Design and Production of a Hybrid Simulator for Staple and Suture Removal on Peers or Simulated Patients in Nursing Education

Removing sutures and staples after surgery is a common medical task often performed by nurses. This procedure requires clinical assessment, adherence to hygiene protocols, patient-centered communication, and, importantly, the technical skill of professionally removing sutures or staples. Training for this task typically involves combining theoretical knowledge with practical skills, the latter often practiced on part-task trainers before transitioning to real patients under supervision. These part-task trainers are commonly static models for suturing, placed on a table in front of the learner. While efforts to integrate technical skills with patient-centered communication may involve a peer or simulated patient (SP) positioned nearby, this approach still spatially separates patient interaction from the technical task. We propose that reintegrating the patient (whether a peer or SP) with the clinical task more accurately reflects real-world scenarios. Training in the form of a hybrid simulation could enhance both the authenticity and effectiveness of learning.

In an interprofessional team incorporating expertise in nursing, medical education and moulage artistry, we developed such a simulator for use in hybrid simulations with peers or SPs. The simulator is worn on the forearm, allowing sutures and staples to be repeatedly applied in advance and then removed during training sessions. It was constructed in a gravity casting process, pouring silicone into a low-pressure permanent mold, with varying amounts of pigment added to achieve a wider range of skin tones. To enhance durability, power mesh fabric was embedded within the silicone, and Velcro straps were sewn in as a fastening mechanism.
The course design was modified to allow for greater emphasis on interpersonal skills, aligning the exercise more closely with a competency-based training approach. Peers or SP wearing the device can be scripted to deliver prompts during role-play depending on the learner’s performance.

To our knowledge, this is the first simulator of its kind. Preliminary evaluations from courses using the simulator will be shared. Continued use will provide further insights into its durability. Significant effort was invested in designing the simulator to account for the diversity of learners. Multiple sizes were produced to accommodate varying arm girths, and a range of skin tone hues was created. While achieving exact skin tone matches for every learner was not the goal, the available hues aim to reflect diversity and serve as a visual reminder of inclusivity.

Future evaluation data will guide improvements to the course concept and simulator design. Looking ahead, we are considering the addition of a reinforced bottom layer made from a durable material. This enhancement would enable the simulator to be used not only for removing sutures and staples but also for their application in similar hybrid simulation settings.