Aim The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are im... more Aim The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. Method A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generali...
AIM To examine the effectiveness of an integrated three-mode bed exit alarm system in reducing in... more AIM To examine the effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care hospital setting in Singapore. METHOD A retrospective before-and-after study design was adopted. RESULTS Our results revealed that the use of bed exit alarms are associated with a reduction in falls incidence. CONCLUSION Bed exit alarm systems are associated with reduced fall incidence. Nonetheless, for an institution to benefit from the technology, there will be a need to take into account the effects of "alarm fatigue", ability of nurses to respond in time to alarms, and selection of right alarm mode/limits based on the patient's profile.
BACKGROUND Employing serious game for assessing nurses' blood transfusion knowledge and skill... more BACKGROUND Employing serious game for assessing nurses' blood transfusion knowledge and skill competency has gained interest among nurse educators worldwide. However, its acceptance by nurses has not been fully explored. AIM To explore the registered nurses' experiences using serious game for nursing skills competency and gather feedback to improve the quality of learning using serious game. SETTING Acute tertiary hospital in Singapore. PARTICIPANTS Registered nurses in inpatient settings. METHODS This qualitative evaluation and feedback improvement study was conducted in an acute tertiary hospital in Singapore between September 2019 and November 2019. Registered nurses who had completed the blood transfusion knowledge and skills competency via the serious game platform were invited to participate in this study. Individual face-to-face interviews using a semi-structured questionnaire were conducted. All interviews were audio-recorded and transcribed verbatim. Data analysis w...
Wound Practice & Research: Journal of the Australian Wound Management Association, 2017
Background: Pressure injuries lead to lower quality of life and incur substantial health care res... more Background: Pressure injuries lead to lower quality of life and incur substantial health care resources and costs. Pressure injury prevention is reported to be much cheaper than treatment of the condition itself. Aim: To evaluate the incremental effectiveness of silicone foam dressing and fatty acids oil spray, in addition to standard care, in preventing sacral pressure injuries among high-risk patients. Method: A randomised controlled trial (RCT) was conducted. Using simple random sampling, patients were allocated into one of the three groups: (1) Silicone foam dressing plus standard care; (2) fatty acids oil spray plus standard care; (3) standard care only. Results: Four hundred and sixty-one patients were recruited. Of these, 3.9% (n=5) developed pressure injuries in the silicone foam dressing group, 5.4% (n=7) developed pressure injuries in the fatty acids oil group and 5% (n=10) developed pressure injuries in the standard care group. The difference was not statistically signifi...
Background:There was a change in rostering practice from a regular three-shift system to an irreg... more Background:There was a change in rostering practice from a regular three-shift system to an irregular three-shift system.Objective:This study observed the trend of absenteeism before and after a ch...
Ineffective communication, during handover, is a major factor in subsequent incidents and patient... more Ineffective communication, during handover, is a major factor in subsequent incidents and patient harm. There is a dearth of evidence on the quality of handovers in a multi-cultural, multi-lingual and cohort care setting, such as in Singapore. This is the first Singaporean study aimed to observe, analyse and evaluate clinical handover by nurses. Fifty shift-to-shift handovers were observed and video-recorded. Content and discourse analyses were used and focused on informational, structural and interactional dimensions of handover. Findings revealed that patient safety information was sometimes missed out. The transfer of responsibility and accountability for ongoing patient care was not explicit and poor information framework and flow during the handover process were observed. Some nurses preferred to perform physical assessments prior to handover instead of during or afterwards. Patients’ background and medical history were either not mentioned at handover commencement or excluded....
BACKGROUND Antimicrobial stewardship programs are essential to reduce the risks of antimicrobial ... more BACKGROUND Antimicrobial stewardship programs are essential to reduce the risks of antimicrobial resistance. METHODS A cross sectional survey was used to evaluate nurses' knowledge and perceptions of antimicrobial stewardship. RESULTS Of 241 nurses recruited, 22.9% reported good knowledge of antimicrobial stewardship. Nurses agreed that ensuring appropriate antimicrobial use, hygiene for preparation, administration and disposal of antibiotics, as well as educating colleagues, patients and public were vital. Many felt that to reduce the impact of antimicrobial resistance, AMS should be included in the undergraduate nursing curriculum. CONCLUSIONS Improving the awareness of and education on AMS and AMR among nurses is an essential element in infection and prevention control.
BACKGROUND The current practice of fluid intake and output monitoring for hospitalised patients i... more BACKGROUND The current practice of fluid intake and output monitoring for hospitalised patients in one local acute care tertiary hospital was unclear and inconsistent. Inaccurate fluid balance monitoring and poor documentation can result in poor clinical outcomes. AIM To provide an overview of the current practice of ordering, monitoring and documentation of patient fluid intake and output during hospitalisation. METHODS Electronic charts of 2199 adults were reviewed for appropriateness and accuracy of monitoring and documentation of the fluid balance records. Data retrieved for each patient included: (1) Was daily fluid balance monitoring clinically indicated? (2) Was daily fluid balance monitoring prescribed by the doctors or initiated by the nurses? (3) Was the daily fluid balance documentation accurate for the entire admission? FINDINGS Of the reviewed patients, 68% were on fluid balance monitoring, of whom 31% were prescribed by medical teams and 69% were nurse-initiated. Among...
Background Mindfulness-based intervention (MBI) has not been evaluated for its feasibility and ef... more Background Mindfulness-based intervention (MBI) has not been evaluated for its feasibility and effectiveness in reducing stress and anxiety among family caregivers of patients on peritoneal dialysis (PD). Objectives (1) To evaluate the feasibility to include MBI during PD training for family caregivers. (2) To determine the effect of MBI on the caregivers’ levels of stress (perceived stress scale, PSS), anxiety state-trait anxiety inventory, STAI), QOL (short-form 36) and reactions to caregiving (caregiver reaction assessment, CRA). (3) To determine differences in the health-related QOL (Kidney Disease Quality of Life Instrument-Short Form, KDQOL PCS and SF-36 MCS) of care recipients with caregivers receiving MBI at 1 month, 3 months and 6 months when compared to those with caregivers receiving routine training. (4) To gather the caregiver’s feedback on the MBI. Methods This feasibility study recruited family caregivers to receive either mindfulness training (MT) or treatment-as-usu...
Introduction: Nurses are encouraged to engage in research activities in order to stay abreast wit... more Introduction: Nurses are encouraged to engage in research activities in order to stay abreast with the current nursing practice. However, limited knowledge about the research process may influence their level of involvement and utilisation of research in their daily nursing practices. This study examines Singapore nurses' perceived knowledge and educational needs in research as well as to explore their preferred mode and duration of education delivery. Methods: This is a multi-site, cross-sectional study that recruited 2248 registered nurses working in Singapore. A self-administered tool was used to examine nurses' perceived knowledge and educational needs in research. Descriptive statistics were used to present the nurses' demographic data; the Kruskal-Wallis and chi-square tests were used to examine the relationship between the nurses' education level and their perceived knowledge and educational needs in research. Results: Nurses in this study perceived low levels of knowledge in research. Majority of those who were involved in research activities had a bachelor's degree. There were statistically significant differences between education level and perceived knowledge (p=0.001). However, there was no significant difference between education level and perceived educational needs. Younger nurses (19–35 years old) preferred shorter duration when attending workshops compared to older nurses (36 years old and above). Skill-based workshop and tutorial or seminar that last no longer than a week was the most preferred educational mode and duration. Conclusion: Nurses with high level of education perceived a higher level of research knowledge and thus reported lower educational needs in research. The results showed the need for continual training programs, even for nurses with bachelor's and master's degrees, in order to better prepare them for evidence-based practice. Understanding the demographic of the nurses and their learning styles is important when devising strategies to teach research.
Aims: This study aimed to identify the prevalence and circumstances of the use of physical restra... more Aims: This study aimed to identify the prevalence and circumstances of the use of physical restraints, complications associated with its use and its association with patients’ characteristics. Methods: This is a prospective observational study design. A convenience sample of elderly patients (aged 65 and above) who were admitted to an acute care hospital from February 2012 to August 2012 were tracked daily to monitor the use of physical restraints during hospitalization. Patient-related variables and type of physical restraint used were gathered from the medical records and the Multi-Dimensional Dementia Assessment Scale was completed through interviews with nurses who had cared for the patients. Independent t-test or Chi-square (χ2) tests were used to examine the effect of a single variable on the use of physical restraints. Multiple logistic regression was done to predict the patient-related variables to the likelihood of being placed on physical restraints. Results: Altogether, 9...
With strict measures in place to contain the spread of coronavirus disease 2019, many have been i... more With strict measures in place to contain the spread of coronavirus disease 2019, many have been isolated as suspected or confirmed cases. Being isolated causes much inconvenience for the patients and family. Patients' and next-of-kins’ needs and concerns during isolation will be shared together with suggestions for key process improvements. Our hospital’s Senior Patient Experience Managers contact all patients admitted to the isolation wards on a daily basis to provide some form of support. Common issues raised were gathered and strategies to help with their needs and concerns were discussed. Being in isolation is a challenging period for both patients and family. Nonetheless, we can implement measures to mitigate against the adverse effects of isolation. Patient education, effective and efficient means of communication, close monitoring for signs of distress and anxiety, and early intervention could help patients cope better with the whole isolation experience. Nursing management may want to consider implementing the measures shared in the article to manage patient’s stress while not compromising on staff safety.
Aim The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are im... more Aim The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. Method A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generali...
AIM To examine the effectiveness of an integrated three-mode bed exit alarm system in reducing in... more AIM To examine the effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care hospital setting in Singapore. METHOD A retrospective before-and-after study design was adopted. RESULTS Our results revealed that the use of bed exit alarms are associated with a reduction in falls incidence. CONCLUSION Bed exit alarm systems are associated with reduced fall incidence. Nonetheless, for an institution to benefit from the technology, there will be a need to take into account the effects of "alarm fatigue", ability of nurses to respond in time to alarms, and selection of right alarm mode/limits based on the patient's profile.
BACKGROUND Employing serious game for assessing nurses' blood transfusion knowledge and skill... more BACKGROUND Employing serious game for assessing nurses' blood transfusion knowledge and skill competency has gained interest among nurse educators worldwide. However, its acceptance by nurses has not been fully explored. AIM To explore the registered nurses' experiences using serious game for nursing skills competency and gather feedback to improve the quality of learning using serious game. SETTING Acute tertiary hospital in Singapore. PARTICIPANTS Registered nurses in inpatient settings. METHODS This qualitative evaluation and feedback improvement study was conducted in an acute tertiary hospital in Singapore between September 2019 and November 2019. Registered nurses who had completed the blood transfusion knowledge and skills competency via the serious game platform were invited to participate in this study. Individual face-to-face interviews using a semi-structured questionnaire were conducted. All interviews were audio-recorded and transcribed verbatim. Data analysis w...
Wound Practice & Research: Journal of the Australian Wound Management Association, 2017
Background: Pressure injuries lead to lower quality of life and incur substantial health care res... more Background: Pressure injuries lead to lower quality of life and incur substantial health care resources and costs. Pressure injury prevention is reported to be much cheaper than treatment of the condition itself. Aim: To evaluate the incremental effectiveness of silicone foam dressing and fatty acids oil spray, in addition to standard care, in preventing sacral pressure injuries among high-risk patients. Method: A randomised controlled trial (RCT) was conducted. Using simple random sampling, patients were allocated into one of the three groups: (1) Silicone foam dressing plus standard care; (2) fatty acids oil spray plus standard care; (3) standard care only. Results: Four hundred and sixty-one patients were recruited. Of these, 3.9% (n=5) developed pressure injuries in the silicone foam dressing group, 5.4% (n=7) developed pressure injuries in the fatty acids oil group and 5% (n=10) developed pressure injuries in the standard care group. The difference was not statistically signifi...
Background:There was a change in rostering practice from a regular three-shift system to an irreg... more Background:There was a change in rostering practice from a regular three-shift system to an irregular three-shift system.Objective:This study observed the trend of absenteeism before and after a ch...
Ineffective communication, during handover, is a major factor in subsequent incidents and patient... more Ineffective communication, during handover, is a major factor in subsequent incidents and patient harm. There is a dearth of evidence on the quality of handovers in a multi-cultural, multi-lingual and cohort care setting, such as in Singapore. This is the first Singaporean study aimed to observe, analyse and evaluate clinical handover by nurses. Fifty shift-to-shift handovers were observed and video-recorded. Content and discourse analyses were used and focused on informational, structural and interactional dimensions of handover. Findings revealed that patient safety information was sometimes missed out. The transfer of responsibility and accountability for ongoing patient care was not explicit and poor information framework and flow during the handover process were observed. Some nurses preferred to perform physical assessments prior to handover instead of during or afterwards. Patients’ background and medical history were either not mentioned at handover commencement or excluded....
BACKGROUND Antimicrobial stewardship programs are essential to reduce the risks of antimicrobial ... more BACKGROUND Antimicrobial stewardship programs are essential to reduce the risks of antimicrobial resistance. METHODS A cross sectional survey was used to evaluate nurses' knowledge and perceptions of antimicrobial stewardship. RESULTS Of 241 nurses recruited, 22.9% reported good knowledge of antimicrobial stewardship. Nurses agreed that ensuring appropriate antimicrobial use, hygiene for preparation, administration and disposal of antibiotics, as well as educating colleagues, patients and public were vital. Many felt that to reduce the impact of antimicrobial resistance, AMS should be included in the undergraduate nursing curriculum. CONCLUSIONS Improving the awareness of and education on AMS and AMR among nurses is an essential element in infection and prevention control.
BACKGROUND The current practice of fluid intake and output monitoring for hospitalised patients i... more BACKGROUND The current practice of fluid intake and output monitoring for hospitalised patients in one local acute care tertiary hospital was unclear and inconsistent. Inaccurate fluid balance monitoring and poor documentation can result in poor clinical outcomes. AIM To provide an overview of the current practice of ordering, monitoring and documentation of patient fluid intake and output during hospitalisation. METHODS Electronic charts of 2199 adults were reviewed for appropriateness and accuracy of monitoring and documentation of the fluid balance records. Data retrieved for each patient included: (1) Was daily fluid balance monitoring clinically indicated? (2) Was daily fluid balance monitoring prescribed by the doctors or initiated by the nurses? (3) Was the daily fluid balance documentation accurate for the entire admission? FINDINGS Of the reviewed patients, 68% were on fluid balance monitoring, of whom 31% were prescribed by medical teams and 69% were nurse-initiated. Among...
Background Mindfulness-based intervention (MBI) has not been evaluated for its feasibility and ef... more Background Mindfulness-based intervention (MBI) has not been evaluated for its feasibility and effectiveness in reducing stress and anxiety among family caregivers of patients on peritoneal dialysis (PD). Objectives (1) To evaluate the feasibility to include MBI during PD training for family caregivers. (2) To determine the effect of MBI on the caregivers’ levels of stress (perceived stress scale, PSS), anxiety state-trait anxiety inventory, STAI), QOL (short-form 36) and reactions to caregiving (caregiver reaction assessment, CRA). (3) To determine differences in the health-related QOL (Kidney Disease Quality of Life Instrument-Short Form, KDQOL PCS and SF-36 MCS) of care recipients with caregivers receiving MBI at 1 month, 3 months and 6 months when compared to those with caregivers receiving routine training. (4) To gather the caregiver’s feedback on the MBI. Methods This feasibility study recruited family caregivers to receive either mindfulness training (MT) or treatment-as-usu...
Introduction: Nurses are encouraged to engage in research activities in order to stay abreast wit... more Introduction: Nurses are encouraged to engage in research activities in order to stay abreast with the current nursing practice. However, limited knowledge about the research process may influence their level of involvement and utilisation of research in their daily nursing practices. This study examines Singapore nurses' perceived knowledge and educational needs in research as well as to explore their preferred mode and duration of education delivery. Methods: This is a multi-site, cross-sectional study that recruited 2248 registered nurses working in Singapore. A self-administered tool was used to examine nurses' perceived knowledge and educational needs in research. Descriptive statistics were used to present the nurses' demographic data; the Kruskal-Wallis and chi-square tests were used to examine the relationship between the nurses' education level and their perceived knowledge and educational needs in research. Results: Nurses in this study perceived low levels of knowledge in research. Majority of those who were involved in research activities had a bachelor's degree. There were statistically significant differences between education level and perceived knowledge (p=0.001). However, there was no significant difference between education level and perceived educational needs. Younger nurses (19–35 years old) preferred shorter duration when attending workshops compared to older nurses (36 years old and above). Skill-based workshop and tutorial or seminar that last no longer than a week was the most preferred educational mode and duration. Conclusion: Nurses with high level of education perceived a higher level of research knowledge and thus reported lower educational needs in research. The results showed the need for continual training programs, even for nurses with bachelor's and master's degrees, in order to better prepare them for evidence-based practice. Understanding the demographic of the nurses and their learning styles is important when devising strategies to teach research.
Aims: This study aimed to identify the prevalence and circumstances of the use of physical restra... more Aims: This study aimed to identify the prevalence and circumstances of the use of physical restraints, complications associated with its use and its association with patients’ characteristics. Methods: This is a prospective observational study design. A convenience sample of elderly patients (aged 65 and above) who were admitted to an acute care hospital from February 2012 to August 2012 were tracked daily to monitor the use of physical restraints during hospitalization. Patient-related variables and type of physical restraint used were gathered from the medical records and the Multi-Dimensional Dementia Assessment Scale was completed through interviews with nurses who had cared for the patients. Independent t-test or Chi-square (χ2) tests were used to examine the effect of a single variable on the use of physical restraints. Multiple logistic regression was done to predict the patient-related variables to the likelihood of being placed on physical restraints. Results: Altogether, 9...
With strict measures in place to contain the spread of coronavirus disease 2019, many have been i... more With strict measures in place to contain the spread of coronavirus disease 2019, many have been isolated as suspected or confirmed cases. Being isolated causes much inconvenience for the patients and family. Patients' and next-of-kins’ needs and concerns during isolation will be shared together with suggestions for key process improvements. Our hospital’s Senior Patient Experience Managers contact all patients admitted to the isolation wards on a daily basis to provide some form of support. Common issues raised were gathered and strategies to help with their needs and concerns were discussed. Being in isolation is a challenging period for both patients and family. Nonetheless, we can implement measures to mitigate against the adverse effects of isolation. Patient education, effective and efficient means of communication, close monitoring for signs of distress and anxiety, and early intervention could help patients cope better with the whole isolation experience. Nursing management may want to consider implementing the measures shared in the article to manage patient’s stress while not compromising on staff safety.
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