Hong Kong

Paediatric Nurses

Association

In this issue :

ISSUE

www.hkpna.com.hk

Feature Story

January 2017 46

Overseas Training in Paediatric Palliative Care in SickKids

An overseas observation visit was arranged from 2nd to 20th November 2015

for me to visit the Hospital for Sick Children or SickKids, Toronto, Canada to enhance

my knowledge and skills in advancing paediatric palliative care services in my unit. The

Paediatric Advanced Care Team (PACT) is a consult service, working in partnership with

all of the inpatient and outpatient teams in SickKids. The aims of palliative care are to

improve the quality of life for patients and their families who encounter life-

threatening illnesses by providing care and support for pain, physical symptoms,

psychological and social stresses. Paediatric palliative care (PPC) focuses specifically on

serving the unique needs of the child and family.

In the first two weeks of my visit, I joined in the PACT activities including

inpatient visits and multidisciplinary meetings, initial consultation of newly referred

patients in the family meeting room next to the PACT office, and the weekly case

conference on both the referred inpatients and outpatients. The grief support

coordinator plays a vital role in grief and bereavement care as well as supporting

frontline staff in confronting the life-threatening illnesses and end of life care for

patients and families. PACT uses the experiences of other families to outline what each

particular option of care decision may look like and reflect on how their goals and

Continue on next page

Wong Yi Fung, Maggie, APN, QEH

values as a family can be attained or may help

families to make the right decision. The

professional relaxed manner and attitude of PACT

members has been very impressive to me, by

taking the time of listening to their needs and

concerns, and obviously establishing a good

rapport easily with the parents for the difficult

discussions that come along.

Dearest HKPNA Members:

Experience Sharing

Experience Sharing :

Overseas Training in Paediatric

Palliative Care in SickKids

Sharing on NRP:

Neonatal Resuscitation Program:

Guidelines Updates

Forthcoming Events

Member’s Communication

Channel

The 9th ICN Conference in Hong

Kong

Professional Development

Activities

Renewal & Application of

Membership

Submission to HKPNA

Newsletter

HKPNA

PACT’s main task is helping people negotiate the overwhelming anxieties about death, suffering, loved

ones and finances. They used to have many worries and terrors. No one conversation can address them all. PACT

is trying to learn what is the most important to the patient and family under the circumstance so that

information and advice can be provided in an approach that is appropriate to the patient and family. The

process requires as much listening as talking.

In the situation of PPC in the neonatal unit, the parent's unwillingness to accept that nothing more can

be done for an incurable ill infant makes a particular challenge to the PACT. Nevertheless, in the young

adolescent, life-threatening illness perspective is shaped by the child's developmental context, which includes

psychological, emotional, and spiritual changes in addition to the physical transitions. The complexity of

thoughts leads to greater reflection regarding his or her beliefs and wishes about death.

With the special characteristics of children at the different developmental stages, treatment goals may

differ among patients and families to meet their individualized needs. However healthcare providers

inadequately prepared in the understanding of the concept of quality of life in the paediatric patients may delay

the introduction of PPC services and thus prolonging the undue physical pain of children as well as the

emotional and psychological sufferings of their parents. One of the greatest barriers for developing and

implementing palliative care service in the Chinese society of Hong Kong is the cultural perception and

misconceptions about palliative care. Chinese culture is used to consider death as a taboo and believe that

talking about death in front of a terminally ill patient will bring bad luck for patient’s health and recovery.

Palliative care is commonly perceived as “caring for a dying person” in some parents who may feel that, by

accepting PPC, child may not be provided with the best possible care and so leading to a preference for active

resuscitation by all means to conservative interventions designed to reduce suffering and provide comfort and

supportive care.

The PACT model in SickKids inspires me greatly

to pay attention to deliver PPC care in Hong Kong. PPC is

also family-centered care. The incorporation of

multidisciplinary approach can also be emphasized in

every aspect of care delivery. It promotes the

communication and coordination of care services. With

the close communication among palliative care providers,

families are better able to choose the plan of care options

that are in line with their values, traditions and culture. It

improves the well-being of the entire family. While grief

and bereavement ca re a re cont inu ing to be

WIENER, L., MCCONNELL, D., LATELLA, L. and LUDI, E. (2013). Cultural and Religious Considerations in Paediatric Palliative Care. Palliative Support Care, February, Vol.11(1): 47-67.

reinforced in Hong Kong, however lack of structured professional PPC service and the comprehensive training

on PPC of health care providers and administrators are the important identified factors for the under-

development of PPC service in the Chinese society of Hong Kong. As the health professionals well placed at

patients’ bedside and the community, nursing staff should be well-equipped with essential PPC skills as the

basic competency to meet the paediatric standard of care delivery worldwide. Healthcare administrators and

policy makers should consider the provision of comprehensive PPC service to meet up with the future

healthcare reforms and challenges.

Reference

HKPNA

Experience Sharing

The 9th ICN Conference in Hong Kong

Chan Yin Ling, APN, UCH

The 9th International Council of Nurses (ICN), International Nurse Practitioner /Advanced Practice

Nursing Network (INP/APNN) Conference, 9-11 September 2016, was held in Hong Kong at the HK

Convention and Exhibition Centre (HKCEC). This was a very important event in the global nursing agenda, and

provided a platform for our professionals from different countries to conduct academic exchange and

promote public health globally. The host organizer was the Hong Kong Academy of Nursing (HKAN) and co-

organized with College of Nursing, Hong Kong (CNHK) and the World Health Organization Collaborating

Centre for Community Health Services (WHOCC) and the Hong Kong Polytechnic University.

The key theme of the Conference was ‘Advancing Nursing, Advancing Health: Emerging Possibilities’.

There were nearly 1000 delegates from around the world to join and over 400 abstracts were received. I was

honoured to be one of the oral presenters. My topic was “Implementation of Nurse Residency Program in a

Neonatal Unit: Experience of a Regional Hospital in Hong Kong.

A survey evaluated a two-year transition-to-practice program to

have engaged the new nurses in safe practice, to have

confidence and reduce their stress in new clinical environment.

Both twenty-eight new nurses and twenty preceptors were

recruited in the survey. The result was statistically significant in

improving the new nurses’ knowledge, confidence and reducing

their stress level. Also, nurses were more willing to stay in the

unit after the program. It was a valuable experience to share with

nursing colleagues internationally.

The subthemes of both the oral and poster

presentation were related to the scientific approach of

advanced practice nursing (APN) in nursing services,

c l in ica l pract ice and pat ient outcomes . The

presentation provided an excellent opportunity to

reflect on the challenges and emerging possibilities in

achieving a strong future for the advanced practice

nurses as well as nursing profession. In addition, there

were six workshops – Advancing Nursing Practice in

Nurse Clinic in the 21st Century, Massage therapy in

Advanced Nursing Practice, the Omaha System: a key

to practice, documentation and information management, The OSCE: creating and implementing a program

for your teaching environment, Prescribing and Nursing Entrepreneurship with renowned international experts

to provide the participants with a unique interactive learning experience. Besides, the Conference was also

complemented by the social programs – the Gala Dinner, Hong Kong Night and Tai Chi Class.

HKPNA

Sharing on NRP

continue on next page

Paediatric nurses at the HK Night with cultural performance

Tai Chi class led by Tai Chi Masters at the HKCEC, discovering the serenity from balancing the mind and body

Neonatal Resuscitation Program: Guidelines Updates

The neonatal resuscitation program (NRP) was initiated by the American Academy of Pediatrics and the

American Heart Association (AHA) in 1987. Standards for NRP are propelled by guidelines defined by

healthcare professionals, and accrediting organizations. It is to ensure safety during the resuscitation and

stabilization of newborn infants. A structured Neonatal Resuscitation Program (NRP) has been proven to gain

significant improvement in management of newborn infants at resuscitation. It is obvious that the need for

simulation-based training NRP is evolving as the new training practice approach.

Overall, this 9th ICN Conference demonstrated and advanced the nursing contributions to health in the

world. This also supported nursing’s contribution to evidence-based healthcare and to have encouraged

problem solving approaches to health priority needs. Most importantly, this biennial ICN Conference held

around the world provides a platform for in-depth exchange of experience and expertise within nursing

profession internationally.

Last but not the least, I would like to recommend this ICN conference which would be held regularly to

our fellow paediatric nurses of both the public and private sectors in Hong Kong.

CHAN Man Yi, NC, PMH

Simulation-based training on NRP

The simulation-based training with standard operating procedures is structured to guide the

participants in safe neonatal resuscitation practices for better outcome for newborn infants. There is the need

of implementing the standardized neonatal resuscitation training and guideline for all healthcare professionals

across the various hospital settings in perinatal and neonatal care services of Hong Kong. NRP aims for

healthcare professionals to grasp the neonatal resuscitation techniques and to enhance team collaboration to

improve the success rate of recovery, and effectively reduce the mortality and disability rate of the newborn

infants.

HKPNA

Participant nurses and doctors in the updated simulation-based NRP training in HK

The developmental consideration for neonatal resuscitation focuses on the essential components

including initial steps in stabilization of the newborn, oxygen administration, positive pressure ventilation, chest

compressions, the use of drugs, and intubation. Besides, the key skills during neonatal resuscitation are effective

teamwork and communication in addition to the acquired resuscitation knowledge and skills in order to be

successful. Nevertheless, the simulation-based approach on NRP emphasizes on communication skills with pre-

and post-resuscitation team briefing, and team collaboration training for effective teamwork and

communication among the resuscitation team members. NRP courses is flourishing in Hong Kong with the

instructors and trainers increasing in the healthcare settings.

Conclusion

Neonatal resuscitation program is updated by the AAP regularly following the recommendation of

resuscitation guideline updates to AHA from after the evidence review and International Consensus on

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care via the International Liaison Committee on

Resuscitation (ILCOR). With the guideline updates in NRP (2015) and the increasing nurses and doctors who

have received the updated simulation-based training, it is hoped that the best evidence based neonatal

resuscitation guidelines will be promulgated across the various hospital settings in HK.

NRP Guidelines Updates 2015 – Points to Note:

Umbilical Cord Management

Delayed cord clamping for 30-60 seconds is

reasonable for most vigorous term & preterm infants;

suggested against the routine use of cord milking for

infants born at less than 29 weeks of gestation;

Temperature stabilization – emphasis on maintaining

normal temperature in delivery room;

Routine tracheal suction no longer recommended for non-

vigorous babies with meconium stained fluid;

Every delivery area must have an oximeter;

Initial Oxygen concentration for positive pressure

ventilation (PPV):

≥35 weeks GA: 21%

<35 weeks GA: 21-30%

Heart rate (HR) remains the most important

indicator of successful resuscitation;

Initial HR assessment – auscultation

PPV begin – consider ECG monitoring

When/if chest compressions begin – ECG is

preferred method to determine HR.

Focus intently on achieving effective ventilation

Strongly recommended intubation prior to chest

compressions.

Administer drug- Epinephrine and/or volume.

IV route preferred, pre-hospital setting may

consider using intraosseous needle

Team debriefing and reflection are key to improving

performance .

Reference: Myra, H.W et al (2015). Part 13: Neonatal resuscitation. 2015 American Heart association Guidelines Update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation:132 (supp 2) S543-S560

Chan J., Chan B., Ho H.L., Chan K.M., Kan PG, Lam H.S. (2016), The neonatal resuscitation algorithm organized cart is more efficient than the airway-breathing-circulation organized drawer: a crossover randomized control trial. European Journal of Emergency Medicine, 23(4), 258-262.

For Neonatal Resuscitation Algorithum 2015

Update, please visit:

https://eccguidelines.heart.org/wp-

content/uploads/2015/10/Neonatal-

Resuscitation-Algorithm.png

HKPNA

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.

Editorial Committee 2016 - 2018

ubmission to HKPNA Newsletter S

ember’s Communication Channel M

enewal & Application of Membership R

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.

HKPNA treasures every idea and comment from members. Please

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

Ms Iris Yeung at DOM (PAED) Office, 9/F, Block F, QEH or the Hon.

Secretary, Ms Rebecca Hui, Ward A6, PYNEH. 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, S404, QEH 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.

rofessional Development ActivitiesP

orthcoming EventsF

Send submission to: Ms Lee Wan Ming, at NC(PAE/Neonatal) Office, K-1007, Block K, QMH OR e-mail: leewm1@ha.org.hk

Short Course on Paediatric Emergency was held on 29/9, 13/10

and 27/10/2016 at Lecture Theatre, Block M, Ground Floor, QEH,

attendance 25, 10 & 13 respectively.

Child Life Symposium 2016 co-organized with Children’s Cancer

Foundation and HK Paediatric Haematology & Oncology Study

Group, was held on 18/8/2016, attendance 46.

Paediatric Immunology and Infectious Diseases Study Day co-

organized with the HK Society for Paediatric Immunology, Allergy

and Infectious Diseease, was held on 3/9/2016, attendance 12.;

lunch symposium, attendance 14; 9th & 10th AGM, attendance 13.

17th AGM Meeting 2016 co-organized with the HK Society of

Paediatric Gastroenterology, Hepatology and Nutrition was held on

6/9/2016, attendance 74.

Special dinner lecture on Newborn Resuscitation Program

Updates co-organized with The HK Neonatal Society, was held on

22/9/2016, attendance 166.

Professional CME Meeting on Child Health 2016 – Update on

Childhood Sleep ad Breathing Disorders co-organized with HK

Paediatric Foundation, was held o 4/10/2016, attendance 14.

BGCA 80th Anniversary Scientific Conference and AGM co-

organized with Boys and Girls Association of HK was held on 7-

8/10/2016 at Yasumoto International Academic Park, The CUHK,

attendance 2.

Chair: Members:

LEE Wan Ming, QMH MA Ella (Chief Editor) CHENG Sau Wai, QEH CHAN Eugenie, QMH

Spring dinner 2017 will be held on 3 March 2017, details to be

announced,

LAW Shing Ping, PWH LO Carol, CMC

TSE Connie, CMC

Working with children in paediatric

setting can be really challenging

especially for newly graduated nurses.

Tell us about a touching, inspiring or

life-changing experience as a nurse in

paediatrics or child health.

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