18/12/24: SHARINGS AND WARD VISITS

First, we listened to an introductory sharing by Grace Lee, Senior Director of HR. I learnt about the history of SACH, how it grew and currently works together with CGH (integrated building). She also shared the differences between working in other acute hospitals, private hospitals and community hospitals but summarised how although there are different challenges for different sectors, all serve with the same purpose. She also addressed many common stereotypes like in which sector who earns more, which was quite interesting to hear. Some issues like balancing ethical issues and practicality in hospitals were also brought up, especially when it comes to how much treatment a patient is receiving. 

Following was a brief sharing by Hui Ying, a Nurse Educator. Nursing for her is rewarding as she faces something new everyday, which keeps her going and that was inspiring to hear even as the job hours itself seems tiring. I learnt about the career progressions and paths of a nurse, such as a nurse educator, advanced practitioner nurse (where education is fully subsidised), nurse inspector etc, which help me realise how broad nursing can be.

Next, we sat through an infection control sharing by Gabriel, a Senior staff nurse who very enthusiastically demonstrated the 7-step hand hygiene, wearing and removing of gloves, masks, aprons to us, as well as the importance of PPE. My friends and I definitely had fun learning with the gloves and aprons provided for us. 

We then visited the variety of wards like the sub-acute, dementia and palliative wards, which all had very different atmospheres. 

Specially for the dementia ward, the wallpapers, garden, decor and special rooms like the quiet rooms were all suited for the patients. Even the door had a bookshelf wallpaper for patients not to see it as an exit. I was impressed at the degree of meticulousness the hospital took, and learnt about things like bright therapy and sundown syndrome, where patients suddenly get more agitated when the sun is down. The nurses there shared with us about how they engage with the patients daily, for example, by getting volunteers to come in every morning or afternoon to tire them out, so that the patients need not rely on medicine to fall asleep at night. I also learnt that there are many types of dementia and dementia patients retain their childhood memories more than the recent past / present memories. 

The palliative ward was intriguing too, with the isolation and counselling rooms, and flytraps for hygiene purposes. At first, I thought the atmosphere would be dull, but then I saw a patient with such a cheerful temperament and teasing the nurses and patients around him. This led me to change my perspective of the attitudes that a patient in a palliative ward could possess. The OT there shared with us their role, to help patients fulfil their last wishes instead of enhancing their cognitive abilities, like learning how to write letters to loved ones. To me, this reflected meaning in which not every individual gets the chance to help others in this unique way and is something I would be honoured to do as my career. 

Lastly, we went to the sub-acute wards, which was very high-tech! There were blue lights which will light up every time a patient is out of their bed. There was even a camera on each housing, which were thermal detectors. I am enthralled by how technology is intertwined with healthcare and am looking forward to seeing how healthcare can further utilise technological tools. This ward mainly contains of patients currently at post-stroke condition and rehabilitation, and is noticeably more spacious and open. The amount of space were for machines that could guide patients to gain back their muscular ability etc.

We also managed to ask two NUS Nursing students in their first year of study, and they were at SACH for 2 weeks as their first attachment. I learnt that this course also covers research methodologies about nursing, consists of many attachements in the future (eg IMH in year 2), and the path to further degrees is not simple. I could really tell their passion for nursing as one of them had initially followed her parent's decision but when it came to university applications, she wanted to pursue something she really wanted, hence she ended up in this course.

19/12/24: A DAY IN THE DAY REHAB CENTRE 

• Job shadowing with OT (Zhu Er, senior OT)

When observing her sessions, I noticed how detailed she had to be, especially for stroke patients where their left side is cognitively degraded, she intentionally sat beside the patient's left side, and carried out games which required attention from the left.  Initially I was curious as to how she knew what to do for every patient, but she clarified how she used to plan for patients at first and over time gained more knowledge as to how to better carry out her therapy sessions.

There was a patient who suffered from a traffic accident, whose goal was to play table tennis again, so the OT did weight and finger training so he could grip and play with strength. She also made the patient practice his turning by placing cones around him and giving him hoops to put on the cones. These were vital to help the patient regain his arm strength and stamina to go back to playing his favourite sport, which was heartwarming to see that such a job exists, to restore people physically back into their purpose. There was another patient with stroke, so the OT used virtual games like sorting out fruits and vegetables into two baskets and there was a trend as to how she kept missing out the left basket. The OT also fused together a sorting and word game together. By intentionally placing the cards that the OT wanted the patient to find on the left side, this could bring to her attention that she is missing out things on the left. Then she had to form sentences with the words found on the cards too.

When I asked her about the difference between OT and PT, she mentioned that OT comprises of more tabletop activities compared to PT, more on detailed actions and upper limbs compared to PT where they focus a lot on lower limbs and arms etc. She also mentioned that she preferred OT because there were more math and calculations in PT which did not suit her, and she also found community hospitals to be her interest over the span of university attachments in SIT. This stood out to me as I realised the importance of exposing myself to various healthcare settings. I also learnt that there are different branches of OT, like house therapists, IMH OTs, pediatric OTs, palliative care OTs, acute and community care OTs etc. When I asked about home therapy, she said how they need to work with other therapists / psychiatrists / community nurses to help change their home environment, need to decide what kind of bar to use, what length and cost constraints, where to install them etc.

• Job shadowing with PT (Khoo Wei Kee, senior PT)

She shared about her reason for pursuing PT, as she feels more inclined to make patients with different goals more motivated to recover. PTs also mainly practice more strenuous activities like walking up the stairs, kicking, walking through obstacles and picking up items on the ground. The PT also mentioned how many take their movement for granted until they lose it, which led me to be more appreciative of my physical abilities. As I observed her sessions, she was also very detailed as she warned the patient to be more aware of what he should do if he accidentally hits something on the ground, as she noticed the patient lifted his leg up more abruptly after hitting an obstacle on the ground, which exposes his risk to injury due to sudden movement and heightened pressure while landing. This made me realise the importance of being observant and quick to inform as a therapist.

At the DRC, there is also gym memberships with therapy assistants and a customised gym plans where the patients will scan their card in the machines and the plans will be generated automatically. This raises concerns regarding Singapore's current public gyms as they do not cater to rehab patients and can be inconvenient for them, due to the lack of equipping of trainers and equipment. For therapy assistants there, they help both OT and PT in SACH, but some help according to their degrees. They mainly help the patients walk around to machines and stations too.

20/12/24: PALLIATIVE WARD, PT V OT

• Job shadowing ITs (In-patient therapy)

I was fortunate enough to visit the palliative ward with one of my friends, and we played bingo with a few patients. Although I had previously played bingo with the typical seniors at active ageing centres, this was a more personal experience as there were only 5 of the seniors we could converse with. We managed to learn hokkien in numbers with the therapy assistant and the patients. They were all laughing at us because we kept on forgetting as we tried to read out the bingo numbers in hokkien. I was impressed by one of the patients who could speak 7 languages and they were all self-taught! They also shared lots of past stories about their younger self, their careers and things they like really anchored the conversations between me and the patients. I noticed how all of them were very talented in their own ways despite not being able to express themselves verbally at times. The OTs also mentioned how it is important to let them sit up instead of lying all the time. A fun fact I learnt: If a patient with diabetes wanted ice cream and is able to consume it, the nurses would simply give since they are in a palliative ward. We also got to try their blended moist fruit that patients usually get if they are unable to swallow solid foods, as well as a baked cookie by one of the patients. Overall, we had a really good time :D

• Sharing by Mr Galvin (Senior OT)

Mr Galvin shared more in-depth as to what OT was all about. Fulfilling a certain goal in life includes activities of daily living (ADL) such as self-play, leisure, school, work, etc. More so, the "occupation" refers to the ADL that an individual finds meaningful. He also shared how OTs are like the jack of all trades but master of none, as they cover the mental and physical aspect, and even do activity analysis and modification and many more. Compared to PT which focuses on strength rehabilitation, OT prioritises the breaking of simple movements into small steps in order to achieve improvement.

In SACH, there are many factors to consider. The first was physical rehabilitation followed by discharge planning. OTs look more at the patient's quality of life and mental wellbeing, and I remember the perspective that he shared, of how OTs should face their patients with what matters to them instead of asking what's the matter with them. I like how OTs are able to help others according to what they prioritise and hold dear, instead of giving a standard service all the time which can be repetitive. Discharge planning was interesting too, as he shared about the myriad of devices and furniture to store in the patient's house that the OTs have to decide. Training the patients to use motorized training and assistive devices is also required to ensure they continue to keep in a decent condition even as they are discharged. There is also a thing called caregiver training where OTs have to ensure that caregivers have the functional mobility and level of assistance that the patient requires for his ADLs. SACH has a taxi model to train caregivers how to manoeuvre the patient safely in and out of such vehicles.

In the community hospitals, there are also group activities for patients, especially those who lack confidence in engaging in social activities, to help them gain some social skills. OTs also form physical and leisure activity groups, pre-discharge groups and discuss about home safety and equipment.

Mr Galvin also shared with us the details of each of the wards. For sub-acute wards, they stay less than 2 weeks and tend to be more medically unstable. In the dementia wards, OTs engage in reminiscence therapy, sensory stimulation and cognitive stimulation activities and make us of what the patients like to do previously to let them regain their memories, dignity, identity, mastery. Even if they do not verbally express or are not able to, they can always feel these intangibles. In the palliative ward, they focus on the patient's being instead of doing, to allow patients to continue contributing to other's lives despite their medical conditions. Hence, when they do activities like cooking, the patients usually instruct but do not do the physical cooking, so there is more engagement over participation. The OT interventions there tend to be legacy work, comfort care and positioning, fulfilment of last wishes, and education on breathing exercises and techniques. Even in the palliative ward, I am amazed at how OTs are able to teach niche physical techniques as well as being able to handle with heavy emotions. 

• Job shadowing with Mr Austria Keen (PT)

I remember Mr Keen as a passionate and bright PT even as he was with patients and talking to us. He shared about how PT is like as a university course, which was described as "intense" especially with the first 2 years of in-depth anatomy studies. Although we had offers from other sectors like pediatrics, he preferred staying in his current sector. He then introduced us to the machinery and equipment they use in the PT room. There was a gait trainer that is almost 20 years old, which allows patients with stroke / are unable to walk to mimic a walking movement for 20 mins in order to get the brain to get used to what is supposed to be normal. By continuously practicing these movements, they can relearn how to walk again. The range of devices in the room made me curious as to the prices of them and Mr Keen shared how the gait trainer can cost around the price of a HDB flat!