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My year of being a Student Nursing Times Editor

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Hazel has been our mental health branch representative for Student Nursing Times for almost a year. She reflects on how much has changed during the past 12 months - for her and for nursing

The last year as student editor has coincided with a lot going on for me both inside and outside university.

I had some ongoing health problems and, for the first time in my adult life, I experienced the NHS as a patient.

I have been privileged to have experienced incredible, compassionate, holistic nursing and student nursing care from my colleagues. I am hugely grateful to them but the impact on me, both personally and professionally, has been especially great due to my changing perceptions of nursing; something that has evolved during my experience with Student Nursing Times.

Don’t worry, I’ll explain.

For me, the editorship was encouragement to think about nursing in a new way. I confess that beforehand reflection had been a skill to ‘tick off’ in my book rather than a practice that I actively engaged in and benefitted from.

”For me, the editorship was encouragement to think about nursing in a new way”

In university and in practice, we often bemoan ‘the disjointed system’. Especially in Mental Health, our work is often insular, frequently working in teams who may be multi-disciplinary but not always multi-speciality.

We see ‘holistic care’ as a gold standard but I, and many more students and qualified staff, feel we are ill-equipped to meet the physical needs of our service users.

Similarly, I have spoken to colleagues in adult, child and learning disability nursing who feel their knowledge of mental health is severely lacking.

However, we know that this will persist until we take ownership of our own learning and experiences, reaching out to colleagues and equipping ourselves with the contacts, the skills and the willingness to keep learning in order to be the best nurses we can be.

”I have seen first-hand the incredible staff that work alongside me in all walks of nursing and midwifery”

This is all well and good, but it’s difficult to take that first step to integrate into the wider system.

Working with Student Nursing Times, especially enjoying the fantastic awards night, I have seen first-hand the incredible staff that work alongside me in all walks of nursing and midwifery. There is so much good going on in the health service but I feel that too often we brand ourselves ‘just nurses’ and don’t celebrate the innovation and compassion that are second-nature to so many wonderful staff.

For that reason, the awards were a particular highlight of my time as editor!

Also, I’ve found that SNT blogs are a great forum to meet other people and share experiences, plus a platform to sing the praises of staff who I have seen going above and beyond.

”The blogs are also a brilliant opportunity to learn something new and start the debate about contested issues”

The blogs are also a brilliant opportunity to learn something new and start the debate about contested issues in nursing and midwifery. The past year has seen the vote to abolish student nurse bursaries, something which I was able to have my say on and debate with other students through SNT.

I also especially enjoyed the process of researching my EU referendum blog and the predicted impact on student nurses of a vote for ‘Brexit’. In the coming months we’ll see how accurate those predictions are! This was a great opportunity to research and really understand the issue.

As a student editor, I have seen my focus change from my own career path and personal progression, to understanding the nursing and the health service as something larger. I have seen the NHS from both sides and I am incredibly proud to be a part of it despite its flaws and restrictions.

Student Nursing Times is a celebration of the incredible work of student and qualified nurses and midwives, so valuable at a time when our professions are under attack from funding cuts and staffing restrictions. It is a community where members can share experiences and understanding and, through learning about others, we can all grow and learn about ourselves.

”Student Nursing Times is a celebration of the incredible work of student and qualified nurses and midwives”

The editorship was an amazing opportunity to share what I had learned and experienced over the past two and a half years, celebrate the amazing contributions of other staff and look more deeply into the key issues that are affecting nursing and midwifery.

I expected the role to be a great opportunity to practice and hone my skills of reflection, which has been invaluable! I had not expected the impact this would have on the rest of my life because. By being in the habit of reflecting and taking time to write down my experiences I have learned more about myself personally as well as professionally.

For me, the recruitment process was excellent. It gave me an opportunity to practice writing in a more chatty style than my essays and ‘structured reflections’ had done at university. By writing a sample blog, I was able to gauge how long the monthly submission would take me and it began the process of thinking about what issues I would like to focus on following being accepted as editor.

(Also, I really did not expect to get it, so I was absolutely delighted when I got the email!)

I really enjoyed being editor. By starting a twitter profile in conjunction with the role, I was contacted by a number of different people feeding back on the issues I had written about to offer their experiences and understanding. I was also offered the opportunity to be part of a virtual support programme for prospective student nurses.

A real highlight was taking part in the SNT Awards ceremony, which was excellent fun and so inspiring. The free champagne was also very pleasant - whilst the tube ride home was not!

Basically, being an editor is your opportunity to write a monthly blog on absolutely anything you would like to that relates to nursing and midwifery.

My more serious blogs have been reflecting on experiences I have had with front-line staff whose dedication has helped me realise what kind of nurse I would like to become.

The year has been marked by the vote to scrap student nurse bursaries and, as part of the editorship, I was able to have my say and join the debate on the subject. My more light-hearted blogs have included the impact of ‘augmented reality game’ Pokemon Go on mental health.

”I’ve learned so much and made so many lovely memories because of the experience”

Basically, there is so much that you could explore and you really can make the role your own.

Finally, a huge shout-out to Victoria Abrahams who – as well as being an SNT student editor – went and scooped the Adult Nursing Student of the Year Award which genuinely could not have gone to a nicer person.

I genuinely have no criticism, at all, whatsoever. It has been a privilege to be a part of SNT and I’ve learned so much and made so many lovely memories because of the experience.

  • 1 Comment

Readers' comments (1)

  • To Hazel Nash please: I read your 22pushups piece thanks to Google bot alerting me to worldwide media on PTSD/TBI/Concussion. I would love to talk with you about current research and our work treating and helping to heal PTSD/TBI/Concussion using Hyperbaric Oxygen Therapy and other complementary therapies.

    Here's a precise:
    DOD/VA/Army medicine continue to insist that there is no effective treatment for TBI brain-injured service members, even as they spend billions of dollars on hopeful, unproven, unscientific, undocumented, off-label and even dangerous interventions with drugs, devices, processes and providers. Meanwhile, the suicide epidemic across the force and within DOD, to include reserves and the National Guard, continues unabated.

    The Institute of Medicine recently issued a report that highlights the plethora of ineffective off-label "treatments" being used across the military, and their negative utility. The report and a summary notes: "The Defense and Veterans Affairs departments spent $9.3 billion to treat post-traumatic stress disorder from 2010 through 2012, but neither knows whether this staggering sum resulted in effective or adequate care. . . ." [NOTE: the overwhelming number of veterans treated for brain injury in TreatNOW Coalition HBOT clinics with diagnoses of only PTSD have been shown to have undiagnosed TBI. The amount spent on TBI, and the off-label treatments that they fund, track closely those noted by the IOM for PTSD.]

    The TreatNOW Coalition has been tracking some of the "treatments" veterans receive in military and VA facilities. These have been reported to us by veterans treated with HBOT by the Coalition. In no case has the intervention referred to "wound healing." In research into the research being conducted on TBI and Concussion, we did not find any mention of healing the physical wound to the brain.

    The Interventions/Treatments for PTSD/TBI at Warrior Transition Units, Intrepid Centers, DVBIC, Walter Reed and across DOD/VA/military medicine include:
    • Pharmacological Treatment Options, including black-box labeled drugs (warn of risk of suicide), starting with selective serotonin reuptake inhibitors (SSRIs) such as: Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine (Prozac), Venlafaxine (Effexor)
    • Over 114 medications, all prescribed off-label for TBI [including now LSD and meth] [Coincidentally, anyone caught using marijuana without prescription -- in some cases the only anti-headache therapy alleged to work for some -- is subject to Article 32 and Other Than Honorable discharge.] NOTE: there have been reports that the DOD may be experimenting with hallucinogenics for PTSD.
    • MDMA (3,4-methylenedioxy-methamphetamine)-Assisted Therapy
    • Botox injections
    • Stellate Ganglion Block (SGB)
    • Neurosteroid replacement
    • Psychotherapy by many names and in many guises:
    • psychopharmacology
    • neuroplasticity coaching
    • cognitive psychotherapy
    • cognitive therapy
    • cognitive rehabilitation
    • neurocognitive therapy
    • cognitive control training/therapy (CCT)
    • Cognitive behavioral therapy (CBT )
    • Cognitive Processing Therapy
    • brainwave optimization biofeedback
    • psychoanalysis
    • affective neuroscience
    • psychophysiology
    • evidence-based psychotherapy (i.e., talk therapy)
    • psycho-educational computer based treatment
    • Brief Eclectic Psychotherapy
    • Narrative Therapy
    • Heart rate variability feedback training
    • Biofeedback
    • Intervention Prevention
    • Exposure-based therapy [Includes in-vivo, imaginal/guided imagery, or narrative (oral and/or written) exposures to traumatic memories, situations, or stimuli. These therapies also generally include elements of cognitive restructuring (e.g., evaluating the accuracy of beliefs about danger) as well as relaxation techniques.]
    • Trauma-Focused Cognitive Behavioral Therapy
    • Intensive trauma therapy (a blend of hypnosis, art therapy, and video technology
    • Imagery Rehearsal Therapy
    • Group interventions for trauma-related psycho-education and social support
    • Psychotherapies, including exposure to traumatic memories, stimuli or situations;
    • Cognitive restructuring of trauma-related beliefs
    • Occupational and behavioral therapies
    • Speech and language therapy
    • Physical therapy
    • Outdoor sports therapy
    • Group therapy
    • Life coaching
    • Immersion therapy
    • Cranial sacral massage
    • Transcranial magnetic stimulation
    • Magnetoencephalography (MEG)
    • Repetitive Transcranial Magnetic Stimulation (rTMS)
    • Cognitive electrical stimulation (CES)
    • Near-infrared therapy (NIR)
    • Polychromatic Light Therapy (PLT)
    • Magnetic Resonance Therapy (MRT)
    • Pulsed electromagnetic fields (PEMF) therapy
    • Off Vertical Axis Rotational Device (OVARD)
    • Eye Movement Desensitization and Reprocessing Therapy (EMDR)
    • Accelerated Resolution Therapy (ART)
    • Prolonged Exposure Therapy (PET)
    • Fear Extinction Therapy
    • Repetitive Peripheral Somatosensory Stimulation (RPSS)
    • Bright-light therapy
    • Chiropractic
    • Massage
    • Resiliency training
    • Stress reduction techniques
    • Interactive Metronome
    • Stress Inoculation Training [emphasizes breathing retraining and muscle relaxation]
    • relaxation/self-monitoring techniques (e.g., “body scan”).
    • Family and couples therapy
    • Complementary and alternative medicine (CAM) approaches: acupuncture, natural products, mind-body medicine, body manipulation and movement techniques, energy techniques, mindfulness
    • Medicinal oils
    • Vitamins and supplements
    • Blueberry extract
    • Detoxification
    • Tai-chi, Pilates and Yoga
    • Qigong
    • Alpha stimulation
    • Meditation
    • Hypnosis
    • Dog-petting and companion dogs
    • Horseback riding
    • Equine-assisted psychotherapy
    • Dance/drama/music/art therapy
    • Transcendental meditation
    • Battle Tap
    • Scuba diving and Aqua therapy
    • Hiking and various outdoor exercise
    • Native American healing
    • Mobile applications by the dozens, including Provider Resilience, BioZen, Virtual Hope Box, Cognitive Behavioral Therapy for Insomnia (CBT-i Coach), Stay Quit Coach, etc.

    Summary: Interventions by DOD/VA/Army medicine do not treat the physical wound to the brain. Not one of the above-listed 80+ therapies/processes/procedures/devices, countless computer applications, and 114+ prescribed drugs has been approved by the FDA for TBI, nor do they "treat" wounds. All are used off-label for TBI. All are controversial at some level. Many of them are brand-new and haven't even been explored in the literature. No risk analysis has been performed, and no tracking is done. Yet neither the DOD nor the VA provide Hyperbaric Oxygen Therapy used off-label to treat and heal brain injury, the one therapy proved by multiple clinical trials inside DOD/VA and around the world to treat and help heal the wound to the brain, safely and effectively.

    Recent research on PTSD from DOD/VA/Army medicine is illuminating and troubling:

    [a] Amir Hadanny & Shai Efrati (2016): Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions, Expert Review of Neurotherapeutics, DOI: 10.1080/14737175.2016.1205487. Persistent post-concussion syndrome caused by mild traumatic brain injury has become a major cause of morbidity and poor quality of life. Unlike the acute care of concussion, there is no consensus for treatment of chronic symptoms. Moreover, most of the pharmacologic and non-pharmacologic treatments have failed to demonstrate significant efficacy on both the clinical symptoms as well as the pathophysiologic cascade responsible for the permanent brain injury. This article reviews the pathophysiology of PCS, the diagnostic tools and criteria, the current available treatments including pharmacotherapy and different cognitive rehabilitation programs, and promising new treatment directions. A most promising new direction is the use of hyperbaric oxygen therapy, which targets the basic pathological processes responsible for post-concussion symptoms; it is discussed here in depth.

    [b] Baughman Shively, S., Iren Horkayne-Szakaly, Robert V Jones, James P Kelly, Regina C Armstrong,
    Daniel P Perl. Characterisation of interface astroglial scarring in the human brain after blast exposure: a post-mortem case series. The Lancet, Neurology, June 2016. DOI: In what is being called a breakthrough study, Dr. Daniel P. Perl and his team at the Uniformed Services University of the Health Sciences in Bethesda, Md., [the medical school run by the Department of Defense], have found evidence of tissue damage caused by blasts alone, not by concussions or other injuries. The New York Times calls it the medical explanation for shell shock: preliminary proof of what medicine has been saying without proof for nearly 100 years -- blasts cause physical damage, and this physical damage leads to psychological problems, i.e., PTSD. The importance of this admission cannot be overstated: this is a DOD discovery with documented evidence that blast injury [IEDs, breeching, whether in training or combat, enemy and/or friendly fire] can lead
    directly to physical brain damage and the accompanying effects, many of which have been heretofore diagnosed as "only PTSD."

    [Commentary on above: Robert F. Worth."What if PTSD is More Physical Than Psychological?," The New York Times Magazine, June 10, 2016. A new study supports what a small group of military researchers has suspected for decades: that modern warfare destroys the brain.

    [Additional commentary on above]: Alexander, Caroline. "Mystery of How Battlefield Blasts Injure the Brain May Be Solved. A landmark study sheds new light on the damage caused by “blast shock”—the signature injury of wars for more than a century." National Geographic. JUNE 9, 2016

    [c] Xavier A. Figueroa, PhD and James K. Wright, MD (Col Ret), USAF Hyperbaric Oxygen: B-Level Evidence in Mild Traumatic Brain Injury Clinical Trials. (IN PRE-PUBLICATION). NEUROLOGY/701565 2016. "There is sufficient evidence for the safety and preliminary efficacy data from clinical studies to support the use of HBOT in mild traumatic brain injury/ persistent post concussive syndrome (mTBI/PPCS). The reported positive outcomes and the durability of those outcomes has been demonstrated at 6 months post HBOT treatment. Given the current policy by Tricare and the VA to allow physicians to prescribe drugs or therapies in an off-label manner for mTBI/PPCS management and reimburse for the treatment, it is past time that HBOT be given the same opportunity. This is now an issue of policy modification and reimbursement, not an issue of scientific proof or preliminary clinical efficacy."

    [d] Wang F, et al. Hyperbaric oxygen therapy for the treatment of traumatic brain injury: a meta-analysis. Neurol Sci. 2016 Jan 8. PubMed PMID: 26746238.
    "Compelling evidence suggests the advantage of hyperbaric oxygen therapy (HBOT) in traumatic brain injury. ...Patients undergoing hyperbaric therapy achieved significant improvement....with a lower overall mortality, suggesting its utility as a standard intensive care regimen in traumatic brain injury."

    [e] E.G. Wolf, L.M. Baugh, C.M.S. Kabban, et al. Cognitive function in a traumatic brain injury
    hyperbaric oxygen randomized trial. UHM 2015, Vol. 42, No. 4, 2015. Dr. Wolf is a principle co-author of the first Army study. This recent USAF paper reanalyzing the data in the cornerstone DOD/VA/Army study concludes: " This pilot study demonstrated no obvious harm [and] both groups showed improvement in scores and thus a benefit. Subgroup analysis of cognitive changes and PCL-M results regarding PTSD demonstrated a relative risk of improvement . . . . There is a potential gain and no potential loss. The VA/Clinical Practice Guidelines define a “B evidence rating” as “a recommendation that clinicians provide (the service) to eligible patients. At least fair evidence was found that the intervention improves health outcomes and concludes that benefits outweigh harm. . . .[emphasis added] Hyperbaric oxygen therapy for mild traumatic brain injury and PTSD should be considered a legitimate adjunct therapy if future studies demonstrate similar findings or show comparable improvement to standard-of-care or research-related treatment modalities." [NOTE: subsequent worldwide studies already published and those underway show comparable improvements.]

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