Nailed It: Is Less Really More?

By: Alaina Herrington

In a perfect world, pictures of our projects or scenarios would be highlighted on a social network as standards of achievement. However, in reality, some of us lack the creativity and the finesse of others. Our posts would be closer to those Nailed It photos on Pinterest, with the cake half falling off the pan.

Have you seriously failed at a simulation experience and Nailed It? I certainly have.

About a year ago, I placed a “used” moulaged bedpan under one of my manikins. To increase fidelity, I applied a manufactured fecal spray. As I really wanted my students to notice the bedpan, I sprayed 2 or 3 more times right before the scenario began. The students entered the room, smelled the fecal odor, and laughed so hard they could hardly talk to the patient. When the scenario was over, the students couldn’t get out of the room fast enough. That’s what happens when a simulation coordinator thinks she needs a strong odor cue in order for the students to get the point. Clearly I Nailed It.

In this instance and many others, less could really be more. I think it’s easy to overdo moulage and/or prepare the environment for our students. For example, when we first started in simulation, we thought every scenario had to be a detailed replica of real life. We were so compulsive we even moulaged under bandages in case students might assess the area, even when wound assessment wasn’t part of the objectives. When we replicated this simulation we no longer included this area in our set-up – we had realized that students never assess the wound.

Sometimes less moulage means spending more staff time in other areas. Now we try focusing on meeting the objectives and decreasing staff workload, while considering how much knowledge the student gains from what we are doing. Will the student lose the realism of the scenario without an elaborate set-up?

We have tried to determine if the simulation modality and associated costs of the set-up are justifiable in terms of student outcomes (Larsen & Schultz, 2014). For example, we ask faculty if the students’ test scores are increasing in the associated concept and/or if the employer is seeing an improvement in performance. While this feedback is not research based, it does provide us with evidence that our hard work is beneficial to student learning. Using content test scores and a scenario validation annually allows us to know if scenarios should be changed and what level of realism is required while still maintaining the International Nursing Association for Clinical Simulation and Learning (INACSL) Standard of Best Practice: Simulation Design.

The next time you think your simulation involves a great deal of time and effort to achieve a high level of realism, look at the scenario objectives, feedback, and learner outcomes. You may not need to put in as much effort as you thought.

Click here  for some easy, successful moulage examples provided by my colleague at Hinds Community College, simulation technology specialist Tammy Nailen. They can all be completed in less than 10 minutes.


Larsen, T. A., & Schultz, M. A. (2014). Transforming simulation practices: A quest for return on expectations. Clinical Simulation in Nursing, 10, 626-629.

2 thoughts

  1. I would love to hear what anyone else thinks about saving time and maximizing learning when prepping for a scenario.

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