Mr Ng, 81 years old, lives alone in Chinatown after his wife passed away. He suffers from Chronic Obstructive Pulmonary Disease and his condition has been deteriorating. His only child lives overseas, and with travel restrictions during the COVID-19 pandemic, Mr Ng became worried. “What if no one knows my wishes should I become unable to make decisions for myself?”
SGH Senior Staff Nurse Vincent Lim stepped in and helped Mr Ng to draw up his advance care plan.
“That was the very first Advance Care Planning (ACP) discussion I facilitated, so it left a deep impression on me. Mr Ng is one of the residents that our Community Nursing team cares for in Chinatown.”
Working in the community means we get to know residents like Mr Ng better over time, through services such as health monitoring and coaching sessions. We also make home visits, and see the residents frequently as we go around the neighbourhood daily.
A key difference in doing ACP in the community is that we interact with residents over a longer period in a social setting. This allows us to build rapport and trust to initiate discussions about ACP.
“The community setting also allows the residents to take time to slowly reflect on their past experiences (such as episodes of hospitalisation), which may shape their goals of care should they become critically ill.”
“With Mr Ng, I started the ACP conversation with him in November 2022, when I became aware of his worries through our many chit-chats. Then I learnt that the daughter was visiting him when travel restrictions were relaxed. I quickly seized the opportunity to schedule a conversation for both of them. In this way, Mr Ng was able to complete his ACP in January 2023.”
“During the ACP discussions, Mr Ng spoke about his wishes and they were understood by his daughter. This remained memorable to me because I observed how facilitating this ACP had helped both Mr Ng and his daughter reconnect and find closure in knowing his goals of care.”
Figuring out the puzzle of life
Despite being only trained in November 2021 on how to facilitate an ACP conversation for patients or residents, Vincent has already received compliments on how he paid close attention and took time to do extensive explanation to the families to help them along.
“Facilitating an Advance Care Planning (ACP) conversation with a patient or resident is akin to piecing together a jigsaw puzzle of their life. Firstly, I try to get a sense of the big picture, through my observations of the patient’s situation. Then I try to find the correct pieces to form the edges of the puzzle. To fill in the missing pieces and complete the puzzle, a lot of patience is required, over many conversations. Although the process may take time and occasionally some pieces may not fit nicely, if you persevere, you will feel a sense of accomplishment.”
“I am motivated to do ACP for my residents because I know that I play a part in helping to give closure to both resident and their loved ones, to act on the best interest of the resident and to be able to provide care that aligns with what the resident wishes. Most importantly, drawing up an ACP empowers residents such as Mr Ng to have a say in their own care goals.”
Vincent coaching a resident on medication management
SGH Advance Care Planning Workgroup is hosting a series of lunch time webinars to share insights and strategies in promoting and facilitating advance care planning for patients. Vincent will be sharing more at the webinar on 4 Oct. Register here https://for.sg/advancecareplanning2 for this free webinar.