Development of a Training Manikin for Intramuscular Injection into the Gluteal Muscle*

Abstract

Administering intramuscular injections is an essential fundamental nursing skill that requires meticulous care in medication administration. Knowledge of anatomy is crucial in selecting appropriate injection sites, as well as understanding the principles and techniques of injection.Such knowledge is particularly important for administering intramuscular injections in the hip area, as an incorrect identification of the injection site poses a risk of damaging the sciatic nerve and blood vessels surrounding the hip muscles. Therefore, training nursing students in the skill of performing intramuscular injections in the hip is vital for safe and effective nursing care.However, traditional training still relies on imported, expensive simulation models that are limited in number. This may raise ethical concerns, safety issues, and accessibility limitations. These problems are especially significant in nursing schools that lack realistic and affordable simulation models for practicing hip muscle injections. As a result, nursing students have fewer opportunities for practical training, which can reduce their confidence and effectiveness. Consequently, there is a necessity to develop durable, cost-effective, and anatomically realistic simulation models to enhance the learning outcomes of nursing students. The main objectives of this study were 1) to develop a training manikin for intramuscular injection into the gluteal muscle and 2) to evaluate the effectiveness of the developed training manikin for intramuscular injection into the gluteal muscle.

The development of the training manikin uses the Research and Development (R&D)methodology, which is divided into four steps, including 1) identifying the requirements for developing the hip intramuscular injection training manikin and reviewing relevant literature; 2)developing the training manikin using a combination of soft and firm silicone materials to simulate muscle and bone layers based on anatomical characteristics. The model enables palpation of key bony landmarks used to identify suitable injection sites. Experts evaluated the prototype for its anatomical accuracy and the suitability of needle insertion points. Subsequently, an electronic circuit was integrated into the model, consisting of two main components: a metal needle detection sensor and a processing and control unit; 3) evaluating the effectiveness of the manikin with a sample group consisting of 30 nursing students and 5 nursing instructors. The research instrument used was an evaluation form assessing the effectiveness of the intramuscular gluteal injection training manikin. Data were analyzed using descriptive statistics, including mean, standard deviation, frequency, and percentage; and 4) refining and improving the manikin.

The results indicated that the developed hip intramuscular injection training manikin achieved a high level of overall effectiveness. The top three highest-scoring aspects were ease of use, ability to support self-directed learning, and cost-effectiveness compared to its benefits. The five lowest-rated aspects were 1) the flexibility and realistic tactile sensation of the manikin, 2)the realistic appearance, 3) demonstration of the external hip structure, 4) portable design, and 5) the accuracy of feedback signals. The developed intramuscular injection model for the gluteal site was shown to be an effective educational tool. It not only enhanced the knowledge and skill level of nursing students but also offered a safe, repeatable, and realistic method for practice. The high satisfaction scores further validate the model's utility in nursing education. Moreover, its cost-effectiveness and ease of production make it accessible to various educational institutions,especially those with limited resources. Further recommendations for future development and research include 1) enhancing manikin quality: improvements should be made to increase the material’s flexibility and make it more closely resemble human skin. Additionally, the alert system should be optimized for greater accuracy and expanded to provide broader coverage. Consideration could also be given to designing manikins that represent patients with varying ages and physical conditions to improve realism and diversity in training; and 2) the development of an application or computer program integrated with the manikin to record students' practice sessions and provide real-time feedback for skill assessment and personalized learning planning.

Keywords: Intramuscular injection, Nursing simulation, Research and development