Nurses' Day Supplement 2023

Extracted from: Singapore Health Special Nursing Issue 2023 - SingHealth

Better patient care THROUGH INNOVATION

Improving nurses’ skills in administering inhalers

Toh Hsiao Peng, Assistant Nurse Clinician, Advanced Clinical & Specialty Nursing
 

Inhaled therapy remains the mainstay treatment for patients with obstructive lung diseases. The effectiveness of medications is dependent on proper administration techniques. There are many different types of inhaler devices used in SKH such as pressurised metered dose inhalers (pMDIs), Ellipta and Respimat. Nurses therefore find it challenging to remember the different techniques used for each. Assistant Nurse Clinician Toh Hsiao Peng, a respiratory specialty nurse, observed that nurses often spend time searching for a user guide for each type of inhaler. “They also struggle to demonstrate the correct way to use the inhaler,” Hsiao Peng shared. Improper use of the inhaler may result in poorly controlled symptoms and even frequent hospital readmissions. To tackle this, Hsiao Peng and her team came up with The Art of Inhaler, a quality improvement project to make it easier for nurses to correctly administer the different types of inhalers available at SKH.

Through a survey, they found out that nurses lacked confidence in teaching patients how to use the inhalers, especially because they did not have a reliable resource to guide them on administering the inhalers. As such, Hsiao Peng and her team worked to standardise inhaler administration techniques and design work instructions. They also created a series of videos and posters to guide nurses on how to use each type of inhaler. These posters were put up at all nursing stations for easy reference.

After developing these resources, one of the key challenges for the team was ensuring that everyone had access to the videos. So, Hsiao Peng turned to the nursing education team to incorporate the teachings in an e-learning module that nurses must complete as part of their competency checklist. Hsiao Peng’s team also conducts periodic audits to ensure that nurses are demonstrating the use of the inhalers correctly. As a result, all the nurses surveyed reported feeling more confident when teaching patients how to use the inhalers. Their knowledge scores also increased significantly, from four to 100 per cent. Additionally, the videos were so well received that even doctors and pharmacists used them to learn the correct techniques. In the future, Hsiao Peng hopes to share the educational videos with other SingHealth institutions and adapt them into patient education materials.

Empowering the COMMUNITY

Supporting the frail elderly 

Zhang Jin, Nurse Clinician, Advanced Clinical & Specialty Nursing

A community nurse for 13 years, Zhang Jin has attended to patients in unusual places, including HDB void decks and stairways, as patients sometimes request for care to be done outside their homes. This is par for the course for the native of Shanxi, northwestern China, who came to Singapore 20 years ago to be a nurse. “In a hospital setting, you have access to the necessary resources. As a community nurse, you work independently and must be resourceful and think on your feet,” she shared.

Visiting different homes has enabled her to manage people from different backgrounds. This has been useful in her current role as Nurse Clinician of Ageing Successfully in Place – Independent Rewarding Lives (ASPIRE), a community-based geriatric intervention pilot project, where she attends to patients aged 65 and above who are frail and require follow-ups by geriatricians. Patients who meet the above criteria are recruited for the programme at partnering clinics (General Practitioners or Polyclinics).

Zhang Jin then performs a comprehensive geriatric assessment of the patients’ functionality, fall risk, incontinence and nutrition status, and psychosocial needs. For ASPIRE, Zhang Jin is part of a multidisciplinary team comprising doctors, physiotherapists, occupational therapists, social workers, dietitians and community partners. Depending on the outcome of the patient’s assessment, she then refers the patient to the subject matter expert in the team for follow-up. Cognitive impaired patients, for example, are placed under the care of a geriatrician for further investigation, while those suffering from malnutrition will be referred to a dietitian.

Most people think that frailty is a normal part of ageing, but this is not so, stressed Zhang Jin. There are multiple contributing reasons that can be prevented with early interventions. She and her colleagues have attended to more than 270 patients since the programme began three years ago.

ASPIRE has been well-received. A daughter who accompanied her mother for the programme was so impressed that she referred her father to it. Another elderly couple who were due to be discharged from their physiotherapy sessions were keen to continue as the scheme is subsidised, with the first session being free and subsequent ones costing $10 each. However, to continue the rehab session, they had to be referred to a community partner, as patients are only allowed to be on the programme for a year. According to Zhang Jin, her work as a community nurse has helped her grow professionally and personally. “Through regular case discussions in a multidisciplinary team, I have been able to expand my knowledge on caring for patients with certain conditions. As a person, I have also grown to be a lot more patient and appreciative of what I have,” she said.
 

Nurturing the FUTURE

Seeking the human touch in an e-learning world

Chen Huiying, Nurse Educator, Nursing Education and Development

When Chen Huiying decided to pursue a career in nursing, she thought she had to forego her childhood dream of becoming a teacher — until she found out about the role of a nurse educator. This position combines her interests in teaching and nursing, and is thus the perfect job for her! In the years that followed, Huiying equipped herself with the necessary qualifications to become a clinical instructor, and thereafter attain her most recent promotion to Nurse Educator at Sengkang General Hospital (SKH). The ward-based educator, with 10 years of nursing experience in critical care, developed a passion for technology-enhanced learning (TEL) during her own learning journey. Huiying took advantage of her tech knowledge, gleaned from various courses she had attended, to create interactive virtual classes and e-learning modules that enhance her students’ learning journey. “I try to incorporate a number of technology tools in my teaching to make lessons more interactive and improve retention. I also look for software tools that allow me to develop e-learning courses on my own, and customise them as needed, without the need to source for a vendor,” shared Huiying. For Huiying, TEL goes beyond creating a virtual classroom — it also means gamifying the learning experience with VR and augmented reality technologies. Together with innovations such as VR headsets and gloves that provide tactile feedback, nurse educators such as Huiying are now trying to create immersive simulations that allow nurses to practise their skills in realistic and engaging environments. “Previously simulation training was performed on mannequins, which took more man-hours as someone needs to observe while a nurse is being trained. With VR, we are able to consolidate learning, as these observations can be done virtually,” Huiying explained. When asked about her perfect classroom, Huiying says it would be a smart classroom where students can attend either in-person or virtually, but can still meaningfully interact and share their learning and feedback through smart devices. However, she stresses that TEL does not replace real-life teaching. “Technology is meant to complement hands-on training. The human touch is always important,” she added.