Introduction to Patients with Open Wounds

The target learning group of this case study was Radiography Students

In this section

In This Section

Learning Outcomes

  • Knowledge

    • Be aware of your own emotions and the emotions of others

    • Providing patient care

    • Manipulation of the x-ray tube and selection of appropriate exposure factors

  • Skills


    • Appropriate use of PPE

    • Communicate effectively with the team and patient

    • Adapt imaging procedure as required for the patient

  • Attitudes/Behaviours

    • Communication

    • Team working

    • Recognise what emotions informed your reactions and behaviour within the situation

Scenario Environment


Accident and Emergency X-ray room


  • Accident and emergency trolley for simulated patient.

  • Personal Protective Equipment.

  • Oxygen mask and tubing to cylinder.

  • Patient gown and blanket.

  • X-ray equipment and adaptive technique pads.

  • Imaging receptor.

  • Venflon applied for pain relief administration.


Silicone mould of open fracture (pre-painted to save time),
applied to the lateral ankle.

Use the skin tones to match to the patient’s skin.

Bruise wheel to apply appropriate to leg.

‘Thick’ and thin blood to add depth and make wound more dynamic.

Atomizer with blood smell sprayed sparingly in the room.


N/A bruising


Simulated patient and Supervising Radiographer for role play.

Simulation facilitator.

Recommend two radiography students to participate at a
time for peer support and to develop teamwork.

Potential Distracters

Patient demonstrates moderate pain on movement of ankle.

If the students are reassuring and shows empathy and compassion
this subsides.

Initial Simulation Setup

Simulated patient on x-ray trolley, in a gown and wearing the oxygen mask, Venflon, moulage applied to ankle and visibly uncomfortable.

X-ray tube positioned away from trolley, centered over the table.

X-ray room on with x-rays disabled.

Case Introduction

Preparatory lecture: It is good practice to provide students with some 2D imagery and ensure they have had an opportunity to learn about different types of pain and how this presents. Including the role of emotional labour, emotional management, and support available.

Briefing: Students are advised to put into practice patient communication and teamwork. Their role is to support the supervising radiographer, NOT to be able to undertake the imaging (especially if first year students).

Students are to consider what emotions they are feeling and observe others including the patient and peer.

Provide the participants with an x-ray referral card.

Available Collateral Information

The students are to take direction from their supervising radiographer and the simulated patient.

Patients back story: Fallen from loft ladder trying to access an item (simulated patient to choose). Landed inverting ankle.

Patient has had pain relief through a Venflon.

Instructions for Personnel

Simulated patient: Display signs of discomfort verbally and non-verbally. This increases when you are being moved. You are able to communicate and answer questions for example, providing information for identification, comfort level and how this occurred. Take note of students’ behaviour as you will be included in the debrief.

Supervising Radiographer: Provide instructions to the students as you would in clinical practice. You are aiming to obtain an anterior-posterior and horizontal beam lateral projection.

Provide opportunity for the students to come close to the patient’s ankle by allowing them to support the leg whilst positioning.

Leave the students with the patient whilst reviewing the first image, this provides an opportunity for communication to take place.

Observe the students’ actions and behaviours as you will be involved within the debrief.

Evaluation Strategy

Pre- and post-simulation evaluation of emotions using visual analogue scales.

The use of the ‘Promoting excellence and reflective learning in simulation’ (PEARLS) debrief model works particularly well, as it initially focusses on emotion.

Involve all present in the room and debrief in situ.  This forms a focus group and data can be thematically evaluated.


  • Dr Naomi Shiner

    Name: Dr Naomi Shiner DPrac, NTF, SFHEA, PgCert, PgCert, Bsc (Hons) R

    Job title: Senior Lecturer

    Department: Diagnostic Imaging

    Simulation experience / simulation research:

    Naomi is a visionary, and an award-winning educator for innovative uses of simulation-based education and moulage to enhance student preparedness; working extensively with external parties to promote best practice and lead in the field of simulation-based education.

    Naomi is the chair for the Society of Radiographers simulation specialist interest group and the health, psychology and social care college simulation group. Naomi has several peer reviewed publications and speaks regularly to an international audience about simulated practice.