#AskOurNurses is an initiative where we invite nurses from various hospital departments to share more about the department, and what it is like to be a nurse in their respective departments.
We have SNM HOUY LING from YISHUN HEALTH COMMUNITY NURSING to share about Community Health Nursing, and address some of the questions you have posted on our IG story. The following are the questions that our guest speaker have answered.
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Qn: Describe Community Health Nursing in 1 word.
SNM Houy Ling: Community nursing in 1 word, I would use excitement. Because community nursing is full of excitement that we will meet and interact with different types of residents in the community.
Qn: How do you juggle so many things at once?
SNM Houy Ling: Through the work of experience and multitask is a potential skill in nursing to master. Some of the following advice may be useful to a novice nurse:
Make a task list and prioritise it
· Start your day with a list, make notes of everything you need to do
· To prioritise the situation and complete the most important things first, put first things first.
Delegating
· Learn to delegate work to your junior staff, so you can prioritise on the critical tasks and accomplish them on time.
Focus
· To stay focus and avoid distractions when you are doing the important tasks with patients such as administering medication and performing procedures.
Qn: What is your self-care routine like?
SNM Houy Ling: Over the past 2 years since the pandemic, it has been a challenging and stressful environment for community nurses as they get deployed out to the acute care setting to help out and assist in the outbreak management in nursing homes and community. Our nurses go out to do screening and swab tests for these residents.
I like to listen to soothing music, drawing (oil painting), playing my instrument (guitar) and singing.
I also read the bible and pray for my spiritual health.
Once in a while, I would treat myself with a good massage and facial.
Qn: What is the most challenging task as a community nurse?
SNM Houy Ling: One of the challenges that our community nurses may face is environmental safety. For example, when they go to a resident’s house alone, they need to do a proper environmental safety assessment because we do encounter residents with mental health issues and alcohol abuse.
Qn: Where do community nurses work in general?
SNM Houy Ling: Our community nurses work in the community. We (i) visit the patients in their homes, (ii) we see patients at the community health post. Community Health Post can be situated at our HDB void decks at the senior activity centres. We usually work together with our community partners. Yishun has 3 wellness Kampung, which allows the residents to come in and participate in activities and exercise programmes. Our nurses do run some of the programmes on a weekly basis. So that is the difference between acute care and community nurses.
Qn: What are the core roles and responsibilities of a community nurse?
SNM Houy Ling: Let me share how a day like as a community nurse. We start off our day with a house visit to our resident. Before we go out to a resident’s home, we will prepare all the necessary preparations in the office. For example, we will read through the patient’s medical record who are hospital-discharged patients. They are getting better and hence can be discharged home. So our community nurses will visit them in 1 to 2 weeks time to check on them if their condition is maintained and stable to help them slowly transit to the community. In the morning, community nurses will prepare all the equipments required in a backpack or trolley bag. In one day, community nurses may visit up to 4 patients.
Our community nurses will also be scheduled to run the Community Health Post (CHP). They will be stationed in the post where residents will walk in to see our nurses. They will run in the post from 9 am to 12pm where they will typically see about 8 to 10 residents. In the afternoon, our nurses can choose to stay at the post, if not they can come back to the office to complete their documentation.
Qn: What is the process like for a novice nurse to become a community nurse?
SNM Houy Ling: Before joining as a community nurse, you need to have strong foundation in clinical practice, particularly in acute care setting for a minimum 2-3 years of experience. This foundation is paramount for a community nurse to prepare you for work in the community.
As a community nurse, you need to equip with strong clinical knowledge, critical thinking and clinical reasoning because when you are out in the community (home visits or Community Health Post), you are requiring to perform physical assessment, history taking of bio-psychosocial aspects, to be able to identify red flag and escalate to the physician accordingly.
The nurse will need to go through a comprehensive assessment and competency skills assessment such as physical assessment skills by APN, case presentation to physician after your home visit assessment. During this process, they will have a preceptor to partner them for the initial 2 to 3 months.
Qn: Are there any cons to community nursing?
SNM Houy Ling: Be aware of the stress and burnout, particularly the emotional and mental stress as a community nurse.
As a community nurse, unlike inpatient and outpatient nurse, we hold our patients or residents till they are stable with their medical condition, it could be 3 to 6 months’ duration. For Community Health Post, we see residents on weekly basis, we provide chronic disease education and self-management skills, so they are able to manage their long term condition well without the need to visit A&E.
Qn: How long have you been in the community nursing?
SNM Houy Ling: This would be my fourth year.
Qn: What is your most memorable interaction with a resident?
SNM Houy Ling: There is a resident referred by community partner. A 70 years old lady, staying with her husband who is 2 years older than her. She has multiple comorbidity (diabetes, hypertension, hyperlipidemia, coronary heart disease) and suffers from major depressive disorder. She moved from Jurong to Yishun and did not go back to Jurong for her medical appointment as distance is an issue for her.
She has 16 medications in the list but she did not take any of them, because she is confused about her medication, and doesn't know where to start. Upon examining and assessing her, BP was very high 200/94 mmHg and BGM was high 13.8mmol/L, she is depressed over her psychosocial issues.
Our team of community nurses built a relationship with her and her husband, educated her on the importance of taking the medication for her BP and BGM control, provided her with dietary and exercise advice and linked her back to the community partner to join their activities.
We taught her and her husband on self monitoring of BP and BGM, now they know how to monitor her own condition and seek for advice if needed.
For a medical appointment, we managed to help to link her back to medical care at Yishun and reviewed by a Geriatrician, reducing her 16 medications to 8 medications now. She knows how to manage her medication now and taking it on a daily basis.
She is able to comply with medication, appointments, follows the recommended diet, exercise regularly, familiar with community resources and even volunteers at the Senior activity centre.
In community, we are able to achieve high job satisfaction, allowing for increased one-to-one patient care where you can spend the totality of the time with the patient in question, uninterrupted by other tasks, other staff or patients.
Lastly, we develop problem-solving, organisational skills, critical thinking and clinical reasoning skills as a community nurse. It was a rewarding and life-long learning experience as a community nurse.
Qn: Do you have any advice for students/nurses who wish to join community nursing?
SNM Houy Ling: Firstly, you need to have a strong clinical skills, judgement and reasoning. You also need to change your mind-set and perspective about the patients. You need to have an open-mind, non-judgemental and be objective on the assessment of the situation. Each resident in the community is unique and different, every one of them has their own personal life experiences, stories and struggles.
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