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Breast cancer is the number one cancer in women in Singapore.
Singapore General Hospital sees between 500-600 newly
diagnosed cases annually. The Breast Cancer Nurse Clinician
provides pre-operative counselling upon diagnosis. She
is also responsible for a comprehensive rehabilitative
program for postoperative patients and is involved in
the follow up support services that include advice on
external breast prosthesis, reducing the risk of Lymphoedema
(arm swelling after surgery). She has a strong network
with survivors of breast cancer and meets the support
group members regularly.
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Diabetes Mellitus affects 9% of the adult population in
Singapore and the incidence keeps increasing. To ensure
success in the treatment of diabetes, patients have to
persevere and comply with the treatment plan and lifestyle
modifications.
The Diabetes Nurse Clinician with her team of nurses
supports the services in the Diabetes Centre. These
are trained diabetes nurse educators who provide education,
counselling and support to patients and their family
caregivers, both in the inpatient setting and at the
Diabetes Centre. The Diabetes Nurse Clinician collaborates
with the endocrinologist, physicians, surgeons, dietitians,
therapists and pharmacists to ensure a coordinated and
comprehensive continuum of care for the patients with
diabetes.
The Diabetes Nurse Clinician is also responsible for
the development, implementation, review and evaluation
of guidelines for nurses and patient training.
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In Singapore General Hospital there is increasing emphasis
on the provision of specialised and holistic care for
the geriatric population of patients. The multidisciplinary
Geriatric team was formed in 2003. The main aim of this
team is to identify the subtle but usually complex medical,
social, psychological and emotional issues associated
with aging and illness in the elderly.
The Geriatric Nurse Clinician is responsible for identifying,
planning, developing, implementing and evaluating standards
for nursing practice for the older aged patients. The
Nurse Clinician also develops patient care guides and
protocols for early discharge planning. The Geriatric
Nurse Clinician forms the main link between the patient,
patients' caregivers and the other members of the multidisciplinary
geriatric team in the hospital and the various step
down facilities in the community.
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In Singapore General Hospital, head and neck reconstruction
surgery aims to provide ablative cure and restoration
of function and reconstruction of form to increase and
improve quality of life.
The Head and Neck Surgery Nurse plays an integral role
as a member of the surgical team. She is responsible
for ensuring that our patients receive holistic care,
support, education and rehabilitation after surgery.
As an expert nurse in the specialty, she is the resource
person who provides consultative services to patients,
their caregivers, nurses and other health care team
members.
The Head and Neck Surgery Nurse is responsible for
the development, implementation and evaluation of the
standards of nursing practice and patient care guidelines
for the head and neck surgery discipline. She performs
her role independently and intradependently, working
in collaboration with members of the multidisciplinary
team.
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Infection Control Nurses (ICN) are members of the hospital
infection control team who are concerned with surveillance
of nosocomial (hospital acquired) infection and infection
control practices. The quality of a hospital is often
measured by its overall infection rates. Prevention
and control of infections help to reduce the patients'
morbidity and mortality as well as occupational hazards
of employees. Hence, the Infection Control Nurses play
an important role in inculcating infection control consciousness
among staff through continuing education programmes
and strict compliance to infection control guidelines
and practices. They conduct epidemiological investigation
of outbreaks of infections and liaise with supporting
departments to ensure an effective infection control
program for the protection of both staff and patients
from nosocomial infections.
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Caring for patients with neurological problems and disabilities
requires special knowledge and skills to support the optimal
functional level, quality of life, and patient outcomes.
Injury or diseases involving the nervous system often
have far-reaching effects. The effects are not only physical,
but also on the cognitive functions, personality and their
behaviour.
The care of neurological patients is usually multidisciplinary.
The unique role of a neuroscience nurse is to co-ordinate
the different aspects of patient care. In collaboration
with other team members, the nurse ensures the safe and
efficacious delivery of specialised neuroscience care
to the patients. The Neuroscience Nurse Clinician receives
referral to attend to patients requiring complex care,
discharge planning and preoperative teachings. She co-ordinates
a biweekly teaching programme for stroke patients and
their families.
Patients and their families need psychological support.
Hence the need of support groups for this special group
of patients. The Neuroscience Nurse Clinician is active
in the support groups for neurological conditions.
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Nurses play a major role in the maintenance of patients'
nutritional health. The Nutrition Support Nurse Clinician
is a member of the Nutrition Support Team comprising gastroenterologists,
surgeons, pharmacist and dieticians.
She conducts daily rounds with the team to see and
discuss the nutrition/feeding plan of all patients who
are referred to the Nutrition Support Service for management
of their nutritional status.
She coordinates the follow-up care on the tube feeding
regimes, performs feeding tube changes and motivates
and guides patients to adapt to changes in lifestyle
for better quality of life.
In addition to developing patient care guidelines and
protocols on nutrition support, the Nutrition Support
Nurse Clinician also helps to coordinate and manage
the assignment of acute and chronic nutritional access
devices, both for enteral and parenteral feeding.
She is responsible for providing education and training
to nurses, paramedical staff and caregivers.
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Musculoskeletal conditions rank second overall in frequency
and cause of restricted / limited activity, affecting
millions of people in the world. The impact of these conditions
necessitated the development of the specialty of orthopaedic
nursing. As a specialty, orthopaedic is diverse, crossing
all age ranges and developmental stages from infancy to
geriatrics. Orthopaedic nursing is devoted to the care
of patients experiencing musculoskeletal disorders.
The role of an Orthoapedic Nurse Clinican is to provide
consultation services to nurses and paramedical staff
for optimal care delivery to patients of this speciality
service. She is involved in planning, directing, coordinating
and evaluating all daily activities related to the care
and counselling of orthopaedic surgery patients and
their family. The Orthopaedic Nurse Clinician also takes
on the responsibility to develop and review guidelines
and standards of clinical nursing practice to achieve
its goal of enhancing quality nursing care.
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Cancer, which can affect any organ or system in the body
now ranks as the highest cause of deaths in Singapore.
The diagnosis of cancer can be a devastating experience
for the patients and their families as it is often viewed
as a death sentence despite the advances in medicine and
science, which now give a better prognosis. The Oncology
Nurse Clinician is not only a specialist nurse in cancer
care, but also a "generalist" as cancer not
only affects the diseased organ but also the person
and his family caregivers - both emotionally and socially.
The Oncology Nurse Clinician provides psycho-social
support and encouragement for patients and their families
during their difficult times, from the time diagnosis
is made throughout the treatment phase, and often to
the end of life for those with terminal disease.
The Oncology Nurse Clinician also acts as a resource
person, conducts training and offers clinical consultation
for the ward nurses in the care of cancer patients with
complex issues. She ensures that the patient care protocols
and nursing care standards are up-to-date with the rapid
advancement in cancer care.
In addition to patient care and staff training, the
Oncology Nurse Clinician also conducts and participates
actively in nursing research to propagate continuous
improvement in the care of the cancer patient.
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Pain is an almost universal after-effect of an injury.
In this context, it serves as a warning system. Pain can
occur without any discernable trauma or it can continue
to persist beyond the period that the actual injury takes
to heal. Hence, it has become even more important now
for any healthcare institution to provide a well-organised
multidisciplinary team collaborating to manage pain.
The Pain Management Nurse Clinician is an important
member of the multidisciplinary pain management team
comprising of anesthesiologists, pain specialist, neurologist,
surgeons, pharmacist, physical and occupational therapists,
social workers, psychologist, psychiatrists, the patients
family caregivers/friends and the patient.
The Pain Management Nurse Clinician is the expert nurse
and resource person responsible for attending to the
urgent referrals for the Pain Service. She conducts
the initial pain assessment and discusses the management
plan with the multidisciplinary team. She is also responsible
for developing, implementing and evaluating training
programmes for the nurses and paramedical staff, as
well as patient education guides.
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A multidisciplinary team comprising of doctors, nurse
clinician, therapists, dietitians and medical social workers
manage the Rehabilitation Service in Singapore General
Hospital. The goal of rehabilitation is towards optimal
functional ability and mobility, enabling a discharge
home and reintegration into family and society.
The Rehabilitation Nurse Clinician plays an integral
role of coordinating, collaborating and communicating
the operational activities and development of nursing
guidelines for the care of the rehabilitation patients.
In addition, the Rehabilitation Nurse Clinician also
develops, implements and evaluates programmes for staff
training and patient teaching.
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The disease management programme for renal patients in
Singapore General Hospital aims to detect renal disease
early and to retard acceleration from chronic renal failure
to end-stage renal failure.
The Renal Nurse Clinician supports the Renal Medical
Team. The Nurse Clinician coordinates and collaborates
with other disciplines to manage patients with multiple
medical problems efficiently and effectively, to achieve
quality of life for the patient.
The Renal Nurse Clinician trains nurses on pre- and
post-management of renal patients on short and long
term dialysis therapy. She is also a patient educator
who develops home care guides to assist the patient
and their caregivers to cope with the advance modalities
of home dialysis.
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The SGH Department of Rheumatology and Immunology was
established in 2003. The multidisciplinary team comprising
of rheumatologist, physicians, nurse clinician and therapists
work collaboratively with other specialists to provide
up-to-date information and management for patients referred
to the team.
The Rheumatology and Immunology Nurse Clinician plays
a major role in the coordination of care for patients
admitted with autoimmune system deficits or connective
tissue diseases (Systemic Lupus Erythematosus, Rheumatoid
Arthritis, Arthritis, Wegner's granulomatosus, Sjogren's
syndrome and many others).
She is responsible for planning, developing, implementing
and evaluating patient care guidelines and protocols
for the management of rheumato-immunology patients.
She develops and implements training programmes for
nurses and paramedical staff. She assesses patients
for psychosocial and emotional responses to their conditions,
counsels them and makes appropriate referrals to the
therapists. She also develops and provides education
to patients and their caregivers relevant to the disease
conditions.
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The Department of Colorectal Surgery in Singapore General
Hospital sees about 600 new cases annually. Approximately
50% of these cases end up with a stoma creation (an artificial
opening on the abdomen to act as the rectum for discharging
of faecal matter). Having a Stoma can be a daunting experience
for anyone who is not fully prepared for the changes as
it entails changes in body image, lifestyle and almost
every activity.
The Stoma Care Nurse Clinician is the main link between
the patients and the multidisciplinary team comprising
the surgeons, physicians, therapists and patients' caregivers.
The Stoma Care Nurse Clinician is an active member of
the colorectal surgery team, who provides up-to-date
and evidence-based information on the nursing management
of colorectal patients with a stoma. She trains nurses
and other support staff to provide individualised counselling
to the newly diagnosed patients with stoma creation,
and their caregivers. She is also the expert nurse with
advanced skills in managing the ostomy appliances. She
is a member of the Ostomy support group and a strong
link between the newly diagnosed patients and the support
group members.
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The Vascular Surgery Team at Singapore General Hospital
offers a continuum of care for patients with peripheral
arterial and venous disease. There is a growing need to
educate our aging population to be aware of the complications
arising from chronic diseases that may lead to avoidable
amputation of limbs.
The Vascular Nurse Clinician provides nursing expertise
in the management of patients who are referred to the
Vascular Surgery Team. Some of these vascular problems
include abdominal aortic aneurysm, peripheral vascular
disease, venous insufficiency, vascular access for haemodialysis
and arterial or venous lower limb ulcerations.
The Vascular Nurse Clinician is responsible for the
development of patient education guides, nurses' training
programmes, patient care guidelines and standards of
practice. She works independently and intradependently
with other members of the health care team including
her supervisors.
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