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The Straits Times (1 August 2020)

Impressed by Sars 'courage'

During the Sars outbreak in 2003, Dr Hoi Shu Yin was a junior nurse in Tan Tock Seng Hospital’s Intensive Care Unit (ICU).

Like other healthcare workers then, she was worried about her safety as medical staff were getting infected as well. But when she saw a senior doctor and nurse calmly intubating the ICU’s first Sars patient, treating the person like any other patient, it left an impression on her.

"That image was one of courage, calmness and responding to the call of duty," said Dr Hoi, 41.

From being a junior nurse during Singapore’s last major infectious disease outbreak, she is now the hospital’s chief-nurse designate, one of the leaders guiding more than 3,600 nurses during the pandemic.

She will assume the position of chief nurse in October. Along with other leaders, she oversaw the conversion of six wards with 230 beds to pandemic wards, and the deployment of over 500 nurses to the National Centre for Infectious Diseases (NCID), to beef up manpower at ground zero of the country’s battle against the virus.

Said Dr Hoi: "When we started operations at the Covid wards, the leaders donned the personal protective equipment with the nurses, and I remember one of my nurse leaders telling her staff that they are all equal now, and there is no hierarchy as they are in the same uniform."

Dr Hoi also appreciated how the nurses deployed to NCID came up with small solutions to be more efficient in serving patients. For instance, to ensure safety, they fixed plastic screens to drip stands to create a barrier between patients and medical staff during swab tests.

A stand-in son or brother

Cold, white and silent. Patients sedated and hooked up to multiple lifelines. The occasional beeping of machines and call bells.

These are the sights and sounds of a typical intensive care unit (ICU), but senior staff nurse Patrick Lin, 30, does not want to describe his workplace as sombre.

Instead, he recalled his most memorable Covid-19 patient in the ICU of the National Centre for Infectious Diseases (NCID), whom he described as a cheerful but slightly breathless gentleman".

"We built a rapport very quickly during my shifts. He would talk to me about his job and family. Sometimes, I would purposely walk past his room to give him a thumbs up to encourage him, and he would raise his hand at me."

In the middle of his stay at the ICU, the patient’s condition deteriorated and he had to be sedated and intubated, said Mr Lin.

But eventually, he became well enough to be transferred to the general ward. When he was being wheeled out of the ICU, he saw me and said, ‘hey thanks’."

Mr Lin was one of more than 500 nurses from Tan Tock Seng Hospital (TTSH) deployed to NCID earlier this year. He was posted to the ICU from February to mid-June. In TTSH, he is part of the Nursing Research Unit, now working on Covid-19-related evidence-based practice and research.

Trained as an ICU nurse, Mr Lin recognises that separation anxiety is an issue that patients and their family members face, as families are not allowed to enter the ICU.

This is especially the case for Covid-19 patients in isolation. He would try to reassure family members when they ring the ICU.

"My biggest fulfilment during my stint at NCID would be having the opportunity to be with my patients in the room during their most vulnerable period, to be their stand-in grandson, son or brother," said Mr Lin.

Helping others regain health and dignity

Ms Loh Jiar Lin, 25, is a senior staff nurse at the Medical & Neurology High Dependency Unit in Tan Tock Seng Hospital. Apart from direct patient care, she also teaches and mentors junior nursing staff who join her unit.

Ms Loh discovered her calling when her grandfather fell sick and was admitted to the hospital multiple times. "I was heartbroken when I saw him struggling with his illness and I felt helpless. I lacked the knowledge and skills to make him more comfortable," she recalls. "This struck a chord with me and made me pursue a healthcare-related course after I finished secondary school."

She moved to Singapore from Malaysia in 2012 to pursue her nursing diploma, and, in 2019, furthered her studies at Singapore Institute of Management (SIM), where she earned a Bachelor of Nursing (Post-Registration), awarded by The University of Sydney, Australia.

Something she found particularly useful in her SIM course was learning physical examination skills. She says: "I am now confident in my patient assessment and am able to pick up subtle changes in my patient’s condition and highlight it to the medical team for early intervention. This is an invaluable skill that has equipped me to be a better nurse today."

She sees herself providing "compassionate and competent bedside care" to her patients in the long run. She remembers caring for a bedbound patient who needed help to get to a commode (mobile toilet). The patient thanked her profusely. "The simple act of helping the patient may be insignificant in the eyes of others, but to my patient who was ill, being able to relieve herself naturally meant retaining her dignity and reducing her reliance on others," Ms Loh says.

Her advice to aspiring nurses? "Nursing is never an easy job. One should have a positive attitude and be resilient. And always have compassion for the people you care for."

Drawing strength from the courage of patients

Ms Kok Hui Scen once thought of quitting the nursing profession because of work pressure, but her patients gave her strength.

A nurse in the palliative care setting at Tan Tock Seng Hospital, she said: “My cancer patients demonstrated much resilience and persistence, which strengthened my will to care for them. As I reflected on what I could have done better to help them, my commitment to nursing grew stronger.”

The 34-year-old, a senior staff nurse at Tan Tock Seng Hospital, also worked on the frontline of the nation’s fight in the Covid-19 pandemic. She was part of the hospital’s healthcare team in charge of suspected Covid-19 cases.

In 2018, Ms Kok embarked on a two-year part-time Bachelor’s of Science in Nursing with Honours (Top-up) programme with Ngee Ann Academy, awarded by King’s College London. She is graduating this year.

She says the course has equipped her with well-rounded nursing skills and in-depth knowledge, which is particularly helpful as she comes across patients from different backgrounds who require different kinds of care.

She adds: “The physical assessment module, for example, has strengthened my foundation in clinical practice and given me greater confidence to manage more complex care.

“My experience with King’s College London has taught me the importance of independent learning and how it should be a continuous effort that goes beyond the classroom.”

She hopes to apply her new knowledge and skills to provide greater patient-centred care. Ms Kok says she is also looking forward to pursuing a master’s degree to advance her nursing career.

She finds joy in caring for her patients and gaining their trust to improve their quality of life.

“The journey of nursing can be challenging but one must never give up. Find your internal drive that can help you to overcome the barriers. Lifelong learning is also essential for nurses to keep our skills sharp and think outside the box to handle any situation. No matter what type of nursing work you do, it all contributes to making a difference to patients’ lives,” she says.

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