Nursing Week Eight

A word of advice, if you happen to have a skills day which involves personal care, do not look at the online training manual in a public library. Anyone who happens to glance towards you will see you looking at detailed diagrams of how to clean a penis. If those people are fellow nursing students, it’s all cool. If, on the other hand, they’re doing maths, it can get a bit awkward.

The SBE day was the last day of term. I was tired and stressing about having an essay to write. I’m still not used to essays. The morning session was quite interesting, using unwieldy manikins to practice helping patients use a bed pan, was and how to change the bedding of an immobile patient. When we replaced the manikins with each other, one key point became apparent, we all needed to communicate with the patient more. When the bed has been raised to a good height for the nurses and you’re being rolled on your side towards the edge of the mattress, the floor is a long way down and it is terrifying. I will try to bear that in mind when I’m on placement! I will also try to remember the point about bringing the bed up to around hip height, it does make it easier. I should try not to take my back for granted.

The second part of the day was more practising observations, mostly blood pressures. I still need more practice! There was also a lot of talking. In theory, I learned how to bath a baby. In practice, I didn’t get to touch the doll and I would probably still be terrified of picking up a wet infant in case I dropped them. Funny thing, I never had that fear when my siblings were babies and they’ve all turned out fine. I would like to do a spoke placement with babies at some point. I am an adult nurse, because I want to keep as many options open as possible, but I do wish we didn’t have to specialise so soon!

Nursing Week Seven

I had a practice session on manual blood pressures with a second-year student, he taught me a very useful trick. If the Korotkoff sounds are too quiet, or it’s just really hard to distinguish between them, look at the needle gage. When the needle starts bouncing, you have the systolic pressure (top number), when it stops bouncing, you have the diastolic pressure (bottom number). It is suddenly much easier! Although, finding the brachial artery is still hard. I just need to be less nervous about poking people. There was a point, I think sometime in 2011, when I understood blood pressure in scientific terms and knew what those two numbers meant. It’s slightly embarrassing to admit that I have mislaid that information.

Two key things happened this week. The first was I got to wear my uniform officially for the first time. We had our Trust Induction. Finding a bathroom to change in and coming out wearing the turquoise trousers and trying to make my collar lie flat was pretty terrifying. We walked as a huddle towards the conference room all desperately hoping nobody would collapse in front of us or even just expect us to know anything. A neon sign saying, ‘I know nothing!’ would have been useful.

It turns out that one symptom of anxiety is not being able to shake the feeling of hundreds of money spiders crawling over my skin. I never noticed that before, possibly because always wearing long sleeves deadens the sensation. It was distracting. Distracting from PowerPoints. PowerPoints are hard to pay attention to at the best of times. I came away knowing that once upon a time, student nurses had to starch and sew the weird little hats they used to wear. I’m quite glad we don’t have to do that, I would probably be kicked out for having a wonky, grubby hat.

Halfway through the day, the information we had been waiting for dropped. Placements. I can’t tell you exactly where mine is, but it’s in a hospital not in the community and it’s close to home. I was so excited! As was everyone else. Concentration dropped further. I think taking a notebook and actually writing notes might have been sensible. It would have helped keep my brain in the room. The main thing being drummed home was that we must get changed on site. No walking to and from placement in uniforms. If you ask me, the infection control reasoning is a bit questionable, I have seen the inside of my rucksack! The more convincing reasoning was: if you’re in uniform and someone collapses in front of you, people will expect you to know what to do. Right, well, leaving a bit earlier and getting changed there it is! There is a reason I am still a student.

Nursing Week Six

Despite the fact it has been an uncomfortably long time since I finished school, I think I am still stuck in the mentality that a term is about 6 weeks and then you get a week off. I get to this point in the term and I’m tired. My motivation is curled up in the corner like a cat and sleeps for sixteen hours a day. Lacking motivation and high anxiety because we had a debate lead to the closest I have come to a meltdown. I didn’t have a meltdown and I did go into the seminar. I even explained to the seminar leader what was going on and that I wouldn’t be taking part in the debate because I can’t deal with it today.

I’m not sure how much I got out of listening to the rest of the class debate aside from some people don’t understand the concept of a debate. You listen to what the other side has to say. You then get your chance at a rebuttal. A good debate does not involve talking over people, shouting people down or degenerating into insults. That is a social media debate (and pointless. And frustrating). I don’t know if it’s an age thing because the people shouting other people down tended to be the younger members of the group or whether it’s just thanks to the internet and the way politicians tend to debate, peoples understanding of the concept has warped.

The one day I managed to poke my motivation into semi-wakefulness was Monday, because we had our second SBE day. The main discoveries of the day were 1) caffeine improves everything and 2) manual blood pressures are hard. We were doing observations. The point about caffeine was an ‘observation’, but not a clinical one. Finding a pulse I can do, keeping track of it is, for some reason, much harder than it has any right to be. Maybe my body is just weird. You are supposed to count pulse rate for a minute…. In all the times someone has checked my pulse, I don’t think they have ever done that and I would know, because I did used to count to distract myself from the fact that someone is touching me. Maybe if someone had ever tried to count for a minute, they too would have lost my pulse at random points. Or maybe that’s just me.

Once we had practiced finding the pulse at various points on the body and listening to the apex beat of the creepiest dolly ever – the thing breathes, I don’t like it – we moved onto blood pressure. I think the person who invented the blood pressure machine is a genius! My dead arm is not the biggest fan of manual blood pressures. Finding the brachial artery and keeping track of where it is when you strap a blood pressure cuff on someone is harder than it has any right to be. Also, using a stethoscope while anxious had the obvious flaw of hearing your own blood rushing and not being able to distinguish that from Korotkoff sounds. It’s also hard to find a balance between getting it within two mmHg and not cutting off the other person’s blood supply for so long that they lose feeling in their fingers.

I have got myself a practice cuff. Beware people!

Nursing Week Five

I can still do maths! Even at nine in the morning, when I’m tired and there are lots of people in the room at computers doing the same test. I feel so accomplished. In Third year, we have six attempts to get 100% on an applied maths test before we can pass. Dodgy mental maths can end up in patients being given the wrong amounts of drugs. Carrying a calculator isn’t always an option. Therefore maths. We do have a website full of practice questions which I am yet to play around on. The sad thing is, I would probably find it fun.

In other news, I have a uniform! No, you can’t have a picture. Because it’s a professional uniform, I shouldn’t be wearing it when I’m not on placement. I also shouldn’t be posting pictures of myself on placement if you can identify where I am from those pictures. So, the safest thing is to not post pictures of me in my uniform. It’s hideous, you’re not missing much. The trousers are turquoise. Who thought that was a good idea? Also, men get to wear black trousers and their tunics have epaulets. Yes, I am sulking. Yes, I know it’s pathetic. At the same time, men and women having different uniforms when doing the same job is archaic if you ask me. Does wearing turquoise trousers damage men in some way? I don’t think so. Or you know, we could all wear black. Because stains don’t show up as much on black. Practicalities.

Hideous uniform aside, we did cover some pretty serious stuff this week. There was a lecture on Safeguarding. We have already had online training on Safeguarding. It’s one of those things, however many times you go over it, it doesn’t get less horrifying. If I get to a point where I stop being horrified by seeing pictures of beaten children or hearing horrible abuse stories, I should go back to science and never leave my lab.

Nursing Week Four

Another week, and late, I know. Are you really surprised? Week four was the first Stimulation Based Education day. We had to come in in our official Oxford Brookes Adult Nursing polo shirts, it was very exciting. The day itself, not so exciting. There was a fair bit of being talked at. A little bit of roleplay, which was interesting. I haven’t really roleplayed in real life since I was a child, it was a strange experience. I quite like trying to get into character, but in the back of my mind I was constantly second guessing and criticising myself for not being believable enough. I suppose this is first year, I have a lot to learn and the more I interact with people the more realism I will be able to bring to practice days. My partner found it quite fake and difficult too, so it was hard to play off each other. Instead of building up a rapport with a patient, it felt more like listing potential solutions to their problems.

The main practical thing we did was learn to wash our hands. I felt like a five-year-old. Some of the group acted like five year olds. We had a tub of liquid to rub over our hands which showed up pink under UV light. It showed up pink because molecules in the liquid fluoresced pink under UV light. Not because it showed up dirt or bacteria. Try explaining that one to people covering their phones in the stuff and then being shocked at how dirty they are.

Minor misunderstandings aside, it turns out I could wash my hands without training. Good news! I appreciate that it’s important, I just didn’t need to spend two hours on it. I could have used some of that time trying to work out how on earth you’re supposed to put on sterile gloves. Those things are fiddly!

Aside from briefly having pink glowing hands, the highlight of the week was sitting outside in Storm Doris because between morning lectures and afternoon seminars, you need some fresh air to keep yourself awake!

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