“Between stimulus and response there is a space. In that space is our power to choose the appropriate response, and there, in our response, lies our growth.”
Viktor Frankl MD
Bridging the Gap in Simulation: How good are you at pretending? At engaging and play acting? If I was to describe a diabetic foot ulcer with a thick purulent drainage, or C-diff, could you see it in your mind? Would you instinctively wrinkle your nose in remembrance of the odor that you will probably never forget........Are you at this moment wishing I hadn't brought it up?
If you had never experienced these two maladies and I asked you to pretend in your scenario that your patient had them, could you do it? Really?
When I began my moulage career, it was considered ground breaking to cover a simulator with chocolate frosting and instruct the nursing students to assist the patient who had just soiled himself; while providing professional care and maintaining modesty. Certainly, the shock value was priceless, and yes, it was progressive. But, lets be honest, chocolate frosting smells like, well, chocolate frosting.
Every simulation session must have enough realism for the participants to become fully engaged in the scenario. They must believe and act as if the patient simulator is someone for whom they are responsible and must provide appropriate care. Having a mannequin that blinks and speaks is wonderful, but for many participants that is not enough to overcome the sense of playacting.
Simulated Realism: Essential, Desired, Overkill
Judith C.F. Hwang, Betsy Bencken
Those who have followed me for a while have heard me discuss the importance of moulage to the simulation scenario. Why is it so important, you ask? Nursing is a sensory experience. While you can read about disease processes in books and study symptoms in theory, you can not fully understand that which you do not know or experience........ It is the interpretation of what is seen, felt, heard, and smelled that allows the student to pull together critical data and integrate this knowledge into their assessment and care plan, more importantly, it sears the knowledge into the brain, allowing them to recall the data for many years following the actual event. (How many of you are still recalling the C-diff mentioned above?)
A true story: A few years ago I was contacted by a nursing instructor with a specific issue. She had a student who had been sent into a patients room to provide basic care to an elderly, sharp as a whip, incontinent patient, with C-diff. Her student, who was poised, professional, and confident, dry-heaved uncontrollably for the first five minutes; unable to regain her composure. Finally, the nurse in an attempt to elevate the obvious discomfort of the patient, relieved the student of her duties and sent her out of the room. The instructor shared it was a difficult experience for all involved.
To Moulage or not to Moulage, there is no question.
HealthySimulation
Lance Bailey
So lets work together to "Bridge the Gap in Simulation," TM creating moulage that engages all the senses, building our scenario storyline and provide enough realism to fully engage our simulation participants.
Wishing you great success in your Moulage endeavors.
Moulage Concepts-
Bobbie Merica, Author/Business Owner
Simulation Coordinator/Consultant
You can read more of my articles at www.healthysimulation.com
Bruises/Contusions
Bruises change in appearance over time, and it is possible to create a timetable of events by looking at a bruise and noting changes in color and progression While bruises are not difficult to create, bruising characteristics such as size, cause, and stage of color progression should be considered prior to beginning Moulage application. When it first appears, a bruise will be reddish looking, reflecting the color of the blood in the skin. Within a day or two, the reddish iron from the blood undergoes a change and the bruise will begin to appear a darker red-blue. Bruising will then begin to progress in color becoming dark blue, shades of purple, reddish to bluish as the background turns green, purple on green, purple on yellow-green, yellow green, yellow-brown, and finally, a return to normal skin color. For healthy individuals, most bruises disappear within seven days, while larger ones generally go away within two weeks. However, bruises may last longer in elderly adults and are often more severe in the color stages.
Ingredients:
Red Blush (powder make-up)
Pink Blush (powder make-up)
Purple eye shadow (powder make-up)
Dark Burgundy eye shadow (powder make-up)
Violet eye shadow (powder make-up)
Gray Purple eye shadow (powder make-up)
Dark blue eye shadow (powder make-up)
Green eye shadow (powder make-up)
Purple eye shadow(powder make-up)
Brown eye shadow (powder make-up)
Yellow cake make-up (powder make-up)
Make-up sponge
Blush brush applicator
Eye shadow applicator
Bruise (Fresh)
Using your fingers or a make-up applicator, liberally apply dark red blush make-up in an abstract pattern (not necessarily circular) to skin of simulator. Using the sponge tip or your fingers, apply color creating a blotchy pattern on the skin; varying the intensity and depth of color as you fade out and away from the center (point of contact) of the bruise and blend into the surrounding skin.
“Feather” bruising colors toward the center (leave the center red) and eventually fading color out on the skin around the outer bruising edges. Keep in mind, color should be blotchy and uneven. If you apply too much color, dab or “lift off” with a 4x4 or make-up sponge. .
Start with blush (red/pink) powder make-up to create your bruise shape.
Very lightly “feather” blue unevenly around the edges.
Bruise (1-48 hours)
Using your fingers or make-up sponge, apply red color in an uneven pattern (not circular,) with uneven intensity and consistency; blotchy.
“Feather” bruising colors toward the center (leave the center red) and eventually fading color out on the skin around the outer bruising edges. Keep in mind, color should be blotchy and uneven. If you apply to much color, dab or “lift off” with a 4x4 or make-up sponge. .
Follow steps for fresh bruise, lightly, unevenly, and randomly apply one or more of the following colors, dark burgundy, violet, gray or purple.
Bruise (3-4 days)
Follow steps for fresh bruise and older (1-48 hours) bruise. Apply green in same pattern, fading the color at the outer edges. Apply blotches of gray and purple to the center, blend. Using a stipple sponge apply more purple over red center, blot with tissue or 4x4 to remove excess and mute color.
Bruise (5-10 days)
Follow steps for bruising (3-4 days). Apply light blotches of yellow over green and blend slightly using your fingers or make-up sponge. “Feather” bruising colors toward the center and eventually fading color out on the skin around the outer bruising edges. Keep in mind; you will have more green, gray and purple at the five day mark, where the color of the bruise has mostly faded out to the yellow, yellow-brown stage by the tenth day.
Environmental Settings:
Public Health case: To Simulator add: Gray hair wig and reading glasses. Using a small paint brush, apply yellow and brown eye shadow to front and sides of teeth to create a slightly “decayed” appearance. Create bruises in varying sizes and progression on upper arms, chest and legs of simulator. Add one set of bruises (1-48 hours) in the shape of “finger print” marks on simulators wrist. (To create proper spacing, apply bruising colors to your fingers, and then grasp simulators arm. Continue with color progression on simulator.) If available add “home” furnishings: Table, chairs, sofa, etc. Create extra clutter to simulators bedside table, (waded up tissues, dishes.) Care provider is patients stressed adult child who has moved back home with her teenage children to care for patient. Participants to arrive at door to follow up on a referral; care provider is resistant to letting them in.
Clean up:
Remove bruises with a soft cloth that has been dipped in GooGone. Remove teeth from simulator. Using a soft toothbrush and GooGone, gently brush away make-up from teeth and rinse under warm water, pat dry with soft cloth and return to simulator.
Time saving hint:
Place old, used, eye shadows together in a multi-seal plastic bag according to bruising stages. Using a rolling pin, carefully roll pin over bag to crumble colors into a fine powder. Apply make-up using a blush brush, eye shadow applicator or your finger.
This article is referenced from Moulage-Bridging the Gap in Simulation TM, book on CD and is, unless otherwise stated, the property of Moulage Concepts. Copyright and other intellectual property laws protect these materials. Reproduction or retransmission of the materials, in whole or in part, in any manner, without the prior written consent of the copyright holder, is a violation of copyright law.
