Singaporean nursing students' perceptions of a career in community nursing.

BACKGROUND: The ageing population and the changing disease profile have been driving the demand for community nurses. However, few nursing students in Singapore aspire to have a career in community nursing following graduation. OBJECTIVES: To explore undergraduate nursing students' perceptions of a career in community nursing and to identify strategies to promote community nursing among nursing students. METHODS: An exploratory qualitative design was used. Four focus group discussions were conducted with a purposive sample of 24 undergraduate nursing students from a university. Interview transcripts were analysed using thematic analysis. FINDINGS: Four key themes emerged as follows: 'mid-life career', 'limited career progression', 'a difficult transition' and 'international nurses-dominated workforce'. DISCUSSION: While most participants rejected a career in community nursing immediately after graduation, they planned to join it at the later stages of their lives to accommodate changing life priorities. Limited career progression and increased difficulty in career transition from community nursing to acute care nursing were identified as deterrent factors in the participants' choices of community nursing as a career. Feelings of marginalization and a lack of role models in community nursing were perceived to be the result of the international nurses-dominated community workforce. CONCLUSION: Community nursing remains an underrated career. There is a need to foster an optimistic career outlook and mobility in community nursing to entice nursing students into this career track. IMPLICATIONS FOR NURSING POLICY: Strategies to enhance community nursing recruitment should focus on providing more quality and diverse community placement opportunities in various community care settings, implementing a clearly defined career developmental plan to elucidate the role of community nurses, and improving community care and cultural competencies to develop a skilled and diverse community nursing workforce.

Evaluation of door to operation theatre time following activation of trauma team.

INTRODUCTION: This study evaluates factors that influence door to operation theatre (OT) time in a tertiary referral centre following activation of trauma team. Specific factors observed in this study were association of the injury severity score (ISS), activation of trauma team and the number of referred specialty to door to operation theatre time. METHODS: Retrospective chart review that evaluates all trauma patients which required immediate operative intervention from January 2011 to December 2015. Trauma patients were selected from the resuscitation log book and data were collected by chart review of selected patients. RESULTS: Only 5 out of 279 patients (1.8%) achieved optimal door to OT time. (<60 minutes) Mean door to OT time was 299.27 minutes (95% CI: 280.52, 318.52). Trauma team activation has shown significant improvement in door to OT time (p=0.047). Time of multiple team referrals (p=0.023) and time of operative decision (p<0.001) both had significant impact on door to OT time. Other factors included were demographics, ISS score, Glasgow Coma Scale (GCS), mechanism of injury and systolic blood pressure on arrival all which showed no significance. CONCLUSION: Trauma team activation in a tertiary centre improved trauma care by reducing door to OT time to less than 60 minutes. Implementation of an effective trauma team activation system in all hospitals throughout Malaysia is recommended.

Screening for colorectal cancer using a quantitative immunochemical faecal occult blood test: a feasibility study in an Asian population.

BACKGROUND: The quantitative immunochemical faecal occult blood test (qFOBT) has been shown to be an accurate method of identifying significant colorectal neoplasia including cancer and advanced adenomas. This study reports the results of a Singapore population-based colorectal cancer screening event using the qFOBT. METHODS: This event was held as part of a colorectal cancer awareness exhibition. All asymptomatic individuals above the age of 40 years with no previous colorectal cancer screening in the last 1 year were invited to participate. Eligible participants were screened using two consecutive qFOBTs with a positive faecal haemoglobin threshold taken at 100 ng/mL. Participants with at least one positive qFOBT result were recalled and advised to undergo colonoscopy. Endoscopic polypectomy or surgery was performed according to colonoscopic findings. RESULTS: A total of 751 (55% male, 45% female) participants with a median age of 53 years (range, 40-85 years) took part in the screening event. Five hundred and forty (72%) participants returned the qFOBT samples, of which 57 (11%) tested positive. Fifty-two of these participants proceeded to colonoscopy. Three participants had sigmoid cancer and 12 had advanced polyps, all of which were located distally in the sigmoid colon or rectum. Five of the participants required surgery for colorectal neoplasia and all recovered well without complications. CONCLUSION: The qFOBT at a positive faecal haemoglobin threshold of 100 ng/ml has a high positive predictive value and is an effective screening tool for colorectal cancer in an Asian population.