A dose of reality
Health education program introduces students to the rigors of patient care

By José Alaniz
June 26, 2000

One day about 15 years ago, an 18-year-old nursing student on the first day of her hospital rotation passed out. Cold. "It wasn’t even from me starting an IV, it was from watching someone else do it," she said. "It came from not knowing what to expect, and then seeing the blood come out. I hadn’t done it, and I’d never seen that blood flow before. That and the general stress of the day just knocked me out."

Experiences like that are what make Rebecca Zielinski, RN, and Kathy Wright, RN, big fans of reality.

And not the kind you see on television shows about desert island survivors or road-tripping twenty-somethings. Zielinski and Wright, founders and directors of Extended Health Education in Arlington, Texas, introduce their students as early as possible to what they call "the reality factor" – otherwise known as the living human body. This helps the students build a comfort zone with their skills, so that, as Zielinski puts it, "they don’t end up passing out during the actual procedure."

Since 1991, when they started teaching a 10-week course for home health aides, that reality factor has extended to a frequent teaching tool for Wright and Zielinski: their own bodies. Today, their expanded school trains medication aides and LVNs, and instructors don swimsuits for sponge-bath class and bare their forearms for a student’s tentative needle.

"We feel pretty strongly that we shouldn’t allow them to do an IV or take a blood sample from a frail old lady or child if we don’t feel comfortable with them doing it on us," said Zielinski, 33, a San Antonio native. "It’s a way to build trust, for us and them."

Through bathing, shampooing, shaving, feeding, injecting, slinging and administering IVs, among myriad other tasks, students learn to appreciate the feel and presence of a live patient in a way no mannequin can provide – although they use those, too.

"You can’t replace the real feeling of the human touch," said Trisha Fahrlender, a 28-year-old LVN who completed the course in 1999 and now works in Grapevine. "I meet nurses from other programs who are envious of all the hands-on clinical experience I got in school."

Not that things always go swimmingly, of course. LaSonya Hughes, who worked as a nurse for 11 years before joining the EHE faculty late last year, already has had her share of student mishaps.

"I had two IVs started on me, and one of them blew up," said Hughes, who hails from Waxahachie, Texas.

"I got a hematoma and it bled for two days. Sometimes the students feel bad about things like that, but they’re very grateful that I allow them to stick me."

In more innocuous ways, EHE’s reality approach seeks to prevent bad nursing habits before they begin.

"If you put a mannequin to bed and leave the siderail down while you go get a pad, you might not learn anything," Zielinski said. "But if you leave someone pretending to be a patient in bed and leave the siderail down, and the patient falls out of bed while you’re gone – that makes quite an impression."

The school’s instructors also seek to develop a more abstract, though crucial, quality: a sense of empathy with the patient’s feelings.

That translates into numerous role-playing games, in which students pretend to be blind, quadraplegic, elderly or otherwise unable to care for themselves. They find they never quite look at a patient the same way after they’ve had to submit to a feeding, Zielinski said: "They discover that they don’t feel as hungry as when they feed themselves. The feeling of being less independent, of feeling degraded and embarrassed and vulnerable, usually means a smaller appetite."

Some students come to the school’s demanding 10-week or one-year programs with that empathy already developed, but others have the extra challenge of finding it.

"Some of them are not sure about this line of work," Hughes said. "They’re not caring, and they approach this like a mechanic – just fix the problem and move on. But this isn’t the same as being a mechanic. We’re dealing with human life here, with the importance of human life. Some are in it just for the money; it’s a job. It’s those sorts of people who usually quit. But I have to take my hat off to the others, those who are really trying. You do see some people go through changes."

Of the 20 percent of students who wash out, most list family commitments or language difficulties as reasons for not completing the program, although many from the Dallas/Fort Worth area’s Nigerian community regularly make it through.

"When it comes down to it, I enjoy caring for people," said Wright, 46, of Merkel.

While not uncommon for students in other schools to perform various procedures on each other, Wright and Zielinski’s approach uses the human body more than most other institutions, said Elizabeth Madigan, Ph.D., assistant professor at Case Western Reserve University’s Frances Payne Bolton School of Nursing. And this despite a trend in more technological approaches to teaching.

"Virtual reality is getting much better as an instructional tool, and high-tech mannequins are getting much more responsive," Madigan said.

But Zielinski and Wright don’t expect to change their "human guinea pig" method of instruction anytime soon – even if Zielinski laments, after 10 years of student needles, "We’re not pincushions. We only have so many veins, you know."

So, whatever happened to that 18-year-old nursing student who passed out on the first day of hospital rotation? Her instructor took her to the cafeteria, fed her breakfast and helped her get "back on the saddle."

Rebecca Zielinski recovered just fine.

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