Practice development and communication


n Technical skills, such as clinical examination and invasive procedures.


However, it is widely acknowledged that decision-making skills seldom develop in the classroom setting [15]


and Benner [16]


recognises that it is only when theory is applied to practice that students learn to deliver care safely. Despite this, many post-registration


courses, study days and conferences remain heavily theoretical. A Cochrane Systematic review [17]


found that a mix of didactic and


interactive education was more effective than either method alone. Therefore, it is now recognised that


simulated environments can help lecturers construct interactive patient situations that provide students with skills training as well as linking theory to practice [18]


of simulated learning include: n Critical thinking n Confidence n Decision making n Skills development [19]


. Simulated patient scenarios also allow References


6. Beldon P. Is wound management training in primary care good enough? Br J Comm Nurs. 2010; 15(9): 29


7. DoH. NHS 2010–2015: From Good to Great. Preventative, People-


centred, Productive. 2009a; DoH, London


8. NHS Institute for Innovation and Improvement. High Impact


Actions for Nursing and Midwifery. Available at: http://www.institute. nhs.uk/building_capability/


hia_supporting_info/your_skin_ matters.html. 2009; (accessed 8 November, 2011)


9. DoH. Quality and Outcomes Framework. 2009b; DoH, London


10. DoH. Using the Commissioning for Quality and Innovation (CQUIN) payment framework. 2008a; DoH, London


11. The Patients Association . Meaningful and comparable


information: Tissue Viability Nursing Services and Pressure Ulcers. 2010; The Patients Association, Middlesex


students to integrate skills from different domains of learning and receive immediate feedback [20]


. It is important to explore the possibility of


providing learning activities that incorporate simulated wounds and which are designed to meet the outcomes of educational modules. This will assist in bridging the theory/practice gap and help to develop students’ confidence in performing wound care skills.


SIMULATED WOUNDS There are many companies manufacturing simulated wounds and some schools of nursing make their own, some of which are placed on actors or student nurses involved in the clinical simulation. They are usually made of rubber and


are mostly classified as low fidelity simulators because although they are useful for skills training they are not as anatomically realistic as medium or high- fidelity simulators or as able to mimic diverse physical parameters [21]


SALFORD SIMULATED WOUNDS PROJECT The wound models made for the University of Salford project are considered medium fidelity, meaning they realistically depict wounds seen in clinical practice and promote realistic responses from students[21]


. . The benefits


Compared with low fidelity models, these wounds contain greater detail in relation to: n Anatomical size n Physiology: when viewed by students the wounds make sense in relation to the causative factors of skin breakdown, for example, a model designed to resemble a pressure ulcer caused by shear and pressure will look like a real ulcer as it will have the typical ‘teardrop’ shape and an undermined cavity


n Tissue: granulation tissue, for example, will be red and look granular, slough will be yellow and stringy and necrotic tissue will be able to be debrided [Fig 1]


n Skin: the simulated wound can be blended to the actor’s skin so it is more convincing — students will be unable to tell where the real skin begins


n Feel: the simulated wounds are made with silicone and replicate the sensation of real wounds.


Extra blood, exudate and slough are


regularly added to the wounds for effect and can be absorbed into any dressings that are applied.


Project development The development of six large simulated chronic wounds and 12 smaller wounds were funded solely from monies awarded from a Vice Chancellor Scholarship within the university. The simulated wounds were designed


. Low fidelity


simulated wounds also require added moulage (the art of applying and making up mock injuries for the purposes of training by clinicians) to assist in the ‘suspension of disbelief ’ [22]


. 36 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012


by special effects and make-up artist, Davy Jones, and lecturer in adult nursing, Melanie Stephens. The wounds were sculpted and moulded to replicate the chronic and acute wounds seen in clinical practice. Jones manufactured resin moulds, which could then be used on real people. From the resin moulds Jones then


produced the wounds as gel-filled silicone appliances. Along with his team, Jones hand painted all the models, making sure he had


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