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

Children Hospital.

HKPNA

Chair : Lee Wan Ming, QMH Tel: 2255 3473

Members : Tsang Shun Yu, QMH ( Chief Editor) Tel: 2255 3480

Cheng Sau Wai, QEH Tel: 3506 7340

Eugenie Chan, QMH Tel: 2255 3468

Mona Leung, TMH Tel: 2468 5655

Ella Ma, PMH Tel: 2990 1955

Connie Tse, CMC Tel: 3408 7822 Carol Lo, CMC Tel: 3408 7827

Views expressed in this publication are not necessarily those of

the Editorial Committee, nor of the HKPNA. The publishers

accept no liability for the contents in this publication. Articles

may be reproduced only with the prior consent of the Editorial

Committee.

ubmission to HKPNA Newsletter S

ember’s Communication Channel M

enewal & Application of Membership R

orthcoming Events F

rofessional Development Activities P

The HKPNA Newsletter is published three times annually. Articles such

as case studies, research findings, work reports, member’s views and

ideas are welcome.

Each article is preferably no more than 250 words. Submit either the

hard or electronic copy of full text and photographs with subtitles.

Author name(s) and contact details should be included. It is the

author’s responsibility to comply with patient privacy and data

protection. Where necessary, informed consent should have been

obtained before submission. The Editorial Committee reserves the right

to select or reject the submitted article.

Send submission to: Ms Lee Wan Ming, at NC (PAE/Neonatal) Office,

K-1007, Block K, QMH OR e-mail: leewm1@ha.org.hk

HKPNA treasures every idea and comment from members. Please

forward your suggestions or input in writing to either the President, Ms

Connie WAN at DOM (PAM) Office, KG34, QMH or the Hon. Secretary,

Ms Ella Ma, ward P5, PMH. Besides, you can contact us via email address:

hkpna@ymail.com

Life Members are also welcome to update any personal particulars

annually and furnish your email address using the same form.

Registered and Enrolled nurses who have experience in paediatric care

are welcome as members. Any nursing undergraduate and pupil nurse,

of the universities and nursing schools, who has interest in paediatric

nursing are also welcome.

Please complete the Membership Application/Renewal Form and

return it to Ms Caroline Lee, Hon. Dep. Secretary, Ward B9, QEH,

Gascoigne Road together with a cheque made payable to “Hong Kong

Paediatric Nurses Association Ltd”. Application forms can be obtained

from HKPNA Hospital Coordinators or downloaded from web site

http://www.hkpna.com.hk . Kindly fill in your email address when

returning the completed form, so that we can keep you informed of the

activity / course information updates.

Editorial Committee 2014 - 2016

Joint Annual Scientific Meeting 2015 Connie Tse, Editorial

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

above)

Special Promotion