COVID-19 has created an unprecedented public health emergency. Nurses are classified as frontline workers and face significant risk for high viral loads, infection, and death (Sim, 2020). Currently, nurses and nursing are highly visible in the media, conducting fever clinics, responding to workforce surges, and caring for critically ill patients, and world leaders acknowledge their contribution in daily reports. This has culminated in a new zeitgeist when the anonymous street artist and political activist, Banksy, portrayed nurses as superheroes (Morris, 2020). Although this acknowledgement and support for nurses is welcome, there is increasing concern about the current constructs of angel and hero used to describe nurses (Stokes-Parish, 2020). This concern was echoed by the British Association of Critical Care Nurses' president, Nicki Credland: We're not angels, we're not heroes, we are human beings that have chosen a career, that are highly educated, that work in a patient safety-critical profession, who simply want to go and do the job that we trained to do and be protected to do it. (British Association of Critical Care Nurses, 2020) In this contemporary discussion article, we propose that the hero and angel constructs undermine the professionalism of the nursing workforce, and reinforces the perception that nursing is an innately feminine, nurturing role. We argue that this discourse continues to undermine the continuing endeavors to consolidate nursing's standing as a profession. Heroes in the COVID-19 Era-The Evolution Nurses' contribution to healthcare outcomes is well documented (Aiken et al., 2011; Guetterman et al., 2019). There are almost 28 million nurses globally, accounting for nearly 60% of the healthcare workforce and delivering approximately 90% of primary healthcare services internationally (World Health Organization, 2020). Nurses are increasingly working in clinical situations where access to essential equipment is limited or denied; they have been exposed to heavy COVID-19 viral loads and have worked long hours, in some instances, and with suboptimal nurse-patient ratios to manage the surge in healthcare demand. Additionally, many have had to simultaneously upskill and develop new ways of working. According to the International Council of Nurses (2020), at least 600 nurses have died as a result of the pandemic. Nurses and nursing have responded to these challenges with maturity, responsiveness, and agility, and perhaps for this reason the constructs angel and hero have been adopted by the media (Frost, 2020; Johnson, 2020; Mosley, 2020; Pownall, 2020). This depiction of nurses as heroes and angels is not new. In their study of the image of the nurse in mass media, Kalish and Kalish (1983) identified that nurses have been portrayed as angels of mercy since the mid-nineteenth century. Although the acknowledgement and support for nursing is welcome, there is increasing concern from political, clinical, and research perspectives about this portrayal. Before examining the consequences of the ange...
Background Moulage is a technique in which special effects makeup is used to create wounds and other effects in simulation to add context and create realism in an otherwise fabricated environment. The degree to which moulage is used in the simulated environment is varied; that is, there is no guide for how authentic it is required to be. To objectively assess whether a higher level of authenticity in moulage influences engagement and better outcomes, a common model to assess authenticity is required. The aim of this study was to explore expert opinions on moulage in simulation and develop an instrument for the classification of moulage in simulation. Methods The instrument was developed in 3 phases: expert panellist recruitment, domain identification, and consensus rounds. A Delphi technique was used to explore themes of authenticity using Dieckmann’s Theory of Realism as a frame of reference. An initial list of elements was raised by a panel of international experts. The experts participated in a further four rounds of questioning, identifying and then ranking and/or rating elements of authenticity in moulage. A priori consensus threshold was set at 80%. Results In round 1, 18 of 31 invited panellists participated, and a total of 10 completed round 5 (attrition 44%). As a result of the Delphi, the Moulage Authenticity Rating Scale was developed. Under the three domains of realism, 60 elements were identified by experts. A total of 13 elements reached the consensus threshold, whilst tensions regarding the necessity for authentic moulage were identified throughout the rounds. Conclusion This study demonstrates the complexity of moulage in simulation, with particular challenges surrounding the experts’ views on authenticity. A prototype instrument for measuring moulage authenticity is presented in the form of the Moulage Authenticity Rating Scale (MARS) to further aid progress in understanding the role of authentic moulage in simulation. Electronic supplementary material The online version of this article (10.1186/s41077-019-0103-z) contains supplementary material, which is available to authorized users.
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