Community nursing: A holistic approach to healthcare

Community nursing: A holistic approach to healthcare

Credit: Singapore Health 

The little red dot is hailed for is its world-class healthcare system that strives to deliver high-quality and cost-effective health services to the community. With a population that is ageing rapidly, the country has been taking steps to mitigate the strain that an ageing population will place on its healthcare infrastructure.

A key strategy has been to shift the country’s healthcare focus from disease management to prevention through initiatives such as the setting up of additional community nursing services   that help residents age well and live independently at home. The programme was piloted in the south east region of the city-state in 2018 and has since become a permanent fixture.

Playing an instrumental role in this public health programme are community nurses from the Singapore General Hospital (SGH). Currently stationed at 36 neighbourhood Community Nurse Posts (CNPs) and with their numbers steadily growing, the community nurses focus on helping the elderly with their chronic disease management, including health assessment and monitoring, medication, self-management and care referral.

“As part of the initiative in supporting seniors who are well or at pre-frail stage, community nurses provide health coaching in preventive health to empower seniors to look after their own health,” said Ms Cui Xue, a senior staff nurse with the Population Health and Integrated Care Office (PHICO) – Community Nursing team at SGH.

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As the programme gathers pace, the role of community nurses has expanded too: in addition to caring for the elderly, they are now supporting younger populations, people who are in their 40s and 50s in need of palliative care as well as mental and oral health support, according to Cui’s colleague, Ms Nur Fadillah Ahmad, a senior staff nurse.

And new services continue to be added, such as Community Outpatient Antibiotic Therapy and post-chemotherapy granulocyte-colony stimulating factor (G-CSF) injections for cancer patients. These treatments are usually administered in hospitals or outpatient clinics, so receiving them at home helps patients avoid hospitalisation and its associated costs. “They also feel more comfortable at home,” added Cui.

Under the outpatient antibiotic therapy programme, a community nurse administers intravenous antibiotics to patients who are in a stable condition in the comfort of their own homes: a much more convenient location for undergoing these rigorous treatment courses that may last for days or even weeks.

Similarly, for G-CSF injections, community nurses teach cancer patients or their caregivers how to administer these injections competently. “We will go to their homes if they are too frail to visit nearby CNPs to supervise and help them gain greater confidence in injecting themselves,” said Cui, noting how this benefits patients who would otherwise need to visit the National Cancer Centre Singapore (NCCS) or a nearby clinic for the injections, which are required a day after an intense chemotherapy session.

Yet another pilot programme implemented for the elderly’s benefit involves oral health screening and education conducted by the community nursing team in collaboration with the National Dental Centre Singapore. The programme aims to enhance older residents’ oral health, so that they retain at least 20 natural teeth when they reach 80 years of age.

A community nurse educating an elderly patient on the importance of oral hygiene// Credit: Singapore Health

A community nurse educating an elderly patient on the importance of oral hygiene// Credit: Singapore Health 

“Poor oral health can lead to conditions such as gum disease and tooth decay, both of which can result in tooth loss if left untreated. Extensive tooth loss can impair a person’s chewing ability and may lead to malnutrition in the long run, especially in the elderly,” said Dr Chan Pei Yuan, a consultant with the department of restorative dentistry at the dental centre.

Chan further highlighted that oral health awareness is still lacking in Singapore, with many people visiting the dentist only when they feel pain, instead of the recommended six-monthly preventive visits.

However, accessing healthcare resources, for the elderly in particular, is not always easy—especially given that a quarter of Singaporeans people is estimated to be aged over 65 years by 2030.

To address this, an integrated healthcare network, consisting of hospitals, polyclinics and private clinics, that provides residents with a wider range of options to choose from based on their convenience and preference was established.

And community nursing initiatives further strengthen this network, expanding its reach by engaging with voluntary welfare agencies like Thye Hua Kwan, NTUC Health and Montfort Care, whose social workers help residents in need of financial and social services.

Together, this holistic approach to care will form a key pillar of the Healthier SG roll-out that will get underway in the second half of 2023.

Adapted by Sruthi Jagannathan from Singapore Health (Holistic health begins within the community)

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