Fresh Bruise Moulage can help clinical learners better assess a simulated patient. Moulage is an essential skill set required in the delivery of healthcare simulation either on a patient manikin or simulated patient. One of the most essential and basic moulage skills required is how to moulage an effective fresh bruise injury. This key skill can assist the clinical team in the healthcare simulation scenario to suspend disbelief and to engage in a more immersive manner. The moulage of a fresh bruise is a skill and requires practice and knowledge in order to be able to complete. This article by Erin Carn-Bennett, RN, MSN will explore how to moulage a fresh bruise for a clinical simulation scenario.
Moulage in Clinical Simulation is Important
Moulage can add increased realism and fidelity to a clinical simulated event and allows the participants to be able to see a real representation of an injury. A simple application of very basic makeup can be incredibly effective to represent a bruise. Application of moulage can assist clinical simulation participants to suspend disbelief in scenarios.
A bruise or contusion is skin discoloration which is caused by damaged and leaking blood vessels underneath a person’s skin. The blood pools underneath patient skin and external bleeding won’t occur unless skin breaks open. Collection of blood under the skin is what makes a bruise visible. Bruises form a mark on skin which can range in color from black, blue, purple, brown or yellow.
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There are four stages to represent in the moulage of a bruise. The first stage the moulage applier should apply red and pink coloring to skin. The second stage occurs from within hours and up to two days post injury. The application of purple, blue, red and even some small black black areas of moulage can be effective.
Moulage Removal Process
Moulage products should be removed from patient manikins as soon as possible. This is because the moulage products can stain patient manikin skins. Clean the patient manikin with soap and water and if the stain still remains recommendation is to escalate products from the mildest to the more abrasive cleaners. Recommendations are to take a stepped approach with the cleaning products. Isopropyl alcohol is the first step up from soap and water and then continues to climb. However check warranties as always with suppliers and also ask them for recommendations of what will work best for their products.
On a standardized patient clean as much of the top layer of moulage products off as soon as possible with wipes and then clean the skin with a normal skin cleanser of choice. All moulage brushes should be cleaned with brush cleaner in between use. There should be consideration given in the standardized patient space around infection control and each organization should have health and safety policies in place to be able to ensure there is no cross contamination risk of moulage products between standardized patients.
Simple Products Required for Fresh Bruise Moulage
In order to make a fresh bruise a make up wheel with the colors of red, medium blue and burgundy will be required. Other required equipment includes a make-up sponge and a tissue. Gloves should be used if applying a fresh bruise moulage to a standardized patient.
Prior to commencement of the application of the moulage tear the makeup sponge. Use the rough edges of the makeup sponge to apply the color from the makeup color wheel to the patient manikin or standardized patients skin. This will reduce the amount of harsh lines present in the bruise and make the bruise a higher fidelity and look more lifelike.
At the start use red cream makeup from the color wheel in order to create a fresh bruise. Lightly apply the red color with the makeup sponge approximately 2 inch × 2 inch circular pattern to the skin of the patient manikin or standardized patient. Then take the tissue and gently blot the red color with a tissue in particular to the outside edges of the bruise.
Ensure that the color is intense and has the highest color level and concentration in the center of the bruise and then fades out as coming out towards the edges. Then dip the makeup sponge into a touch of blue makeup on the color wheel. With the blue color lightly apply a second layer of color. This blue color should stretch approximately through one third of the bruise from the point of impact out.
Color intensity can be altered depending on the pressure utilized by the applier of the moulage with the makeup tools such as the sponge. The use of a tissue again should be employed to lightly blot the edges of the second layer of the bruise. Once again ensure that the largest concentration and depth of color remains at the point of impact and fades out around the outside edges of the bruise.
Finally a make-up sponge that is then dipped in the burgundy makeup color on the wheel can further create the point of impact. This can be achieved by lightly using a blotting motion from the inside edges of the bruise at the point where the red and blue colors meet. Once again the use of a tissue to blot the colors to faded and blended edges can be incredibly effective. See more great tips in this downloadable pdf: Bond University Moulage Resource Book by Jessica Stokes-Parish & Giulia Roiter.
This article has explored the moulage basic concept of the application of a fresh bruise to either a patient manikin or a standardized patient. This is a basic skill which can be mastered by anyone who works in the clinical simulation field. With some basic gear and infection control considerations, increased fidelity can be achieved with the moulage of a fresh bruise.
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