Nursing Week 3

Week three. I still feel utterly clueless. I am a little bit more confident finding my way around our campus, but going up to the main library had me completely lost again.

Key discovery for this week? Nurses do a lot of reading. Evidence based practice means that as far as possible clinical decisions should have research support. Everything from treatment plans to way of practice should be evidence based. Evidence, expertise and taking the fact that patient are human and have feeling and preferences about the way they are treated into consideration. Evidence based practice means being able to search and make sense of academic literature.

I did more than half a science degree. I am familiar with databases and academic papers. I was taught how to use a database; in as much as ‘you pick out key words then keep trying to narrow it down until you’ve got a manageable number of papers’ but not once did anyone mention search strategies. Having a search strategy means that instead of having a vague idea about something you’re sort of interested in, coming up with a few key words and panicking at the thousands of results Pubmed shows up, you can be systematic about it. So, it was that in the third week of Nursing, not a degree commonly associated with research, I was forced to take on the challenge of forming a research question. Studying biochemistry, my questions were given to me. I assume the logic being that the science was complicated and subject too large for students to deal with without guidance.

Composing a question is hard. Composing a question so that it fits the PICOt (Population, Intervention/Issue, Comparison/Context, Outcome, time) is even harder, partly because which version of PICOt you use depends on whether you’re looking for qualitative or quantitative data. Who decided that two such similar words should mean two completely opposite things? Besides that, doesn’t it make more sense, unless you’re comparing two treatments, to have a mixture of both types of data? Shows what I know.

Choosing a question out of the list of suitable questions is the hardest of all. I had one, researched it, then changed my mind at the last minute. The second question was definitely a better choice. Searching the literature itself had pros and cons compared to biochemistry. A major pro is that I understood a good 80-90% of the abstracts that came up and a good 80-90% of the actual articles. Result. There are fewer unexplained acronyms. Less background knowledge is assumed. However, CINAL as a database is so clunky compared to Pubmed, which itself is clunky compared to Google. Academics need to be Google for their codes.

The highlight of the week was picking up my NHS SMART card, I feel so official.

A letter from 22 year old Robin

It’s that time of year again. It always takes me by surprise when I get an email from a year ago updating me on how things are now. It’s something of a relief to see that year on year things are improving. After the initial moment of ‘wow was I messed up!’ has passed of course. 

 

Here it is, from 2016:

Dear Robin,

It’s been an odd week. On Monday I binged at university for the first time since returning. Yogurt and granola. Which incidentally I’d had to get out of the bin where I’d thrown it the previous evening. The guilt over that had me take 12 Senna tablets and fast from Monday afternoon to Wednesday evening. I’d intended to continue on until Friday, but I had a meltdown in my Chemistry practical. I lost the ability to think. I couldn’t convert between ml and cm3, I utterly panicked and fell apart. I went back to my flat, I asked Narnie to make a doctor’s appointment for me, which she did and I returned to Banbury, where I spent the following four days in intermittent binge-mode. I ought to answer that question, the answer is one that I doubt you would believe. I weigh less than 7st. On Wednesday, despite bloating, I was just over 6st 8lbs. Right now I am probably closer to 6st 12lbs thanks to the binging, I cannot know for sure, I gave up my scales to Narnie. In the week I have been restricting heavily, but at weekends, at least one day often turns into a binge. I hope, wise, 23-year-old self, that you are still alive and that I succeeded in freeing us from this trap. I hope that you’re fit and preferably still under 8st. I hope that you’ve got the binging in check. There is a tiny part of me that wants to know, did you ever reach 6st? A part of me hopes you did. How did you do in your Second year exams? I hope you got that First. I believe in us, I know that if I can keep the food thing in check and focus on the things that really matter you’ll do it.

That brings me back to the letter from my 21-year-old self. You might find it hard to believe, but I am so proud of you. A year ago you were so fragile, a baby bird, wings still damp, teetering on the edge of the nest, but still holding onto hope. Letting hope fill you after all of the darkness. Even for all that, you had no idea of just how much you’d achieve over this year. Maybe that critical voice is disappointed, but just for a moment let’s turn its volume down and feel proud of just how much has changed. Lee helped monumentally. You went to Italy with Arlo. You did that. You organised that. You dealt with the fear and got on the plane, asked for directions, checked into the hotel, caught the train, admitted when dealing with Arlo was too much but didn’t give in yourself.

Did you go on a date? You went on several. You had a transgender girlfriend who shared your name for two months. You lost your virginity. Do I regret that? Not entirely. I know now that I am sex-repulsed asexual. I know now that I’d rather date another asexual person. I do feel slightly used. Yet I learned so much and for a while I was so incredibly happy. There is another thing that at the beginning of last year was almost inconceivable, there have been moments, so many moments that I have felt happiness. Perhaps they are still brief. Perhaps yes, I still live in a snow globe, but I have so much more hope now for the future given how much has changed over this last year.

I am back at university. In the January exam I came 5th of the entire cohort of second year Bioscientists, I got just over 90%. Things are hard. I have gone home early twice. I have missed a few lectures. I spent a night in hospital because I was suicidal. Yet here I am. Achieving despite that. Not giving in. Not giving up. Right now I feel overwhelmed, but reading that letter from a year ago rekindled some of that hope. I was a fledgling bird then, I learned to fly over the past year.
I hope that you stick with uni. I hope that you finished that essay and secured that work experience. I hope that you’re part of the Student Minds committee and that you’re now running a support group. What are your thoughts about your future career now if I might ask? Have you started that blog yet? I hope you have. I hope that you’ve stuck with Jado. Which belt are you now? Green or Blue I would hope. Have you finished Pearl’s book? I really hope that you’ve done that. So much can change. So much will have changed by the time you read this. I hope that I’ve made you proud. I hope that you’re coping with Third year. I have faith in you. Have there been any more dates? It’s hardly my priority. Right now I have the ED to deal with and university. Still, I’d like to think that if the opportunity arose you’d take it.

In terms of eating, I hope that you can be comfortable. I hope that you’re at least moving towards a point of being thin, fit and healthy rather than as underweight as possible. At the very least I hope you’re functional. I don’t want my biggest achievement to be how low my weight was. There are more important things. Yet I am terrified of returning to depression and binging. That is possibly my biggest hope for you, I hope that by now you have the binging in check.
To my past self, I love you. You are so much stronger than you believed. To my future self, I hope that you love me, but more than that, I hope you have achieved what I am still struggling with and love yourself

Love,
Your 22 year old self