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Hong Kong
Paediatric Nurses
Association
In this issue :
ISSUE
www.hkpna.com.hk
Feature Story
April
2018
50
Gastrostomy Tube Insertion – A Systematic Approach
Experience Sharing
Ms Kwee Yung, Nurse Specialist, Paediatrics, Tuen Mun Hospital
Experience Sharing: • Gastrostomy Tube
Insertion – A Systematic
Approach
• Symposium on “Towards
Better Health for Children
2018”
Nurse’s Story: • Take the Ride
• The Journey Starts at
the Paediatric & Adolescent
Medicine
HKPNA Activities: Spring Dinner 2018
Professional Development
Activities
Renewal & Application of
Membership
Member’s Communication
Channel
A nasal gastric tube (NGT) or oral gastric tube (OGT) is a most often readily
available means to provide enteral feeding for sick children at bedside. However,
some potential risks reported with prolonged NGT or OGT include oral
aversions, pharyngeal discomfort, sinusitis, gastritis, psychological trauma,
misplacement etc. So, when children with expected prolonged need of enteral
feeding and a reasonable prospect of patient survival, gastrostomy tube (G-tube)
placement should be considered. In the past, parents and caregivers often had a
wrong concept of replacing an NGT/OGT with a G-tube as a big surgery that
may limit the daily activities of their child. Clinically, there is a lack of
standardized guidelines to provide a systematic approach for gastrostomy tube
placement.
The guidelines include four domains:
1. Decision for Gastrostomy Placement
When a decision to proceed a gastrostomy insertion is made by clinical
management team, doctor and specialist nurse will discuss with the child &
his/her parents to clarify any query. Appropriate information will be provided by
the ways of demonstration, dialogue conversation and written information. All
cases will also be referred to aero-digestive team for comprehensive assessment
and Paediatric Surgeon will be consulted too.
In early 2016, a comprehensive approach for gastrostomy tube placement was
developed in Tuen Mun Hospital. The approach includes care pathway,
guidelines, discharge and follow up process to guide and provide a holistic
approach for the whole journey.
2. Perioperative Management
Systematic workflow checklist is developed for standardized perioperative
management includes pre-operative preparation and post-operative immediate and
subsequent care.
3. Caregivers Empowerment Training
Before patient discharge, gastrostomy care training will be provided with
demonstration and return demonstration to ensure care-takers are competent in
managing routine care and emergencies at home.
4. Multidisciplinary Follow Up After Discharge
Upon discharge, patient will be referred to multidisciplinary team: paediatric Continue on next page
Forthcoming Events &
International Conference
Submission to HKPNA
Newsletter & Young
Nurses’ Sharing
HKPNA
Continue from last page
Conclusion
A comprehensive standardized guidelines and care pathway clarify pre-operative misunderstanding,
provide comprehensive logistics and strengthen the care-takers’ competence in taking care of patients
with gastrostomy tube insertion.
2
5 10
In-patients
Transfer to other hospitals
Home after operation
Result
There were total seventeen children underwent gastrostomy tube insertion from early 2016 till end of
2017. Ten of the children were out-patients and were discharged on Day 9 – Day 36 post-operatively;
five were transferred out to other hospitals for continuous care. For those out-patient cases, phone
follow up was provided. All of the children did not encounter significant problems after discharge and the
care-takers were confident in handling the gastrostomy tube at home.
surgeon, dietitian, Community Nursing Service etc. for follow up to ensure patient will receive holistic
care even after discharge.
HKPNA
Symposium on “Towards Better Health for Children 2018”
Ms Tang Sze Kit, Ward Manager, Prince of Wales Hospital
As one of the country members of the Asia Pacific Paediatric Nurses Association (APPNA), the Hong
Kong Paediatric Nurses Association (HKPNA) was glad to host a symposium, themed “Towards Better
Health for Children 2018” on 13 Jan 2018 in Hong Kong. More than one hundred participants joined the
symposium. After a simple but solemn opening ceremony, Associate Prof. Rashanee Seeda, President of
APPNA and Ms Susanna Lee, founding President of APPNA gave the opening and welcome addresses to
all participants. It was honored that APPNA had invited well-known paediatric experts to be the
speakers at the symposium.
After the symposium, a gala dinner was arranged to thank all the speakers and organizing committee
for their unfailing support to APPNA and the symposium.
Speakers included Professor Kate Chan (Assistant Professor of the Department of Paediatrics, Faculty
of Medicine, the Chinese University of Hong Kong); Professor Simon Lam (Associate Professor of the
Department of Paediatrics, the Chinese University of Hong Kong); Dr. Daniel Chiu (Specialist in
Paediatrics); Ms Chan Yim Fan (International Board-certified Lactation Consultant); Ms Chan Kam
Ming, Maria (Nurse Consultant - Neonatal Care, Department of Paediatrics and Adolescent Medicine,
United Christian Hospital) and Dr. Dorothy Tam (Specialist in Paediatrics). Wide ranges of paediatric
health care topics were shared in the symposium. All the participants enjoyed an updated information
on respiratory syncytial virus disease in infants, micronutrients and child health, updated on
vaccination for children, breastfeeding in infants and myths of feeding from neonate to toddler.
HKPNA
The Journey Starts at the Paediatric & Adolescent Medicine Department Ms Tang Chung Yan, Sandy, Registered Nurse, Alice Ho Miu Ling Nethersole Hospital
Nurse’s Story
Take the Ride?
Mr Wong Chi Fung, Registered Nurse ,Tuen Mun Hospital
Babies are no different from adults; they may encounter brain, eye, heart, lung, gut problems as you could
ever think of, especially for premature babies. Babies are admitted in the neonatal intensive care unit
(NICU) for treatment and life support. The ward that I work in is not a surgical center; so babies who
require surgery are needed to be transferred out to other hospitals.
Transporting a sick baby is never easy and always an emergency. An incubator, a portable ventilator, a
cardiac monitor, two cylinders of oxygen tanks and a medium-sized shoulder bag are all you have to carry
on board the ambulance with your little baby and the escorting doctor. The journey usually takes at least
30 minutes to another hospital. Should anything happen during the journey you need to manage by your
own. Therefore, I found transporting a sick baby is a super challenging and exciting task.
To do so, firstly, you need to equip your brain. I feel grateful that my supervisor has given me chances to
attend valuable courses like the S.T.A.B.L.E. Program especially for sick infants, Inter-Facility and Critical
Transport Medicine Course (ICCTM) and safe procedural sedation program. Besides knowledge that I have
acquired from these programs, I have also learnt about one word - ‘Preparation’ : always prepare
yourself, your equipment and your mind. Finally yet importantly, bringing money with you to take the ride
as you need to take a taxi for the return journey.
Secondly, you need to know your equipment. ‘Learn more, know better and equip yourself’- one of my
mentors always told me. I am glad that I have joined the ‘Equipment Competency Enhancement Program’.
In the program, members made quick references and did demonstrations repeatedly so I could refresh
myself and through practices to familiarize with the equipment operations.
In these two years, I have been many NICU babies’ papa. If you ask me now, ‘Are you still afraid
of transporting a sick baby?’ I will answer ‘YES’. Nevertheless, if you ask me ‘Can you take this
baby for the ride’? I will give you the definite answer ‘YES’ because a father will do everything for
his babies.
From University to Hospital
As a freshman in society, I was excited but yet nervous towards my first job in nursing. I was grateful
that the Hospital Authority has implemented mentorship program for new graduates to help newbies to
adapt to the new environment. Moreover, the inclusiveness and affinity of other team members have
made me get involved very quickly into the department. I was pleased that my journey started with this
great team.
Establishing Trust with Patients and Their Relatives
The therapeutic communication technique I learned in school has been used most frequently. Kids,
young adolescents as well as parents need more communication and interactions to build up trustful
relationships. Therapeutic communication helps me prioritize the physical, mental and emotional well-
being of patients while maintaining professionalism.
Continue on next page
HKPNA
Spring Dinner 2018
Ms Connie Tse, Editorial Committee, HKPNA
HKPNA Activities
Chinese New Year is a time of good fortune and happiness, celebrating the custom of reunion and blessing.
The Year of the Dog has come swiftly and the celebration of it seems to have come to a halt.
To let the festive continue, the HKPNA has held a spring dinner on 9 Mar 2018, to give members a chance
to chat and greet. The dinner started after President Ms Iris Yeung gave her blessing and led a toast to the
floor. Eight tables were filled with cheerful faces. The joyous atmosphere was pushed high by interesting
games arranged by the organizing committee. Members exhibited their talents and teamwork to grab as
many gifts as they can.
A Big Group of the
HKPNA Members
Members with Guest
Professor Lau Yu Lung
Fishing for Luck
Members Awarded
with Their Presents
Personal Development
To enhance professionalism, we need to receive various trainings to equip ourselves for challenges. Regular
drills enrich my experience to cope with different cases and emergencies. My problem-solving skills have
been cultivated throughout these trainings. In addition, lectures held by doctors and experienced nurses
help consolidate my clinical skills and knowledge. On-line resource is another platform providing the most
up-to-date and evidence-based information to nurses without boundaries.
With the solid foundation that I have built, I am confident that I am well equipped and ready to continue my
nursing career journey.
Evolving from Manual to System
The rapid development of science and technology enhances and optimizes different industries. Our team
has undergone a transition in the drug administration process. The new system – ‘In-patient Medication
Order Entry’ (IPMOE), has been introduced in the beginning of 2017 in our department. It redesigns the
workflow for doctors, pharmacists and nurses to replace the traditional manual prescription. Besides,
Electronic Patient Assessment Form-Paediatrics (ePAF) was implemented for better access and
documentation of initial nursing assessment. With the new systems, we have enhanced work efficiency and
accuracy.
Continue from last page
HKPNA
Professional CME Meeting on Child Health 2018 - Gut
Microbiome and Use Of Probiotics, Prebiotics and Synbiotics
in Children, co-organized with the Hong Kong Paediatric Foundation
was held on 6 Feb 2018.
Hong Kong Society of Paediatric Surgery Dinner Symposium
on The Management of Intestinal Failure in Children", co-
organized with the Hong Kong Society of Paediatric Surgery was held
on 7 Feb 2018.
Hong Kong Paediatric and Adolescent Dermatology Society -
2018 HKPADS Paediatric Dermatology Symposium, co-
organized with the Hong Kong Paediatric and Adolescent Dermatology
Society was held on 3 Mar 2018.
Professional CME Meeting on Child Health 2018 - Human Milk
Oligosaccharides and Neonatal Immunity, co-organized with the
Hong Kong Paediatric Foundation was held on 13 Mar 2018.
Hong Kong Society of Paediatric Surgery Annual General
Meeting & Annual Scientific Meeting - Paediatric Solid
Tumors, Surgical Management of Paediatric Solid Tumors,
Building Blocks of Psychosocial Care & Child Life Services for
Child Cancer Patients and Their Families, Nursing
Management of Paediatric Patient with Solid Tumors, co-
organized with the Hong Kong Society of Paediatric Surgery, was held
on 17 Mar 2018.
Hong Kong Society of Paediatric Respirology and Allergy -
What's New? Gut Microbiota & Food Allergies Management,
co-organized with the Hong Kong Society of Paediatric Respirology and
Allergy, was held on 20 Mar 2018.
The 14th Congress of the Asian Society for Pediatric Research
Emergent and Relevant Issues in Child Health Hosted by the
Philippine Pediatric Society, Inc. will be held on 2-4 Oct, 2018 in
Philippines. Please visit http://aspr2018.com/ for details.
rofessional Development Activities P
orthcoming Events F
enewal & Application of Membership R 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.
Life Members are also welcome to update any personal particulars annually
and furnish your email address using the same form.
ember’s Communication Channel M 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. Besides, you can contact us via
email address: hkpna@ymail.com
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. Send submission to: Ms Lee Wan Ming, at NC (PAE/Neonatal) Office,
K-1007, Block K, QMH OR e-mail: leewm1@ha.org.hk
ubmission to HKPNA Newsletter S
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
Chair: Lee Wan Ming, QMH
Members: Tse Connie, CMC (Chief Editor)
Chan Eugenie, QMH
Cheng Sau Wai, QEH
Law Shing Ping, PWH
Lo Carol, CMC
Ma Ella, HKCH Commissioning
Invitation of Articles Submission Paediatric Young Nurses’ Sharing To facilitate young nurses working in paediatrics to speak
up / out for professional growth and development that
knows no boundaries, and share in the HKPNA
Newsletter column
Please send submission to:
Ms Lee Wan Ming at
NC (PAE/Neonatal) Office, K-1007, Block K,
QMH or Email: leewm1@ha.org.hk
with template download from HKPNA website
The 7th ICCN International Conference on Clinical Neonatology Symposium organized by HK Neonatal Society will be held on 23-26 May 2018 in Turin, Italy. Please visit www.iccn2018.eu for details.
Evening seminar - Anxiety problems in students across the spectrum from the mild to the severe end, co-organized by the Hong Kong Society of Adolescent Health, will be held on 11 May 2018
nternational Conference
The 6th Asia Pacific Congress of Pediatric Nursing (APCPN)
Pediatric Nurses - A unified Voice towards Achieving SDGs
and Reducing Inequalities Organized by the APPNA will be held
on 27-29 Aug 2018 in Bali Nusa Dua Convention Center (BNDCC)
Nusa Dua - Bali, Indonesia. Please visit www.apcp-pitika2018.org for
details.
The HKPNA offers sponsorship for members to attend the APCPN,
interested members please contact hospital coordinator for details.
I
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