Nurse be nimble, nurse be quick… especially when you have to prick
Every nurse would probably remember their first time doing an intravenous (IV) cannulation on a patient. There would be the anxiety and stress of inserting the IV cannula needle successfully into a vein. Nerves would lead to excessive probing– known as ‘fishing’ or over-puncturing a vein, resulting in bruising!
Nurse Clinician Andrea Choh clearly remembered her ‘first’. As a new nurse then, the first patient she had to cannulate was in the renal ward. “Renal patients have very very thin veins. It was very stressful and I was not successful,” she recalls.
Little did Andrea realise that she would be involved in a project that would help nurses with this skill, 18 years later.
Assembling the Dream Team
How did the project – IV Nimble – come to fruition? Deputy Director of Nursing Ang Shin Yuh shares:
“We had previously used gaming technology for education, as well as incorporated sensors into fabrics. One day, while chatting with our technology partners, we came up with the idea of using a game and a virtual patient to teach nurses an essential skill such as IV cannulation.”
After securing a grant from the Singapore University of Social Sciences, Shin Yuh brought the idea to the Nursing Quality Management team members, NC Andrea and Senior Nurse Manager Teo Kai Yunn, who had worked on a blood transfusion game. She next roped in Nurse Educator Kathlyn Wang who specialises in training nurses in venepuncture and cannulation. Finally, she recruited Senior Executive Kelly Woh, and Associate Executive Nur Fidtria Binte Sahat from the Nursing Administration Division.
Let’s play a gameTogether with their technology partners, the team developed an incredibly immersive game called The IV Nimble to train nurses in IV cannulation.
In conventional training, nurses insert the cannulation into a prominent vein in a silicone hand which have fluids to simulate blood. However, there is no way to determine if the vein has been connected correctly.
With the IV Nimble, nurses don a special pressure sensor glove which is able to sense the pressure and of the cannula needle as it is being inserted into a 3-D printed hand. The IV Nimble is then able to assess the IV procedure.
The nurses put much thoughts into creating a much more versatile and realistic hand to suit a wide range of needs. To mimic different conditions such as thinner veins, darker complexion or swelling, the team are working to create different versions of the artificial hand. The glove was designed to be usable by both right handers and left handers, easy to put on, and allow nurses to use it with latex gloves on.
Mr Tan Ah Kow, the virtual patient on the screen, tells you if he is in pain and responds to questions.
Introducing Mr Tan Ah Kow…The dashboard was also linked to a virtual patient avatar – Mr Tan Ah Kow – who responds. Credit for Mr Tan went to Nursing Executives Kelly and Fidtria. With their strong background in IT, they worked together to programme Mr Tan’s responses and behaviour. “Although we were not familiar with the programming language, Chatscript, we were able to learn it quickly because of our coding background,” said Kelly. This duo burnt many evenings learning Chatscript from a professor based in the United States.
After reading the original script by the nurses, they pointed out that it was not realistic and added Singlish, colloquial phrases and words. “Being layman, we could easily put ourselves in the patients’ shoes. So we offered some suggestions to make the avatar’s verbal responses sound more realistic,” explained Fidtria. As a result of their programming, Mr Tan Ah Kow speaks like a local, understands different accents and yelps “OUCH!” when cannulated wrongly.
What’s your name? Are you okay? Kathlyn lit up when recalling the experiences of the nurses who had participated in the pilot.
“The nurses found it very fun and engaging because they could interact directly with the patient while practising their cannulation. We created different patient scenarios, with different questions and answers so our nurses would be more confident when communicating with actual patients.”
Kathlyn added, “People skills like empathy, friendliness and being able to allay patients’ fears are equally important for nurses to master, which is lacking in the tradition method of cannulation training.”
Using IV Nimble, the trainers are able to step back and observe both the human interaction, as well as technical skills.
Kathlyn quipped, “And isn’t it human nature to play? Everyone loves playing games!”
Gaming championsThe project was not without challenges. “We had to work out how to have all the components flow well into one game. There was a lot of trial and error to get the conversing with the avatar bit and the cannulation skills portion as close to the real life experience as possible,” said Shin Yuh.
There was also the time pressure to complete the project in six months. Everyone being clear on their roles helped them to complete the project on time.
Kelly hopes to be involved in more of such projects. “Fidtria and I learnt a new coding language. We also learnt about cannulation from the nurses and what the expected outcomes for patients are.”
The whole team enthusiastically agreed the results were totally worth the effort and the pain – building something that greatly helps nurses. Kathlyn pointed out that in this New Normal, a lot of training is online which is not ideal for picking up certain skills. Experiential learning projects like these overcome the limitations and aid education.
Shin Yuh is pleased with how projects like these are building a culture of innovation, “It’s wonderful when colleagues from different backgrounds and experiences come together to rethink and meaningfully transform the way we work.”In fact, the Quality Management Team has already lined up more of such games! “This is the way forward!” declared Andrea.
Want to help our nurses level up their nursing capabilities and skills? You can support them by donating to their innovation fund here:
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