Holistic care passed on in community through generations

Left: Karen Li, Advanced Practice Nurse, Princess Margaret Hospital joined CNS for nine years since 2009.
Center: Cheung Sau-lan, former in-charge of Community Outreach Service Department, Alice Ho Miu Ling Nethersole Hospital joined CNS for 37 years since 1980.
Right: Leung Siu-hung, ex-Nurse Consultant, Kowloon East Cluster joined CNS for 28 years since 1990.

Going through a long and winding path in time of change, community nurses are taking care of patients with more complex care needs, ranging from foetuses who require postnatal care to elders on palliative care. Community nurses in the HA have performed over 870,000 home visits last year, in which about 84% covered patients over 65. Through the sharing of community nurses of three generations, we see their persistent sense of commitment and passion. Let us recollect the development of CNS now.

Mobile chest drain care monitored by community nurse to empower patients on self-management of drains at home.

Community nurses deliver a wide spectrum of services. Services include wound care, nasogastric intubation feeding, catheter care and drug advice. They also provide specialty nursing services such as surgical care, wound and drain care, ostomy care, geriatric care, postnatal and infant care and end-of-life care. For chronic disease management, it covers cardiac rehabilitation, pulmonary rehabilitation, stroke rehabilitation, diabetic care and renal care. Moreover, community nurses provide health education and advice.

As 70-year-old Cheung Sau-lan, former in-charge of Community Outreach Service Department of Alice Ho Miu Ling Nethersole Hospital recalls, the then government Medical and Health Department decided to grant 75% subvention for CNS in Hong Kong in April 1977. Shortly afterwards in 1979, the government confirmed full subvention for CNS and recognised the service as an integral part of Hong Kong’s healthcare care. In those days, different hospitals developed and promoted CNS based on the principle of patient-centred care. Services, very often self-initiated, were delivered mainly through accumulated experience and observation of community nurses on patient’s needs.

In the old days, around 20% of the patients had chronic diseases and the rest primarily required sick care management of a single illness. Community nurses mainly provided personal care services such as wound care, stroke rehabilitation and catheter care. Sau-lan adds that in the days when the service of Maternal and Child Health Centres was uncommon, community nurses also provided postnatal and infant care and advice for families with newborns.

Leung Siu-hung, former Nurse Consultant, Kowloon East Cluster who joined community nurse team in 1990 recalls, realignment and standardisation of service models took place due to the surge of demand for CNS after HA took over the management of CNS from then Hospital Services Department in 1991. To pave the way for professionalism, a series of service protocols and guidelines were introduced in CNS including conducting health assessment at ward and referring patients to appropriate home care and community services.

Coordinated by the Yang Memorial Social Service Centre, there were 20 graduates in the first community nursing training programme in Hong Kong. They received certificates on the International Nurses Day in 1977.

The ageing population with complex medical needs, especially chronic diseases, is a challenge to CNS. To overcome this, Karen Li, Advanced Practice Nurse of Princess Margaret Hospital points out that community nurses have put in place various improvement measures. ‘Case management model of care’ has been adopted since 1996 to empower patients with chronic health condition and carers towards self-reliance on illness management. The ultimate goal of this service model is to help patients recover in their community environment and also to reduce avoidable hospitalisation.

The service of Maternal and Child Health Centres was not common in the 1970s. Community nurses provided postnatal and infant care advice and home care for families with newborns.

Besides, four Community Nursing Centres were set up at Shui Pin Wai Estate in Yuen Long, Fu Cheong Estate in Sham Shui Po, Oi Man Estate in Ho Man Tin and Yue Wan Estate in Chai Wan. The Centres provide services ranging from nurse consultation, care advice, health assessment and healthcare education. The overall service attendance of these Centres was more than 57,000 last year. In addition, United Christian Hospital, Kowloon Hospital and Princess Margaret Hospital rolled out a programme named ‘Hospital-at-home: Virtual Ward’ in 2011 for end-stage patients to receive palliative care at home, with patients and carers support of holistic and multidisciplinary team care.

“We maintain close liaison with different community organisations and departments, such as community centres, Housing Authority and Social Welfare Department,” Karen adds, “Through fostering community partnership, recuperation of patients and ageing in place are ensured through holistic care and collaboration of various parties.”

A senior community nurse coached and mentored student nurses at patient’s home.

Although Siu-hung and Sau-lan have both retired, they hope that community nurses will strive to continuously enrich themselves in the knowledge and skills of delivering holistic nursing care to patients and carers throughout the entire patient journey. Karen recognises the importance of evidence-based practice as a solid foundation of policy and strategy making of nursing care delivery, as well as development of the nursing profession in the academic arena.

CNS 50^th Anniversary Commemorative Book