Sample Research Paper on Impacts of an ageing population with chronic diseases on nursing practice in Singapore.

Impacts of an ageing population with chronic diseases on nursing practice in Singapore.


This paper explores the impacts of an ageing population with chronic diseases on nursing
practice in Singapore. It also seeks to analyse the current influence on nursing and the
contemporary nurses’ role plus the potential impact on health care system in Singapore. The
nurse is the image of health worker. For many in health facilities all over the world, and in
Singapore, this is a profession of passion for the ill and the afflicted where nurses provides
services to patients medical and mental needs. As assessed, nurses also assists in treatment and
day to day care and home-based care, facilitates psychosocial research and facilitates medical
care in general. Chronic diseases in Singapore are on an exponential increase which has resulted
in continuous demand on nurses in terms of working hours and the hours dedicated per patient.
This has a negative influence on the overall healthcare system in Singapore due to increasing the
nurse to patient ratio.

Keywords: nursing, ageing, healthcare, chronic diseases.




It is the ultimate desire of all people to continually enjoy sound and healthy life. A health
population is said to have diverse significance that a society and a country enjoy. With a health
population, money employed in the health sector to buy medicine, remunerate health offices,
build health infrastructures, and fund research find its way in more development oriented
projects. Healthy individuals are also able to work; hence, cater for their needs, and at the same
time, contribute in the revenue kitty of the nation. Therefore, healthy individuals are bound to
serve as the basis for prevention efforts across their society. They are also bound to pledge their
support to established health and human services (HHS) to foster a healthier society, and in the
long-run, a healthier nation.

Aging is a fate that befalls every individual that is blessed to get to that stage (Cheah,
2001). In addition to the myriad benefit that a nation derive from the aging population in terms of
expertise, experience among others, the same condition presents some challenges that the
country has to put up with. In Singapore, one of the major institutions that face direct impacts of
ageing is the nursing fraternity which has to put up with the increasing chronic diseases in
individuals, especially during their old age. According to U.S. department of health and human
services, (2010), an ageing population suffers from multiple chronic diseases like asthma,
hypertension, diabetes and heart complications that require prompt and effective attention. Such
diseases do not only present positive impacts, but, in actual facts, the negatives impacts outdo
any positives that an ageing population would present to the nursing fraternity.

Ageing population with chronic diseases in Singapore

The trend of population growth in developed countries which includes Singapore,
indicate that there is an increasingly ageing population. This coupled with lifestyle changes has
been influential on the rise in prevalence in chronic diseases as reported by Brenda and Yeoh,
(2009). According to them, complex illnesses that have prolonged durations are rarely cured
completely. The morbidity and mortality of these diseases have since overtaken the infectious
diseases and they account for more than 83% of all deaths among people of 65 years and above
according to the world health organization (Yeo, Harris, & Majeed, 2012). Some of the rising
cases of chronic diseases in developed countries are cardiovascular diseases which are non
communicable diseases that have complex causes and contribute to disabilities. Other examples
include cancer, diabetes, arthritis, sclerosis, respiratory diseases, depression, end-stage renal
disease all of which are on the rise as explained by Ramirez & Sylvia (2008).

The increasingly aged population which is estimated to be increase by 20% by the year
2030 is one of the most rapidly rising ageing population in the world, and this has played a big
role in the rise of the prevalence (Wong, 2008). While this may also be attributed to better
detection methods at early stages, it has had a notable impact on the nursing fraternity’s daily
routine as patients require continuous attention of health workers especially nurses to attend to
them. This in turn puts strain on the already stretched nursing work force, prompting even the
government to plan reducing the estimated patient nurse population ratio from the current 249 to
210 patients for every nurse so as to ease the pressure on nurses. As observed by Wong and
Chieh (2008), Singapore has about 34200 trained nurses to take care of about 8 to 10 patients in
the larger hospitals.

Role of the nurses

Social care burdens of the Singaporean nurses are evident due to an increasing number of
elders with a preference for home based care as it is with most developed economies (Brenda and
Yeoh, 2009). The most common stressors in nursing profession include workload and emotional
distress due to continuous contact with the afflicted. In addition, prominent job dissatisfaction
usually arise from role ambiguity and conflict of interest which is as a result of unscheduled job
assignments which is often the case when dealing with aged patients with chronic diseases
(Parikh, Atish, & Tanmay, 2004). Generally, the patients’ expectations in Singapore have gone
up and increasingly nurses need to be very competent in medical and/or psycho-social
assessment. In addition, general continuous professional development to keep up with global
trends and be at par with nurses hired from China, Philippine and other countries to cater for the
shortages (Wong & Chieh, 2008). The recognition of Advanced practice Nurse (APN) by the
government and regulators was welcome. Nurses have to keep up to date registers and at the
same time contact new patients who might be disinterested in honoring follow-ups (Cleary,
Horsfall, Mathulakshmi, Hapell, & Hunt, 2013). The contemporary nurse has a role of
developing a personally tuned plan for each patient that will ensure or enhance compliance. He
or she has to also act as an accessible link between the patient and professionals so as to maintain
condition improvement and prevent worsening health which would not be beneficial to the health
workers, the government or the individual (Cheah & Heng, 2001). The nurses also have to juggle
between managing home based patients and in-hospital assignments in a country that is still
working to establish community nursing programs. For these reasons, newly recruited nurses
who are starting on the chronic disease management programs undergo more training for extra
medical skills especially in physical examination and prescribing, identifying multiple conditions
so as to develop a realistic rehabilitation plan.

The impact this has had on the individual nurse is that too much demand on the nurses
lead to job dissatisfaction and consequently many social and psychological disorders when stress
levels are beyond the nurse’ coping ability as reflected by Tosh, Anq, & Devi (2012). Nursing is
ranked top as most stressful job in health and/or medical occupation and 27 th in 130 diverse
occupations by the American national institute of health (Golshiri, et al., 2012). Unexpected
response of patients, irregular patients’ conditions and sharing of the patients’ psychological
situation are some of the contributors to emotional distress among nurses. In the medical
profession, one of the most rewarding attribute is the positive response of a medical case a health
worker is dealing with. Most of the doctors do not interact with the patients with chronic
conditions as much as the nurses do, more so if the patients are elderly and have to be cared for
at homes, the nurse who handle such cases have to remain committed to caring for an aged
patient with sometimes debilitating chronic condition that will only end fatally. Sometime, they
may not be at liberty to reveal the outcome of the condition and these impacts negatively on the
psychology of the average nurse.

Impact on the healthcare system

Chronic diseases have a largely negative impact on the health system. Some of the
positive impact is that clinicians and nurses get real experience and are more prepared to deal
with similar conditions in future. This is not an advantage that the state maybe looking forward
to discourage because, the diseases experienced during old age present a bigger challenge in
terms of the fiscal demand, especially in sheer consideration that 80% of Singapore’s primary
healthcare is provided by the state as put by (Wong & Chieh, 2008). While the remaining 20%, is
reliant on private sector and/or family health care providers. Chronic diseases have a protracted
timeline with most of them ending fatally, or leaving the individual in a state that they cannot

manage to contribute to the economy positively (Baker, 2011). The eminent conditions also
present a huge budgetary constrain on healthcare facilities due to issues like readmission, and
continuous follow ups among other health care services. This calls for a multifaceted approach
and complications management as well as community care centers that would serve as
prevention and management points (Ramirez & Sylvia, 2008).

This is usually complicated by duplication of cost and services where a patient moves to
a different health facility or on other health care service providers due to claims of
dissatisfaction. This becomes a great challenge when there are no online patient databases and
only acts to tie up funds which would have been used on other patients. In future clinical data
may have to be put online or on a platform that can be share by health practitioners countrywide
so as to prevent duplication and enhance sharing of information from the data from various
health facilities under the ministry of health (MOH). Such a move would will ease sharing of
experiences also by doctors and nurses and eventually lead to better healthcare. Under the
primary care partnership scheme and the Elder shield insurance, the government is reported to be
actively involved in providing essential subsidies for chronic diseases. This serves as cushion for
the savings of patients with significant chronic conditions (Wong & Chieh, 2008)).

In addition to the above issues, there is also direct pressure on hospitals facilities. To
illustrate this, in 2008, the number of hospital beds that were available in Singapore would only
serve patients at a ratio of 3 beds per every 1000 patients requiring admission (Wong & Chieh,
2008). Hence, as the population becomes more elderly the demand for such basic needs would
increase. In addition, the work load on the side of the nurses would also double, noting that they
are also in the process of aging.


Nursing politics and different perspectives on health and healthcare
While the state encourages maximization on funds such as the Medifund, Medisave and
Medishield so as to balance between affordability, accessibility and quality and give Singapore
one of the best medical services in the world as observed by (Wong & Chieh, 2008). Singapore
is ranked 6 th worldwide by the world health organization. Despite this, the medical services are
still not free of charge and this is crafted so as to curb over utilization and indirectly encourage
healthy lifestyle that in turn will reduce the prevalence of lifestyle-chronic disease in old age
(Baker, 2011). The largely simple approach of the Singaporean government creates a different
approach on Medicare where everybody is covered as opposed to the US version where a large
number of people are left out as reported by Cheah, Wong, and Pang (2010).

As demographic trends gravitate towards more people above the bracket of 65 years,
healthcare systems become more challenged by chronic diseases of old age; hence, the need for
more inclusive healthcare. According to Kalisch, Lee, and Monica (2010), nurses may have
heavy workload in hospitals, care centers and home-based patients but they remain adequately
compensated and very motivated. In addition, majority of them consider passion and not salary
as the driving force. Teamwork, patient, compliance and trust has been associated with high level
of job satisfaction where it exists.

With a promise from the government of a possible 20% pay rise in 2014, and Advance
Practice Nurse Recognition, nursing practice in this country will only get better opportunities and
their roles continue expanding as observed by Derbyshire & Davies (2011). APNs have more
authority and more involvement in patient management especially those with chronic diseases
who are under their care. They act as bridge between the nurse and the doctor. Nevertheless,
there is an ongoing cause of concern for doctors who may feel less powerful and fail to provide

support to these advanced nurses and the nursing practice; hence, the need for clear roles to
prevent over wrapping between the nurses, APNs doctors and specialists (Mehta, 2006).


Singapore may have one of the highest percentages of chronic diseases among the aged in
the world, but this city state has managed to attain one of the most successful health systems in
the world in terms of efficiency, effectiveness and government involvement. The nurse in
Singapore has a central role. The recent recognition of APNs will go a long way in retention of
most experienced nurses in Singapore. The integration concept will also help management of
community based care by providing support framework for aged care facilities and nursing
homes, by moving from ‘compartmentalization to an information sharing system. The nursing
practice has not and will not rise above specialists’ practice and doctor’s role in caring for aged
patients with chronic diseases, but it has received more recognition and will continue to be
fundamental in the healthcare system of Singapore.


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