At the height of the coronavirus pandemic in April, nursing veteran Associate Professor Liaw Sok Ying donned scrubs and went back on duty at the National Centre for Infectious Diseases’ (NCID) pandemic Intensive Care Unit (ICU).
Before Singapore’s Circuit Breaker began in April, Assoc Prof Liaw volunteered to support nursing services during the coronavirus pandemic.
Her return to clinical practice on secondment was supported by the University and came almost 20 years after she left her job as an ICU nurse at Tan Tock Seng Hospital to take on the role of a Nursing educator.
It was a decision that the registered nurse of 25 years wrestled with. “While my colleagues were battling the pandemic closer to the frontlines, I felt unsettled. Even though I was contributing to pandemic response by preparing final-year Nursing students to get into the field, I felt that joining the essential workers at the frontlines was the right thing to do at that time,” she said. She took comfort in her decision to volunteer, knowing she could relieve her fellow nurses of the pressure and strain they were under.
Aligning Theory with Practice
Faculty members of NUS Nursing were called upon to return to critical care facilities as part of measures to strengthen staffing levels at the ICUs so that they could cope with a surge in patient loads. “Returning to the ICU was challenging for me as critical care nursing is technically demanding and care technology has evolved since I last practised in 2001,” said Assoc Prof Liaw, who has been teaching for the past 15 years. To refresh her knowledge and skills, she pored through videos and even brought home manikins from the simulation lab for hands-on training, to refine her skills in procedures such as endotracheal tube suctioning. A crash course and competency assessments organised by the NCID further prepared her for the demanding stint.
“While my colleagues were battling the pandemic closer to the frontlines, I felt unsettled. Even though I was contributing to pandemic response by preparing final-year Nursing students to get into the field, I felt that joining the essential workers at the frontlines was the right thing to do at that time.”
At the pandemic ICU, Assoc Prof Liaw began her eight-hour shifts as a registered nurse by buddying with an experienced staff nurse to provide care to severely ill COVID-19 patients. “Some of the cases we took were heavy ones, such as patients on dialysis who needed extracorporeal membrane oxygenation (ECMO),” she said, recalling she was a little overwhelmed by the advanced technology employed at the ICU.
To familiarise herself with the new environment after a long period away from the hospital setting, Assoc Prof Liaw mapped out a learning roadmap: she would start small by helping out with basic care tasks such as turning and tube-feeding the patients, and even taking on the role of a “runner”, to help fetch items for colleagues who were not able to enter and exit the ICU room freely due to infection control measures. “Due to the uncertainty of the situation, I told myself that I needed to pick things up fast and be ready to take cases competently and confidently,” she said. Gradually, she stepped up to take cases and perform the role of a charge nurse, providing holistic care for patients.
Embracing Psychosocial Care: The Essence of Nursing
At the pandemic ICU, nursing took on a strong psychosocial focus for Assoc Prof Liaw, as family members could not be there with the patients. She was able to empathise with the patients and their family members, often using music and small talk to diffuse the sense of anxiety in the wards. Chatting with the patients helped her to build rapport with them as well as assess them clinically. She recounted how she upgraded the assessment of a patient from “confused” to “orientated” on the conscious level chart, after learning that he was a scientist and engaging him in conversation about his work. “Through our exchange, I also found him to be very fearful about his condition, so I would constantly update and reassure him about his improving health status based on his vital signs,” she shared.
“I felt like I experienced training anew and better understood a nursing student’s journey during clinical rotations. When students go into a new setting for the first time, it’s important to be humble, to be very hands-on and step up to the task at hand, while learning to work as part of a team.”
After learning that this patient had rejected video calls with his family out of fear of worrying them about his state of health, Assoc Prof Liaw freshened him up and convinced him to participate in a video call with his family. It was a touching moment for her when she witnessed the family reaffirming their love for one another and making plans to patronise their favourite hawker stall after his recovery. “After the chat, he looked more cheerful,” she beamed.
Remembering another call between a mother and daughter that took place on Mother’s Day made her tear up behind her goggles. “It was emotional for me too as I felt for these patients who had to be away from their families during this time of uncertainty,” she recalled.
Taking Lessons Back to School
“I felt like I experienced training anew and better understood a nursing student’s journey during clinical rotations. When students go into a new setting for the first time, it’s important to be humble, to be very hands-on and step up to the task at hand, while learning to work as part of a team,” she reflected, adding that the lessons she has learnt would translate to valuable advice for her students. Having experienced different kinds of coaching styles from the seasoned nurses, she highlighted another lesson for all educators. “Let’s be more nurturing to pass along our wisdom, caring and confidence to our new and future nurses.”
Finally, as a director of education at NUS Nursing, she plans to use her experience to align the educational process with the realities of nursing practice. Her clinical experience has prompted her to reflect on the importance of academic-clinical collaboration to bridge the theory-practice gap and ensure evidence-based practice, with the ultimate goal of improving the quality and relevance of nursing education.
Assoc Prof Liaw in PPE, holding a portraiture of her drawn by a patient.