Monday, December 19, 2016

Ang Mo Kio Thye Hwa Kuan (Week 1), 05 - 09 December 2016 - Reflection

By Bernard Goh - My first attachment in the Nursing course

Ang Mo Kio Thye Hwa Kuan

PHOTO: Ang Mo Kio Thye Hwa Kuan
Community Hospital at Ang Mo Kio, Healthcare & Medical Facilities
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Stepping in the entrance of Ang Mo Kio Thye Hwa Kuan marks the first step into the real application of Nursing. As I don on the uniform, it was a mixture of eagerness and anxiety to do what I had been looking forward to excel in. As this was my first attachment in the Nursing course, I would have naturally set some goals for myself.

As much as one would like to try and learn as many skills as possible through these 2 weeks, it is also understandable that from a student’s position, we would only be allowed to do a few of them.


I have told myself to keep an open mind and accept that practical application may differ from theoretical teachings. Secondly, seize as much opportunities to learn and absorb and maximize the usage of my time during my stay in AMK THK these 2 weeks as every moment counts. Lastly, expected the unexpected. Being in healthcare setting, we can never be too sure what will happen the next moment. Staying alert while keeping composed would help to ensure work is done while preventing myself from over-tiring mentally.


The first attachment in the Nursing course begins by adapting to a different professional healthcare environment other than the one at the educational institution.

PHOTO: The first attachment in the Nursing course begins by adapting to a different professional healthcare environment other than the one at the educational institution. Theoretical teachings and practical application may differ but are still the best ways to prepare ourselves for the job. On-the-job training is still the necessary part of the programme which every healthcare person has to go through in order to become competent in their work. The purpose of nursing attachment is to put into use what is being taught and practice in the classroom and the laboratory.
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At 0700am in the morning, I began the visual rounds together with my partner. Initially, we scanned through all the beds, patients and environment feeling somewhat calm yet uncertain as we are unaware of what to look out for specifically. Hence we could only start of by looking at the general impression and look out for things that we are certain.


It was not long until the first shocked came to me. One patient requested help to sit up and I was about to handle the patient without the awareness that he was under contact precaution. This gave me a stern warning to re-examine my visual rounds to make sure I did not miss out crucial information.


Many unexpected situations faces the new attachment students.

PHOTO: Many unexpected situations faces the new attachment students. One patient requested help to sit up and I was about to handle the patient without the awareness that he was under contact precaution. This gave me a stern warning to re-examine my visual rounds to make sure I did not miss out crucial information. Here is one experience of what an understudying nurse would gain in an attachment at AMK- THK hospital. There are many important soft-skills to develop, like patient - staff communication, relationship and bonding.
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Shortly after, we were gathered around to receive the report for the day. As expected, I was totally lost as I could not catch most of the information despite staring at the computer screen. There were too many short forms and jargons used that was still unfamiliar to me and it’s a clear sign that I needed to find out what they were.


However, time did not permit as we needed to prepare the patients for breakfast. Food trolleys rolled in as we standby to dispatch the food to the individual beds, taking note that we will always need to double check patient’s identification so that the right food is delivered to the right patient. As we were collecting the food, other staffs have already efficiently prepared the patients to receive the food by sitting them up or propping their beds.

Concurrently, medications are being prepared to be served either before or after meals. All these activities that are ongoing reflects how efficient and well versed the staffs are in their work, which is something that we are all expected to quickly pick up from.



Many medical short forms and jargons are used during the activities at the wards and there is no opportunity for unnecessary playing of words.

PHOTO: Many medical short forms and jargons are used during the activities at the wards and there is no opportunity for unnecessary playing of words. What is most important is the accuracy of information transfer. The vital needs and feelings of the patients cannot be compromised. We learned that sophisticated intellectual presentation does not contribute to overall professionalism of the healthcare industry; warm and caring attitudes does. Small little gesture counts a lot especially to those who are bedridden.
Surprisingly, normal people could understand the healthcare staffs better than the ascetics who are "characterised by severe self-discipline and abstention". Asceticism promote the self more than the contribution to holistic well-being of the community. That means there must be personal interconnections at all levels. Holistic care simply means taking into account mental and social factors, rather than just the symptoms of a disease. But it is not simple at all. There are many challenges and this is what all the staffs in AMK-THK are expert in handling.
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Subsequently in the day, I got to observed a few procedures that were going on between multiple patients. For those in my cubical, wounds dressing was observed as I watched how the staffs carried out the procedure. But more importantly, I was also looking out for how the patients respond and react before, during and after the procedure.


Patient transfer for fall risk patients was also observed. The lesson learnt was that it always better to be safe than sorry. Even though the staff assisting was a guy, he requested help from one more guy to ensure the transfer is almost perfectly safe. I learned that fall incidents of patient is a serious issue and should not be taken for granted in any case.


The staffs at Ang Mo Kio – Thye Hua Kwan Hospital focus their attention on both the patients and the attachment students.

PHOTO: The staffs at Ang Mo Kio – Thye Hua Kwan Hospital focus their attention on both the patients and the attachment students. They ensure that the patients have the best care and their needs are met. At the same time the staffs guide and monitor the students closely so that they can pick up the necessary skills. They put special emphasis on holistic care-giving but mindful of the needs of the care-givers too. Their efforts produce satisfied patients and competent healthcare personnel. The staffs are both exemplary care-givers as well as educators.
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Following up, my partner and I went to review the case folders of the patients under us. Our patients are mainly contact precautions with MRSA and high fall risk patients with difficulty in proper communication. Through this process, we could gather more information on our patients without personally interacting with them. I feel that benefit of this approach allows us to quickly get vital information that we may need to know so that we can act more appropriately.



Reviewing the case folders of the patients to get vital information in order to be able to act more appropriately.

PHOTO: Reviewing the case folders of the patients to get vital information in order to be able to act more appropriately. Then doctors, nurses, therapists and dieticians work closely to chart a customised rehabilitation plan for every patient. At Ang Mo Kio – Thye Hua Kwan Hospital, while the staffs strive for clinical and service excellence, they also help the patients to achieve total independence at the end of their stay.
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One of the more tiring procedures would be the bathing of patients. The difficulty level would depend greatly on the condition and the level of independence of the patient. Such procedures of cleaning patients and handling their waste have been commonly frowned upon by outsiders who do not understand importance of these procedures. To me the patients are in need and we are here to care for them, as simple as that, which is why we are healthcare professionals.


Through the process of simply helping them to bathe, many other nursing skills were involved. Proper patient transfer, the amount of details to looking for when cleaning, looking out for any equipment attached to their bodies, communication and interpretation of patient’s level of comfort through non-verbal cues.


Cleaning patients involve handling their waste, proper patient transfer, helping them to bathe, communication and interpretation of patient’s level of comfort through non-verbal cues.

PHOTO: Cleaning patients involve handling their waste, proper patient transfer, helping them to bathe, communication and interpretation of patient’s level of comfort through non-verbal cues. Different patient requires different approaches and methods. The difficulty level would depend greatly on the condition and the level of independence of the patient.
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Next up was vital sign taking. This was initially thought to be the less challenging procedure, but to me surprised I was faced with some difficulty as well, which reminded me again on the situation of expecting the unexpected. For me, I encountered a patient who made 2 short inspiration in 1 complete breath. This caught me off guard as I wasn’t sure of how to count. Subsequently, there was a patient who keep on shaking while I was trying to keep track of his respiration rate, which proved to be another challenge as it was difficult to communicate the message across to the patient to stop shaking.



Vital sign taking is a challenge when the patient are in the critical stage.

PHOTO: Vital sign taking is a challenge when the patient are in the critical stage. Those who are in critical stages, for example, comma patients, different skills are required to interpret and record the readings from the measurements.
Vital signs definition: The pulse rate, blood pressure, body temperature, and rate of respiration of a person. The vital signs are usually measured to obtain a quick evaluation of the person's general physical condition.
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Lastly, was the experience with nasogastric tube feeding. Although the steps was exactly like how the school has thought us, it was inevitable that nervousness sets in as it was the first time performing the procedure on a real patient. However, it was also due to the school’s teaching that keep us in check of safety. For example, we are always observing the 6 rights of patients, making sure we perform the feeding with utmost proficiency, preparing the equipment beforehand to improve efficiency and much more.

In conclusion, my take away from the first week of attachment is that nursing is more than just technical skills and theory. Many other soft skills and adaptability to different situations are equally important as well in helping us manage ourselves to ensure the best outcome for not only the patient but ourselves as nurses too.

By Bernard Goh - My first attachment in the Nursing course (Week 1)


The school’s teaching prepare and keep us in check of safety, the 6 rights of patients, and many technical skills.
PHOTO: The school’s teaching prepare and keep us in check of safety, the 6 rights of patients, and many technical skills.  AMK-THK give us opportunity to learn soft skills and adaptability to different situations. With the skill and experience gained, I am looking forward to serve as a healthcare professional, when I successfully graduate from school. But at the moment I am beginning to feel sad about leaving the patients, although they are still in very good hands.
Posted by Sharon Tang on Thursday, 20 December 2012 - Live Caricature Service in Thye Hua Kwan Hospital for the Year End Party
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An afternoon-event at Thye Hua Kwan hospital, the staffs lined up and waited to get the caricature done.

PHOTO: An afternoon-event at Thye Hua Kwan hospital, the staffs lined up and waited to get the caricature done. Staffs enjoyed their job as always, when seeing all the happy faces around. They were curious to see the cartoon version of themselves.
Posted by Sharon Tang on Thursday, 20 December 2012 - Live Caricature Service in Thye Hua Kwan Hospital for the Year End Party
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Reference