Jaundice

Jaundice Skin Tone on Newborn or Elderly Patient:

Skill Level:

Beginner

Supplies:

(SIM-Safe) Yellow make-up

Equipment:

Make-up sponge

Cotton swab or small paint brush

Technique:

Using a make-up sponge that has been dipped in yellow make-up, begin applying colorant to the simulators skin, sclera, nail beds and tongue using a gentle blotting technique. When working colorant across the skin, allow patches of "natural" skin to show through and create a natural fade.

Using a cotton swab or small paint brush that has been dipped in yellow colorant, lightly blot sclera, nail beds, and tongue to deposit color and tint yellow. If "over-blotting" occurs (and you begin to pick up color from the simulator instead of depositing) apply a light coat of setting powder to the skin to absorb excess moisture before applying another coat of colorant.

Quick Fix:

To much color? Using a make-up remover cloth, gently blot the colorant to lighten and blend to the skin.

Cleanup and Storage:

Using a soft clean cloth or make-up remover towelette, remove the make-up and any remaining product residue from the skin of the simulator according to manufacturer directions.

Training Scenario:

Simulation Suite Location: ER Room or walk-in clinic. Place a wig and reading glasses on an elderly simulator. Using a make-up sponge, apply yellow colorant to skin, nail beds, sclera and tongue. Apply 1st & 2nd degree abraisions to the forehead, side of face, hands and knees. Patient Documentation: Include chart documentation that supports a fall on cement driveway including scrapes and abrasions, a slight smell of "old" alcohol and some agitation. Patients' neighbor found him lying in the driveway and persuaded him to come in when he refused calling for an ambulance. When taking the patients vitals, set temperature probe to indicate a fever.

Use in Conjunction With:

Teeth, aged

White or "clay" stool

Dark Urine

Sweat

Odor: Foul

What the experts have to say:

NURSING SIMULATION:

The jaundiced, injured elderly man in this scenario provides an opportunity for every level of learner to develop insights for QSEN competence in person-centered care. Let’s consider how simulation can be one piece of a bigger story to augment the wider curriculum.

This patient and his family could be introduced and reintroduced in foundations, community health, geriatrics, health assessment, critical care and could even be used for an end of life scenario. Who are his loved ones? Where are they? What are their stories? Is there elder abuse? What services are available in his situation? What other healthcare team members need to be consulted?

What could have helped prevent his serious condition? When this elderly man presents to the ED, the team will surely look for the cause of his symptoms. But what about when he goes home? Faculty could introduce a paper and pencil case study in class and follow up with several crises over time, leading to the present scenario and moving beyond, into his future.

What was his story when he last was seen by a provider? How did the patient’s status get to this current situation? What are the planning priorities moving forward? Where will follow up occur? Who will be involved?

Healthcare faculty from nursing as well as other health professions could collaborate to develop a family system and sequence of crises and events over time, incorporating the need for interprofessional collaboration and shared projects. Learners from different healthcare disciplines could build interprofessional role awareness and communication skills. Students would benefit from “seeing” the patient over time to better grasp the lived experience from diagnosis to death.

Here is a challenge for faculty; nursing and other health professions need to coordinate curricular planning, maintain consistency for case studies, and progress over the patient’s life span in a reasonable and believable sequence. This can be a very fun and creative process for faculty and has been done with success in at least two programs I am personally aware of. What ways could you add your own creativity to this? Consider patient care videos, family biographical stories, add a cultural component or a mental health crisis.

Now our elderly man has a persona, and his case has developed to demonstrate what we really see in today’s health environments. Herein lie diverse learning opportunities that can meet many learning styles by stimulating all the senses with realistic simulation, cognitive processes with paper and pencil case studies, kinesthetic learning with skills practice and hands on-simulation patient care, incorporation of narrative pedagogy and visual and auditory learning. Perhaps with such practice our graduates will be more attuned to prevention, empathy, and seeing the bigger picture.

Sara Manning, MS, RN, CHSE

Coordinator of Clinical Simulation Education

NLN Simulation Leader

Assistant Professor of Nursing

PRE-HOSPITAL SIMULATION

My thoughts about getting the simulation right lies in getting a few key areas in place - the first area of fascination for me is ensuring that we have made the environment realistic for every scenario.

So much teaching takes place in white walled classrooms that are nothing like the patients own home or the simulated clinical setting. Why? Clinical environments are not usually white walled.

I will spend a few minutes teaching how this type of simulation can be improved - simply using basic teaching technology.

Secondly and more importantly, I will take time to explain the importance of building a quality environment.

In human factors education there is the shell model - which explains that we have many aspects acting upon our ability to care for others - these include how we relate to other people, how we work within rules and procedures and how we relate to and interact with our environment.

Patricia Benner in her work on novice to expert suggests that it is these subtle visual and auditory cues that shape our ability to make decisions.

Visual and auditory cues are not just from the colour of the patient, but also include the environment that they find themselves living in- as a paramedic my environment changes constantly and so it has always been a key component of my teaching.

Handing over at hospital involves the paramedic or EMT being able to portray what they have seen, smelled and considered.

Here in the UK we have developed high fidelity strategies - but we originally started with a low fidelity approach.

The simplest way to teach this is to use your PowerPoint projector to project the patients home environment onto the walls in every scenario - behind the simulated patient.

We do the same with hospital wards etc..

This is the patients flat - what do you see?

I loved the thoughts of professor Sara above - about following this patients story over time to show deterioration over time. This can easily be achieved by searching the Internet and building a PowerPoint presentation of the patients home to match their deterioration and social decline.

This is the patients bathroom and kitchen - what do you see?

We would suggest to the students that - Hopefully you have spotted signs of pride! Bed is made - surfaces are clear and clean - but we are on hard times - do we drink to cope? Or do we live like this because of drink?

If you project a photo such as the one below we can see beer - cigarettes and a lack of furniture

Eventually we deteriorate a little more

Of course so many of our alcoholics are not impoverished and may be actually affluent

Getting the smell right is another lesson for another week!

Please remember that your patient must be right for the environment you are trying to recreate - in the picture below you can see that the image does not make sense...

Dave Halliwell, PHD student

Dave Halliwell is a UK collaborator and has been studying simulation for his PhD which is nearing completion - after 7 years of PhD study he has some insightful takes on the best ways to enhance learning. David is a paramedic by trade, previous Olympic gold commander ( sailing), and Head of Education for UK NHS ambulance service with 3000 staff. He is often found at international conferences talking about simulation!

NOTICE: The information contained on this page does not and is not intended to convey medical advice and should be used for simulated training purposes only. Moulage Concepts and/or contributing authors are not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.​