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Posted: 6/13/2002

Nursing students can expect to face many challenges in their education, but it is unlikely anyone foresees an assignment involving eating candy.

That’s just what the students in instructor Kate Lears’ Nursing for Community Health course are asked to do. And while most cannot correctly complete the task, they gain an invaluable lesson.

The undergraduate course includes a clinical rotation at HERO (Health Education Resource Organization), a local agency for people with HIV/AIDS. The students case manage the clients, working one-on-one to assess needs and provide care, education, counseling, and referrals.

To help her students get a sense of the daunting challenge patients face when placed on multiple HIV/AIDS medications, Ms. Lears uses candy to represent the medications.

She begins the exercise by pouring an assortment of M&Ms, red hots, licorice, sour balls, and other candies onto a table. The students are given a prescription for a typical HIV/AIDS regimen, which can, in reality, range up to 50-60 pills a day. They fill the prescription with the candies before them and are assigned the task of following the regimen over a four-day period which includes the weekend.

“Students leave feeling upbeat and very optimistic about following the course of ‘drugs.’ They return after four days with a newfound realism of just how hard that can be,” explains Ms. Lears.

“This exercise gives the students a tremendous amount of empathy and insight into the problems their patients can have with adherence,” says Ms. Lears.

The students experience firsthand that taking medications - as one drug in the morning, another three times a day, one with meals, another on an empty stomach - can be overwhelming.

“Keep in mind that most of the clients at HERO are at a real disadvantage,” Ms. Lears points out. “They deal with issues like homelessness, depression, and substance abuse, and the majority have low income and low education levels. If the students in my class experience such difficulty in following the regimen, then imagine what it is like for these patients in light of everything else they face.”

While the candy exercise is an interesting lesson for the students, adherence to an HIV/AIDS regimen by an actual patient is crucial. Missing just one or two doses can quickly create drug resistance, not just to that drug but possibly to the whole class of drugs.

“Once someone is resistant to a medication, that’s permanent - the drug is no longer effective for the patient,” says Ms. Lears, “And it’s not as if there are plenty of other drugs available. We need to make sure that the drugs we have continue to work.”

In addition she explains that a drug resistant strain of the virus can be transmitted to people already infected with a drug sensitive strain.

After the four-day period, students discuss the potential medication resistance they would have developed based on their adherence. They discover that more harm can be done to HIV/AIDS patients by putting them on regimens that they will not be able to follow.

“The lesson learned is that there’s a need to simplify the regimen as much as possible and tailor the plans to the person’s lifestyle.” This, Ms. Lears explains, is called “creative dosing.”

“You really have to get to know the patients, and become familiar with what they face day in and day out. Obviously, if someone is homeless, then a drug that needs to be refrigerated is going to represent a real challenge!”

Of the exercise itself, Ms. Lears has received a lot of positive feedback from her students. “It’s a fun activity, and a real eye-opener. In the three years that I have carried out the exercise, not one student has been able to adhere to the regimen 100 percent."