When one of her patients began to throw a tantrum - shouting and banging her head against the walls - 31-year-old nurse Nur stepped in to try and calm her down.
But the hysterical woman kicked her in the chest, leaving her winded and shaken for the rest of the day.
Incidents like these are not uncommon, said Ms Nur, who declined to give her full name.
In her 14 years as a nurse, she has seen colleagues bitten, slapped and punched at work - both by patients and their family members. "This is something we didn't talk about at school, and it can be quite traumatising for young nurses," she said. "Even verbal abuse just spoils your day and lowers your morale, but you still have to carry on with the shift."
Worryingly, nurses who spoke to The Sunday Times said they felt such incidents of verbal and physical abuse are on the rise.
All of them said they had been on the receiving end of such abuse before, and that roughly four in 10 patients are likely to raise their voices against healthcare staff.
Last November, local medical journal Annals Academy of Medicine also published an editorial estimating that seven in 10 healthcare workers have faced physical abuse, and that there is generally "significant under-reporting" in this area.
Those at greater risk tend to be young and female, as well as front- line staff who come into contact with patients more frequently.
Accident and emergency departments (A&E), intensive care units, and other places where emotions run high tend to be where many abuse cases occur. "In the A&E, sometimes patients have to wait for two or three hours," said Madam Brenda Lee, 58, who has been a nurse for more than 40 years.
Those with fractures, for instance, may be in pain but are still considered Priority 2 - behind those with critical conditions such as heart attacks. And those with relatively minor injuries, such as sprains, headaches and animal bites, are considered Priority 3.
"Naturally there's a lot of frustration because they all want treatment immediately," Madam Lee said.
Mr Abdul Hadi Kamarolzaman, a former nurse who now teaches healthcare staff how to protect themselves in such tense situations, said simple techniques can help calm patients down. He himself was once attacked by a psychiatric patient wielding a drip stand.
"For many (patients), what they really want is for someone to listen to them," he said. "Show them that you are able to empathise, and allow them to ventilate."
However, he also teaches his students how to handle situations that threaten to become violent - for example, breaking free of grabbing hands or chokeholds without hurting the patient. He, too, has been hearing that the number of abuse cases has been going up, although he is not sure why. However, he stressed the important role that hospital managements play in preparing their staff for this part of their work.
"The management needs to be aware that this is an important part of nurse training," he said. "If you get it right, you can preserve morale and prevent attrition."
Ms Sue W, 29, who has been working as a nurse for five years, added: "Verbal abuse cases are rarely escalated to the police because of pressure from the management." She typically keeps her eyes peeled for tell-tale signs of aggression and calls for backup or tries to de-escalate the situation before anything happens.
Veteran unionist K. Thanaletchimi, who has been president of the Healthcare Services Employees' Union for 20 years, said hospitals should encourage their staff to report such incidents. At the very least, patients can be made to realise they could have handled the situation better. "It's about the 'heartware' - whether other people feel they should treat other human beings with basic dignity and respect," she said.
Hospital staff trained to handle difficult patients
Public hospitals say that staff are taught how to deal with difficult situations involving patients, including when to call for backup.
At the National University Hospital (NUH), there were 155 reported cases of abuse last year, down from 162 the year before.
Said an NUH spokesman: "We understand that patients can get abusive because they are unwell and some may display different behaviour because of their illness.
"Family members may be anxious for their loved ones.
"However, we do not tolerate abuses against our staff and will take action to protect them."
At Tan Tock Seng Hospital (TTSH), there are surveillance cameras and alarm buttons to call for security guards if needed.
Said a TTSH spokesman: "In a potentially difficult situation, our staff are trained to try and understand the cause of any aggression.
"This allows them to respond more appropriately."
Khoo Teck Puat Hospital has seen an increase in the number of reported abuse cases, from 25 in 2011 to 41 last year. However, a hospital spokesman added that these numbers are "very much under-reported". He said: "On a daily basis, many of our healthcare workers are subjected to disrespectful and unkind treatment by the public that goes unrecorded."
He added that front-line staff are trained to manage abusive behaviour, including when to escalate the matter to their supervisors or rope in other colleagues for help.
Nanyang and Ngee Ann polytechnics, which offer nursing diplomas, said students are taught to handle such difficult patients through role play in class. Hospital staff also guide them during attachments.
A Nanyang Polytechnic spokesman said: "They are taught how to diffuse the situation by first trying to understand the patients' concerns." A Ngee Ann Polytechnic spokesman added: "In recent years, we have heightened students' awareness on how to deal with stressful situations at the workplace, such as bullying behaviour, sexual harassment and physical and verbal abuse from patients."
This article was first published on March 27, 2016.
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