Siew Hoon is also a Clinical Assistant Professor with Duke-NUS Medical School who believes that resilience — the essential trait of a nurse — has enabled her to become who she is today. “Resilience equips nurses with the mental and emotional strength to navigate the complexities of the healthcare landscape, overcome obstacles, and ultimately make meaningful contributions to advance nursing knowledge and improve patient care,” she said.

This attribute was evident in Siew Hoon as soon as she joined nursing fresh out of school and thrived in the rich clinical environment of SGH’s colorectal surgical ward. The clinical experience she gained there taught her the importance of a rigorous and evidence-based approach towards improving patient care. Even now, her resilience holds her in good stead as she juggles various roles, from providing direct patient care to doing research.

As a researcher, Siew Hoon draws on her clinical experience to not only inform her research projects, but also improve existing nursing practices, education and policies. She retains an interest in nursing care quality, outcomes, and issues pertaining to the workforce.

In 2018, Siew Hoon served as the Principal Investigator of a research paper, which documented SingHealth’s nursing heritage. She counts it as “one of her most memorable projects that has touched her on a personal level”. It also won the Best Publication Award in the 2023 SingHealth Nursing Awards. Entitled ‘Memories of Nursing in Singapore – An Oral History Approach’, her team interviewed 54 nurses — whose work experience ranged from 10 to 54 years — “to capture the experiences, perspectives and wisdom of nurses throughout history, preserving their contributions to healthcare and nursing practice for future generations”.

The interviewees shared their motivations for joining the profession and some rewarding moments. They also spoke about major events in Singapore, such as the Spyros disaster of 1978 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. The interviews also covered the nurses’ observations on the evolution of nursing roles.

“Through this project, sharing stories of resilience, innovation and advocacy inspires current and future generations of nurses, fostering a sense of pride, identity and commitment to the profession,” said Siew Hoon. Among the many findings, she and the team noted that the role of a nurse is rapidly expanding, and that continuous learning will be necessary for nurses to keep up with the changing healthcare landscape.

One personal lesson that holds a special place in Siew Hoon’s heart is that nursing is about the human touch and that bedside nursing still forms the core of the profession. With the support of her supervisors, she is still covering clinical duties at SGH’s colorectal surgical ward. “It’s essential to stay connected to nursing care at the frontlines while conducting research. Ultimately, our goal is to improve healthcare outcomes on a broader scale,” she stated.

Refusing to adapt isn’t an option

Sng Qian Wen, Nurse Clinician, KK Women’s and Children’s Hospital

“Adaptability has become a fundamental trait for nurses to thrive in the ever-changing healthcare industry,” said Nurse Clinician Sng Qian Wen.

This mindset propelled her to get involved in nursing research in 2013. Qian Wen was part of a team that set out to evaluate caregivers’ satisfaction with their stay in KK Women’s and Children’s Hospital’s (KKH) Children’s Intensive Care Unit (CICU) to identify areas of improvement in practices and facilities provided to them. Interviewing selected caregivers, she garnered positive feedback in areas such as involved decision-making, patient education, and respectful treatment from staff. However, they highlighted a need for rest and shower facilities, charging ports, and vending machines. Calling it her most memorable project, Qian Wen said that the experience not only deepened her knowledge of research methodologies but also how to improve the experience of caregivers and patients in the hospital.

Thereafter, Qian Wen started to get more involved in research while maintaining her clinical nursing duties. This expansion of her nursing role resulted in a sense of personal satisfaction while establishing a strong support network. She is thankful for SingHealth’s support for nurse researchers, and the many opportunities to present their findings and upskill themselves through lectures and workshops. “I’ve had the privilege of meeting different luminaries in the paediatric intensive care research world through international events and conferences. These exposures broadened my perspective. It’s inspiring to see many bright minds working tirelessly to improve patient outcomes,” she said.

It is also through her strong support network of mentors and supervisors that enabled her to embark on one of her most proudest projects to date: the nurse-led feed protocol for CICU. Chosen as the leader of the small team of CICU nurses, Qian Wen sought to devise a customised patient feeding protocol for KKH’s CICU. Adopting an evidence-based approach, she and the team started looking through successful models of feeding protocols used worldwide. At the same time, the team examined their existing clinical practice to identify issues like the accurate documentation of fluid intake by patients.

Besides her team, Qian Wen worked alongside other hospital stakeholders such as CICU doctors, dietitians and nurses. With this multidisciplinary approach, the team was able to formulate and implement a patient-feeding algorithm for their CICU. “This was one of the projects that made me grow the most, as I learnt research skills, implementation skills, change management, and communication skills,” Qian Wen recalled. Additionally, the project also saw significantly positive outcomes for patients and nurses alike. With the new feeding protocol, her patients were able to receive their required nutrition in a timelier manner. Furthermore, the new feeding algorithm was also found to be more user-friendly, saving time and reducing additional workload for the clinical nurses. Yet, even with such positive results, Qian Wen still seeks to find ways to continue improving nursing work processes and clinical care. “I realised that these projects are a continuous work-in-progress as well. It doesn’t end when the data collection is over.”

A grandson’s tribute

Tan Kai Beng, Assistant Nurse Clinician, Sengkang General Hospital

The memory of his grandmother’s last days still gets Assistant Nurse Clinician Tan Kai Beng emotional, but the experience set him on the road to a career in nursing. “Deep inside, I knew that healthcare was something I was really interested in, especially because of my past experience of my grandmother’s hospitalisation,” said the 34-year-old.

Kai Beng’s grandmother had fallen ill suddenly and was admitted to the intensive care unit (ICU). Unfortunately, she passed away after a prolonged stay. Still, Kai Beng is grateful for the care shown by his grandmother’s nurses. “As the patient’s caregiver or family, the experience can be isolating. Although the healthcare workers were very busy, they tried to be attentive and update us whenever possible.”

Not only was he inspired to become a nurse, Kai Beng developed an interest in geriatric nursing. Initially, he worked in a multidisciplinary ward after joining Sengkang General Hospital (SKH) in 2017. In 2021, he chose to pursue a specialisation in Gerontology as he wanted to “empower elderly patients and their caregivers to be confident in providing continuity of care at home for seniors to age well and thrive”.

Kai Beng is also on the Nursing Quality Management team, which evaluates existing patient safety and nursing work processes to improve nursing standards. This aligns with Kai Beng’s drive for research and innovation, which is evident by his involvement in the nurse-driven Delirium Care Management Quality Improvement Project.

Due to his training in gerontology, Kai Beng was one of the resource nurses in the elderly delivery care protocol project. He contributed to the planning, data collection, and implementation of the new delirium care protocol at SKH. He was impressed by the collaborative nature of the project, since the team comprised of nurses from different departments. “By getting such differing views, you are then able to scale the project and make it sustainable,” explained Kai Beng.

The team sought to propose and implement a nurse-driven delirium care protocol to better identify at-risk elderly patients aged 65 and above, and reduce the number of falls, pressure injuries, and use of physical restraints among them. By identifying at-risk patients early, nurses can then implement non-medication interventions outlined in the delirium care bundle. Kai Beng observed that improving cognitive stimulation, diet, bladder and bowel care through simple measures such as therapeutic activities, maintaining oral hygiene, and regular toilet trips can prevent and/or reverse the patient’s delirium.

Since its implementation in 2021, the protocol has achieved encouraging results based on feedback from the nursing team. In a post-implementation survey, Kai Beng and the team found that, among 1,700 patients, the use of physical restraints on delirious elderly patients reduced from 9 per cent to 7 per cent, with the number of at-risk patients decreasing from 27 per cent to 21 per cent. It was unsurprising that the nurse-driven delirium care management team clinched the Best Team Award for Nursing Excellence at the SingHealth Nursing Awards in 2023.

Kai Beng also clinched the Best Nurse Publication of the Year award for his work on another Quality Improvement Project, which compared the effectiveness of two popular skin disinfection techniques: concentric circle, and back-and-forth. Kai Beng was pleasantly surprised that his skin disinfection study struck a chord with not just healthcare professionals but the general public as well. In fact, he discovered his research article being referenced in a TikTok video on skin disinfection by a US-based nurse. “It was unanticipated; I’d never have thought that an article we wrote would be on TikTok. And it reached a much larger audience beyond Singapore,” exclaimed Kai Beng.

The cancer conundrum

Koh Sze Fui, Nurse Clinician, National Cancer Centre Singapore

When she was a 17-year-old nursing student, Nurse Clinician Koh Sze Fui struggled to support a church friend who was diagnosed with cancer. She had limited knowledge of the disease, but spending time with her friend taught her a lot. She saw the value that oncology nurses brought to patients, from diagnosis to discharge — this experience inspired her to specialise in oncology.

“It’s very stressful to be diagnosed with cancer,” she said. “When a patient makes difficult demands or reacts negatively, it’s important to understand what caused it.” This is something she tries to inculcate in the new nurses in her ward as part of her role in overseeing their on-the-job training. “I find it meaningful to journey with patients and support them through the emotional ups and downs.” This led her to consider ways to improve the patient experience at the National Cancer Centre Singapore (NCCS).

As part of the patient care management system, Sze Fui and her colleagues used an internal scheduling system called RAPID for booking chemotherapy treatments. When NCCS moved to its new building, a new system was required to handle the expected increase in patient volume. Sze Fui became a part of a multidisciplinary team assembled to work on the Chemotherapy Scheduling System (CTS) project. She collaborated with colleagues from other departments such as pharmacy and clinical operations to evaluate the requirements for a new system.

Sze Fui was heavily involved in the initial research and development of the CTS, and was on hand to lend her expertise, providing valuable feedback and highlighting on-the-ground difficulties during the trial and implementation phases of the project.

The team expanded the functionality of the old system, which then enabled NCCS nurses to control their resources more efficiently. For instance, the enhanced CTS not only allows clinical operations staff to book a patient’s chemotherapy treatment sessions, but also monitors the real-time status of the patient, even if treatment is delayed. “This expanded monitoring enhances patient safety,” highlighted Sze Fui.

Sze Fui also explained that the CTS is now integrated with the centre’s main medical database system, enabling full access to a patient’s shared medical information. This interconnectivity is invaluable, as the CTS can alert staff if the patient has existing ailments or allergies that may prolong the treatment duration. It will also preemptively extend the patient’s appointment to avoid unwanted scenarios such as double-booking.

With the new CTS fully functional at NCCS, Sze Fui and the team are already looking to improve the system, such as getting it to process raw medical data and churn out reports to better inform nurses and assist in audits. She is grateful to be part of the team working on this. When asked the most valuable lesson she has learnt, she shared: “It’s about understanding the needs of all the stakeholders and finding a solution that would be ultimately be the best for patients.”

Nursing the basics of research

Norasyikin Binte Hassan, Senior Nurse Manager, Changi General Hospital

“I think I’m quite a curious person by nature. I like to ask questions, and what I enjoy most about nursing research is the interaction with people, be it fellow nurses and healthcare professionals, or patients,” shared Senior Nurse Manager Norasyikin Binte Hassan, who is currently in the Nursing Research department.

The 45-year-old joined the profession upon the advice of a teacher who had observed her affinity for working with people, and has been with Changi General Hospital (CGH) for over two decades. Since then, she has worked in various nursing disciplines, developing therapeutic connections with patients and an understanding of their diverse needs.

Seizing opportunities to upgrade and enhance her nursing skills and knowledge, Norasyikin obtained her Advanced Diploma and Bachelor’s degree and, subsequently, a sponsored Master’s degree specialising in nursing research. This exposed her to various research methodologies such as the systematic review, and honed her qualitative research skills, which dovetailed nicely with her extroverted personality and inquisitive nature.

“Qualitative research involves a lot of human interaction. I enjoy meeting people, and listening to their stories, so interviewing feels second nature to me. I think that keeps me motivated. Specialising in nursing research also allows me to continue doing work that has clinical impact, which is important to me,” she added.

Norasyikin’s expertise in research complements her role as a healthcare educator in clinical ethics, a field that focuses on decision-making processes to enhance patient care while minimising harm. “It’s crucial to find the synergy between clinical work and research, while ethical considerations ground these research efforts,” explained Norasyikin. “At the heart of this is the provision of holistic care for patients and for people. This is what guides me as a nurse.”

In 2022, Norasyikin and her team conducted participatory action research to design a curriculum for healthcare ethics education at CGH, aimed at helping nurses navigate ethical dilemmas encountered in their daily work. The dilemmas can range from managing repeated demands for food by patients with dementia, to decisions about life support and end-of-life care. Norasyikin collaborated with nursing stakeholders to identify common scenarios to aid nurses’ understanding, and shared practical tools to facilitate their decision-making.

To date, Norasyikin has conducted more than five runs of the workshop, and the feedback has been overwhelmingly positive. “It has supported and enhanced the nurses’ work. When dealing with demanding patients, they now recognise the signs and know how to respond accordingly,” she shared. Norasyikin continues to evaluate the workshop; drawing on her research background, she recently interviewed nurses on how the workshop has impacted them.

She was also involved in facilitating a one-day module in Healthcare Ethics, Law, and Professionalism at the National University of Singapore (NUS). This core academic module is part of an initiative by the Ministry of Health-appointed National Ethics Capability Committee (NECC) to enhance the capability of healthcare professionals in clinical ethics.

In addition, Norasyikin mentors nurses in CGH’s Nursing Research Fellowship Programme, and coordinates with the NUS Alice Lee Centre for Nursing Studies, helping to identify suitable research topics and supervise honours projects for nursing students at CGH. To date, she has nurtured more than 15 nurses and 60 honours students in conducting research projects, many of whom have published their studies and received awards.

“Even as I guide the younger nurses, I am learning from them. They are more expressive and versatile, with a strong keenness to learn. It inspires and reminds me to continue upskilling to stay relevant,” she said.

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