A Kinder ICU: Integrating palliative care earlier in the ICU journey

Published on 9 May 2026

NUH and TTSH have jointly launched A Kinder ICU programme, which aims to provide critically ill patients palliative care earlier in the ICU, alongside active treatment.

At a glance

• About 20 per cent of ICU patients pass away in the ICU while undergoing treatment.
• A Kinder ICU is expected to benefit more than 7,600 ICU patients over the next four years at NUH and TTSH.
• Within 48 hours of admission, ICU nurses will engage caregivers to understand the family’s needs and priorities, to uncover concerns that may affect medical decisions.

While the Intensive Care Unit (ICU) is best known for life‑saving interventions, an ICU admission often entails overwhelming anxiety and uncertainty for patients and families. An estimated one in five ICU patients does not survive their ICU stay, yet palliative care is often introduced only in the final hours or days.

However, a profound shift has begun to take root in Singapore’s ICUs – one that embeds comfort and dignity within the care journey. This is the heart of A Kinder ICU, a new initiative jointly launched by the National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), integrating palliative care earlier into intensive care settings.

Supported by the Lien Foundation with an investment of $3.93 million, the four-year programme leverages expertise from both hospitals to advance a progressive, multidisciplinary model of palliative care integration within the ICU settings, building on existing efforts at both institutions.

In early 2024, NUH launched the Palliative Care Nursing Network (PCNN), a nurse-led initiative to empower nurses to conduct comprehensive assessments of palliative needs and manage symptoms. This includes Palliative Care Resource Nurses, who are specially trained to provide advanced interventions for complex cases, supported by palliative care specialists.

Boosting multidisciplinary capabilities

To operationalise the key features outlined in A Kinder ICU, the hospitals will train about 800 ICU staff over the next four years, consisting of ICU doctors, nurses, therapists and social workers that anchor this programme.

Nurses, in particular, play a vital role in advocating for patients while also identifying caregivers who may require psychological support.

“Because nurses are with ICU patients 24/7, we are often the first to notice subtle, non-verbal signs of distress,” said Ms Charmaine Sim Peizhen, Advanced Practice Nurse, Medical Intensive Care Unit, NUH. “By strengthening palliative care training, nurses are better equipped to bring this sensitivity into every shift and translate bedside observations into timely action.

“This enables us to lead palliative care reviews, initiate difficult conversations with families, and advocate for patients who can no longer speak for themselves.

“Through A Kinder ICU, we hope to further advance the role of nurses in initiating and championing palliative care as part of everyday ICU practice.”

Gently woven into the ICU care journey

For patients and caregivers, A Kinder ICU brings together targeted interventions to enable early identification of palliative care needs, and the delivery of appropriate, compassionate care.

Nurses are empowered to proactively assess all ICU patients for palliative care needs, as well as symptoms such as pain, breathlessness, and confusion, especially in patients who are unable to communicate. A checklist integrated into the electronic medical record system will prompt doctors to consider specialist palliative care referrals within 72 hours of ICU admission.

Within 48 hours of admission, ICU nurses will engage caregivers to understand the family dynamics, concerns and priorities, with appropriate referral to medical social workers as necessary, and revisiting these conversations as the situation evolves.

Supportive initiatives such as art and music therapy, and legacy-making projects, will also be integrated within A Kinder ICU, to promote comfort and emotional wellbeing for patients and families.

Care transitions will be carefully coordinated to ensure seamless continuity and dignity, regardless of whether patients recover, transfer to another ward, or spend their final days at home.

A precious gift of final goodbyes

This approach resonates profoundly with social service professional Ms Sim Bee Hia, 60, whose brother-in-law, Mr Yeo Cher Yong, passed on the night of 14 February 2025, after he developed flu-like symptoms and shortness of breath just a few days before.

It was a devastating blow for Ms Sim and her family, as the 73-year-old retiree had seemed healthy and lived an active, independent life. Mr Yeo went to the NUH Emergency Department on 12 February after his condition deteriorated, and the doctors eventually discovered he had undiagnosed leukaemia, which had severely weakened his immune system.

Mr Yeo had developed a serious lung infection and needed a ventilator to help him breathe. His kidneys also began to fail and he required dialysis.

Adj A/Prof Matthew Edward Cove, Senior Consultant, Division of Respiratory & Critical Care Medicine, NUH, who attended to Mr Yeo, explained his condition patiently and clearly to Ms Sim and her family, preparing them for the possible developments ahead, while providing assurance that active treatment was still ongoing.

Earlier, Dr Yee Choon Meng, Head & Senior Consultant of the Division of Palliative Care at the National University Cancer Institute, Singapore (NCIS), and Ms Cindy Chua, Assistant Director of Nursing at NUH, had also met with the family to provide an initial explanation, helping to prepare them for the more detailed update from Adj A/Prof Cove.

After learning that his prognosis was poor, the family reached out to close friends to come and say their goodbyes. Throughout this difficult journey, the ICU nurses provided quiet support, including helping to play a cherished video of Mr Yeo interacting with his young granddaughter and allowing her a brief visit.

By the early evening of 14 February, Mr Yeo’s vital signs had begun deteriorating, though the family did not realise how close the end might be. Exhausted after the long hours in the ICU, they had planned to leave the hospital to freshen up and return later.

As the family prepared to leave, Ms Mico Kok Aun Yen, an Assistant Nurse Clinician in the ICU, ran after them and gently suggested that it might be best for someone to stay by his side, as Mr Yeo’s vital signs were deteriorating. Understanding the significance of this, Ms Sim persuaded the family to remain. Ms Kok encouraged them to continue talking to Mr Yeo and staying close.

Later that night, as Mr Yeo’s condition worsened further, the medical team explained that dialysis was no longer beneficial. It was therefore stopped, allowing the focus to shift to keeping him comfortable. The family stayed at Mr Yeo’s bedside to say their final goodbyes, and he passed away shortly after 11pm.

Reflecting on the experience, Ms Sim said, “Palliative care is not giving up. It is about preparing families for what is to come, and caring not just for the patient physically, but also for the family emotionally. Healthcare professionals like Adj A/Prof Cove, Dr Yee, Cindy and Mico made a very difficult journey easier.”

“If Mico had not called us back, we would not have been there when my brother-in-law passed,” Ms Sim shared. “That moment, and the care shown by the team, is something our family will always remember.”

In consultation with Adj A/Prof Matthew Edward Cove, Senior Consultant, Division of Respiratory & Critical Care Medicine, NUH; Dr Yee Choon Meng, Head & Senior Consultant, Division of Palliative Care, National University Cancer Institute, Singapore (NCIS); Ms Cindy Chua, Assistant Director of Nursing, NUH; Ms Charmaine Sim Peizhen, Advanced Practice Nurse, Medical Intensive Care Unit, NUH, and Ms Mico Kok Aun Yen, Assistant Nurse Clinician, Critical Care Unit, NUH.