With an increasingly dominant role of technology in healthcare delivery, driven by both demand and supply factors, one question that will confront us as we stare into the future is whether the current nursing curriculum is sufficient flexible or holistic to prepare future nurses? This innovation project has again reminded us the profound and rapid changes that technology has brought to healthcare, especially in things related to the internet technology.
According to the World Economic Forum (1), the top hard skills expected to be in demand in the future are
- cloud computing
- artificial intelligence
- analytical reasoning
- people management
- and UX design, and a long list.
Most of these are not part of a traditional nursing curriculum. As the technology world is expanding, we wonder how the nursing curriculum might look like in ten- or twenty-years’ time versus now. It will not be surprising if future nursing students find themselves learning mathematics, entrepreneurial skills, programming, etc., as part of their core curriculum. The only constant is change so who knows?
Interdisciplinary collaboration brings in new perspectives from members of different background and this is useful for breaking away from old mind-sets, injecting new ideas and analysis. In this blog post, we describe an interdisciplinary innovation project between Singaporean students and an industry partner, on their journey to co-create a game for professional healthcare setting.
The Challenge: Online Content for Dementia Rehabilitation Facilities
The current pandemic has shown the drastic switch from physical activities to telehealth to ensure the continuity of quality care to clients. Although physical activities are still the preferred mode of therapy for dementia clients, having digital ones will serve as an extension especially during times where physical sessions are restricted. Clients are homebound but their rehabilitation care must continue.
Technology can be used to replace some card and board games such as memory games, which are commonly used in dementia care. Many traditional games like Monopoly® have already gone online so this is approach is not something very new.
In geriatric settings, dementia clients generally find it a challenge to sustain concentration while sitting on a chair and staring at the screen. It is important to include meaningful activities for older adults with dementia. (2) Therefore, mini-physical sessions of activities and/or games were included in between the digital games. It not only improves their concentration for the subsequent digital games but also helps to hone the clients’ motor skills!
Singaporean students collaborated with HoviCare Singapore to develop an in-house game that can help aid in their rehabilitation programme for their clients with dementia. The centre has always aimed to provide their clients with the individualised quality rehabilitation services. HoviCare currently uses a curated mix of third-party resources. The next step forward for HoviCare would be having more in-house solutions, which would also pave the way for better control of content resources as well as potential to add analytic features and scale up operation in the future with a common digital platform.
The same challenge for students in Singapore and Finland
The MANPIT project had started in 2019 in collaboration with Ngee Ann and Metropolia. The project wished to share the best practices in innovation studies and students were to start working on the similar kind of innovation projects, first online and then face-to-face. (3)
- In Metropolia, innovation studies (10 ECTS) are mandatory to all degree students (4).
- In Singapore, Ngee Ann Polytechnic seeks to develop and support an entrepreneurship ecosystem through a host of initiatives and programs, and start-up projects are organized as Interdisciplinary free choice studies (5)
In MANPIT-project, Metropolia students completed an innovation project, in where a staff member at HoviCare could make an online journey in different countries with the clients. The journey included photos, videos, country specific activities and food experiences. The clients made the journey at the premises of HoviCare in Singapore.
Ngee Ann students created an online game for HoviCare clients. The theme was also about travelling but this time in a familiar environment in Singapore as a virtual game. The multidisciplinary team comprised students from the School of Health Sciences (HS) and the School of Info-comm Technology (ICT). The team brings to the table both the necessary healthcare nursing knowledge and the technical prowess needed for the challenge.
According to Laura-Maija Hero (6) students` learning experience in a multidisciplinary innovation project comprises three categories. These are solvable conflicts and unusual situations; becoming aware of and claiming collaborative agency; and internalising phases of the innovation process.
The Solution: Game – Singapore Unlocked!
Singaporean students designed a game around the Singapore Zoological Gardens. With the Singapore Zoological Garden being a popular attraction among Singaporeans, having virtual tours can help give clients a sense of belonging and familiarity! They incorporated both the digital games and physical activities into a single care session.
Students wanted to have the option of involving caregivers and the HoviCare staff since they play important roles in the rehabilitation of clients (7). There will be opportunities for self-participation in such activities and games with little supervision to group-participation with caregivers and HoviCare staff together. Caregivers could be untrained family members or even simply be a domestic worker in the context of Singapore. Pre-activity tutorials and interactive sessions embedded within the games are crucial to engage and on-board these caregivers in the journey.
The project was held over the course of a COVID-19 pandemic, with restrictions on physical activities and a constantly evolving national policy on pandemic control. It was simply not possible to meet up physically in person within the team and with the industry partners. Significantly, it also curtailed meeting and interactions with clients and end-users.
The early adaptation and ‘acclimatisation’ to online technology and a new modus operandi within the team are important in reducing anxiety and getting comfortable with another way of doing the same old thing – meeting up and getting things done – virtually. Moreover, the students did it for the entire duration of the project. Rushing to the school early in the morning or staying back in school for late evening meetings are a thing of the past! Now it could be done any time anywhere, which is both a boom and a bane. Meetings that would no longer be restricted to school hours. Technology has brought convenience but has also blurred the boundaries between school hours and personal life.
Students were also not able to visit HoviCare to have a first-hand experience of their ongoing programmes. The information from HoviCare together with the knowledge of dementia care from their nursing program, allowed students to tweak the games and programmes to suit the needs as closely as possible for the dementia clients
Interdisciplinary collaboration and important role of users
Nursing students commented on interdisciplinary collaboration: “Being nursing students, dementia care is our forte and it is vital that we engage our ICT peers so that they have some ideas about dementia care before embarking on the project. HS nursing students would focus on the physical activities and games ideas while the ICT students focused on game digitalisation and development, including platform optimisation. The ICT students also taught us (nursing students) the importance of perseverance. It is time-consuming and tedious to code the games. When a new suggestion arises, they must change the whole coding and programming system. Yet no complaints are heard, and they focus on producing the best digital solutions to help the clients.”
The nursing students also learned something new about colour schemes in the process. In art therapy, dark colours can indicate dampened mood. However, for digital games, dark colours are widely used as a background colour to provide stark contrast in visualisation. Hence, warm colours, as suggested by the ICT team, were used to address the issue of poor eyesight as well as brightening up the mood.
Interdisciplinary teamwork can be a double-edged sword and it is vital that students with different expertise and perspective engage each other and work well within the team. (8) Once the team is formed, the students quickly worked to know each other well and to increase common understanding and sharing of expertise, allowing progression and completion of the innovative project successfully.
End-users’ role in game development is important and the team’s regret was not being able to directly engage and interact with the elderly clients in-person. The absence of direct contact disrupted the initial plan to engage the clients for testing of the games. By testing the games with the clients under an in-person experience at the centre might have been more advantageous, especially in the early stage to allow to focus on the game design and development, leaving out other factors that may affect the game and system performance and overall experience of users in an out-of-centre remote session.
The students’ experience with an inter-disciplinary approach to healthcare innovation highlighted again the importance and benefits of such a strategy and why this approach could or should be widely adopted in the curriculum of institutions of higher learning. MUAS has been an avid champion of such a strategy and NP has in recent years increasingly adopt this practice as well.
1. World Economic Forum. (2019, January 14). These are the 10 most in-demand skills, according to LinkedIn. (weforum.org)
2. Tierney, L. & Beattie, E. 2020. Enjoyable, engaging and individualised: A concept analysis of meaningful activity for older adults with dementia. International Journal of Older People Nursing. (onlinelibrary.wiley.com)
3. Ahokas, A., Hokkanen, H. & Tan, H-Y. Innovation in pandemic world and beyong. Metropolia University of Applied Sciences. Tikissä Blog. Published 11.3.2021
4. MINNO® Innovation projects – building the future today.
5. NP: The Poly for Budding Entrepreneurs. Cultivating an innovation mindset, leading the entrepreneurial spirit. (np.edu.sg)
6. Hero, L-M 2019. Learning to develop innovations. Individual competence, multidisciplinary activity systems and student experience (Doctoral dissertation). Annales universitatis Turkuensis, 475, Faculty of Education, University of Turku, Finland.
7. The Caregiver Space. (2017, October 5). How Social Interaction Plays a Principal Role in Dementia. (caregiverspace.org)
8. Vestal, A., & Mesmer-Magnus, J. (2020). Interdisciplinarity and Team Innovation: The Role of Team Experiential and Relational Resources, 51(6), 738–755.
Aija Ahokas, Manager of Education Export / Senior Lecturer (MEd, RN, Specialist Qualification in Product Design). Ms Ahokas has many years of working experience abroad. Her core competencies are in different international activities, networks & partnerships. Transnational education is close to her heart. Ms Ahokas is the project manager of MANPIT-project.
Hannele Hokkanen, Senior Lecturer (MSc (health care), RN, Specialist Qualification in Product Design). Ms Hokkanen teaches gerontological nursing and she is the coordinator of innovation projects in health care.
Yu Ni TAN Dip (NSG), Alumni, School of Health Sciences, Ngee Ann Polytechnic, Singapore. Yu Ni graduated from Ngee Ann Polytechnic in 2022 and is eagerly waiting for her nursing degree program to start in the summer. She is ever positive and optimistic about everything.
Raynee JW THAM Dip (HSN), Alumni, School of Health Sciences, Ngee Ann Polytechnic, Singapore. Raynee participated in the project as a final-year diploma nursing student and graduated from Ngee Ann Polytechnic in 2021. Driven by her enthusiasm and interest for the project, she remained intimately involved with the team despite her earlier graduation. She is currently an undergraduate nursing student.
Natalie SH YEH Dip (NSG), Alumni, School of Health Sciences, Ngee Ann Polytechnic, Singapore. Natalie was an enthusiastic second-year nursing diploma student when she became involved in the project. She graduated from Ngee Ann Polytechnic in 2022 and is looking forward on embarking on her new journey as an undergraduate nursing student in the summer.
Hong-Yong TAN, Senior Manager for Timetabling / Lecturer (MBBS). Dr Tan has previously worked at different public hospitals and healthcare organisations in Singapore, in various clinical and administrative roles. He is currently a lecturer with the School of Health Sciences in Ngee Ann Polytechnic where he teaches at both the diploma and post-diploma levels. He is always curious and eager to explore and learn, traits that he hopes to rub off on his students.