Fidelity. Reflection on this design characteristic related to ensuring fidelity and barriers to it. For exam-ple, the designer noted that she referred to a variety of sources to create realistic patient cases including nurs-ing textbooks, online opioid calculators, and contacting a physician who specializes in pain management. Envi-ronmental fidelity was promoted by using moulage to create body fluids such as urine and liquid stool. Barri-ers to fidelity noted in the designer log related to the known capabilities of the human patient simulator. For example, one log entry read, “To adequately portray delirium, the limitations of the mannequin have to be taken into account. Agitation is not an option with the mannequin – it just isn’t real.”