They are the most critically ill and vulnerable, often unconscious and not able to speak for themselves. President’s Nurse Patricia Yong choose to care for these patients, in the Intensive Care Unit.
“In the Intensive Care Unit (ICU), we care for the most ill of patients, whose conditions are often unpredictable. At any sign of deterioration, we use our specialised skills and extensive knowledge to provide interventions that sustain life, working closely with the clinicians and other members of the ICU team,” says Ms Patricia Yong, Deputy Director, Nursing (DDN).
“To be a good ICU nurse, you need to be sharp, observant, possess an analytical mind, have the humility to collaborate with others, and be a good listener,” says Ms Patricia who is a winner of the President’s Nurses Award this year.
“More importantly, you must speak up for your patients, as many of them aren’t able to. And you have to speak up for their families and loved ones too, as ICU nurses are very involved with patients and their families, building rapport and providing explanation of the treatment and care plans,” she emphasises.
Why she chose to be a nurse
When crossing the road to catch a bus after school one day, 9-year-old Patricia was hit by a car which she never saw coming. She sustained facial injuries, with deep cuts near her mouth and lips. While she could not remember much of her hospital visit, she was particularly grateful to a nurse who held her hands while the doctor treated her injuries.
At 15, she was admitted to ICU after a surgery. The first person she saw when she opened her eyes was an ICU nurse, who patiently explained to her the various tubes she on her body so that she was less anxious and afraid. Both experiences influenced her career choice.
Where details matter
After graduating from nursing school, Ms Patricia joined SGH in 1985 and has been here ever since. She was first posted to a Medical Ward where she spent seven years, followed by a short stint in the Major Operating Theatre and the Orthopedic Surgery Department.
In 1993, there was an opening in the ICU and there, she found her calling. Loving the structured and detailed care, Ms Patricia knew then that she wanted to specialize in Intensive Care.
Aware that every detail matters in the care of critically ill patients, Ms Patricia would set aside time on her way home to think of ways to do better the next day. After a resuscitation, for instance, she would repeat the scenario in her head, going through every step to identify areas for improvement. “Reflection helps me to learn deeply, especially about myself and from others,” she says.
“In ICU, our reward is to help patients progress from being in critical condition to health again, so we plan towards that.” Applying the meticulous organization and planning skills of an ICU nurse, Ms Patricia was part of the ICU team which spearheaded a project in 2018 to use patient lifters to get patients out of their beds sooner, as early ambulation helps with recovery.
Winning trust the thinking way
Caring for patients in critical condition also means ICU nurses often bear the brunt of the family members’ anxiety.
“About 10 years ago, the family of a patient accused my team of ICU nurses of inflicting bruises on the patient. At that time, there was a lot of attention on a case of patient abuse in a nursing home, which put nurses in a bad light. It was extremely stressful for my team as the family scrutinised and questioned everything we did. I had to remain unfazed and guided the team on how to stay cool, to interact with the family without compromising care or rapport.
“I discovered that the patient was on blood-thinning medication which caused her to bruise easily. By taking time to explain the patient's treatment plan to the family in detail, we managed to allay their anxieties and won the trust of the entire family,” shares Ms Patricia.
Not every story has a happy ending though. In the ICU, nurses are often the first to catch patient’s signs of deterioration. They will try to get hold of family members to be there when patients pass on, and are present for these moments.
During the SARS epidemic in Singapore in 2003, Ms Patricia could only watch helplessly as many patients fell to the then-unknown virus, among whom were colleagues from SGH. What really broke her heart was seeing the patients pass on without their loved ones by their side, as these patients were all in isolation.
Planning ahead to be always ready
In 2014, Ms Patricia, who was by then an Assistant Director, started implementing a system to increase the pool of nurses trained in Intensive Care. She rotated nurses quarterly from Intermediate Care Area and High Dependency units to the ICUs. She also deployed nurses among the various ICUs – Medical, Surgical, NeuroSurgical and Burns - for cross-training.
This proved to be a far-sighted move as it gave SGH a bigger pool of competent and well trained ICU nurses to deploy when COVID-19 hit early this year. Besides skills and familiarity with procedures, these nurses already have existing working relationships with the ICU teams to fall back on, to work well as a team.
Ms Patricia, together with her colleagues from the ICU team
Ms Patricia was also able to leverage lessons from SARS to the current COVID-19 pandemic. As the nursing lead for Disease Outbreak in SGH, Ms Patricia was involved in planning COVID-19 operations, including staffing and workflow in the ICU and Emergency Department. She also oversees nurses managing COVID-19 patients in the ICU.
“Having learnt from various disease outbreaks since SARS, such as H1NI, Ebola and MERS-COV, hospitals in Singapore are more prepared. Over the years, we held drills in screening, triaging, isolation and containment. There was also more training to help healthcare workers get familiar with the donning and doffing of personal protective equipment.”
Never let our guard down
“The COVID-19 pandemic is not over. We must remain vigilant in our infection control practices at work, and to carry on with our lives in a responsible manner. We must not let our guard down.
“And when this pandemic ends, we never know when the next outbreak – big or small - will happen. What is most essential is to always adhere to strict infection control practice. The simple act of proper hand washing or using alcohol hand rub help to save lives.”
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