From the desk of Adrianne E. Avillion, DEd, RN

Staff Development Weekly: Insight on Evidence-Based Practice in Education, December 17, 2010

Editor's note: This feature is written by nursing staff development expert Adrianne E. Avillion, DEd, RN. Each week, Adrianne writes about an important issue in the area of staff development or answers reader questions. If you have a question for Adrianne, e-mail her at

Implementing simulation in a cost-effective manner

The use of simulation as an education strategy is an effective way of teaching not only psychomotor skills but critical thinking, problem solving, and evidence-based practices. Some organizations are able to purchase state-of-the-art simulation manikins, which can cost as much as $250,000. There are ways, however, to establish effective simulations in an economical way.

Start by identifying space for the simulation. You may be using areas such as emergency departments or empty patient rooms. Many educators opt for setting up a classroom space as the simulation headquarters. The space should be big enough to have room for a patient bed, bedside cabinet, necessary patient-care supplies, and about 12 people, including educators and people who will act out the roles of family members, patients, and clinicians.

You may choose to develop your own simulation scenarios, but it can save time and money to use ready-made simulations found in textbooks or online. One example is the Quality and Safety in Education for Nurses (QSEN) website, funded by the Robert Wood Johnson Foundation, at

You may be fortunate enough to have high-fidelity simulation manikins, but, if not, don't despair. There are many techniques you can use to simulate various disorders and injuries, including moulage, which is a simulated pathologic condition such as bleeding or open wounds. Here are some examples:

  • Blood that stays in place on extremities (either on a human participant or manikin): 1 bottle Karo corn syrup, 2 bottles red food coloring; 1-2 drops of blue food coloring. Mix well and apply.
  • Bruising: Crumble and mix old blue and green eye shadows into a powder and apply with a soft brush.
  • Burns: 1 bottle theatrical Liquid Latex, 1 bottle glycerin, 1 tube theatrical grease paint in black. Paint on and smooth out liquid latex over the manikin or human to a thin film and allow to dry. If using an actual person as the patient, be sure that he or she is not allergic to latex. When dry, pinch or pull up spots on the film to simulate the appearance of burn blisters.
  • Jaundice: Wrap the face of a manikin with yellow plastic wrap. Don't use this for human participant victims!

These are just a few suggestions to get you started. Here are some resources for additional information:

  • Kisner, T., & Johnson-Anderson, H. (2010). "Simulation on a shoestring budget." Nursing 2010 40(8), 32-36. This article offers excellent advice (see the above suggestions for simulating bruising and jaundice) for implementing simulation in an economical way.
  • Amick, B. (2010). "Simulations, moulage." Retrieved December 13, 2010 from This site is a good resource for simulations and recipes for various problems (such as the one for blood and burns above).
  • Grant funding: Consider seeking grant funding for simulation implementation. Some resources include the Robert Wood Johnson Foundation at and the National League for Nursing: Nursing Education research at
  • You can also purchase moulage online for various prices: or

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