Hong Kong Paediatric Nurses Association In this issue : ISSUE www.hkpna.com.hk Feature Story June 2015 42 Chief Editor’s Message Feature Story Cure Sometimes, Treat Often, Comfort Always Cure Sometimes, Treat Often, Comfort Always Feature Story Audrey Chan Former NC, PICU, QMH Keen readers would have noticed that we have a new design for this issue of newsletter which is a refreshing green tone with lively pictures adopted, since the 2nd version of purple in 2008. Hope to give readers a fresh look from our new column “Stories from young nurses”. In this issue, we have invited one of our former nursing leaders, Ms Audrey Chan to be our feature story. She wishes to share with us her reflection on two particular aspects: the core of nursing and attitude. And for those of you who are interested in the thoughts of passionate junior nurses, the two Stories from our young nurses will be what you are looking for. We hope you enjoy reading them, are touched and inspired by their words as we do. We love to learn, Ms Blondi Kwok from Playright, will share with us how hospital play alleviates anxiety of children. . After being a paediatric nurse for 30 years; having passed through a career pathway journey from Staff Nurse, Nursing Officer, Nurse Specialist and Nurse Consultant, I enjoyed my role as a clinical nurse immensely. Collectively these experiences become my invaluable, resourceful data bank that I could make prompt reference. On reflection, there are two areas that I would like to share with the help of 2 quotes. The first area is on the foundation and the core of our nursing profession - the role of a carer and a comforter. Among all nursing specialties, I am sure paediatric nursing has the highest “touching” score. Our patients are the dependent group relying heavily on the carers. We provide care, we talk, we teach and we support both the sick children and the families. Hippocrates, the Father of Western medicine had a famous quote “Cure sometimes, treat often, comfort always” and its Chinese translation was “痊癒有時, 治療常作, 安慰常 存”. The description encompasses our daily work. The innovation in medicine is paralleled with the increasing number of children with chronic diseases, a radical cure may not be achievable. There is a trend for early discharge and home based care because of the general recognition that it is beneficial for the child’s normal development. The sincere support and encouragement from nurses are important to empower the parents and the children in the transitional process and to take up the responsibility of self-care. Learning from experience: Hospital Play Alleviates Anxiety and Negative Emotions in Children Stories from our Young Nurses - Amazing Agnes - Sharing from a SCBU nurse HKPNA Activities: The HKPNA Spring Dinner Special Promotion Joint Annual Scientific Meeting Professional Development Activities Forthcoming Events Renewal and Application of Membership Members’ Communication Channel Submission to HKPNA Newsletter
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Hong Kong
Paediatric Nurses
Association
In this issue :
ISSUE
www.hkpna.com.hk
Feature Story
June 2015 42
Chief Editor’s Message
Feature Story Cure Sometimes, Treat Often,
Comfort Always
Cure Sometimes, Treat Often, Comfort Always
Feature Story
Audrey Chan Former NC, PICU, QMH
Keen readers would have noticed that we have a new design for this issue of newsletter which is a refreshing green tone with lively pictures adopted, since the 2nd version of purple in 2008. Hope to give readers a fresh look from our new column “Stories from young nurses”.
In this issue, we have invited one of our former nursing leaders, Ms Audrey Chan to be our feature story. She wishes to share with us her reflection on two particular aspects: the core of nursing and attitude. And for those of you who are interested in the thoughts of passionate junior nurses, the two Stories from our young nurses will be what you are looking for. We hope you enjoy reading them, are touched and inspired by their words as we do.
We love to learn, Ms Blondi Kwok from Playright, will share with us how hospital play alleviates anxiety of children. .
After being a paediatric nurse for 30 years; having passed through a career pathway
journey from Staff Nurse, Nursing Officer, Nurse Specialist and Nurse Consultant, I enjoyed
my role as a clinical nurse immensely. Collectively these experiences become my invaluable,
resourceful data bank that I could make prompt reference. On reflection, there are two
areas that I would like to share with the help of 2 quotes.
The first area is on the foundation and the core of our nursing profession - the role of a
carer and a comforter. Among all nursing specialties, I am sure paediatric nursing has the
highest “touching” score. Our patients are the dependent group relying heavily on the
carers. We provide care, we talk, we teach and we support both the sick children and the
families. Hippocrates, the Father of Western medicine had a famous quote “Cure sometimes,
treat often, comfort always” and its Chinese translation was “痊癒有時, 治療常作, 安慰常
存”. The description encompasses our daily work. The innovation in medicine is paralleled
with the increasing number of children with chronic diseases, a radical cure may not be
achievable. There is a trend for early discharge and home based care because of the
general recognition that it is beneficial for the child’s normal development. The sincere
support and encouragement from nurses are important to empower the parents and the
children in the transitional process and to take up the responsibility of self-care.
Learning from experience: Hospital Play Alleviates Anxiety
and Negative Emotions in
Children
Stories from our Young Nurses
- Amazing Agnes
- Sharing from a SCBU nurse
HKPNA Activities: The HKPNA Spring Dinner
Special Promotion
Joint Annual Scientific Meeting
Professional Development
Activities
Forthcoming Events
Renewal and Application of
Membership
Members’ Communication
Channel
Submission to HKPNA
Newsletter
HKPNA
Learning from Experience
Hospital Play Alleviates Anxiety and Negative Emotions in Children
Blondi Kwok Manager (Community & Hospital), Playright Children’s Play Association
The second area is on our attitude to work.
Previously there was an advertisement appeared twice with a gap of 10 years focusing on the same person at the
age of 8 years old and 18 years old. Though she was blind, she danced happily. At the end of both advertisements,
the screen showed “你的日子如何, 你的力量也必如何”. The difference was when she was 8 years old in 2003, she
was happy because she said she felt more superior than the others since she was not afraid of the dark. When she
was 18 years old in 2013, she danced happily because she could master cooking a Chinese dish though it was not
easy. It was from the media that we knew she was accepted to study in a renowned University in US in the coming
semester because of her excellent academic achievement. Despite the commonly considered unfortunate condition
for her, her positive attitude through positive thinking had enabled her to face each obstacle with a cheerful smile
and dancing steps. “Your strength will equal to your days” is the English bible’s translation of “你的日子如何, 你的
力量也必如何”.
The “days” represent not only a quantity number of days but rather more towards of the quality of the mind-set. It
is certain that our cumulative nursing experiences are to be treasured, yet the positive mind-set supersedes the
value. Each day we face new knowledge, new skills and new challenges, our job satisfaction index is directly related
to our viewpoint whether we have a positive or negative attitude.
Currently we all agree that our workload is heavy and the public is expecting very high standard from the health
care providers. Instead of feeling the stresses and discouragement at work, it is my hope that the two quotes I
mentioned will become our inner support to thrive for better care of the children and ourselves.
Playright Children’s Play Association (Playright) began providing
its comprehensive Hospital Play Service in Hong Kong in 1994.
More recently, with sponsorship from Hong Kong Disneyland
Resort, Playright appointed the University of Hong Kong’s
School of Nursing to conduct a research on the ‘Effectiveness of
Therapeutic Play in Minimizing Anxiety and Negative Emotions
of Hong Kong Chinese Hospitalized Children’. A press
conference was held on 23 November 2014 to share the positive
results of the research study with the public.
The key findings of the research were that children who
received hospital play intervention reported less negative
emotional behaviour and lower levels of anxiety.
The University of Hong Kong recruited a total of 304 children
aged 3 to12 years in two acute-care public hospitals for the
study. Of these subjects, 154 received the therapeutic play
intervention by a Hospital Play Specialist in addition to the usual
medical and nursing care while 150 received the usual medical
and nursing care only.
Dr Li Chi-kong (left), Dr Li Ho-cheung (middle) and Dr C B Chow (right) answer questions from reporters
“This research shows that the hospital play
service can easily and effectively relieve
negative pressure and emotions in children
caused by their illnesses and help them
understand medical procedures,” said Dr. Li
Ho-cheung, William, Assistant Professor at
the University of Hong Kong’s School of
Nursing. He added that sick children often
need additional support to face their pain
and discomfort.
HKPNA
Making hospital play a routine service
The findings heighten the awareness of the public on the importance of integrating therapeutic play as an
essential component of holistic and high-quality care to ease the psychological burden of hospitalized children. It
is crucial to have more hospital play specialists to facilitate the integration of therapeutic play into routine care for
hospitalized children.
Dr Li Chi-kong, Chairman of the Central Coordinating Committee in Paediatrics of the Hospital Authority,
appreciates the love and care Playright has given sick children. He said it was worthwhile to encourage Playright
for their efforts over the past two decades, adding that Playright has valuable experience that could be referenced
to enhance children’s wards. He hopes more specific recommendations could be gathered for children’s hospitals
and that additional research is explored in the future.
Medical dolls and toys to prepare children for medical procedures
“Playright is now providing its play service in five public
hospitals in Hong Kong,” said Dr C. B. Chow, BBS, JP,
chairman of Playright Children's Play Association. “In the near
future, we recommend this service be extended to the
upcoming Hong Kong Children’s Hospital and all other public
hospitals as a routine service. Play can be a form of therapy to
release a child’s negative emotions and allow them to easily
understand medical procedures, thus relieving pressure and
creating a positive attitude. Moreover, the hospital play
service has been widely used in many hospitals as a routine
service in the United States of America and England, where it
has shown high level of effectiveness”.
During the press conference, a child and her family also
shared their personal hospital play experience. The mother
praised the Hospital Play Specialists to use medical dolls and
various play activities to explain medical procedures to her
daughter, ultimately reducing her fear so that she was able
to accept her treatment of intravenous injections, daily
peritoneal dialysis and kidney transplant operation.
Chan Sum-yuet (10-year-old) and her mother share how Hospital Play Specialists support them to face hospitalization and medical procedures
It was encouraging to see many doctors and nurses
in the field showing their support by joining the
press conference, which was combined with the
celebration of Playright’s 20th anniversary of
providing hospital play services. The press
conference was regarded a success, judged by the
18 press reports following the event. Besides, many
reporters came and lastly there were 18 press
reports about the research study to raise the public
awareness the needs of hospital play service to
children. Playright is hoping to see the service
develop in more hospitals in Hong Kong, including
the coming Hong Kong Children’s Hospital.
Guests celebrate Playright's 20th anniversary of providing hospital play services
HKPNA
Stories from Our Young Nurses
Amazing Agnes
Hui Nga Yong RN, PICU, UCH
Agnes was a happy 4-year-old child who loved drawing and playing piano. She was healthy
all along until one day before the Christmas Eve of 2011, she was attacked by streptococcus
pneumonia. She rapidly required intubation and mechanical ventilation, and consequently
switched to HFOV (high frequency oscillator ventilation) with 100% oxygen plus nitric oxide
therapy due to pulmonary hypertension. In addition, in order to support her blood pressure,
high doses of inotropes were used. What’s more, she suffered persistent high fever despite
the administration of Panadol and antibiotics.
Her chest X-ray demonstrated bilateral severe haziness and there were multiple patches of
narcotic tissues. Since her lungs were too stiff, high ventilator pressure was necessary to
maintain sufficient ventilation to her. Unfortunately, tension pneumothorax developed in
both lungs. To resolve the emergency situation, a total of 3 chest drains were inserted
eventually.
At that time, I was rotated to PICU from general adult medical ward for just 2
months with 1 year RN experience only. I was totally unfamiliar with how to
manage a critically ill child. I also did not know the prognosis of such kind of
disease with the above presentations. From the expert opinion of a number of
senior doctors, it was predicted that Agnes could merely recover and would finally
be to the way of death.
My nursing as well as medical colleagues and I all felt very sorry for this little girl. But we
never gave her up. We hoped she could feel as comfortable as possible. We wished her
condition could be reversed even for a very small step. In view of Agnes’s dependency
of HFOV, we tailor-made a cushion for her head to relieve pressure and prevent
pressure sore from developing due to prolonged lying in bed with HFOV, which
restricted her head position. Though minimal disconnection of ventilator was
unfavorable, we still underwent vigorous chest physiotherapy and performed suction via
endotracheal tube to clear up her secretions. It was actually a high risk procedure
because disconnection for even a few seconds could already lead to severe desaturation.
Her SpO2 could be as low as single digit. A very lengthy manual bagging varies from 5
minutes to over an hour was required afterwards before she was able to be reconnected
to HFOV. We also helped turning her position if possible. Nevertheless, we had
attempted a difficult positioning. We tried turning her to prone position carefully with 3
chest drains to let her lungs to have better ventilation.
Surprisingly, Agnes was improving bit by bit. The critical phase lasted for nearly 1 month, followed by around 2 months’
rehabilitation phase. HFOV was stepped down to conventional ventilator, later on extubated to BIPAP, then only required
low flow oxygen via nasal cannula, and subsequently free of respiratory support. On the other hand, chest drains were
removed one by one. However, three fingers of Agnes’ right hand were darkened because of the prolonged use of high
dose inotropes. In the end, gangrenous distal phalangx of index finger was amputated. Nevertheless, her recovery was
rapid. She could do her favorite hobbies again very soon – drawing lovely pictures and playing on the piano. She led a
normal and happy child life just as before.
I was so amazed by the strong vitality of a little child. Child’s ability to recover is really unpredictable. They are so much
tougher than those critically ill adult patients that I have seen before. I have learnt from my colleagues a lot not to give
up any chance to help our small patients. They are all very adorable. Miracle will always happen around us!
HKPNA
HKPNA Activities
Sharing from a SCBU nurse
The HKPNA Spring Dinner
Audrey Grace Pike RN, SCBU, QEH
Yau Ching Man Debby Chair of Promotion Committee
I am a nurse working in a special care baby unit, and there are babies who do not get to go home to a family with a
mom and a dad, and I remember a particular baby's story.
This baby boy's face was particularly blue as compared to the rest of his body because of the trauma at birth. I was
happy to have picked up this “traumatic cyanosis” by myself. I was even happier as I saw it gradually fade away. I
remembered his mom came to visit him for the first time and I was very unsure if I should introduce her to the ward
and explain her baby's condition. Would she get offended since she was planning to sign off her baby? Would she
even visit him again? I decided to be brave and welcome her with my usual friendliness, and I was so relieved that she
accepted the ward introduction and she even held her baby. Days and weeks went by and nurses would cuddle him
and say how cute he was. He seldom fussed for attention. He cried only when he was very hungry. Finally he was
arranged to go to a foster family. I was overjoyed to know that he did not need to go to an orphanage! On the day
he left the SCBU two nice social workers came to pick him up. They even inquired as much information as they could
about the baby! I changed his diaper and cuddled him for the last time, with gladness overflowing for him that there
was a home prepared for him.
Spring dinner was held on 13 March 2015 at Golden Federal Restaurant in Nathan Road, Jordan. There were a total
of 106 participants from 11 hospitals enjoying the precious moment together.
The response from the participants of the dinner event was positive and the relationship among Hong Kong
Paediatric nurses was strengthened. We look forward to the Spring Dinner in 2016 and hope more nurses can join in
the fun together.
Five guests were invited and have joined the dinner:
Dr. Chan Chok Wan, Honorary Advisor of Hong Kong
Paediatric Nurses Association; Dr. Wong Hiu Lei Lilian,
President of Hong Kong Paediatric Society; Dr. Chan
Chi Fung, Vice President of Hong Kong Paediatric
Society; Mrs. Tien Luk Sau Ken Gloria, President of
Hong Kong College of Paediatric Nursing and Ms.
Leung Fung Yee, Chief Nursing Officer of Hong Kong
We are happy to announce that the Joint Annual Scientific Meeting, co-organized by the Hong Kong Paediatric Nurses Association
and The Hong Kong Paediatric Society will be held on 19th September 2015 at Public Education Centre, Prince of Wales
Hospital. The theme of this year is “Health for the New Generation: From Early Life to Young Adulthood”.
The Joint Annual Scientific Meeting is a unique platform for various disciplines to share the visions in child health related issues and
scientific updates. This half-day event consists of a keynote lecture and free paper presentation sessions. The oral presentation
session will be divided into theme-based, doctor and nurse sessions. Total 4 prizes will be awarded to the best poster presentation
and the best oral presentation in each session.
We are honoured to have Professor Joseph J. Y. Sung, SBS, JP, Vice-Chancellor and President of the Chinese University of Hong
Kong to deliver the keynote speech. Members, doctors and other health care workers are encouraged to submit papers . Your participation would be of utmost importance to make this meeting a success.
The deadline for abstract submission is 6 July 2015, please visit http://medicine.org.hk/hkps/ for more information.
Call for Young Nurses’ Stories We sincerely invite young nurses to share their stories in paediatric nursing with our readers. Selected submission will be awarded.
Please visit http://www.hkpna.com.hk for information.
Simulation Based Neonatal Resuscitation Program co-
organized with the Hong Kong Society of Neonatal Medicine,
Hong Kong College of Paediatricians and A&E Training Centre,
TSKH with five classes held on 9 Nov, 21 & 28 Dec 2014 and 18
Jan, 1 & 8 Mar 2015, with attendance 79.
Short Course in Paediatric Neurosurgery was held on 1, 24 &
30 Apr 2015, with attendance 149.
Update Series on Child Health 2015 co-organized with the
Hong Kong Paediatric Society and the Hong Kong College of
Paediatricians will be held on 13 June, 18 July, 1 & 22 Aug at the
Jordan Valley St. Joseph’s Catholic Primary School.
Joint Annual Scientific Meeting 2015 will be held on 19 Sep
2015 at Prince of Wales Hospital (refer to special promotion at