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Creating Burns to Teach Debridement Technique

  Submitted by: Kathryn King on April 15, 2019
  HomeGrown Solution Number: 308
Identification of the Problem
Over 1 million people present with burns to the Emergency room each year in the United States (US) (Sheridan, 2018). Approximately, 91% of burns in the US are treated and released in an ER setting (American Burn Association [ABA], 2017). All ages, sexes and races are affected by burns with males having a higher incidence than females. Most burns occur in the home and approximately 24% occur in children under the age of 15 years of age (ABA, 2017). In a clinic or ER setting, the advanced practiced registered nurse (APRN) needs to know how to assess and treat burn patients appropriately. The APRN students (PNP, AGPC, and FNP) in MNSc and DNP programs had a need to learn the skill in a safe simulated environment prior to going into clinical practice where they may encounter this type of patient. A major skills station required by our MNSc and DNP APRN Program is burn care/debridement. We were seeking a realistic, easy to produce, and cheap simulation to teach students the procedure for burn care. We consulted a burn specialist from the local Burn Unit from a major hospital in the south for standard procedures in burn debridement. Following this consultation, we set about developing burns that not only look real and “oozed”, but that also have a layer of material that peels off like skin and can be washed away with a washcloth. This station allowed our APRN students to evaluate the depth of the wound, discuss patient education strategies and practice burn care management guided by our burn specialist. References: American Burn Association (ABA). (2017). Burn Injury Fact Sheet. Retrieved from: https://ameriburn.org/wp-content/uploads/2017/12/nbaw-factsheet_121417-1.pdf Sheridan, R.L. (2018). Initial evaluation and management of the burn patient. Medscape. Retrieved from: https://emedicine.medscape.com/article/435402-overview#a5
Unique Idea
Glue and stage makeup were applied to extra manikin arms to look like burn wounds. Arms were allowed to dry, and then set out on a table. Students then learned how to “debride” the wounds. The arms could also be attached to manikins, or the process applied to the legs or abdomen as desired.
To simulate debridement of burn wounds for clinical skills education.
1. Manikin arms (we used "amputated limbs")
2. White liquid school glue
3. Hairdryer (optional)
4. Tweezers/forceps
5. Stage makeup: colors - black, brown, burgundy/dark red, bright red
6. Scab blood gel
7. Stage blood
8. Makeup remover
9. Cotton tip applicators
Steps to Creating the Solution
1. Apply a thick layer of school glue to manikin arm(s). It works best if you squirt the glue onto the arm and then use a gloved finger to spread it out and smooth it (Figure 1). Allow the thick layer of glue to dry. It helps to use a hairdryer to speed up the process. If using a hairdryer, the arms will dry in 1.5 hours, otherwise, it will take a full day.
2. Use forceps with teeth to “rough up” the dried layer of glue to create areas and degrees of burn. Create holes and peel some flaps back as desired (Figure 2).
3. Apply black stage makeup to the inside of holes (burns) created, and to the flaps of glue peeled back (Figure 3).
4. Apply brown stage makeup directly around the holes/flaps. Apply burgundy stage makeup around holes outside of the brown and bright red stage makeup in remaining space between holes/flaps (Figure 4). Blend all the colors together using your finger.
5. Using a cotton tip applicator, apply globs of “fresh scab blood” under/ around flaps and in holes. You can also spread a thin layer in areas between holes if desired. It does not create a “web” effect like stage blood. Using your finger, spread “stage blood” across areas between holes. To make the wounds appear to “ooze” more, you can apply a layer of stage blood over the “scab blood” (Figure 5).
6. TO CLEAN ARMS AFTER USE: Wash glue/makeup off with soap/warm water and using a washcloth. If some makeup is left behind, scrub arms with Ben Nye* “makeup remover” until clean.