Nursing Times Issue 8

Nursing
Times
VOL. 3, NO. 1 MAR 2022

RafflesMedGrp RafflesHospital

TABLE OF CONTENT CONTRIBUTING WRITERS

ANCC ACCREDITATION Lilian Yew
WITH DISTINCTION 04 Karyn Choo Li Ping
Lee Pei Boon
BEHIND-THE-SCENES’ STORIES 05 Lai Kwok Fern
The Skilful Nurse in the Intensive Care Unit (ICU) 07 Siti Zarinah Abdul Rahman
COVID-19 Special: Travel Testing Centre ANC Kavitha Majunar
Lee Pei Ying Beatrix
NURSES’ VOICES 08
Nursing Education EDITORIAL TEAM
Chief Editor:
CLINICAL UPDATES Lilian Yew, Chief Nurse
Post-Discharge Follow-up Members:
(PDFC) Project Karyn Choo Li Ping, Nurse Educator II
Pan Li Jing, Nurse Clinician II
Wong Siew Fong, Assistant Nurse Clinician
Choo Jie Ling, Staff Nurse I
Rathigka Subramaniam, Senior Staff Nurse II

PRODUCED BY
RMG Corporate Communications

12

ON THE RADAR 13

FUNNY MEMES 15

Get Involved! SCAN FOR
If you would like to submit an article, or share a nursing story, MORE DETAILS
contact [email protected]

FOR NURSES BY NURSES
Join the Singapore Nurses Association (SNA)
All SNA Members receive:
• Special rates for SNA and Chapter talks and seminars
• Discounted registration fees for SNA hosted and partner conferences
• 3 issues of Singapore Nursing Journal (E-copy); 3 issues of newsletter; SNA Connect (E-copy)
• Lifestyle benefits (Please find out more at http://www.sna.org.sg/lifestylebenefits)

2 Nursing Times Vol. 3, No. 1

“A nurse is to Chief
maintain the air Editor’s
within the room Note
as fresh as the air
without, without Raffles Nursing Times is a quarterly e-newsletter
lowering the published by Raffles Hospital, which serves as a
temperature.” unique platform for our nurses to stay connected.
It highlights updates from our nurses and student nurses,
Florence Nightingale and with these exciting contributions, we keep abreast
of clinical practices, new technologies and arm ourselves
with the latest and greatest from the nursing world.

Through Raffles Nursing Times, we also hope to interact
with Raffles nurses and stay in touch with our nursing
friends from all walks of the field. This is an exclusive
e-publication for nurses, prepared by Raffles nurses.

For this edition of Nursing Times, we put the spotlight
on some refreshing behind-the-scenes stories where we
profile the daily lives of our nursing heroes and heroines
at the Intensive Care Unit (ICU).

The next issue of Raffles Nursing Times will be published
in June 2022. If you have stories to share, please submit
them before 1 May 2022. Mark your calendars and
stay tuned to our next issue!

Sincerely,
Lilian Yew (Ms)

Chief Editor

3 Nursing Times Vol. 3, No. 1

From left to right: CE Siti Zarinah, NE Karyn Choo, CE Jai Vaishnavi, Chief Nurse Ms Lilian Yew,
CE Dira d/o Haridas, Senior Exec Khine Myat Thu, SNE Wang Hongwei

RAFFLES HOSPITAL IS COMMITTED TO LIFELONG LEARNING OF NURSES.

We are proud to achieve ANCC NCPD Accreditation with Distinction is awarded
Accreditation with to organizations that demonstrate exemplary and inno-
Distinction for Nursing vative practices that go above and beyond the ANCC
Continuing Professional NCPD requirements. The ANCC formally recognizes
Development (NCPD) organizations that provide high-quality nursing continu-
from ANCC ing professional development and ensures educational
activities are designed using evidence-based criteria. By
participating in NCPD learning provided by an ANCC
accredited organization, registered nurses maintain con-
tinued competence in a rapidly changing health care
environment.

Organizations that achieve ANCC NCPD Accreditation
with Distinction are committed to quality learning and
are invested in your future.

Learn more about Raffles Hospital at www.rafflesmedicalgroup.com/
or ANCC NCPD Accreditation at nursingworld.org/accreditation

4 Nursing Times Vol. 3, No. 1

BEHIND-THE-SCENES’ STORIES

RH ICU Team – From Left to Right : Simon Thong Jun Wen, Poliquit Keith Joy Panila, Chng Huai Ci, Cho Hui Zen, Javier Zenia Pabualan, Lee Pei Boon, Misador Maria Katrina Collera

‘Behind-the-scenes’

The skilful nurse in the
intensive care unit (ICU)

“As an ICU nurse, I’m far better at giving LAST aid than I
am at giving FIRST aid.”

In this issue, we go behind the closed doors of the Intensive Care Unit (ICU). An ICU nurse is also
known as a critical care nurse. Critical care nurses provide most of the direct care to patients in life-
threatening conditions in ICU. Critical care nurses commonly provide care to patients who got into
accidents, or are suffering from cardiac diseases or brain injuries, and patients recovering from
complex surgeries that need frequent nursing care.
Critical care nurses must be physically, mentally, and emotionally strong to work with seriously ill
patients and their loved ones. Most patients in a critical care unit are physically and emotionally
unstable, and they require respiratory and heart monitoring as well as treatment adjustments. Critical
care nurses are responsible for managing medication doses, anaesthesia and ventilator support.

5 Nursing Times Vol. 3, No. 1

BEHIND-THE-SCENES’ STORIES

The Skilful Nurse in the ICU

SSN I LEE PEI BOON Q. What motivates you to work as an ICU Q. Share with us a memorable experience
nurse? in the ICU.
Years of Working
Experience: 9 Years I love experiencing new challenges that The most memorable experience was an
require hands-on and critical care skills. ICU patient from Bangladesh. He became
Q. How did you start working as a nurse in I am driven to learn new knowledge and severely ill due to complications and had
the ICU? skills so that I can better manage the to be provided with ECMO. In ECMO, blood
various cases that get admitted to us with is pumped outside of your body to a heart-
With previous years of working in general complications. I also appreciate how there lung machine that removes carbon dioxide
ward, I was looking to take up new is a higher allowance rate for intensive and sends oxygen-filled blood back to
challenges. Thus, I sought opinions from care nurses. tissues in the body. Blood flows from the
my peers and decided to pursue a career right side of the heart to the membrane
pathway as a nurse in ICU. And here I am, Q. What do you enjoy most working in the oxygenator in the heart-lung machine,
practising as an intensive care nurse, facing ICU? and then is re-warmed and sent back to
new and exciting challenges everyday. the body. This method allows the blood to
Besides taking care of severely ill patients, bypass the heart and lungs, allowing these
Q. Share with us your day-to-day routine I enjoy handling special equipment organs to rest and heal. ECMO is used in
in ICU. such as ventilators, CRRT (continuous critical care situations, when your heart
haemodialysis), IABP (intra-aortic balloon and lungs need help.
Typically, I take over reports from my pump), and ECMO (extra-corporal
colleagues when it is my shift and I ensure membrane oxygenation), just to name a We spent Christmas and New Year’s Day
a proper handover to the team taking few. together as he was in ICU for more than
over the next shift. Throughout my shift, three months. We did our best to sustain
I perform nursing care for critically ill Q. What were some changes over the years his life, but unfortunately, he eventually
patients together with my team. We are that have left a deep impression while passed on. I know our team had delivered
always on standby for any emergency working here – i.e. Workflow processes, holistic care but not everything is within
cases, which are unpredictable. All of technology and patient care activities? our control. Nonetheless, I am thankful to
our patient units are always ready and have been able to help care for this patient
equipped to receive all types of patients at Technological advancement is definitely until the very end.
any point of time. the top of the list as many advanced
equipment were introduced over the years
which helped in caring for the patients
better.

In the last two years, the pandemic has
definitely changed our usual workflow.
Processes have to be re-designed to align
with the latest for COVID-19 protocols.

At times, I feel that the pandemic has
taken a toll on our mental and physical
health. However, I am grateful to be
working here where team members
support each other and we pull through
together.

6 Nursing Times Vol. 3, No. 1

BEHIND-THE-SCENES’ STORIES

COVID-19 Special – Travel Testing Centre

assistants (HCA) and swabbers on rotating From left to right: Operations Executive, Amira; Operations
shifts. As demand for our services grew, Manager Beatrix Lee Pei Ying; Operations Executive, Izzahar
so did our team. Currently, I oversee
OPERATIONS MANAGER, the centre, which has a team of three
BEATRIX LEE executives and 70 locum staff as HCAs,
swabbers, and phlebotomists.
Even as the COVID-19 pandemic settles
in Singapore, there are still new changes Q. Share with us the daily routine at Travel
and protocols to implement to align Testing Centre.
with the updates from local authorities.
Operations Manager Beatrix Lee Pei We provide pre-departure PCR, ART and
Ying shares how the Travel Testing serology tests. The centre is also listed as
Centre (TTC) was set up to cope with the MOH’s Quick Test Centre (QTC) for people
COVID-19 testing demand, as well as the who arrived via VTL and needs to be
other services Raffles Medical Group swabbed within 24 hours of arrival.
provides for the community.
Q. What were some challenges faced during
Q. Share with us how your team has helped the setting up process and any memorable
to set up the Travel Testing Centre. patient experiences?

The centre was initially named Arrival Staff training for HCAs is always a
Testing Centre and was meant to cater to challenge as they must master numerous
visitors who arrive in Singapore via VTL for systems, such as RCMS and EMR within
their Day 3 and Day 7 PCR swabs. However, a short period of time. To overcome this
the requirement for Day 3 & Day 7 swabs challenge, we started a buddy system
was dropped with further easing of border and would attach new HCAs to a senior
restrictions. The centre then pivoted to HCA for a day so that they can familiarise
provide swabs pertaining to travel and was themselves with the process.
subsequently renamed to Travel Testing
Centre (TTC). Since TTC is RMG’s biggest swab centre
in Singapore, we receive patients from
We started with a team of two executives all walks of life. One memorable patient
and hired 30 locum staff as healthcare for the team was a foreign patient who
attempted to bribe our HCA and swabber
to produce a false positive swab result so
that he could get compensation from his
travel agency. We declined his offer firmly
and politely, and he eventually left the
centre amicably.

7 Nursing Times Vol. 3, No. 1

NURSES’ VOICES

Nursing Education

With many foreign nurses joining our Raffles family as Enrolled Nurses, the Nursing Education
Department (NED) has developed a structured programme to help support these nurses who
are ready to embark on a journey to take on a Registered Nurse’s role.

This programme supports the role transition, development of professional practice behaviours,
job satisfaction, organisational commitment, clinical judgment, and knowledge in our
nurses. As an adjunct to the existing Nursing Orientation Programme in Raffles Hospital, this
programme provides support, mentoring, and education based on application of knowledge
and clinical skills for newly promoted registered nurses. Let us hear from our Clinical Educator,
Siti Zarinah Abdul Rahman, and participants in this first run of the course.

Role Transition:
From Enrolled Nurse (EN) to Registered Nurse (RN)

CE SITI ZARINAH
ABDUL RAHMAN

Teaching the Role Transition: From Enrolled Nurse (EN) to Registered Nurse (RN) Course was
quite memorable for me. Most of the participants in my course were apprehensive about
transitioning from an EN to RN. Indeed, they have every reason to be.

Even with four years of experience as an Enrolled Nurse before pursuing my course to be
a Registered Nurse, I too had my fair share of hesitation and insecurities. With my own
experience in mind, I sought to address my participants’ concerns by sharing insights about
their new roles, additional responsibilities, and critical decision-making, referencing our
hospital guidelines and policies. When participants asked me to discuss an issue encountered
in the clinical setting, I would always oblige so as to ensure this remains a highly interactive
course.

I shared with the participants that my goal was not to make them a master of being a RN.
Rather, I wanted to equip them with critical thinking skills and the ability to fulfil more
responsibilities including supervision and delegation of duties to other EN or support staff. This
course aims to ensure that participants are accountable for their nursing practice, and adheres
to the Singapore Nursing Board (SNB) legislative, regulatory and institutional requirements,
and is in line with their professional development.

8 Nursing Times Vol. 3, No. 1

NURSES’ VOICES

Nursing Education

Feedback from Participants

SN II, GLORIA JOSEPHINE
MARY MICHAEL, WARD 10C

The Role Transition: From Enrolled Nurse (EN) to Registered Nurse (RN) Course has
helped me to identify some of the most important documents in the ward, understand
how to prevent errors in administering medication, understand the common causes of
near-miss cases, perform root cause analysis measures, and familiarising myself with
the reporting process hence allowing me to report effectively in the e-HOR system.

Being a registered nurse also comes with new challenges and learning points. Most
importantly, I learned how to put my theoretical knowledge into practice in the ward
and make every shift smooth sailing. CE Zarinah also helped to highlight my areas of
improvement so that I can provide the best care to patients.

SN II CABE DAN ALBERT CRISOLO,
OPERATING THEATRE

As time passes, we learn that our role as an EN will eventually expand to include more
responsibilities as we move on to become a RN. This course made me realised my
additional accountability and responsibilities as a registered nurse. We are constantly
reminded that patients’ safety remains our number one priority and that we are our
patients’ trusted partner for health.

In this course, even though we had it virtually, I learnt a lot. One notable learning point
is on managing patients with care during difficult times. My perception also changed
on how care should be delivered. Many important planning and evaluations need to be
considered and critical thinking skills must be utilised daily. As a nurse in the Operating
Theatre, I found that it is a totally different environment. Therefore, there must always
be a mutual understanding in every situation in each field.

I believe that working as a nurse is not easy because patients’ lives depend on nurses’
knowledge and skills. Being able to communicate effectively, putting ourselves in our
patients’ shoes, and having the patients’ trust are essential for a nurse. When all the
assessments, planning, interventions, and evaluations that were carried out for our
patients result in patients’ “Thank you”, it makes my day and makes my job fulfilling.

9 Nursing Times Vol. 3, No. 1

NURSES’ VOICES

Nursing Education

Feedback from Participants

SN II TIGLAO RAYMOND
FRANCISCO, WARD 13

The Role Transition: From Enrolled Nurse (EN) to Registered Nurse (RN) Course is very
informative and useful for new RN. It covers various, relatable aspects of transitioning
from an EN to RN. What I find most useful was the lesson on how to handle challenging
patients or other healthcare professionals, and the appropriate approach to handle
different situations. I also learned the importance of having critical thinking skills, and
how to implement safe nursing care practices when attending to patients on a daily
basis. The relatable case scenarios presented were helpful on how to approach such
challenging circumstances that we had or may experience in the future.
Thank you to our mentor, CE Zarinah, for organising this course. It was a pleasure
to attend as the presenter was passionate and engaging in every session, and my
co-participants’ humour and energy kept our classes lively. To sum up, the whole
programme boosted my confidence in facing daily challenges that arise at work.

SN II, KOCHUPURACKAL KUNJU
JAIMY, WARD 10D

Being in the pioneer batch in the Role Transition: From Enrolled Nurse (EN) to Registered
Nurse (RN) Course at Raffles Hospital, this course is an eye-opener for me as I start my
new role as RN. This course helped participants understand their additional roles and
responsibilities as new RN and it coached us on how to handle challenging situations,
apply critical thinking skills, ensure our knowledge and skills align with Raffles Hospital’s
nursing guidelines. During the monthly sessions, CE Zarinah also raised my morale and
taught me to look at things with a positive mindset.

10 Nursing Times Vol. 3, No. 1

NURSES’ VOICES

Nursing Education

Feedback from Participants

SN II DE LA CRUZ JOMAR
RAMOS, WARD 13

This course is for the newly promoted RN. It introduces participants to the definition,
roles and responsibilities of the registered nurse in providing nursing care to patient,
next-of-kin, other healthcare professionals as well as the community. The main reason
of taking this course is to refresh our minds and improve our critical thinking skills while
ensuring that we abide by all the different policies and relevant assessment to evaluate
our professional nursing practice.
I learnt a lot from different theories and concepts that can help me grow and gain more
experience in my nursing career. I also learnt the need to work rationally in a challenging
environment, which can test our limits but we learn how we must work together as one
to ensure the best care given to patients, which must be our top priority. I am personally
grateful to CE Zarinah for what I learnt in this course. I am gratified to hear positive and
encouraging feedback from our previous patients which makes the job satisfying despite
the heavy workload. This motivates me to continue doing my best for my patients.
This course is very meaningful not only because of all the knowledge that I gained, but
also through the interacting and sharing with other participants that motivate me to
strive more for the better health of patients. I highly recommended this course.

SN II CLAUDIO MAUREEN RACHEL
ARCIBAL, WARD 10

Being the first batch participant of Role Transition: From Enrolled Nurse (EN) to
Registered Nurse (RN) Course of Raffles Hospital, I would say that this course was very
helpful in assuming my new role as Registered Nurse. This course helped participants
understand the weight of our responsibilities as a new Registered Nurse and taught us
how to handle challenging situations, abiding by the law and ethics of our profession. CE
Zarinah also raised my confidence as a registered nurse.

11 Nursing Times Vol. 3, No. 1

CLINICAL UPDATES

Post-Discharge Follow-up WRITTEN BY
Call (PDFC) Project
ANC, KAVITHA MAJUNAR,
WARD 10D

Post-Discharge Follow-up Call (PDFC) project was launched in the surgical Benefits of PDFC Project
wards in July 2019. Each ward assigned one Registered Nurse (RN) to follow-up
with patient’s call and collect data. The targeted patients are those who had • It allows nurses to check the well-being of the
undergone surgeries. The assigned RN will explain PDFC to the patient upon patient after discharge. This includes the pain score
discharge and obtain a verbal consent from patient if he or she agrees to the and the condition of surgical wounds. The usual
phone call from the respective ward. questions to patients as per template will help to assess
patient’s need in pain management and wound care.
Objective By assessing these two main conditions, issues such as
early signs of wound infection can be detected. Hence,
The objective is to check on patient’s well-being within three to four days patient can be advised to seek early medical attention
after patient’s discharge, to recognise post-discharge issues, and assist in for additional pain killers for wound management.
intervention on behalf of specific patient, with the following intended benefits:
• Re-admission due to post-surgical issues can be
• Increase patient and family satisfaction prevented. This also creates a trust between patients
and nurses.
• Build rapport and trust with patient

• Give support to patient and caregiver from time of discharge to 1st TCU

• Improve discharge process and reduce re-admission rate

Discussion and Conclusions

Patient’s safety and satisfaction have always been our main priority in this project.

100 900

90 459 463 800
363 298 700
80 600
90 140 142 283 353 107 Q4 2021 500
70 48 81 77 Q1 2021 Q2 2021 75 400
300
60 Q2 2020 Q3 2020 Q4 2020 Q3 2021 200
100
50 0

40
30

131
20

10 84
0

Q1 2020

Pt Scored 3 and above for Pain Control Pt has NO concern with Wound Healing Pt has no issue with TCU Date
Total Re-admission Cases Answered Calls Total Surgical Patient

Analysis Action Taken

Out of a total of 1,895 discharged surgical patients (Jan ’20 to Dec Ward supervisor has ensured the continuity of good practices that
‘21), 1,299 (68.5%) patients responded to phone calls. With the facilitate minimal re-admissions and patients’ feedback. Above
above data, there were four patients who were re-admitted due results have been shared to all staff during Ward roll call. It is
to uncontrolled pain, and surgical wound issues. There were 1,754 advised that nurses will continue the current practice for PDFC for
cases with no issues on pain control, 915 patients with no concern all surgical patients.
on wound healing and 920 patients with no issue with TCU date.

Outcomes

Gradual increase in the Customer Satisfaction Index (CSI) from Year
2020 to 2021.

12 Nursing Times Vol. 3, No. 1

ON THE RADAR

On the

Radar

Let us welcome our new nursing leaders and
new nurses for this quarter!

SNC II LAI KWOK FERN, WARD 13

After spending almost 20 years in a restructured psychiatric hospital, I decided to leave my
comfort zone and explore the ILTC sector when my friend approached me to help them set
up a new nursing home. Being a psychiatric-trained nurse, I am able to apply my skills in
dealing with difficult patients as well as the diverse staff in the nursing home setting. The
three years of experience I gained through the set-up has enhanced my leadership skills.
After I have set up and stabilised the nursing home operations, I started hunting for my
next challenge. That was when I came across the job recruitment advertisment by Raffles
Hospital.
I did research on Raffles Hospital and I was amazed by how they have progressed over the
years. I have always been fascinated by the autonomy that nurses in private hospitals are
granted as compared to restructured hospitals, thus I decided to give it a shot. During the
interview with Chief Nurse, Ms Lilian Yew and Associate Director, Ms Yasmine Poh, I was told
that Raffles Hospital is expanding, and their future plans are exciting. I joined Raffles Hospital
and I have never looked back since.

13 Nursing Times Vol. 3, No. 1

ON THE RADAR

Let’s Welcome Our New Nurses
Jan 2022 – Mar 2022

Grace D/O Mugunnan Operating Theatre Senior Staff Nurse II
Valencia Paulina Erika Edades ICU Staff Nurse I
Muhammad Alfian Bin Mohamad Hazari OT Senior Staff Nurse II
Thilaka D/O Krishnan Singapore Land Tower Senior Staff Nurse II
Ameresh Vijian Nair Heart Centre Staff Nurse I
Nur Ba'eyah Binte Roslin PCN Senior Staff Nurse I
Nur Illyyani Binte Mahmood PCN Senior Staff Nurse I
Subashini D/O Sethambaram Ward 8 Senior Staff Nurse I
Nurshahirah Binte Mohamad Shahril SLT Enrolled Nurse II
Joanne Fe Oquendo Medina Shaw Centre Staff Nurse I
Siti Nurzarifah Binte Hussain A&E Senior Staff Nurse I
Nur Hudah Binte Musli Dialysis Centre Staff Nurse I
Menaka D/O Veerasenan A&E Senior Staff Nurse I
Sindhu D/O Raveendran Fertility Centre Senior Staff Nurse I
Rosnani Binte Satubi Shaw Centre Senior Enrolled Nurse I
Pan Fei Cancer Centre Senior Staff Nurse II
Bella Natalie Nuryanto Fertility Centre Staff Nurse I
Pascua Anna Carolina Navora Ward 13 Staff Nurse I
Thong Jun Wen (Simon) ICU Assistant Nurse Clinician
Zhang Yu OT Senior Staff Nurse II
Maryann Ashlyn Fernandez RHS Staff Nurse I

14 Nursing Times Vol. 3, No. 1

JUST FOR NURSES

Funny
Memes

Dear Nurses! Here is a list of funny memes to help you destress after a hard day’s work in
this tough pandemic! Time for some humour and de-stress!

When showering is not Guess how Intermittent When you are about to sleep,
enough in this pandemic! Fasting came about? Nurses and thought of something
Some days you feel so dirty invented it! you missed out at work. And
that showering won’t be it’s a dreadful ‘narcotic’!
enough.

New nurse blues ~ make And when it took forever to Continuity of Care ~ Wishing
sure this is part of the tour! report ~ Ahh… Charting: this to all of you working in
80% of Nursing! the 12-hour shift!

15 Nursing Times Vol. 3, No. 1



Nurses Learning Hub invite
Registered Nurses to apply for
the Bachelor of Nursing
(Top-up).

DEGREE AWARDED
This programme is designed to enable
Registered Nurses in Singapore to expand
their knowledge base in the discipline of
nursing and apply this to their practice
without leaving home.

Students who successfully complete the
programme will be awarded the Bachelor
of Nursing by La Trobe University.

COURSE DELIVERY
The Bachelor of Nursing programme is
conducted in block mode with face- to-face
sessions for both lectures and tutorials,
and is fully taught by academics from La
Trobe University.

This Degree is also supported with on-line
learning utilising study guides, required
readings and activities, and assessment
briefings for each subject.

ADMISSION REQUIREMENTS

Applicants must hold a current nursing certificate or diploma from a recognised school of nursing and

have current registration with the Singapore Nursing Board.

Duration: 24 months (Part-Time)

Designation: Bachelor of Nursing

Accredited by: Singapore Nursing Board

Supported by: Singapore Nurses Association

For promotion information and to apply, contact:
Singapore Nurses Association
77 Maude Road Singapore 208353
Tel: (65) 6392 0770
Fax: (65) 6392 7877
Email: [email protected]

“Live life when you have it.
Life is a splendid gift - there is nothing small about it”

Florence Nightingale

WHAT IS NURSING? NURSING @ RAFFLES
Nursing can be described as both an art and a science; The nursing team at Raffles is closely-knitted.
a heart and a mind. Nursing is more than a career. It is Our nurses come together to care for our
a calling. patients.

A NURSING CAREER WITH RAFFLES Our nurses are given opportunities to develop
Find out more about the career development and build on specialised areas of interests, and
track and opportunities. are encouraged to pursue lifelong learning.

(v 1.0 03/21)