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This systematic review aims to evaluate the effectiveness of simulation in enhancing the knowledge and skills required for preventing, managing, and treating pressure injuries (PIs) among nursing students. A systematic review of English articles published between January 1, 2014, and March 31, 2024, was conducted to determine the effectiveness of simulation in PI education. PubMed, Cochrane Library, Medline (OVID), Scopus, Web of Science, CINAHL, and Science Direct databases were searched using the keywords "simulation", "pressure ulcer", "pressure injury", "nursing", and "nursing education". The study data were analyzed using the content analysis method. Of the 101 articles retrieved from the databases, 5 met the eligibility criteria. The study found that simulation in PI prevention and management education increased students' knowledge and skill levels, enhanced their satisfaction and communication skills, and was more effective than traditional didactic education. This systematic review supports the use of simulation as an educational tool for nursing students in preventing, implementing protective interventions, and managing PI. Furthermore, it encourages further research to explore the role and effectiveness of different formats of simulation, particularly high-fidelity simulation, in PI management education and their impact on student achievement and clinical practice. [ABSTRACT FROM AUTHOR]

• Professional moulage is not widely researched; however, it enhances the fidelity of simulation activities, when applying it in simulations. • Students can perceive moulage differently and their senses and emotions are triggered by moulage when the fidelity is high. • Simulation is an effective tool for training nursing students and even more so when moulage is used to increase fidelity. The simulation community knows immersive clinical simulation works, especially high-fidelity simulations that portray situations close to real-life. The question remains: what is the role of moulage in the effectiveness of this strategy? This article describes students' perceived fidelity of moulage used during a burns simulation activity. In a mixed method study, 85 nursing students completed the Moulage Authenticity Rating Scale (MARS) and responded to two open-ended questions that explored emotional fidelity. Most respondents rated the moulage burns high in fidelity. Respondents' senses of sight, touch, hearing, and smell were triggered giving way to intense emotions. However, sensory overload may have led to the students missing clinical cues. The moulage met the criteria for physical, conceptual, and emotional fidelity, contributing to students' engagement during the simulation activity. Educators could improve student engagement by enhancing the fidelity of simulation activities through moulage whilst considering the cognitive load. [ABSTRACT FROM AUTHOR]

• The simulation intervention facilitated the development of essential skills in wound care. • Students enjoyed collaborating with SPs, recognizing the value they bring to the simulation experience. • The simulation experience aligns with six out of the eight standards outlined by Wounds Australia. High-fidelity simulation is an effective tool in nursing education, but a research gap exists in its application to wound care training. This study explored the acceptability of working with simulated patients (SPs) with moulaged wounds to improve students' wound care skills. This descriptive qualitative study used semi-structured interviews with 14 student nurses who competed a high-fidelity wound simulation. Data were analysed using a deductive thematic approach. Findings are presented with reference to the Australian Standards of Wound Prevention and Management guidelines. Four main themes (and six subthemes) were identified: realism (moulage and SPs), situational awareness (decision making and task focus), reflective practice (learning from others and self-reflection), and consolidation of practice. The standards-based simulation proved effective and acceptable to students. [ABSTRACT FROM AUTHOR]

This study aimed to share homemade moulage recipes for three different types of burn and describe experienced burn team members' evaluations of these moulages. In this descriptive study, nine experienced pediatric burn team members (nurses and doctors) evaluated moulages using the moulage evaluation form after in situ simulations. The burn team members generally evaluated the moulages as realistic. The moulages helped them feel like they were treating real burn cases, facilitated their engagement in the scenarios, and positively affected their patient-management skills. Burn moulages function as effective tools for training health science students and professionals working in the field of burn care. • The burn team found burn moulages to be realistic. • The burn moulages were suitable for training burn teams and undergraduate students. • The burn moulages positively affected the patient management skills of burn team members. • The burn moulages facilitated the engagement of burn team members in the scenario. [ABSTRACT FROM AUTHOR]

Simulation-based learning affords participants the opportunity to practice high-acuity, low-incidence situations without risk to the patient. The realism of a simulated scenario is often referred to as fidelity. High levels of fidelity imply high levels of realism. One method of enhancing fidelity is the use of moulage. Commercially available moulage kits and professionally applied moulage are often expensive and therefore not practical in the resource-constrained environment. Cost-effective alternatives are required for the resource-constrained environment. Students at a South African university used readily available, low cost materials to apply self-constructed, low cost moulage for a bandaging practical. A cross sectional design used a purpose-designed, validated questionnaire to gather data related to face and content validity of the self-constructed moulage. Frequency analysis formed the cornerstone of Likert-type quantitative data analysis. An open-ended question afforded participants the opportunity to express their own opinions related to the moulage experience. The results revealed that there was both high face validity and high content validity of the self-constructed moulage. Participants found the activity enjoyable and a generally positive learning experience. The self-constructed moulage was realistic and added to the fidelity of the scenario. Participant confidence was improved and their engagement in the learning activity was enhanced. Participants found the self-constructed, low-cost moulage more realistic that commercial products that they had been exposed to. The use of low-cost, self-constructed moulage is a feasible and economically viable means of enhancing fidelity within the resource-constrained simulation setting. This technique is not necessarily limited to emergency medical care and can be used in other areas of healthcare simulation. • Medical moulage has the potential to improve simulation fidelity. • Commercially available moulage kits are usually too expensive for purchase in the resource-constrained environment. • Self-constructed, low-cost medical moulage is a simple, cost-effective technique for use in the resource-constrained simulation environment. [ABSTRACT FROM AUTHOR]

This study reports on the use of moulage within a simulation to introduce first year diagnostic radiography students to open wounds in preparation for clinical practice. A mixed-method quasi-experimental design was used. Visual Analogue Scales were used to capture state feelings at the point of seeing open wounds. Interpretative Phenomenological Analysis was used to draw themes from focus groups and an interview following clinical placement. The simulation reduced negative feelings whilst emotional preparedness, distraction and excitement increased. Five major themes were identified including emotional engagement, engagement with wound, building relationships, developing professional self and simulation impact. The use of moulage and a simulation provides an opportunity to explore initial reactions. Students actively reflect on this experience during clinical practice changing practice. The impact of open wounds can be long lasting and support from radiographers should allow these new experiences to be processed reducing the risk of burnout. • Simulation promoted students to reflect and problem solve enhancing the learning process. • Simulation reduced emotion, such as stress, worry and anxiety. • Open wounds are both exciting and a distraction for first year students. • Pain and 'the unknown' are psychologically challenging for students. [ABSTRACT FROM AUTHOR]

There is a national drive to increase allied health professions simulation training. However, there is a paucity of literature within diagnostic radiography in relation to clinical simulation. No research could be found regarding the impact of simulation in radiography with complex clinical burns scenarios. This research aims to explore the perceptions of radiography undergraduate students regarding their preparedness for the complex care requirements in imaging examinations of clinical burns cases using a mixed methods approach. A small-scale simulation-based teaching session was developed in a Scottish HEI, using role play and moulage to create realism. Twenty-eight undergraduate student radiographers participated in the scenario. Students completed pre and post-scenario questionnaires using Likert scale and free response data. Focus groups were undertaken three months after the simulation to obtain rich qualitative data. Common themes were identified via a process of initial coding and a 6-phase thematic analysis. Thematic analysis demonstrated a marked increased perception of preparedness post-scenario; students felt more prepared to undertake their role in the imaging of complex care patients (Likert scoring increased with both mode and median post-scenario). Common themes that were identified were patient centeredness, realism and learning. Within this limited pilot project, the use of simulation was an effective means of preparing students to understand their role within the complex care setting (with respect to the traumatic realism of burns) in preparedness for professional practice. Additionally, students related to the practical understanding of the complexity of human factors that exist within clinical practice. • An innovative use of moulage to introduce students to burns patients. • Simulation is effective in preparing students for imaging complex patients. • Simulations provide a safe environment to experience difficult situations. • Facial burns can prevent students from 'seeing' the patient beyond. • Moulage provides realism to a simulation promoting a physiological reaction. [ABSTRACT FROM AUTHOR]

Background Simulation Based Education (SBE) is used as a primer for clinical education in nursing and other health professions. Participant engagement strategies and good debriefing have been identified as key for effective simulations. The environment in which the simulation is situated also plays a large role in the degree of participant engagement. Various cues are staged within simulations to enhance this engagement process. Moulage techniques are used in current-day simulation to mimic illnesses and wounds, acting as visual and tactile cues for the learner. To effectively utilise moulage in simulation, significant expense is required to train simulation staff and to purchase relevant equipment. Objective Explore the use of moulage in simulation practice today and its influence on participant engagement. Design Using a systematic process to extract papers, we reviewed the literature with a critical-realist lens. Data Sources CINAHL Complete, ERIC, Embase, Medline, PsycINFO, SCOPUS, Web of Science, Proquest, Science Direct and SAGE. Review Methods 10 databases were systematically reviewed using the keyword “moulage” to answer the question “How does the authenticity of moulage impact on participant engagement?”. 1318 records were identified prior to exclusion criterion were applied. 10 articles were targeted for review, following exclusion for English language and publication between 2005 and 2015. Results The resulting 10 papers were assessed for quality using the Medical Education Research Study Quality Instrument (MERSQI). The majority of papers were situated in dermatology teaching, with only one nursing paper. Study participants were both undergraduate and postgraduate. Most of the studies were undertaken at a university setting. No papers comprehensively addressed whether the authenticity of moulage influences learner engagement. Conclusions Results were limited, yet clearly outline a widely held assumption that moulage is essential in simulation-based education for improved realism and subsequent learner engagement. Despite this, there is no clear evidence from the literature that this is the case, suggesting that further research to explore the impact of moulage on participant engagement is warranted. A number of recommendations are made for future research. [ABSTRACT FROM AUTHOR]

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The UofL Center for the Deterrence of Biowarfare and Bioterrorism's (CDBB's) training involving standardized patients, who can make convincingly accurate representations of clinical signs and symptoms, and patient simulators has proven to be an effective means of enhancing bioterrorism preparedness. In addition to providing ready access to formative measures of preparedness, both of these teaching and learning tools also offer the option of summative evaluation of skills and knowledge acquired during training sessions. The use of moulage allows for very realistic representations of cutaneous anthrax and smallpox as well as other conditions such as recluse spider bites and chickenpox with which these biothreat infections can be confused. Exercises and drills expose deficiencies and permit essential reinforcement of skills developed in training. Unannounced exercises are especially useful in assessing public health preparedness. [ABSTRACT FROM AUTHOR]

Most nurses at some point of, or throughout, their career will be involved in infusion care. Therefore, it is important to provide a realistic learning environment to nursing students regarding how to safely practice intravenous (IV) therapy administration. The aim of this study was examining the effect of simulation-based learning on IV therapy administration knowledge, performance and clinical assessment skills of first-year nursing students. This study was a randomized controlled quasi-experimental study. A total of 62 students was included in the study. The students were randomly assigned to either hybrid simulation (HS) (n = 31) or low fidelity simulation (LFS) (n = 31) groups. In the HS group, each student performed in the standardized patients using moulage, and the LFS group each student was performed with mannequin using visuals. Each of the students' level of IV therapy administration knowledge, performance and clinical assessment and satisfaction and self-confidence score was evaluated. After the lecture, demonstration and simulation training, there was a statistically significant difference between groups in terms of knowledge (p < 0.05), IV catheter insertion performance in simulation and clinical (p = 0.00; p = 0.00) and clinical assessment to classify IV therapy complications on real patients (p = 0.00). Also, satisfaction and self-confidence scale scores of the students in the HS were significantly higher than in the LFS group (p = 0.00). However, there was no significant difference in simulation design scale scores between the two groups (p = 0.164). The students in the HS group better transferred they had learned in the teaching environment to clinical practice. Also, the results show that creating an effective environment in simulation had a positive effect on the development of the students' clinical skills. [ABSTRACT FROM AUTHOR]

In wound care simulations, the practice can be performed on 3D-wounds formed by moulage. Moulage helps the student to perceive the etiology, physiology, and healing processes of the wound, and it can also be used to improve the students' wound assessment skills. The aim of this study is to investigate the effectiveness of moulage in the improvement of pressure injury assessment skills of nursing students. A quasi-experimental study. A nursing faculty at a public university. All fourth-year students (n = 73) who take the simulation elective course were invited to participate. Fall semester students (n = 38) constituted the control group and spring semester students (n = 35) formed the intervention group. The coin-flipping method was used to match the education period and student groups. The intervention group simulation was performed using moulage, and the control group simulation was performed using a pressure ulcer visuals. The same simulation scenarios were used for both groups. The data were collected using the Simulation Design Scale, Student Satisfaction and Self-Confidence Scale, and student identification form, knowledge test, performance checklist and feedback form developed by the researchers. Students' knowledge scores for pressure injury assessment have improved significantly in both the intervention group (pre-test:61.71 ± 9.77 and post-test 70.57 ± 12.53, t = −4.27, p < 0.001) and the control group (pre-test: 66.81 ± 13.47 and post-test 73.06 ± 15.50, t = −2.34, p = 0.02). Laboratory and clinical pressure injury assessment skill scores of the intervention group students were significantly higher than the control group. Besides, the correct staging percentages of the intervention group students are higher than the control group students during the clinical practice (χ2 = 5.05, p = 0.02). It can be concluded that the simulation with moulage was effective in improving the skills of nursing students who received training for pressure injury assessment and in transferring what they learned to the clinical setting. [ABSTRACT FROM AUTHOR]