The state of wound assessment tools in Singapore: an evaluation study.

OBJECTIVE: Variations in wound assessment and documentation remain an issue for clinicians despite efforts to standardise practices using national guidelines such as the Wound Care Assessment Minimum Data Set (WCA-MDS). As little is known about the quality of the wound assessment tools (WATs) used in Singapore, this study aimed to determine whether the existing WATs used meet the WCA-MDS criteria and clinicians' needs. METHOD: The study adopted an action evaluation methodology to evaluate seven well-established WATs, such as the Applied Wound Management (AWM) and National Wound Assessment Form (NWAF), and eight locally-designed WATs against the 34-item WCA-MDS criteria. Two clinicians reviewed the WATs using a self-developed audit form between June and July 2020. RESULTS: The results show that only five WATs met at least 50% of the 34 criteria indicators, with the MEASURE assessment framework achieving the most at 68%, followed by TIME-CDST at 65%, Hospital C WAT at 56%, NWAF at 53%, and AWM form at 50%. The five most common criteria indicators included wound type/classification, date and time of wound, wound size, wound bed tissue type, and exudate information. Most criteria indicators under the 'patient information' and 'specialist's referral' subdomains were omitted, reflecting the lack of focus on these areas in the local WATs. CONCLUSION: Despite advances in WAT development in the literature, the current state of wound assessment and documentation across healthcare institutions remains inconsistent. There is a need to focus on clinician training and establishing a nationally-validated WAT in Singapore.

An Exploratory Study on Death Anxiety and Its Impact on Community Palliative Nurses in Singapore.

Nurses working in palliative care settings encounter death and dying regularly and face a greater risk of developing death anxiety and negative attitudes than their counterparts. Such distress and apprehension can cause care fatigue and affect patients' quality of life. Death anxiety remains an underresearched area in Asia, where death and dying are still considered taboo. This study explored death anxiety and its impact on community palliative nurses in Singapore and was conducted at a community hospital in Singapore from January to June 2018. Purposive sampling was used to recruit 16 nurses of different job grades for the face-to-face interviews, which were transcribed verbatim and analyzed using the data analytical approach of Miles et al. Four overarching themes were generated: (1) intrinsic factors influencing death anxiety, (2) extrinsic factors influencing death anxiety, (3) emotional struggles and coping, and (4) need for death education and psychological support. Gaps in palliative care education and death education need to be contextualized to increase the community palliative nurses' awareness and acceptance of death and enhance their death literacy in a multicultural setting.

Implementing the Clinical Occurrence Reporting and Learning System: A Double-Loop Learning Incident Reporting System in Long-term Care.

BACKGROUND: Most incident reporting systems have been questioned for their effectiveness in improving patient safety as they serve as an administrative reporting system. LOCAL PROBLEM: The long-term-care sector faced unique challenges, such an aging population and resource constraints, and its current incident reporting systems lack contextualization to address its needs. METHODS: This quality improvement project was conducted at a 624-bed nursing home in Singapore from January to September 2019, using the Plan-Do-Study-Act methodology. INTERVENTION: The existing incident reporting system (known as Clinical Occurrence Reporting and Learning System-CORALS) was redesigned to facilitate double-loop learning and workplace improvement initiatives. RESULTS: The results demonstrated significant improvement in nurses' postintervention knowledge and confidence in handling future adverse events and greater staff awareness and information dissemination on patient safety issues. CONCLUSION: A double-looped system could improve nurses' patient safety awareness and their workplace practices, which would ultimately lead to better patient outcomes.

Nursing Home's Measures during the COVID-19 Pandemic: A Critical Reflection.

This study examined the pandemic measures taken by nursing leaders to cope with COVID-19 at a nursing home in Singapore. The pandemic has affected over 215 countries, sparking a series of containment and pandemic measures by governments and healthcare organizations worldwide. Long-term care facilities are especially vulnerable to the pandemic, but little has been reported about the nursing homes' measures in handling the pandemic. The present study used Morley's (2014) three-stage critical reflection method to review meeting minutes, organizational emails, and government advisories on the COVID-19 pandemic measures undertaken by nursing leaders at a nursing home in Singapore between January and June 2020. The pandemic measures were broadly classified into four groups: (1) infection surveillance and containment measures; (2) ensuring continuity in clinical care and operational support; (3) resource and administrative coordination; and (4) staff training and development. Nurses have played a vital role in the fight against COVID-19 by ensuring continuity in patient care and demonstrating clinical leadership in pandemic efforts. This study proposes a useful nursing pandemic structure that outlines a set of functions and measures required for handling a pandemic and that can be applied to various medical emergencies and contingencies.

Value of Nursing Objective Structured Clinical Examinations: A Scoping Review.

BACKGROUND: Objective structured clinical examinations (OSCEs) have been used globally in medical education and touted as the "gold standard" for competence-based assessments. However, the value of OSCEs in nursing education has not been extensively evaluated. PURPOSES: This review aims to report the global trends in nursing OSCEs; evaluate their validity, reliability, acceptability, and costs; and present the characteristics of validated nursing OSCEs. METHODS: This is a scoping review involving a systematic search in 7 electronic databases. RESULTS: A total of 204 studies, published between 1982 and 2018, were included in the review. We found that nursing OSCEs were extensively used across various nursing specialties in 33 countries and confirmed their validity, reliability, and acceptability in nursing education. CONCLUSIONS: This review confirms the value of OSCEs in nursing education and presents the underlying characteristics of validated nursing OSCE designs.