Low-cost simulators for assessing wounds and skin lesions: an experience report

ABSTRACT

Objective:  to describe the production of low-cost simulators for teaching the assessment of wounds and skin lesions.

Method:  an experience report, guided by the precepts of technological production research, carried out at a public higher education institution in the Federal District - Brazil, between January 2022 and December 2023. To develop the study, we followed the step-by-step development of replicable low-cost simulator models for training skills in wound assessment and dressing technique.

Results:  three wound simulator models were produced, representing: lesions with granulation tissue and lesions with necrotic and infected tissue, both with regular and level edges, lesions with eschar and necrosis, and macerated, regular, and uneven edges.

Conclusion:  Products can be an option for developing skills such as creativity, adaptive capacity, and material handling.

DESCRIPTORS:
Teaching Materials; Low-Cost Technology; Simulation Training; Nursing Education.

HIGHLIGHTS

1. Simulators: artifacts used in health teaching.

2. Low-cost simulation: produced with inexpensive materials.

3. Low-cost simulation: teaching nursing skills.

4. Production of low-cost simulator models.

RESUMO

Objetivo:  descrever a produção de simuladores de baixo custo para o ensino de avaliação de ferimentos e lesões de pele.Método: relato de experiência, guiado pelos preceitos da pesquisa de produção tecnológica, realizado em uma instituição pública de Ensino Superior do Distrito Federal - Brasil, entre janeiro de 2022 e dezembro de 2023. Para o desenvolvimento do estudo, seguiu-se a etapa de elaboração do passo a passo replicável de modelos de simuladores de baixo custo para o treino de habilidades em avaliação de feridas e técnica de curativo.

Resultados:  foram produzidos três modelos de simuladores de feridas, sendo eles representados por: lesões com tecido de granulação e lesões com tecido necrótico e infectado, ambas com bordas regulares e niveladas, lesões com esfacelo e necrose, bordas maceradas, regulares e desniveladas.Conclusão: os produtos podem ser uma opção no desenvolvimento de habilidades, como a criatividade, capacidade adaptativa e o manuseio de materiais.

DESCRITORES:
Materiais de Ensino; Tecnologia de Baixo Custo; Treinamento por Simulação; Educação em Enfermagem.

HIGHLIGHTS

1. Simuladores: artefatos utilizados no ensino em saúde.

2. Simulação de baixo custo: produzidos com materiais não onerosos.

3. Simulação de baixo custo: ensino de habilidades em Enfermagem.

4. Produção de modelos de simuladores de baixo custo.

RESUMEN

Objetivo:  describir la fabricación de simuladores de bajo coste para la enseñanza de la evaluación de heridas y lesiones cutáneas.

Método:  informe de experiencia, orientado por los preceptos de la investigación en producción tecnológica, realizado en una institución pública de enseñanza superior del Distrito Federal - Brasil, entre enero de 2022 y diciembre de 2023. Para desarrollar el estudio, seguimos el desarrollo paso a paso de modelos replicables de simuladores de bajo costo para el entrenamiento de habilidades en la evaluación de heridas y técnica de vendaje.

Resultados:  se elaboraron tres modelos de simuladores de heridas: lesiones con tejido de granulación, lesiones con tejido necrótico e infectado, ambas con bordes uniformes y nivelados, lesiones con esfacelo y necrosis, maceradas, con bordes uniformes y desnivelados.

Conclusión:  los productos pueden ser una opción para desarrollar aptitudes como la creatividad, la adaptabilidad y la manipulación de materiales.

DESCRIPTORES:
Material didáctico; Tecnología de Bajo Coste; Formación con Simulación; Educación en enfermería.

HIGHLIGHTS

1. Los simuladores: artefactos utilizados en la enseñanza sanitaria.

2. Simulación de bajo coste: producida con materiales poco costosos.

3. Simulación de bajo coste: enseñanza de habilidades de enfermería.

4. Producción de modelos de simuladores de bajo coste.

INTRODUCTION

Wounds are classified according to their depth, shape, etiology, size, amount of exudate, odor, location, and appearance. By evaluating these points, it is possible to indicate the appropriate treatment and dressings for healing¹, and nurses are the key professionals in monitoring this process. During their training, nurses must develop skills to identify, assess, and treat wounds². However, some studies have revealed gaps in nurses’ knowledge about assessment, treatment, and types of dressings, which leads to difficulties in selecting technologies, especially for pain relief, and in characterizing the phases and stages of healing. This lack of knowledge compromises the quality of care and patient safety¹,³-⁴.

A study conducted with primary care nurses revealed that gaps in knowledge about the assessment and treatment of wounds begin at the undergraduate level, when nursing students find it difficult to relate coverings, materials, and other technologies to the characteristics of the injury to be treated, making this a factor that causes insecurity when faced with situations that require decisive positioning in wound treatment⁴.

Given this, there is a need for investment in undergraduate nursing education through active methodologies that foster greater autonomy and confidence in performing dressings¹-².

Among the various existing methodologies, realistic simulation has been used with positive results in terms of student learning, greater confidence, decision-making, and, consequently, an improvement in the quality of nursing care⁵. When applied to teaching wound assessment and treatment, it offers several benefits, such as improved assessment, use of dressings, and dressing techniques, and increased safety and confidence in carrying out procedures²,⁵.

Dressing techniques require training on the part of students to gain confidence and there are educational resources, such as simulators, which can help them in this process. Simulators are technologies that represent individuals, complete anatomical parts or parts and are classified according to their complexity into low, medium, and high, to improve the traditional teaching offered to students⁶. In addition to these, there are also low-cost simulators which are generally made from easily accessible, less expensive materials with reasonable durability and good quality.

These simulators can be used to train specific skills, such as assessing wounds or injuries and even dressing techniques. To do this, there are various ways of creating wound models that resemble reality, such as the moulage technique, which consists of creating, imitating, or replicating something through the use of makeup⁶.

The use of low-cost simulators in teaching environments for health professionals has numerous benefits, including increased self-confidence, learning, knowledge retention, and cognition⁶. With this in mind, this experience report aims to describe the production of low-cost simulators for teaching the assessment of wounds and skin lesions.

METHOD

This is an experience report in which the technology developed was guided by the precepts of technological production research⁷. The study was carried out at a public higher education institution in the Federal District, by teachers and students on the Nursing course from January 2022 to December 2023. In this context, the experience focused on the development of technology. To this end, the study followed the step-by-step development of replicable low-cost simulator models for training skills in wound assessment and dressing technique.

To develop the low-cost simulators, the steps defined by Knobel and Costa⁸ were used as a reference: identifying the educational need, searching for ideas and inspiration, and pilot testing the material.

Identifying the educational need

Faced with the COVID-19 pandemic, the undergraduate nursing program has had to adapt the way it offers its courses, implementing hybrid teaching to enable the return of activities in the nursing laboratory. Given the restrictions imposed, such as the impossibility of sharing materials between students, and ensuring the safety of teachers and students, technological innovations for the teaching-learning process were required.

In this context, the teachers of the Fundamentals of Nursing course opted to use alternative educational resources to help with the learning process on content related to skin lesions, wound assessment, and treatment, realizing that the use of pictures, slides, or books alone is not enough to fix the content⁹.

Search for ideas and inspiration

The search for inspiration took place through a literature review, in which publications were selected that addressed the production of low-cost simulators for health teaching⁸,¹⁰. A study whose aim was to present and evaluate, according to teachers’ perceptions, a low-cost simulator for peripheral venipuncture, concluded that it was a successful teaching strategy since it contributed to increased learning and student self-confidence and the acquisition of technical skills related to the procedure¹⁰. In addition, the use of low-cost simulators, such as the childbirth, suturing, and medication administration simulator, encourages teamwork and provides an environment conducive to creativity and problem-solving⁸.

Pilot test of the material

In terms of material resources, we used expanded polystyrene sheets (15mm and 20mm); smooth E.V.A. sheets in light pink and beige; moldable E.V.A. masses in white, brown, yellow, black, beige, red, orange, and pink; glue for E.V.A. and expanded polystyrene sheets; artificial blood in red and black; a palette of make-up shadows; a stylus; scissors. and expanded polystyrene sheets; red and black artificial blood; yellow coloring paint; latex sponges; a palette of make-up eyeshadows; a stylus; scissors; eyelash and eyebrow brushes; thin round brushes; black graphite pencils; a blue pen; a plastic spatula; absorbent cotton and a ruler (Figure 1).

Figure 1
Materials for making the lesions. Brasília (DF), Brazil, 2023.

Below are the steps involved in making the lesions on the expanded polystyrene sheet:

Step 1: the size and shape of the expanded polystyrene sheet (20cm x 20cm) was chosen, and marked with a pen and ruler, and the sheet was cut using a stylus (Figure 2);

Figure 2
Cut of expanded polystyrene board and E.V.A. sheets. Brasília (DF), Brazil, 2023.

Step 2: Using a pen and ruler, the flat sheets of E.V.A. were measured according to the size of the expanded polystyrene sheet that had been cut. The flat E.V.A. sheet was then cut out using a stylus or scissors and E.V.A. glue was used to glue the flat sheet to the expanded polystyrene sheet (Figure 2);

Step 3: the size and shape of the lesion to be simulated was defined on the smooth E.V.A. sheet using a pen (Figure 3);

Figure 3
Drawing of the shape of the desired lesion and application of moldable E.V.A. putty to the bed and edges. Brasília (DF), Brazil, 2023.

Step 4: the moldable E.V.A. putty was applied in the desired color all over the bed and the edges of the drawing with the help of a spatula, leaving the elevations asymmetrical or symmetrical, according to the etiology of the lesion to be represented (Figure 3);

Step 5: using a latex sponge, red, black, and yellow artificial blood, black E.V.A. putty, and other colors were applied to the wound bed to form the desired tissue. An eyelash and eyebrow brush was used to create a bead effect. On the edges, we used the eyeshadow palette for make-up and red artificial blood, for an effect of inflammation in the perilesional region (Figure 4).

Figure 4
Making up the appearance of the bed and edges of the lesion. Brasília (DF), Brazil, 2023.

Stage 6: the lesion was finalized in the desired manner (Figure 5).

Figure 5
Result of the lesion. Brasília (DF), Brazil, 2023.

Since the production of low-cost simulators for assessing wounds and dressings, the models have been used in the Fundamentals of Nursing subject as a technological resource in the teaching and learning process for students. In practical classes, workstations are set up with the various models of injuries and wounds created by the students, and tasks are carried out at each one. Examples include evaluation using the MEASURE¹¹ mnemonic, application of the TIMERS¹² acronym, and opening and handling sterile materials.

Regarding ethical aspects, the guidelines set out in National Health Council Resolution No. 510/2016 were followed.

RESULTS

The use of mannequins, low, medium, and high fidelity simulators, and the simulation strategy itself are gaining ground as teaching resources and methodology⁸,¹⁰. In the health sector, simulators can be found for training in draining ascitic fluid by catheter puncture¹³, obstetric procedures such as simulating childbirth with a dummy, controlling postpartum hemorrhage, perineal suturing¹⁴, administering medication to infants¹⁵, assessing injuries and performing dressings⁶,¹⁶, among others.

However, some technologies, especially mediumand high-fidelity ones, come at a high cost, as many are manufactured in other countries and need to be imported. It is therefore necessary to develop low-cost technologies to meet the diverse social contexts found in education⁶,¹³,¹⁵.

As an option for low-cost simulators, the resource for assessing wounds described in this experience report makes it possible to insert it into different educational realities to contribute equally to the process of training health professionals. In addition, low-cost technologies awaken the creativity of those who produce the material, thus favoring the development of clinical thinking at each stage of making the wounds, to meet the same objectives as high-cost technologies concerning wound content⁶.

It is important to note that each student was instructed to make their own simulator, which already encouraged them to prepare for the subject (they needed to know the types of lesions, types of exudates, and viable and non-viable tissues in the wounds, for example), making it an important reinforcement in their studies and the acquisition of cognitive knowledge, and not just the training of psychomotor skills after making it⁶,¹⁶.

For simulators to achieve their objectives, it is of the utmost importance to use techniques that provide a minimum of fidelity to what is being studied. Moulage is a technique that can be used to develop low-cost simulators, especially when it comes to making different types of injuries with different fidelity perspectives. It is through moulage that different models of wounds can be created, which makes it possible, during a simulated teaching activity, to come into contact with wounds of different etiologies, which have different aspects of the wound bed and the peri-injured skin, contributing to the development of skills for assessing the injury⁶,¹⁶.

A quick search for customizable portable wound simulators on the Internet revealed considerably high prices, compared to the cost of producing the material presented in this experience report. Some models can cost more than a thousand reais. The cost of the materials used to build the simulator did not exceed fifty reais. The main potential of the material is its accessibility, which enables students to exercise the skills expected when studying skin lesions, as well as encourages them to develop their learning beyond the university campus, as it is an activity that can easily be carried out at home.

CONCLUSION

The production of low-cost simulators, described in this article, can be a successful option as a teaching strategy for assessing wounds and skin lesions, but also for performing dressings, since it is an easily executable practice that, when associated with theoretical and practical classes, can help develop skills for performing the procedure in question.

Limitations include the fact that although the materials used to develop the wound models are easily accessible and inexpensive, they are sensitive and have variable durability, which means that they have a finite period of usability. In addition, during skills training, such as dressing, it is advisable not to rub and clean the models with aqueous solutions, such as saline solution, as the materials can break down. However, it is possible to apply coverings and adhesive tape. Another aspect is that it is impossible to reproduce all the wound models in Styrofoam, especially the more complex and deeper ones.

This method provides students with an alternative way of studying and enables them to develop other important skills, such as creativity and adaptability, in addition to the experience of handling materials and memorizing the stages of dressing. In this way, this material can be an ally for both teachers and students in the area of teaching the practice of dressings for nursing.

Regarding the contributions of the experience described, the models produced and customized are easily reproducible and accessible, so they can be made by purchasing the materials listed. The innovation was an opportunity for the partner teachers and students to have contact with the various types of lesions, to produce lesions and wounds of different etiologies and characteristics, to train their practical skills in cleaning and debridement, as well as have contact with the handling of the materials for the procedure.

• HOW TO REFERENCE THIS ARTICLE:
  Jorge MM, Medeiros LS, Cartaxo CJM, Justino RR, de Jesus CA, Cauduro FLF. Low-cost simulators for assessing wounds and skin lesions: an experience report. Cogitare Enferm [Internet]. Ano [cited “insert year, month and day”];30. Available from: https://doi.org/10.1590/ce.v30i0.98220

References

• ¹ de Sousa MBV, Bezerra AMF, Costa CV, Gomes EB, da Fonseca HTA, Quaresma OB, et al. Assistência de enfermagem no cuidado de feridas na atenção primária em saúde: revisão integrativa. Rev Eletrônica Acervo Saúde [Internet]. 2013 [cited 2023 May 26];(Suppl 48):e3303. Available from: https://doi.org/10.25248/reas.e3303.2020
  » https://doi.org/10.25248/reas.e3303.2020
• ² dos Santos BRF, Guimarães RS, Nascimento MHM, Henriques KGG, Miranda SVRS, Cervantes SWC, et al. Realistic simulation training in wound and dressing care: an experience report. Res Soc and Dev [Internet]. 2022 [cited 2023 May 26];11(12):e96111232992. Available from: https://doi.org/10.33448/rsd-v11i12.32992
  » https://doi.org/10.33448/rsd-v11i12.32992
• ³ de Lima BR, Silva GO, Galdino-Júnior H. Avaliação das prescrições de enfermagem e médicas para curativos em um hospital universitário: implicações éticas. Enferm Foco [Internet]. 2020 [cited 2023 May 27];11(5):67-72. Available from: https://doi.org/10.21675/2357-707X.2020.v11.n4.3334
  » https://doi.org/10.21675/2357-707X.2020.v11.n4.3334
• ⁴ Vieira CCO. Avaliação e tratamento de feridas: conhecimento de enfermeiros da Unidade Básica de Saúde em técnicas de curativo [[thesis on the Internet]. Sinop: Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso; 2017 [cited 2023 May 27]. 74 p. Available from: http://bdm.ufmt.br/handle/1/1952
  » http://bdm.ufmt.br/handle/1/1952
• ⁵ Chícharo SCR, Silva RMCR, Pereira ER, Nogueira LRD, Prado LDSR, da Silva MRB, et al. Realistic simulation in teaching nursing practices in wound care: account of experiences. Res Soc Dev [Internet]. 2021 [cited 2023 May 27];10(9):e29010918180. Available from: https://doi.org/10.33448/rsd-v10i9.18180
  » https://doi.org/10.33448/rsd-v10i9.18180
• ⁶ Pereira GA Jr, Guedes HTV, organizators. Simulação em saúde para ensino e avaliação: conceitos e práticas. São Carlos: Cubo Multimídia; 2021. 261 p.
• ⁷ Polit DF, Beck CT. Fundamentos de pesquisa em enfermagem: avaliação de evidências para a prática da enfermagem. 7. ed. Brasil: Artmed Editora; 2017. 658 p.
• ⁸ Knobel R, Costa RRO. Confecção e uso de simuladores de baixo custo: experiências da Medicina e Enfermagem. In: Pereira GA Jr, Guedes HTV, organizators. Simulação em saúde para ensino e avaliação: conceitos e práticas. São Carlos: Cubo Multimídia; 2021 [cited 2023 Aug 16]. 24 p. Available from: https://website.abem-educmed.org.br/wp-content/uploads/2022/03/LIVRO-Simulacao-em-saude-para-ensino-e-avaliacao.pdf
  » https://website.abem-educmed.org.br/wp-content/uploads/2022/03/LIVRO-Simulacao-em-saude-para-ensino-e-avaliacao.pdf
• ⁹ Molonha A, Fakhr BO, Custódio FA, Lopes TP, Roecker S, Araujo JP. Simulation as a teaching-learning strategy in wound treatment: experience report. Rev Baiana Enferm [Internet]. 2020 [cited 2023 May 28];34:e37039. Available from: https://doi.org/10.18471/rbe.v34.37039
  » https://doi.org/10.18471/rbe.v34.37039
• ¹⁰ de Oliveira SN, Canever BP, da Silveira NI, Fernandes SR, Martini JG, Lino MM. Low cost peripheral venipuncture simulator: from confection to evaluation. Rev Enferm UERJ [Internet]. 2024 [cited 2024 Aug 17];27:e45584. Available from: http://dx.doi.org/10.12957/reuerj.2019.45584
  » http://dx.doi.org/10.12957/reuerj.2019.45584
• ¹¹ Keast DH, Bowering K, Evans AW, Mackean GL, Burrows C, D’Sousa L. Measure: a proposed assessment framework for developing best practice recommendations for wound assessment. Wound Repair Regen [Internet]. 2004 [cited 2024 Jan 23];12(1):1-17. Available from: https://doi.org/10.1111/j.1067-1927.2004.0123S1.x
  » https://doi.org/10.1111/j.1067-1927.2004.0123S1.x
• ¹² Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, et al. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care [Internet]. 2019 [cited 2024 Jan. 23];28(Suppl 3a):1-52. Available from: https://doi.org/10.12968/jowc.2019.28.Sup3a.S1
  » https://doi.org/10.12968/jowc.2019.28.Sup3a.S1
• ¹³ Silveira BWM, Araújo LAA, Albuquerque LS, Vasconcelos FO, Lima EBM, Góes AC, et al. Assembly and use of a low-cost paracentesis simulator for the teaching of puncture and drainage of ascites. Rev Col Bras Cir [Internet]. 2022 [cited 2024 Oct 10];49:e20223099. Available from: https://doi.org/10.1590/0100-6991e-20223099
  » https://doi.org/10.1590/0100-6991e-20223099
• ¹⁴ Knobel R, Menezes MO, Santos DS, Takemoto MLS. Planning, construction and use of handmade simulators to enhance the teaching and learning in Obstetrics. Rev Latino-Am Enfermagem [Internet]. 2020 [cited 2024 Oct 11];28:e3302. Available from: https://doi.org/10.1590/1518-8345.3684.3302
  » https://doi.org/10.1590/1518-8345.3684.3302
• ¹⁵ de Araújo MS. Construction, validation and evaluation of the effectiveness of a low-cost simulator aimed at teaching medication administration to infants [thesis]. Natal: Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte; 2023 [cited 2024 Oct 10]. Available from: https://repositorio.ufrn.br/handle/123456789/57627
  » https://repositorio.ufrn.br/handle/123456789/57627
• ¹⁶ da Silva BMS, Dutra LN, Dias LO, Goulart MCL, Góes FGB, Ávila FMVP. Use of moulagein the clinical simulation of dressings among nursing students: an experience repor. Rev Enferm UFSM [Internet]. 2024 [cited 2024 Oct 10];14:e8. Available from: https://doi.org/10.5902/2179769284878
  » https://doi.org/10.5902/2179769284878

• Associate editor: Dra. Luciana de Alcantara Nogueira

Publication Dates

• Publication in this collection
  28 Mar 2025
• Date of issue
  2025

History

• Received
  26 Jan 2024
• Accepted
  06 Dec 2024