare,” she elaborates. “Instead of thinking about medication or sending them straight to the hospital, we investigate the source of the problem.” A spike in blood sugar could simply have been due to a forgotten course of medication; an elderly man in pain may simply need some over-the-counter pain plasters. These solutions, while simple, are no less effective. Giving patients more ownership of their health is rewarding, she says, because it becomes a shared responsibility between the patient and nurse. To ensure she delivers the best care she can, Bevin polishes up her physical assessment skills and strives to be more of a generalist. “I try to observe my doctors, seniors and allied health colleagues so that I can pick up new skills from them.”
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ZHANG YUNFANG SENIOR STAFF NURSE, AGEINGIN-PLACE COMMUNITY CARE TEAM, YISHUN HEALTH
SOMETIMES, IT HELPS TO PAUSE AND JUST LISTEN. This is the biggest mindset shift that Yunfang has learnt from her time as a community nurse with the Ageing-inPlace Community Care Team (AIP-CCT). While nursing has its protocols and processes, these may not be as applicable outside the ward when one goes into the community. This is because home environments are affected by social or financial circumstances, she explains. Her role is not to prescribe solutions or give instructions, but to facilitate ways for her patients to best manage their conditions and minimise their re-admittance to hospital. “It is not just about how complex their diseases are, but how much support they have,” she adds. Someone with complicated diabetes but has sufficient help at home may do better than someone else with a sprained ankle who lives alone. Yunfang focuses on building more meaningful connections to get to know her patients and their conditions. When they are happy, able to live in a safe environment, and know where to go for help, they will be more compliant with medication regimes, medical appointments and their disease management; then she can help solve their medical issues. Apart from the friendships she builds within the community, Yunfang has also amassed a wider repertoire of knowledge. She says, “I see many types of diseases and conditions, more so than in a ward, so I need to constantly upgrade and seek help from colleagues with relevant skillsets.”
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