Everyday heroes in your neighbourhood

January 2019

We're sure you already know all about what nurses do in the hospital. Our everyday heroes ensure their patients' well-being at the bedside, assist in surgeries and advocate for patient health, amongst other amazing things they do every day! But have you ever wondered about what they do in the community? It's a different ball game altogether!

In our quest to learn more, we reached out to the community nursing team at Changi General Hospital (CGH). In addition to creating the model of community nursing which is now implemented as a Regional Health System pilot, CGH provides community services in the east via community health posts, senior activity centres and home nursing.

We were lucky enough to sit down with eight members of the team for a chat to find out more about what it means to be a community nurse.

Top row, from left to right: Assistant Director of Nursing (Advanced Practice Nurse) Zhang Di, Nurse Clinician (Advanced Practice Nurse) Gan Peiying, Senior Staff Nurse Rafidah Abdul Rahim, Senior Staff Nurse Imma Harliny Abdul Rahim

Bottom row, from left to right: Nurse Manager Joanne Yap, Senior Staff Nurse Joey Wan, Nurse Clinician Kee Mong Nee, Assistant Nurse Clinician Low Bee Geok

CTGB: How did community nursing begin in CGH?

Zhang Di: When I was tasked to set up community nursing in January 2017, I only had our basic roles and objectives as a guide. There was plenty of uncertainty regarding where we should anchor our services so that we are able to deliver care within a conducive environment.

When a Senior Activity Centre (SAC) first approached us to collaborate, I was hesitant. They offered us a consultation room to provide support to their residents, but I was unsure if it would be feasible and adaptable across other venues. There were really no similar set-ups for us to refer or learn from.

After lots of hard work and overcoming countless challenges, we are proud to say that we now have 12 community nurse posts located within 12 different SACs, each providing a wide scope of nurse- led services.

CTGB: That's really cool. Community nursing must have been something really new to CGH. Why did the team members decide to switch from inpatient care to community nursing?

Michelle: I think I have been in inpatient care for about... nine years? During my time in acute nursing, I was constantly worried and concerned about my patients who have been discharged. How are they coping at home? Are their caregivers able to manage their conditions? Are they following our instructions?

So, when there was an opportunity to join community nursing, I knew straightaway that it was for me. Now, I am happy that I am now on the ground to ensure that my patients are living well in the community.

CTGB: Can any of you describe a typical day in the life of a community nurse?

Peiying: Sure! We normally start the day with a quick huddle to keep each other posted on what's happening at different nurse posts and events. We will then head out to our posts in the community to start the day’s work.

In a typical day, our work can range from seeing our patients at our nurse posts or in their homes, conducting talks to facilitating health screenings. At times, we also have meetings with our community partners to better understand the needs in the community so that we can improve our services to meet these needs. So, it really varies.

CTGB: The life of a community nurse sure sounds exciting. Does anyone have any memorable experiences in the community?

Joanne: Once, my team had to visit a client with uncontrolled diabetes. She was extremely resistant to insulin treatment and we could not understand why. After building rapport with her, we found out it was because the additional step of administering insulin was upsetting her morning routine.

Hence, we came up with a plan to complement her living habits. We found a clinic nearby which was willing to supervise her treatment and got the help of a nearby SAC to keep a lookout for her.

This is a classic example of a community nurse working as a bridge between clients, healthcare facilities and community partners to help our clients be as independent as possible.

Bee Geok: For me, joining community nursing helped me understand the difference between the hospital and the home. As the home may not be as conducive as the hospital, we depend on the caregivers to ensure that the patient remains well taken care of in the community.

I remember a patient who was admitted into hospital up to 4 to 5 times each year in 2016 and 2017 for a recurrent bacterial skin infection and fluid overload. The family had thought that the swelling of the patient's lower limbs was a norm! After proper caregiver training, the patient was only admitted once in 2018. Caregiver education is key in reducing unnecessary hospitalisation for patients.

CTGB: What is the main difference between acute and community nursing?

Imma Harliny: In the acute setting, we work closely with other healthcare professionals in a controlled and contained environment. In community nursing, we work independently during house visits and need to rely on our own problem-solving and risk assessment abilities. I guess you can say that we have a higher level of autonomy in community nursing!

CTGB: Seems like community nursing is very diverse! What's the best part about it?

Joey: Every day in the community is a new adventure! We don't know what will happen until we visit our patients in their homes. Thankfully, we are trained to handle unexpected situations and emergencies in any environment. Working in a diverse environment is challenging, but to be able to provide care to the patients who need it at home makes it the best part of community nursing.

Rafidah: We get a glimpse of our patients' lives when we make home visits. When patients and their family members are comfortable with us, they tend to share more – health information, concerns and even (laughs) food! When a bond is built, they trust us to assist them with their concerns. To me, that is job satisfaction.

To raise awareness of community nursing, the community care team at CGH had contributed to the research of the nursing drama, You Can Be An Angel 3. Want to learn more? Watch the drama now on Toggle!