Excellence beyond the bedside

We mark 140 years of nursing in Singapore by showcasing the diverse ways in which CGH nurses continue to advance patient care and elevate healthcare delivery.

A clinical instructor for the EAGLES programme, Siti Suhana, Assistant Nurse Clinician, CGH, walks nursing students through the steps for checking a defibrillator commonly used in the ED.

Exceptional patient care emerges not from isolated efforts, but from the integration of continuous learning, evidence-based practice and transformative innovation. Guided by this philosophy, Changi General Hospital (CGH) creates a dynamic ecosystem where nursing professionals are empowered to deliver care that is both compassionate and cutting-edge.

In this ecosystem, CGH builds and reinforces the foundational knowledge and skills that enable nurses to provide safe and competent care. Research efforts bridge the gap between theoretical knowledge and practical application, while innovation propels the profession forward, creating new solutions to complex healthcare challenges.

At the heart of quality care is a well-informed, confident nurse.

In nursing, education is not merely about sharing information, it sparks transformation. Nurse educators play a quiet yet powerful role: shaping best practices and new standards through meaningful learning experiences that leave a lasting impact.

Nurse educators guide and prepare in-service nurses and students in acquiring competencies in various clinical areas. They develop, implement and evaluate a holistic curriculum to equip nurses with the knowledge and skills to deliver quality care. They also guide aspiring nurses in developing teaching competencies.

The Enhanced Assessment Guide & Learning Experience for Students (EAGLES) transforms how nursing students approach their clinical placements in CGH. Using the Clinical Learning Passport as a structured and interactive guide, nursing students participate in comprehensive learning experiences across key areas within the Emergency Department (ED). This initiative enables nursing students to rotate through different areas in the ED, including triage, treatment and resuscitation rooms.

Nurul Atiqah, Senior Staff Nurse, CGH, conducting Code Blue training, where nurses sharpen their lifesaving expertise, practising vital skills like CPR and coordinated emergency response.

Students experience interactive, station-based learning with hands-on activities ranging from checking manual defibrillators to performing intramuscular injections. These practical experiences expose nursing students to varied patient presentations and clinical situations within the ED.

While aspiring nurses benefit from structured postings, ward nurses are supported through customised in-service education programmes that are tailored to meet the unique needs of each ward and specialty.

Clinical instructors and nursing leaders collaborate to ensure that educational interventions are both clinically relevant and practically applicable. Through real-time needs assessments, the team identifies knowledge and skill gaps, then develops targeted interventions to address these areas promptly and effectively.

“We use interactive teaching methodologies such as simulation, discussion and case-based teaching to keep learning sessions relevant and engaging,”  shares Mas Linda Mohamad, Assistant Director, Department of Nursing Education, CGH. “Nurses walk away with renewed confidence and clinical clarity.”

A key focus area to help nurses improve their critical competencies is the Code Blue response. This hospital emergency occurs when a patient is in cardiac or respiratory arrest. This vital training equips nurses with the confidence and skills needed to handle such situations effectively. Nurses undergo theoretical and practical lessons covering teamwork and role allocation, as well as the use of resuscitation equipment and management of life-threatening situations.

Nurses also develop competencies in specialised areas such as tube feeding, tracheostomy care, and dementia and delirium management. The dementia and delirium care training employs diverse teaching methods to enhance learning effectiveness. Nurse instructors use case studies, role-play exercises and real-world scenarios to strengthen nurses’ ability to recognise and manage these conditions. Visual aids and group discussions encourage active participation, while staff competency is evaluated through return demonstrations, scenario-based assessments, quizzes and structured discussions.

Vickianne Vickneswari, Senior Clinical Instructor, CGH, engages students in an intramuscular injection training exercise.

While CGH helps its nurses develop ‘hardware’, it has also created a structured communication enhancement workshop: International Nurses: Harnessing Effective Actions through Reflective Thinking (IN-HEART).

Recognising Singapore’s multicultural healthcare environment, this workshop was designed to help international nurses thrive in our healthcare setting. IN-HEART serves as a cultural bridge, helping international nurses understand local healthcare practices, patient expectations and communication norms, while celebrating the diverse perspectives and experiences they bring to the healthcare team.

Through various learning modalities, international nurses develop not only technical communication skills but also the cultural competency and sensitivity that are essential for effective patient care in Singapore’s multicultural population. “When we educate with compassion and purpose, we don’t just change practices — we transform lives,” adds Mas Linda Mohamad.

Nurses engage in research to ensure that the care they provide is not only compassionate, but also current, evidence-based and responsive to evolving patient needs. Structured programmes such as the Nursing Research Fellowship and Residency Programme provide nurses with the support, mentorship and resources necessary to conduct meaningful research. “In order to improve patient care and nursing practice, every nurse should get a chance to immerse in nursing research,” says Jessica Yu, Assistant Director, Department of Nursing Administrator, CGH.

In recent research endeavours, patient-focused studies include examining caregiver needs in renal disease, stroke education effectiveness, and how patients adapt to a non-invasive ventilator (NIV) device at home.

Senior Nurse Manager Norasyikin Hassan demonstrates how to wear the non-invasive ventilator mask to enhance patients’ ability to adapt to home NIV successfully.

Collaborating with the respiratory physicians from the CGH Department of Sleep Medicine, Surgery and Science; and Department of Respiratory and Critical Care Medicine, CGH nurses explored how patients with chronic respiratory conditions adapt to using NIVs at home from the early stages of diagnosis.

The research aimed to describe patients’ adaptation experiences with home NIV to enable timely assessments of users’ home environments and enhance successful adaptation. Previous research had focused mainly on hospitalisation or remote monitoring rather than the home adaptation process.

The findings enable nurses to provide personalised patient education tailored to individual home environments. By providing more effective support during the critical adaptation period of the NIV, patients are better prepared for the realities of ventilator use and its impact on daily life.

CGH nurses also conduct profession-focused research to improve nursing practices. They include understanding graduate nurse transition experiences, psychological safety in healthcare environments and cultural sensitivity in patient care. “This dual focus ensures that research efforts contribute to both immediate patient care improvements and long-term professional development,” says Norasyikin Hassan, Senior Nurse Manager, Department of Nursing Education, CGH.

At CGH, the Nursing Transformation team recognises that innovation and research create an acceleration effect when working together. Research lends credibility to new approaches, while innovation provides the practical pathways that make research findings actionable and sustainable in real-world healthcare settings.

Understanding the value of innovation in healthcare delivery, CGH’s Nursing Transformation team has established a structured framework that enables nurses to navigate the innovation process, and to identify potential contributors and collaborators.

Nurse innovators at CGH possess a unique advantage. Their first-hand experience enables them to recognise challenges and gaps that might otherwise go unnoticed. These insights become valuable opportunities to inform innovations in processes and solutions in patient care.

Nurse innovators further analyse emerging technologies and concepts with partners, evaluating their potential for trials in hospital settings. They work closely with internal and external partners to co-create innovations that benefit patients.

Innovation enhances opportunities for advancement in knowledge and skills development. The Multi-user Augmented Reality and Interactive Simulation (MARIS) is one example of several successful nurse-led innovations. This mobile application was developed by a team which included nurses from various departments, to enhance nurses’ learning and share best practices in preventing and treating pressure injuries.

“The integration of AI allows for the automatic assessment of learners’ skills, allowing our nurse educators to focus their attention on learners needing additional support,” explains Tam Fong Cheng, Nurse Clinician, Department of Nursing Quality, Informatics and Transformation, CGH.

Similarly, the implementation of the Pre-Anaesthesia Assessment via the Mobile Health Buddy App, demonstrates how nurses have successfully identified operational challenges and developed practical solutions that enhance both efficiency and patient care quality.

Before patients undergo anaesthesia for surgery, nurses assess their medical history, current health status and potential risks. This app streamlines that process by enabling nurses to complete these assessments digitally, making the workflow more efficient and improving communication between healthcare teams. This approach ensures patients are better prepared for surgery without compromising care quality.

In 2023, CGH launched the Nursing Innovation Training Roadmap, a career development pathway that provides nurses with the skills and knowledge necessary to become effective innovators. “This initiative empowers nurses to actively contribute to the hospital’s mission of advancing healthcare delivery through innovation,” explains Nuri Ng, Assistant Director, Department of Nursing Administrator, CGH.

Building on this foundation, CGH introduced an interest group that further empowers nurses to become innovators through peer collaboration and shared learning. The SparkTank Interest Group connects nurses from different specialties and experience levels to spark innovative thinking, creating an environment where innovation can flourish organically.

Through structured governance, comprehensive training pathways and collaborative platforms, CGH nurses are thus equipped with the knowledge, skills and inventive mindset necessary to deliver exceptional patient care while advancing the nursing profession as a whole.

MARIS employs augmented reality to simulate patients with pressure injuries.