Transitioning from academia to clinical practice can be a challenging period for first-year diagnostic radiography students. Their reactions and behaviours when working with patients with visible conditions have the potential to make a lasting impact on the patient. The practice of emotional labour is used to display an organisationally acceptable demeanour; however, it is associated with burnout. There is limited research into the emotions experienced when student radiographers meet patients with open wounds. This research evaluates the use of a simulation using moulage in preparing students for these encounters in advance of clinical placement.
This research used a longitudinal quasi-experimental design and mixed methods approach. Students (n=97) were randomised into a control and simulation group. The simulation group participated in a simulation incorporating moulage. Their role was to support the imaging of a patient who had suffered an open fracture. Quantitative data was collected before and during placement using Visual Analogue Scales (VAS) to measure student feelings upon seeing an open wound. Qualitative data was collected at two stages. Firstly, twenty-four small focus groups (n=5) were conducted at the debrief stage of the simulation and were analysed using thematic analysis. Secondly, semi-structured interviews were conducted with students (n=7) following their experience seeing an open wound in clinical practice. These were analysed using Interpretative Phenomenological Analysis (IPA). All three stems of data collection were then triangulated to identify new meta-inferences.
Statistically significant changes were identified following the simulation, with improved emotional preparedness and a reduction in negatively valenced emotions. This emotional trend was sustained into clinical practice, but the level of feelings aligned with the students in the control group. Following the simulation debrief, six themes were identified: emotion, realistic simulation, pain, difficulty communicating, developing teamwork and patient-centred care. Five superordinate themes emerged from the IPA interviews: experiencing a new environment, navigating new relationships, preparation, engagement with wound, and emotional management. Through a process of triangulation, meta-inferences were discussed under the following headings: simulation to reality, knowledge is power and emotional support.
The simulation provided students with the experience of seeing an open wound ahead of clinical practice, thus improving their emotional preparedness and reducing their anxiety. The use of moulage enhanced the authenticity of the simulation promoting a similar emotional reaction to those experienced in a real situation. Students gained a better understanding of their role in providing quality patient-centred care, allowing them to consider adjustments to their practice and behaviours before working with real patients. Peer support and teamwork were developed through the simulation, and this was sustained into clinical practice.
During clinical placement, students found a lack of information relating to the patient pathway contributed to a lack of closure. This was emotionally challenging. Evidence indicates the implementation of a simulation using moulage, would have a positive impact on emotional labour, improving the student and patient experience.