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Nursing instructors are experts at mock injuries

Don't ever mix lemon juice with grated parmesan cheese. It's something best left to the experts.

"It not only looks like barf, it smells like barf," said Kaaren Harris as she held the stuff out for inspection.

Even better, or maybe worse, the longer the stuff sits around, the more it smells, said Harris, a simulation specialist in the Ridgewater College nursing program in Willmar.

Harris and Jeanne Cleary, the program's director of simulation, stir up the lemon juice/parmesan mixture and lots of other concoctions to bring authenticity to their classes using the lab's sophisticated simulation manikins.

"We really try to jazz up our simulations," Cleary said. "The more real, the better."

The two have become experts in moulage, French for "to form." It is the art of applying mock injuries for training purposes to manikins or to live volunteers.

The life-size manikins, which can cost in the neighborhood of $60,000 apiece, can't bleed or do other unappetizing things on command. But clever use of moulage makes it look like they can.

The instructors can have patients "talk" to the student nurses using a microphone connected to a computer system. They do the patient's talking and watch the action through a one-way window in the control center.

"We can't have the doll throw up," Cleary said. But they can have the manikin say, "I've been throwing up; it's over there," and wait for the students to find a container nearby.

Cleary joked that the "barf" recipe is a surefire method of identifying the pregnant students in the class. They'll be the ones turning green when they smell it.

Obviously, they have to be careful how they handle some of the recipes, because the food coloring in them could stain the manikins' skin.

"We have a few lessons we've learned," Cleary said. One of their manikins has a permanent "strawberry birthmark" to show for a great idea that didn't pan out.

The two instructors bring a combined 50 years of experience working in intensive care units. They call on that to help them introduce students to serious traumas and puzzling medical situations.

Adding sound, color, fluids and mocked-up injuries helps the students get a better feel for what they'll see in real-life situations, Cleary said.

"We are getting feedback from employers that our students are coming in better prepared, because they did it here first," she said. A group of students agreed that they have learned a lot in the program's simulation exercises.

Gross out

It is an added benefit of their job that Harris and Cleary really like to gross people out.

"This is the most fun I've had in nursing," Harris said, "and I've been in nursing for 45 years."

Their work has led to a cookbook, "Moulage for Manikins," that spells out how to make authentic-looking bodily fluids for use in simulations.

"Jeanne Cleary and I are the Martha Stewarts of moulage," Harris said.

Proceeds from the $25 book are donated to the Ridgewater College Foundation to be spent on simulation efforts. Harris's son David helped them start a Web site,, to promote their book and offer moulage tips.

Cookbook may seem to be an odd name for a book of recipes for artificial pus, mucus, vomit and bloody stool, but the book has been popular. They've sold about 200 of them, and are planning a second printing. The book includes tips and cautions on how to use the moulage, as well as information on cleaning manikins.

The women are actually gourmet cooks, and they have developed a knack for seeing potential in an ordinary kitchen cupboard.

Cherry pie filling can simulate postpartum blood clots. A combination of Alka Seltzer and ginger ale makes a nice foamy mouth. Salsa can imitate gastro-intestinal bleeding.

Jell-O helps add texture to other fluids. Canned peas could be mashed up to look like wound drainage or bile. A few peas, raisins or corn kernels can be added to artificial vomit or stool to simulate partially digested food. A stick of red licorice under the manikin's skin feels like a distended neck vein.

Good quality makeup can be used to simulate bruises, chemical burns or wounds.

"I love Halloween," because it's a good time to pick up lots of fake gore, Harris said. The day after the holiday, she snaps up all she can at half price, but sometimes she just can't wait.

This year, she bought tattoo sleeves as soon as she saw them, because she didn't want to lose the chance. She thought they'd be useful to demonstrate some of the challenges in finding veins in heavily tattooed patients.

Harris is particularly proud of the help she receives from her grandchildren. When she shops with her 6-year-old grandson, he'll see a new product and say, "Grandma, you've got to buy this."

They love to visit Grandma at work to see what's new. Her grandson has even helped her come up with some edible moulage-related treats.

"If a 6-year-old can do it, it's gotta be good," she said. "If you can gross out a 6-year-old, that's great."