These nurse practitioners are forging new paths to meet the needs of an evolving healthcare landscape.
Stepping up to the challenge
Becky readily agreed to be trained for a trailblazing role at the Singpore National Eye Centre (SNEC) when it was offered to her. She was one of six nurses in a pioneer batch who spent a year learning how to carry out injections into the eye to treat swelling that can lead to blindness.
After 100 injections supervised by an SNEC doctor as part of her training, Becky began her new duties as an intravitreal (IVT) nurse injector at the Retina Centre in SGH’s Diabetes & Metabolism Centre in late 2018.
On a busy day, she could be administering injections on as many as 40 patients with eye diseases. One such disease is age-related macular degeneration, a condition associated with ageing that damages sharp, central vision. Many of these patients also have diabetes.
Previously, doctors handled the injections at the end of each session of consults, which led to patients waiting a long time for the procedure. The IVT nurse injector initiative has not only improved the patient experience and expanded the capacity of the IVT injection clinics, but also helped develop competencies of the nursing workforce to support the changing healthcare needs of patients.
Palliative care at home
Since June last year, Advanced Practice Nurse Zhu Xia has been taking care of patients with advanced cancer remotely due to the pandemic. This is made possible through a telemedicine service by the National Cancer Centre Singapore (NCCS) for eligible patients on palliative care at home.
Patients are usually referred by their oncologists to Zhu Xia who assesses their suitability for remote palliative care. If suitable, she journeys with them for 12 weeks as part of a programme, which provides comprehensive palliative care via video and phone consultations. The telemedicine clinic is led by Zhu Xia and her colleague from NCCS’ Division of Supportive and Palliative Care.
Zhu Xia partners a doctor for the first video session with patients. Subsequent consultations are handled by Zhu Xia over the telephone, and more video consult sessions are arranged, if needed. Every week, she checks with patients on their physical and psychosocial symptoms via a questionnaire. This allows her to make adjustments to each patient’s treatment plan based on their individual needs. So far, more than 60 patients have enrolled for the service.
Through this programme, Zhu Xia has built a close relationship with her patients and their caregivers. They feel at ease knowing that Zhu Xia can be reached by phone or text message when they need assistance.
Bringing care to the patient’s doorstep
Thanks to a new joint initiative between the Marine Parade Polyclinic, Singapore General Hospital (SGH) Campus community nursing team and Montfort Care, elderly residents living in Marine Terrace can now have shared video consultations (VC) with their primary care and community service providers.
Nasri, who leads the community nursing team at Katong Community of Care, has played a key role in this shared care project since it was launched in July 2020. The seeds for the initiative were sown during the “Circuit Breaker” period last year. Community nurses identify suitable residents for joint VCs with primary physicians of Marine Parade Polyclinic. The joint VC sessions between residents, physicians, Montfort Care social workers and community nurses are conducted at a kiosk located at GoodLife! Marine Parade, a programme under Montfort Care.
Teleconsultation via phone or video alone may not adequately replace face-to-face consultations when elderly residents are unable to describe their conditions due to language barriers, mental and cognitive impairment, or the lack of self-monitoring devices. As the community nurse posts are located in the neighbourhood, they offer great convenience for the elderly who need to seek nursing care support in managing their chronic diseases.
For patients with diabetes and complex needs, Nasri and his team use a mobile application called PACE-It to improve their care with multi-stakeholders. The pilot project was launched in December 2020 by the Marine Parade Polyclinic physicians, together with the community nurses, Montfort Care social workers, and care coordinators from Changi General Hospital’s Neighbours for Active Living programme. The app acts as a convenient integrated platform for the various care providers to share information and assessments of the same residents they are caring for. These include their vital signs and social-psycho states, leading to a more holistic understanding of the residents.
A boost to parenting self-efficacy
Over her 30-year nursing career, Thilagamangai has contributed to the progress in maternity and child health in Singapore through her involvement in various research and quality improvement projects. Today, she is a Co-Principal Investigator (PI) in a study that looks into ways to better equip parents to care for their firstborn.
In this project, Thilagamangai and her team identify suitable engagement methods and interventions for early parenting as well as maternal and child health programmes. She shares that with the growing recognition that the first 1,000 days of a child’s life — from conception to his or her second birthday — presents a unique window of opportunity to optimise the child’s development, this study is well-positioned to help parents embark on their journey to shape their child’s future. The Communityenabled Readiness-for-1000-Days Learning Ecosystem (CRADLE) project will recruit 700 participants, to be placed randomly in one of three groups, each receiving varying levels of interventions and engagements according to their pregnancy and the child’s development stages.
Thilagamangai and her team of nurse-midwives at KK Women's and Children's Hospital (KKH) will provide personalised care to participants in the high-engagement group. They will help address participants’ concerns during pregnancy via face-to-face engagements, teleconferencing sessions and phone calls.
Thilagamangai hopes that through analysing data collated from participants, she and her team will be able to design effective strategies to enable first-time families to optimise their parenting journey. This will, in turn, have a long-term impact on each child’s development in life. In time to come, Thilagamangai’s work could potentially shape the implementation of early parenting and mother-child care programmes nationally.
For more inspiring stories of our nurses, read the 2021 Singapore Health Special Nursing Issue, produced in conjunction with Nurses’ Day.