Chua Thian Poh Community Leadership Programme

Tan Hui Han
Year 2 Student
Faculty of Arts and Social Sciences
Chua Thian Poh Community Leadership Programme (CTPCLP)
Facilitating Discharge Wishes and Easing Discharge Concerns for Patients and their Families at the Ren Ci Community Hospital

Carrying out an independent research project at Ren Ci Community Hospital was a fantastic learning experience. While I had learnt a lot about research methods as a psychology student as well as during lessons conducted by the Chua Thian Poh Community Leadership Programme (CTPCLP), putting these skills and theories into practice was a very different experience altogether.

One of my key takeaways is understanding the importance of scoping a research project well. Being involved in a pro-bono consulting team in NUS for non-profit organizations, I know very well the importance of having a clearly defined scope for consulting projects, yet I failed to clearly scope my own research project right from the start. The lack of a clear scope at the start of this project led to quite a few difficulties while carrying out the research. For instance, quite some time was spent on researching on current community services available for discharged elderly. Though that helped me to understand the background of the project, a lot of the collated information was already known to Ren Ci, thus a lot of the research proved to be redundant and did not contribute much to the project, which ended up focusing more on the situation within the hospital. A keener awareness of what would be the most reasonable and effective scope given the time that I had was also a takeaway that I had from the project. While I did try to scope my project better as time went by, I was often overly ambitious in terms of breadth, which compromised on the depth of some research areas.

Another learning point I had in terms of carrying out a research project is the importance of understanding status quo before beginning the project. This includes the stakeholders that may be affected by the project, as well as any developments that are taking place that may affect the project. This was one thing that I overlooked, as I went straight down to carrying out my research and implementation without finding out enough about what was currently in place. For instance, I simplified a few brochures on pressure ulcers and MRSA (a bacterial infection) in order to include them in the discharge file. It only occurred to me to check with the department who released these brochures after I completed the editing. However, after I sought the department’s opinion, I found out that these brochures were already given at admission, and giving simplified versions out at discharge would probably be repetitive and unnecessary. Thus I learnt that understanding the full picture and the opinions of various stakeholders before commencing the project or any implementation is very important to avoid duplication and unnecessary work.

Conducting interviews was my main research methodology. With the help of an experienced medical social worker, I gained many important skills for conducting good interviews. While it was not too difficult to come up with interview questions on paper, I soon realized that conducting an interview was much more difficult than I had imagined. This was especially due to the profile of the people being interviewed. Given that most of them were advanced in age and had been staying in the hospital for a while, the interviews had to be conducted with sensitivity. While I went into each interview with an ordered set of questions, I soon realized that the key to a good interview was to first build up a good relationship with the patient. General questions should also be asked, to allow patients to freely express themselves, before asking more specific questions to prompt further responses. While the interview may aim to get a certain set of information from the patients, it is important to have a natural conversation, before skilfully directing the conversation back to the planned questions at appropriate moments, where links can be drawn.

Even if the research methodology is carried out well and interviews are conducted skilfully, I also realised that results may not always offer as much direction or information as they were expected to. While I wanted to find out the discharge concerns of patients through the interviews, I soon realized that a majority of patients had no discharge concerns, or at least gave a negative response initially. I soon inferred that it may be too hard to imagine any concerns since the patients have yet to be discharged. Therefore, flexibility is very important. Eventually, what I did after advice from the medical social worker was to ask specific scenario-based questions instead, so as to infer some concerns from the patients’ responses. Therefore, my experience allowed me to understand the importance of being prepared for results that may not meet up to certain hypotheses or expectations, and to have an open mind and a back-up plan when that happens.

One discovery I made while carrying out my research project was that there are many initiatives that are being rolled out by the government, especially by the Agency of Integrated Care (AIC). The sheer number and variety of collateral that are available online and in hardcopy is extremely impressive. However, while a lot of thought and effort have been put into these initiatives, I soon realized that there are often limitations in the effectiveness of these measures on the ground level. While the many materials developed by AIC or other agencies (such as Health Promotion Board and Housing and Development Board) may be useful for educated and informed caregivers, these people form the minority in a community hospital like Ren Ci. All the patients I spoke to were at least in their fifties, and they were either living alone, or with caregivers that spoke little English. Therefore, many of these initiatives fail to reach out to the patients and family members at Ren Ci, due to the unique demographics of these people, who have more specialized needs. While this issue formed the need for my research project and the Go Home Stay Home committee at Ren Ci as a whole, it would be very helpful if government initiatives in the future could cater more to such groups in the population.

My experience at Ren Ci also exposed me to certain perspectives in the Intermediate and Long Term Care sector that I had not known before. For instance, one focus of care and discharge is to help patients or residents to help themselves. I was particularly impressed when I heard about plans at the nursing home to explore the idea of group living for the more able and independent residents. While many may see nursing homes as places where the elderly are taken care of, I realised that there is a growing mind-set where residents are encouraged to help themselves and each other. At the Ren Ci nursing home, there is a resident volunteer in each ward that helps out with certain tasks. At the community hospital, patients are also encouraged to take care of their own shower or medication needs if they are able to. Thus I saw for myself that beyond care and help, empowerment of patients and residents seems to be one of the more important beliefs in the sector.

Overall, my experience at Ren Ci has been a very fruitful one. It has allowed me to gain much insight into the Intermediate and Long Term Care sector. Though most of my research project was carried out at Ren Ci’s community hospital, I was also able to visit the Nursing Home and Long Term Care unit on several occasions. While much more can be done for the patients and residents, I am truly inspired by the efforts that have been put in thus far to improve the quality of life of the patients and residents. While my project was a research project, much emphasis was also placed on implementation, where I managed to develop some collaterals that aimed to suit the needs and preferences of patients and families at Ren Ci. I truly hope that these efforts have contributed to the overall Go Home Stay Home vision of Ren Ci, and will help patients and residents have a smoother transition back home.