Alumni nurses respond to Covid-19 pandemic: “Fear keeps me on my toes”

Elgin Chiang, an ICU nurse at the Singapore General Hospital.

“The COVID-19 patients that I care for are intubated and placed on ventilators at the isolation ward, requiring a higher level of care that Intensive Care Unit (ICU) nurses are trained to provide.

Our care is directed at keeping these patients well, and alive. This involves monitoring their parameters and ventilation requirements round-the-clock, and carrying out treatments known to benefit them, such as prone positioning.

The ICU is one of the most specialised and technical jobs in nursing. ICU nurses have to be well versed in monitoring laboratory data and recognising early signs of deterioration. We frequently perform diagnostic procedures such as phlebotomy and bring important results or details that may have been overlooked to the medical team’s attention.

Besides advising the senior consultants of the minor details that are crucial for saving a patient’s life, we also advocate for the patient, raising and voicing any concerns with respect to each patient. 

Most people face deaths only a few times in their lives. I have seen more than a few in the last three years. I separate myself and my emotions from the dying patient.  Respect and compassion are integral virtues in ICU nursing. Every last office I perform, I honour my patient with the due respect, talking him or her through the procedure and addressing the patient like I would a living one. At the end of the day, when I leave the hospital, I try to emotionally disconnect what I’ve experienced. While this is hard at times, knowing how to detach our emotions is part of taking care of ourselves. Healthy detachment keeps us from being overwhelmed, so we can give our best care to patients.

This is my first pandemic, but I have been able to put my training to good use. Infection control measures are now more stringent but they have always been our modus operandi, and we are trained and constantly retrained to use protective equipment properly.

As an ICU nurse, Elgin has been trained and retrained in infection controls, which are de rigueur in his job.

In a crisis, it is important to be prepared and have contingencies in place. Currently, 10 beds in our 50-bed isolation ward have been converted to ICU care. Although the situation seems to be stabilising, we are prepared to convert more beds within the isolation ward and other areas should there be a need.

To ensure our medical supplies continue to be adequate, we constantly innovate on the job to find ways to adapt and conserve usage without compromising any aspect of patient care and safety. For instance, we have recently reviewed the usage of inotropic and sedative medication to ensure what we prepare and titrate is appropriate and necessary to the respective patient. Proper screening and segregation of staff and patients in respect to the care level and isolation requirements also help in reducing usage of the appropriate PPE.

We have an open communication channel with our managers, and can quickly acknowledge and raise potential issues so that we can brainstorm ideas and tackle the issues before they affect us.

Because of the great teamwork, I am holding up well. There’s fear, but it keeps me on my toes and reminds me of essential work I am doing as a critical care nurse. This responsibility, and the support from my family, strengthen me.”