The long wait finally over?

Years ago—eight or more—some nursing homes in Hong Kong partnered with local hospital teams to provide medical consultations via a telecommunications set-up. It never has worked.

The equipment was set up as planned. Nursing home residents who are too frail to travel and wait long hours in an outpatient department sit in front of a computer in the nursing home. But hospital doctors’ schedules are rather unpredictable, so residents and nurses still have to wait.

After a long wait, residents need to go to the bathroom, or are too tired or in too much pain to remain seated, so they ask to go back to bed. Or the nurse has to answer an urgent phone inquiry, or it’s time to give out meals or medications, and so on and so forth. In the end, the resident or the nurse is not there when the doctor finally shows up at the other end of the telecommunications set-up.

Now, it’s the doctor’s turn to wait and, of course, his or her schedule is too filled to wait for long, and residents are usually not fast enough to connect with a doctor who is always on the go. That’s why this mode of telemedicine doesn’t work.

With smartphones, all these nightmares will disappear. Apps allow residents and others to connect immediately with doctors, and vice versa. Problems associated with lack of portability of telecommunications equipment is no longer a deterrent to the timely consultation needed by seniors, no matter where they are.

Although I am not personally a fan of smartphones, I applaud the advance of technology and all those who put so much effort into popularizing their use.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. 

Does iPhone mean it’s all about me?

Social norms are more dynamic than I imagined. It has become acceptable, when a couple goes out for dinner, for each to be absorbed in their own smartphone. Then, I ask, why go out to dinner together? Just to eat at the same table? Is a smartphone more fun in the presence of a person who is not engaged in what you are doing? This puzzles me.

I have also seen younger persons sitting at a table together, all playing with their phones, not looking at each other. This is different from the sight of a child comfortably playing with his or her toys, secure in the knowledge that his mother is around. It seems the person I like to hang out with—go to dinner with—is no longer as interesting as the game I am playing on my iPhone. I am still pondering the deeper meaning of these relatively recent phenomena, which say a lot about how we relate to each other as humans. How will these new norms affect intergenerational communication? Where should we draw the line between acceptable and unacceptable social behavior? These are questions with no easy answers.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Dim sum and family: Prescription for blessing

Chinese seniors are easy to please. Traditional older-Chinese folks’ idea of a blessing is simple—having dim sum with the family. Better still, doing so on a regular basis. Going for dim sum in a Chinese teahouse or restaurant is such a deeply rooted cultural behavior that, even to date, it has not gone out of fashion. Young and old alike, we all go for dim sum every now and then—sometimes for morning tea, sometimes for brunch, lunch or even afternoon tea, probably because we Chinese from the southern part of Canton, China, love food.

To a Chinese senior, having dim sum with one’s children and grandchildren is the symbol of a complete family, of being blessed in old age. It is something to boast about if a family can have five generations, all dining together. It is also a source of great delight to the elders.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Fashion statement

If one lives long enough, one will see fashions coming full circle. I see clothing styles from my youth becoming fashionable again. Sometimes, when my sisters and I window-shop, we make fun of each other about the dresses displayed. We say that we regret not saving those clothes. If we had been more patient, we would have stayed trendy without having to spend much. But who knows whether out-of-style clothes will make a comeback.

Although some clichéd styles have made a comeback, fashion in a general sense has made some progress. I use the term “progress” because I think the subtlety in trends reflects improvement. While I lament lack of imagination in today’s fashion, I admire its boldness. Nowadays, fashions are more diverse and eccentric. It is as though young people are making loud statements about who they are and what they do. In a certain sense, it is liberating. 

There are no more rules in fashion. While, in the past, everything was symmetrical in design—the collar, the neckline or hemline, the sleeves and the seams—symmetry is no longer in style. Asymmetry rules.

Asymmetry rules!

If, in the past, society subscribed to a common notion of beauty, this is certainly not the case today. There are no more rules for beauty. Character has a higher value. What a person wears is how the person expresses him or herself, and now we have freedom of expression. So there is less group-think and more individualized ways of living. Fashion is no exception.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Fast lane not always quickest way to go!

Life is busy. Busy people can accomplish more within the same period of time than non-busy people, but being busy doesn’t equal being diligent or proficient. Being busy does not mean getting lots of things done well. Being busy seeing people doesn’t necessarily increase our social network or win friends for us.

One thing for certain, a busy life makes our entire being tense up. We frequently look at our watches, checking the time, making sure that nothing has been missed. We go faster and faster until things spin out of control. Our actions become brisk and abrupt, and we become short-fused.

As I grow older, life in the fast lane doesn’t seem to be taking me to places faster. Rather, it makes me bad-tempered. I get upset when people who work with me do not understand me fast enough. My speech gets faster, but I don’t always make myself clear. Being busy can mean that I am not being thorough. More often than not, being busy means that I am hard pressed for time, and I become rude. I easily forget my manners. Regrettably, as E.M. Forster wrote, “Rudeness poisons life.”

Are we missing something?

Hong Kong is known for its efficiency, and because we are so busy—and therefore short of sleep—some of us sleep standing up. Do we know what we have missed by being so fast? What have we sacrificed to be efficient?

Wake me when I get there!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

A lost cause, if ever there was a cause

To bring about closer collaboration between the medical and social sectors, the Hospital Authority (HA) of Hong Kong, which manages all public hospitals in Hong Kong, has announced, after a three-year pilot project, that it is ready to implement an integrative care model for helping at-risk elderly people who are discharged from hospitals meet their immediate transitional needs. Under the guidance of the HA, non-governmental organizations (NGOs) will have a social worker from the collaborating NGO stationed in the hospital to assess patient needs.

When I learnt about the initiative, I realized it was already a lost cause for community nurses to be champions of community support and care. I worked as a community nurse for a year in the mid-1980s. Back then, there was not much emphasis on community services and care, but now it is entirely different, with governments and health authorities all over the world realizing the importance of keeping patients in the community.

To me, nurses can also be brokers of community services as long as they have knowledge of the service agencies and support services available in the community. It intrigues me as to why we need another professional—a social worker—to come and be stationed in a hospital. Many community nursing centers are an integral part of hospital services. Community nurses go to the wards to assess patients prior to discharge when they receive a referral from the attending doctor. Now, a social worker will be stationed in the hospital and visit the unit to conduct patient assessments. It is a duplication of health resources.

Given the nursing shortage, nurses are ever so cautious when it comes to taking up new roles and responsibilities. Yet, when we focus only on what we cannot do because we believe we are overloaded, we do not see the possibility of what we can do. We need to show stakeholders that we are willing to take on new responsibilities for the purpose of providing holistic care to our patients.

At one time, nurses could have been the champions of community care. We could have done so much more for our patients. But we stayed in our comfort zone of defined practices. We would only see patients who had a referral—to dress a wound, give an injection or teach self-administration of injections, supervise walking exercises or change a catheter. Anything that was to be done had to come with a physician’s order.

Why would health education or patient counseling need a doctor’s referral? Charging for services is, of course, an issue. That is understandable. However, what is stopping nurses from going the extra mile to do the liaison work, to find out the needs of patients and families, and refer patients to the community support services they need, instead of asking them to seek a referral at their next doctor visit?

We need to wake up to the call of our nursing vocation and make ourselves visible and accessible.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Life in waiting

Sometimes, I think about a relative, who is disabled, and his wife, who also uses a wheelchair. I never imagined how different the pace of life could be when one is disabled, compared with the pace that I am used to. It was only when I went for a day out with them that I came to realize that people who are disabled have much less flexibility in managing their lives. Not only that, they have to spend a lot of time waiting.

To go out using the Rehabus (a vehicle with a hoist for wheelchair users, organized by the Hong Kong Society of Rehabilitation), they have to book in advance. And if the time and date they need the bus service are not available, they have to wait for the next suitable time slot. Otherwise, they can’t go to whatever event they intend to attend. Unlike those with healthy bodies, they can’t always take the bus, the underground or any other form of public transportation.

Yes, they can book a private taxi with a hoist that accommodates two powered wheelchairs, but there are not many taxis like this, so they are not always available. Also, they are relatively expensive, which is an inhibiting factor for many people who are disabled.

Over the years, my relatives have adapted to a way of living in which waiting for their turn has become a part of life. As an able-bodied person, I am always on the go and in charge of my time. If I need to get to a place for which no bus service is available, I will catch a taxi. I will explore whether a place I need to visit is served by other means of transport, how I can get there the fastest—subway, ferry, minibus, etc.—what the connections are and how long it will take. Then off I go. But my relatives have to arrange for transportation well ahead of time. Mostly, they request Rehabus to come and pick them up at a prearranged time and place. There is no such thing as a spur-of-the-moment outing. Choices are much more limited.

Before we went on our outing, we planned the day in advance. We estimated how we would spend our day. But they were only estimations. Although it was possible that we would finish our excursion ahead of schedule, there was nothing we could do to save time, so we went ahead with our plan. All we could do was wait. We waited for a pick-up after movies, after going to the mall, after a family meal, and so on.

The Rehabus schedule dictates their pace of living whenever they go out. If they book transport to pick them up after dinner at a family gathering, they may need to leave midway through the event. As much as they would like to spend more time with everyone, they have to leave, because the Rehabus only runs up to a certain time in the evening.

Through spending time with my relatives, I have come to appreciate how people with disabilities go about negotiating the pace of their lives. It is only through these experiences that I have come to realize that independence has different meanings to people with different levels of physical ability.

I have also come to realize that it must be the same for all vulnerable populations in our society. Not only do people with disabilities have their life schedules governed by external factors and timetables outside their control, but they must make adjustments to their planning and wait their turn. For example, say the elevator can only take one wheelchair at a time. Because they may not be able to run up the stairs, they have to wait for an elevator that is empty enough to take them to their destination floor. In a way, Darwin’s theory still rings true: Those who are fittest get it all.

Three people in wheelchairs wait their turn for an elevator.

What considerations should we bring to the forefront when designing infrastructure for an all-inclusive society?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.