Research has shown that enhanced realism increases the effectiveness of simulation-based experiences (Koukourikos et al., 2021). The use of high-fidelity simulation provides more realistic physical, psychological, and conceptual features that mimic real world experiences. Moulage plays a significant role in enhancing the realism of simulation as well. It engages the learner by giving them a realistic tactile component that act as visual cues and can be assessed during the simulation activity. This allows the learner to really become immersed in the simulation-based experience.

There are often barriers to implementing the use of moulage. Simulation educators may be limited to what they can apply to their simulators. High fidelity simulators have a significant cost involved and often stain easily. Many educators do not want to risk permanently staining these expensive educational tools. Pictures and other means for representing the wounds or other injuries often distract from the realism from this scenario. More options are needed on ways to apply moulage to high fidelity simulators without fear of permanently damaging the simulator skin. Providing options to address this barrier may increase the use of moulage within simulation programs.

References

Koukourikos, K., Tsaloglidou, A., Kourkouta, L., Papathanasiou, I. V., Iliadis, C., Fratzana, A., & Panagiotou, A. (2021). Simulation in clinical nursing education. Acta Informatica Medica, 29(1), 15

• scar wax
• liquid latex
• water-based paint
• transparent adhesive dressings, such as Tegaderm
• no stain blood for human patient simulators
• double-ended spatula or tongue depressor for carving
• scissors
• paint brushes of various sizes
• make-up sponges

1. Scoop out a nickel size ball of scar wax from the container. Roll the wax between your fingers to warm it and make it more pliable. Roll the wax in the shape of a log. Place the log-shaped wax on top of a 2 by 2 1/2 inch transparent adhesive dressing. Create a large long hump in the center of the dressing in the shape of the intended laceration. Use your fingers to blend and thin the edges of the wax on the clear portion of the dressing.
2. Use your double-ended spatula or tongue depressor to carve a line down the center of the thickest part of the laceration. The line can be thin or thicker dependent on how deep you would like the laceration to appear.
3. Paint the inside of the laceration with bright red water-based paint. Blot a dark red (or red and a little brown) paint around the outside of the laceration. Blend with a make-up sponge. The paint should cover the entire wax wound and any adhesive not covered by wax. Blend well.
4. Add no stain blood to the carved portion of the laceration. Place drops of no stain blood around the laceration and blend with a make-up sponge. Allow to dry for one hour.
5. Check to ensure the no stain blood has set. Add a layer of latex over the top of the entire wax laceration. Allow 24 hours for the latex to set. This process can be completed quicker by the use of a fan on a low setting.
6. When you are ready to use the laceration, carefully remove the paper bag of the adhesive dressing. Place the laceration on the simulator in a place that will not have significant pressure applied. Use additional no stain blood to blend around the edges of the wound once in place. Add more no stain blood to the carved portion of the laceration if desired to mimic bleeding.
7. Additional tips:

• Place an additional transparent adhesive dressing on your simulator prior to placing your moulage wound to provide an additional barrier to staining.
• When you are done utilizing the moulage wound, simply peel away the adhesive dressing and wipe off any no stain blood with soap and water.
• Use a larger transparent adhesive dressing for larger or deeper wounds.
• Use scissors to trim any unnecessary portions of the transparent adhesive dressing around the wound to increase realism. Take care to avoid accidentally nicking the simulator skin.
• Use this same method to create a pressure ulcer wound. Roll a quarter size portion of wax into a ball. Press on the adhesive dressing. Use your thumb to create an indention in the center of the wax. Blended down the edges using your fingertips. Used a double-ended spatula to create small grooves within the indention to represent the ulcerated skin. Use an appropriate colored water-based paints according to what stage pressure ulcer is desired. Cover in latex and allow to dry.