Table of Contents
Chapter 1: Introduction
In hospitals, cardiac arrests have increased significantly while the survival rate is below 23%. The survival rates demonstrate the importance of prompt responses from nurses and patient care assistants (McNally & Ong, 2013). Notably, nurses and patient care assistants form the most important group of first responders in their efforts to promote positive outcomes for patients who experience in hospital cardiac arrests. Unfortunately, many nurses lack the competencies required in providing effective response and resuscitation to patients with cardiac arrest (Zimmerman et al., 2015). Moreover, the anxiety that nurses and patient care assistants experience in their efforts to resuscitate patients may be too overwhelming limiting their effectiveness. There is evidence that nurses and other responders can increase the survival rates of for patients experiencing in hospital cardiac arrests if they act quickly and deliver cardiopulmonary resuscitation.
Statistics indicate that a minute delay of initiating cardiopulmonary resuscitation contributes to a 7% decrease in survival rates. For this reason, it is explicit that first responders need the relevant competencies as well as the confidence that can empower them to deliver effective cardiopulmonary resuscitation. If the first responders are competent enough to initiate resuscitation, they can work together towards the reduction of mortality rates associated with in hospital cardiac arrests (Castro, Cruz, & Briones, 2014). Many hospitals register negative patient outcomes when it comes to enhancing the survival rates of patients with cardiac arrests (Simpson, 2016). Particularly, healthcare organizations have cited the lack of competency as well as inadequate confidence as the main factors that prevent first responders from acting promptly and initiating resuscitation. As a result, the healthcare organization should invest in rigorous orientation programs that present first time responders with the opportunity to acquire the required competencies and confidence in initiating cardiopulmonary resuscitation.
Through successful orientation of new nurses and the training of existing nurses, it is possible to ensure that cardiopulmonary resuscitation takes place immediately and efficiently. The American Heart Association presents specific guidelines that emphasize the significance of immediate cardiopulmonary resuscitation. Through effective orientation and training programs, hospitals can increase positive outcomes and reduce the response times. The reduction of response time means that first responders will act immediately in the provision of cardiopulmonary resuscitation (Oermann et al., 2014). The use of a mock code in training programs that seek to empower staff members is one of the effective ways of ensuring that the first responders develop the skills and confidence needed in the delivery of cardiopulmonary resuscitation (Chalkias et al., 2013). The mock codes serve as a simulation of the cardiac arrest scenario and demonstrate how nurses and patient care assistants should act immediately and efficiently to increase the survival rates.
Problem Statement
The number of patients who succumb to in hospital cardiac arrests has increased significantly. First responders such as nurses and patient care assistants make efforts of initiating cardiopulmonary resuscitation. However, the low survival rates of patients with cardiac arrests demonstrate that there is an underlying problem with the speed of response. An effective response to the cardiopulmonary arrest should take place within a minute while defibrillation should follow within two minutes according to the American Heart Association Guidelines. Unfortunately, many healthcare facilities do not meet the expected survival rates due to slow response and the inefficiency of response. Apparently, there is a need for effective intervention to increase survival rates for patients who suffer in hospital cardiac arrests.
Problem Background
Many healthcare organizations are striving to hire new nurses with the purpose of ensuring that their facilities have adequate staff members. As a result, these facilities have faced the compulsion to hire freshly graduated nurses who lack diverse experience in the nursing practice. Many nurses lack the competency required to deliver quality health care in acute care settings. As a result, many of these nurses lack the capabilities, knowledge, and skills required for the initiation and performance of the cardiopulmonary resuscitation (Machado, Albuquerque, & Oliveira, 2017). Particularly, freshly graduated nurses do not have the skills or the confidence they require to perform the cardiopulmonary resuscitation. As a result, many healthcare facilities have continued to register negative outcomes in their efforts to promote survival rates in patients who suffer in hospital cardiac arrest (Kunkel, Kopp, & Hanson, 2016). Whereas nurses and patient care assistants represent the first responders to cases of in hospital cardiac arrest, their lack of competency in this area has become a major issue.
Previous studies have demonstrated that there is a need for efforts and proper intervention strategies to ensure that nurses have the skills required in performing cardiopulmonary resuscitation. In cases where healthcare facilities provide orientation programs that cover the resuscitation process, there is minimal knowledge retention (Mora et al., 2015). Moreover, other training methods used in equipping nurses with the necessary skills do not register the expected outcomes. As a result, the nurses do not register the retention of knowledge and skills. In many instances, many of the nurses lose the skills within six months of the initial training (Seung & Park, 2015). Moreover, many orientation programs focus on teaching methods that do not involve practical applications. For this reason, many of the nurses attending such programs can narrate the steps they should take in performing resuscitation but are unable to carry out the process successfully.
Other healthcare facilities do not have regular assessment programs that ascertain the fact that nurses can retain the knowledge that they receive during training. In the current facility, many nurses lack the competencies required in the performance of a cardiopulmonary resuscitation (Reiter, Strother, & Weingart, 2013). Moreover, training and orientation programs used in the past have proven ineffective in the promotion of knowledge retention as well as the application of skills in real cases of cardiac arrests. Moreover, the facility has not been using an effective simulation approach that is similar to the code blue scenario. Novice nurses require rigorous training that properly simulates the code blue scenario and provides them with competencies and confidence to handle the situation (Mora et al., 2015). Experienced nurses also require refresher courses to increase their competencies in the performance of cardiopulmonary resuscitation.
Description of the Practice Change, Quality Improvement, or Innovation
The major practice change in the reduction of mortality rates associated with in hospital cardiac arrest is the inclusion of a mock code in the nursing orientation and training programs. Particularly, a mock code method seeks to replicate the code blue scenario and all the processes involved in resuscitation. It involves a simulation approach in which the trainers create a similar scenario to the one that nurses experience in real practice. The inclusion of the mock code in orientation and training programs would register positive outcomes in enhancing survival rates (Simko et al., 2014). The mock code simulation will serve as an effective approach to the delivery of important knowledge regarding the most effective measures to take in resuscitation.
The objective of the mock code programs would be to improve response times for first responders when handling the code blue scenario. Experts of the mock code simulation will provide a debriefing to all the staff members regarding the recent statistics of mortality rates associated with in hospital cardiac arrests. The experts will explain that the facility is facing a critical problem in its efforts to increase survival rates for patients who suffer cardiac arrests (Thompson, Cook, & Flannery, 2017). The selected committee of experts will hold meetings with the necessary stakeholders in the healthcare organization. Notably, stakeholder involvement is of critical importance because it promotes the success of the practice change. The stakeholders have specific interests, a remarkable level of influence, as well as the power required to determine the direction of the practice change.
The primary stakeholders will include the nursing leaders in the organization, staff development officers, acute care experts, nursing researchers, medical surgeons, and other interested specialists. These stakeholders will need to agree on the need for a practice change to improve the quality of care delivered (Williams et al., 2016). It will be imperative to highlight the evidence supporting the use of mock codes in empowering nurses to develop more competencies in the delivery of resuscitation in a code blue scenario to convince the stakeholders. The relevant change theory for this case is the Lewin’s Change Model that focuses on preparing all the staff members for the change, implementing the change, and evaluating the outcomes. The implementation of the mock code simulation will take place for a month, and the evaluation of the outcomes will follow.
Rationale for the Practice Change, Quality Improvement, or Innovation
The mock code simulation can register positive outcomes in the competencies of nurses and the improvement of response times in code blue scenarios. The code blue simulation presents an opportunity for nurses to collaborate with other healthcare professionals in the delivery of quality health care. Undoubtedly, the mock code method is likely to register desirable outcomes in the retention and application of knowledge and skills that the nurses acquire. The implementation process described above prepares all the stakeholders, staff members for the practice change, and reduces the cases of resistance. As a result, it addresses any potential barriers that would hinder the effectiveness of the delivery method. The use of mock code simulation focuses on evidence based practice to improve positive patient outcomes in acute care settings.
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Chapter 2: Literature Review
Literature Search process
The researcher identified the articles used in the literature review after a rigorous electronic search from different databases such as CINAHL, PubMed, as well as the University library. The literature search focused on identifying recent scholarly articles that highlight the most effective design for a mock code when handling in hospital cardiac arrests. Moreover, the researcher focused on identifying articles that discuss the implementation of a mock code simulation in the intensive care unit setting. The key search terms included mock code design, mock code simulation, in hospital cardiac arrest, and nurse competencies in cardiopulmonary resuscitation. The researcher identified 30 articles published in the last five years that were relevant to the topic of study.
Identification of Best Practices
It is imperative to consider the conclusions that many scholars have presented concerning mock codes to identify the best practices in the design and implementation of mock code simulations in the intensive care unit setting. According to Franklin (2015), a simulation is an effective approach that helps nurses to develop new competencies and improve patient outcomes. Particularly, a mock code simulation is of critical importance in resuscitation training. Nurses can learn important skills through experiential learning. Based on this study, it became explicit that the simulation approach recreates a real scenario that can help nurses to undergo realistic training on how to carry out proper resuscitation. Mock code simulation serves as an effective approach because of its interactive and realistic format. However, the author was keen to highlight that one of the best practices in mock code simulation is to develop teamwork and communication. In the view of Thompson, Cook, and Flannery (2017), mock code training and simulation serve to improve the knowledge levels of nurses if carried out effectively. Particularly, there is a need to implement high-fidelity simulation that registers positive outcomes in the training of nurses. The authors emphasized the need for embracing high-fidelity simulation to increase the competencies of nurses.
In the acute care settings, high-fidelity simulation has proven to be effective because it makes use of human patient simulators as well as computer-based applications that allow nurses to gain experiential skills. High-fidelity simulation replicates realistic clinical situations but does not pose any dangers or risks to the patients. For this reason, nurses can benefit immensely from this type of simulation. Hommes (2014) agrees that high-fidelity simulation is one of the best practices in mock code design because it is likely to register higher levels of effectiveness. Particularly, the simulation allows nurses to develop decision-making skills and apply them effectively when addressing different clinical scenarios. High-fidelity simulation presents the most positive outcomes, and healthcare facilities should embrace this approach when carrying out a simulation. All these studies emphasize the need for realistic clinical scenarios that help nurses to develop the necessary skills that they can use in addressing emergencies. Nurses can give their feedback while the trainers can introduce a repetitive cycle that promotes knowledge retention.
Sarasnick, Pyo, and Draper (2017) have cited some of the outstanding benefits of improving the knowledge of nurses. Particularly, simulation presents healthcare facilities with an opportunity to prepare nurses for some of the outstanding challenges in their nursing practice. Specifically, a simulation has the potential to improve patient safety outcomes and reduce the mortality rates because nurses gain competence and confidence. Curl et al. (2016) conducted a study that compared integrated simulation and other traditional approaches in helping nurses to develop new skills and competencies. The study revealed that simulation is one of the effective approaches that enhance the experience of nurses. These studies emphasized the fact that nurses must recognize their specific roles in the simulation process so that the process can be beneficial. In some simulation instances, nurses face confusion because they are unaware of their designated roles. However, the proper design of simulation exercises should reflect a clear designation of roles for each nurse. Couloures and Allen (2017) argue that simulation can be effective in improving cardiopulmonary resuscitation if carried out in a proper design. The study demonstrated that a simulation is an effective approach to improving the competencies of nurses in carrying out cardiopulmonary resuscitation. However, the design of the simulation and the designation of the specific roles for the nurses serve to improve the outcomes of the simulation process.
The emphasis on mock code simulations is to ensure that nurses recognize the importance of responding within the first minute when a cardiac arrest occurs. Many of these studies have emphasized the importance of debriefings before the simulation process. The debriefing should help the nurses to identify the specific purpose of the simulation process that helps in gaining new competencies. Particularly, the debriefing process prepares the nurses adequately for the exercise and helps them to recognize the importance of making decisions during the simulation process. The use of debriefings helps nurses to gain awareness of the important elements of the simulation process, a factor that increases knowledge retention. Without debriefings, it would be extremely difficult for the nurses to recognize the main objectives of the simulation process. Since the training programs target freshly graduated nurses who lack sufficient competencies, it is imperative to address their concerns before the simulation process. In mock code simulation, Oh, Jeon, and Koh (2015) highlighted the effects of the simulation process on knowledge retention among nurses. It emerged that if nurses were supportive and took the exercise seriously, they were able to learn new skills and gain a higher level of confidence in providing acute care. An effective design of a simulation process should register positive outcomes in the development of competencies as well as the gaining of new knowledge.
Roh et al. (2013) agreed that simulation could increase the competency of nurses in carrying out the cardiopulmonary resuscitation. Particularly, simulation serves as an effective delivery method that helps nurses to put their skills into practice without placing the lives of patients at risk. Notably, cardiopulmonary resuscitation can prove to be a challenging first aid process for many nurses. The anxiety governing the process makes it more confusing for many nurses. However, it is possible to reduce such anxiety using simulation. The design of the simulation process should focus on meeting the needs of the nurses if it is to register positive outcomes. A simulation model that does not give attention to the needs of nurses may fail to meet its objectives. For this reason, Hunziker et al. (2013) suggested that simulation should adopt a design that helps nurses to cope with the anxiety associated with the performance of cardiopulmonary resuscitation. Before the simulation process, it is important to identify the factors that lead to uncertainty and hesitation among the nurses. In the view of Williams et al. (2016), a mock code simulation is only successful if it meets the needs of the registered nurses.
Nurses who request for a mock code simulation have specific needs and fears that prevent them from carrying out effective resuscitation. However, if the focus of the mock code simulation is to improve the competency levels of the nurses without any form of judgment, then it can benefit the facility. Notably, all these scholars have emphasized the need for collaboration and teamwork when carrying out any form of simulation. Without successful collaboration, it becomes difficult to meet the specific objectives of the process. Through collaboration in simulation, nurses learn important lessons on how they should work jointly when making critical decisions that affect the welfare of patients. Based on the views of Kunkel, Kopp, and Hanson (2016), setting up a simulation exercise must replicate the actual settings in which the real code may appear. Notably, the simulation must bring on board all the equipment and resources that the learners will need so that they can respond effectively to a code blue scenario. For this reason, proper planning of the simulation exercise determines its effectiveness. With all the equipment in place and the nurses having an effective briefing on the purpose of the code, they are likely to learn significant lessons.
Healthcare facilities that set up mock code simulations should recreate realistic scenarios that help nurses visualize how they would decide with the core objective of saving the life of the patient. In a mock code simulation, there should be an emphasis on timing. The expert should time the simulation properly to help nurses recognize the value of acting promptly and efficiently in the case of a real scenario. After the exercise, a debriefing should follow so that the educators and learners can discuss the success of the simulation. Notably, the process of debriefing should focus on the feelings of the learners after the exercise their views on what was successful, as well as their concerns about communication. During the debriefing sessions, the learners should highlight the main elements of their experience throughout the simulation. As Simko et al. (2014) highlighted, an in-depth discussion of the simulation process should precede the debriefing process. The learners should be able to identify how they can reduce the response time as well as develop strategies for responding effectively in the future. The educator should help the learners appreciate the significance of the simulation exercise and clarify any issues that are of concern to the learners.
Evidence Summary
For this project, three categories were defining the evidence; namely, the competence and confidence of nurses, the use of simulation, and the effectiveness of mock code simulation.
Competence and confidence of nurses. Novice nurses lack the necessary competencies required in the delivery of quality care. Many of these nurses acquire a diverse range of knowledge from nursing school but do not have the opportunity to put it into practice. The transition from nursing students to practicing nurses presents certain challenges. The dynamic environment of health care delivery can prove quite challenging for newly graduated nurses (Curl et al., 2016). It is imperative to help such nurses to acquire the necessary skills in the delivery of quality health care. Critically ill patients pose the greatest challenge to newly graduated nurses because they are unable to effectively assess the patient status and make important decisions regarding the type of care required. In certain situations, the nurses are unable to make defining decisions or determine the right course of action to improve patient outcomes (Hommes, 2014). Moreover, novice nurses lack the competence that would motivate them to take up the responsibility of delivering care in critical conditions.
Many of the interviewed novice nurses have admitted that the workplace environment presents numerous uncertainties that make it difficult for them to deliver quality care. With such uncertainties, the nurses are likely to be hesitant when it is time to address critical conditions. In some instances, the nurses may be unable to respond in good time, a factor that registers negative patient outcomes. It takes time for the nurses to gain the required competencies and confidence that will empower them to make critical decisions in health care delivery (Sarasnick, Pyo, & Draper, 2017). Particularly, orientation programs help such nurses to develop remarkable levels of competencies. For the orientation programs to be effective, healthcare facilities must ensure that they can meet the needs of the nurses. It is apparent that many nurses lack the confidence to perform the cardiopulmonary resuscitation. Based on the available evidence, nurses delay in taking action and performing resuscitation, a factor that leads to adverse effects (Thompson, Cook, & Flannery, 2017). Experienced nurses also lack the confidence in acting promptly with the view of saving the life of the patient in the shortest time possible. Many nurses lack the strong conviction that time is of the essence when dealing with cardiac arrest.
The lack of successful collaboration among the nurses makes it difficult for them to make effective decisions and deliver cardiopulmonary resuscitation in the shortest time possible. The response time associated with the initiation of the cardiopulmonary resuscitation is highly wanting, a factor that demonstrates knowledge and competency gap among the nurses. The ability to deliver successful cardiopulmonary resuscitation requires immediate action with the recognition that every single minute lost decreases the survival rates (Blondon et al., 2017). Unfortunately, nurses do not have such important knowledge. They also lack the composure of acting immediately and making decisions with the aim of saving the life of the patient. The comfort levels of nurses when handling cardiopulmonary resuscitation is significantly low. Many nurses experience high levels of stress and anxiety when faced with a code blue scenario. As a result, they act inappropriately and forget how to operate the equipment. For this reason, many nurses are yet to develop the required levels of comfort for them to handle a code blue scenario.
The use of simulation. The use of simulation has emerged to be one of the effective ways of helping nurses to acquire new competencies. Recent studies have emphasized the use of high-fidelity simulation and its capacity to register high levels of effectiveness (Franklin, 2015). Scholars who have evaluated simulation as an educational intervention have highlighted its significance in helping nurses develop a higher level of confidence in the delivery of care in critical conditions. Moreover, the recreation of realistic situations in simulation makes it an effective way of educating and training nurses. Many healthcare facilities have included simulation in their orientation and training programs because of its potential to register positive patient outcomes (Zimmerman et al., 2015). Different health care agencies have given recommendations on the importance of simulation as an approach that mirrors the task environment in which nurses operate.
Simulation is an effective teaching strategy that nursing educators use to prepare nurses for more challenging responsibilities. In many instances, high-fidelity simulation emphasizes the use of human patient simulators as the most effective strategy for making the scenarios real. Each simulation session should have a specific goal and objective that determines its design (Kunkel, Kopp, & Hanson, 2016). Designers of simulation sessions must give attention to the specific needs of the learners. As long as the simulation conforms to the needs of the learners, nurses are likely to register a remarkable level of competencies after the exercise. Experts have highlighted that simulation sessions register certain strengths in helping nurses to acquire critical thinking skills as well as decision-making skills (Young Sook, Issenberg, & Soo, 2014). The session can be highly interactive and repetitive a factor that promotes knowledge retention. The high-fidelity simulation should focus on individualized learning in which the nurses have designated roles.
The role assigned to the nurse should help in developing certain competencies that the nurse requires. It is important to receive feedback after each simulation session to determine the experiences of nurses. Before the simulation process, there is a need for a pre – briefing with the primary objective of introducing the nurses to the simulation exercise. The pre-briefings help in highlighting the objective of the simulation and ensuring that the nurses prepare for the exercise adequately (Thompson, Cook, & Flannery, 2017). Debriefing sessions should follow the simulation exercise as the educators help nurses to reflect on their experiences. High-fidelity simulation helps to recreate an actual health care activity that nurses must handle (Sarasnick, Pyo, & Draper, 2017). If simulation focuses on the needs of the learners, it is more effective in promoting knowledge retention and ensuring that nurses exhibit new competencies.
Healthcare facilities should be able to design effective simulation sessions. Particularly, each simulation session should help nurses to acquire a new skill and to develop a higher level of comfort in handling critical nursing situations (Curl et al., 2016). Simulation can help nurses to overcome their anxiety and confusion when handling critical care situations. Particularly, nurses who attend simulation sessions have reported a remarkable level of progress in gaining the required confidence to act promptly and appropriately in the delivery of quality care (Castro, Cruz, & Briones, 2014). Simulation helps educators to adequately meet the needs of nurses and prepare them for challenging roles in the nursing practice.
Effectiveness of mock code simulation. Mock code simulations prepare nurses for handling cases of in hospital cardiac arrests. According to Delac et al. (2013), the use of mock code simulation can help healthcare facilities to register positive outcomes after cardiopulmonary resuscitation. Statistics indicate that survival rates after in hospital cardiac arrests are usually below 23%. Nurses are unable to act promptly and resuscitate patients appropriately, a factor that contributes to low survival rates. Mock code simulation seeks to help nurses to develop the competencies and confidence required in carrying out cardiopulmonary resuscitation. In the view of Alsomali et al. (2013), mock code simulation can reduce mortality rates associated with cardiac arrests. Such simulations prepare nurses and empower them to take action when faced with a cardiac arrest scenario. Particularly, mock code simulations recreate a real code blue scenario and allow the nurses to evaluate the patient and respond sufficiently and register survival rates.
Based on the findings of Alturo, Franceschini, and Kalidindi (2014), mock code simulations can increase survival rates and ensure that nurses respond within the first minute. The findings from the study that these authors conducted indicated that simulation sessions of code blue scenarios equip nurses with the confidence and skills they need to use when resuscitating patients. The mock code simulations help the nurses to perfect their technical skills in using different equipment when carrying cardiopulmonary resuscitation (Oermann et al., 2014). Most significantly, the recreation of the code blue scenario helps the nurses to learn important decision-making skills that they can use when faced with a critical condition of a patient with cardiac arrest. Undoubtedly, mock code simulations prepare nurses mentally, emotionally, psychologically, as well a physically, empowering them to carry out successful cardiopulmonary resuscitation.
Since nurses are the first responders when handling cases of cardiac arrests, then the mock code simulations help them to take a leading role in responding immediately and using the relevant medical equipment to save the life of the patient. Mock code simulations register high levels of efficiency because they ensure that nurses learn the proper technique of cardiopulmonary resuscitation (Chalkias et al., 2013). Using the right technique registers positive outcomes in the patient. For this reason, resuscitation simulations prepare nurses adequately for cardiac arrest emergencies. The nurses become familiar with the American Heart Association Guidelines for performing resuscitation with special attention on the airway, breathing, and circulation. Mock code simulations focus on activities such as positioning the patient, the compression depth, the recoiling of the chest, the bag mask ventilation, the proper use of the equipment as well as the required medications (Meaney et al., 2013).
Regular mock code simulations lead to knowledge retention and promote high levels of confidence among the nurses. With regular practice, it becomes easier for nurses to take control of the situation and resuscitate patients effectively (Couloures & Allen, 2017). Additionally, Machado, Albuquerque, and Oliveira (2017) agree with other scholars that regular mock code simulations serve to improve the outcomes of cardiopulmonary resuscitations. Recreating the emergency environment helps nurses to recognize the importance of making important decisions and acting within the first minute as a way of increasing survival rates.
Recommended Practice Change, Quality Improvement, or Innovation
Evidently, the available evidence demonstrates the effectiveness of using simulation in helping nurses to acquire new competencies. Compared to other traditional delivery approaches, simulation seems to present desirable outcomes in boosting the confidence of nurses and preparing them for challenging situations. Many nurses lack the competencies, comfort, and confidence required to respond effectively to critical and acute care situations (Williams et al., 2016). For this reason, integrating simulation exercises into orientation and training programs for the facility will be a remarkable move in promoting nurse competencies. Particularly, the facility registers low survival rates of patients who suffer cardiac arrests. Implementing mock code simulations during orientation and training programs will help nurses to exhibit higher levels of preparedness in handling the emergency.
The healthcare facility should introduce mock code simulations that recreate the code blue scenario to help nurses to learn the procedures of resuscitation and the important decisions that they need to make. Notably, the healthcare facility will need to carry out a rigorous assessment of nurse needs and concerns before designing the simulation sessions. Particularly, healthcare facilities need to develop nurse centered mock code simulations during training as a way of increasing their effectiveness. The educators and instructors guiding the nurses throughout the simulation process should ensure that each nurse engages in a reflective exercise during debriefing (Roh et al., 2013). Such reflective exercises can help the nurses to retain knowledge and to identify their emerging learning needs. It is necessary for the educators to give special attention to feedback delivery during the simulation process (Zimmerman et al., 2015). All new nurses will need to attend mock code simulations regularly so that they can gain sufficient skills and confidence.
Based on the available evidence, mock code simulations call for effective collaboration among the nurses. For this reason, the facility should encourage the nurses to share their experiences and work together towards the achievement of positive patient outcomes. The facility will need to evaluate the effectiveness of mock code simulations and determine the different strategies of improving the simulation sessions (Young, Issenberg, & Soo, 2014). Educators should take the measures of ensuring that simulation sessions are interactive and that nurses can express their fears and concerns regarding the resuscitation process (Sodhi, Singla, & Shrivastava, 2015). The facility will need to prepare nurses for the simulation process as a way of increasing the positive benefits. If the facility designs effective simulation sessions, it will be possible to meet the needs of nurses and to ensure that they can respond effectively to cardiac arrest emergencies.
- Alsomali, S., Carlisle, M., Barton, J., Clarke, S., Ng, V., & Yao, A. et al. (2013). Board 103 – Program Innovations Abstract The Code Blue Training Initiative. Simulation In Healthcare: The Journal Of The Society For Simulation In Healthcare, 8(6), 402.
- Alturo, L., Franceschini, D., & Kalidindi, S. (2014). Board #201 – Program Innovation Mock Code for Real Changes. Simulation In Healthcare: Journal Of The Society For Simulation In Healthcare, 9(6), 439-440.
- Blondon, K. S., Maître, F., Muller-Juge, V., Bochatay, N., Cullati, S., Hudelson, P., & … Nendaz, M. R. (2017). Interprofessional collaborative reasoning by residents and nurses in internal medicine: Evidence from a simulation study. Medical Teacher, 39(4), 360-367.
- Castro, M., Cruz, M., & Briones, R. (2014). Code blue. Nursing, 44(6), 65-67.
- Chalkias, A., Koutsovasilis, A., Mystrioti, D., Dragoumanos, V., & Xanthos, T. (2013). Outcomes of cardiopulmonary resuscitation efforts in a Greek tertiary hospital. Acute Cardiac Care, 15(2), 34.
- Couloures, K., & Allen, C. (2017). Use of Simulation to Improve Cardiopulmonary Resuscitation Performance and Code Team Communication for Pediatric Residents. Mededportal Publications, 13.
- Curl, E. D., Smith, S., Chisholm, L. A., McGee, L. A., & Das, K. (2016). Effectiveness of Integrated Simulation and Clinical Experiences Compared to Traditional Clinical Experiences for Nursing Students. Nursing Education Perspectives (National League For Nursing), 37(2), 72.
- Delac, K., Blazier, D., Daniel, L., & N-Wilfong, D. (2013). Five alive: Using mock code simulation to improve responder performance during the first 5 minutes of a code. Critical Care Nursing Quarterly, 36(2), 244-50.
- Franklin, A. E. (2015). Effectiveness of Simulation Preparation on Novice Nurses’ Competence and Self-Efficacy in a Multiple-Patient Simulation. Nursing Education Perspectives (National League For Nursing), 36(5), 324.
- Hommes, T. (2014). Implementation of simulation to improve staff nurses education. Journal for Nurses in Staff Development, 30 (2). 66-69.
- Hunziker, S., Pagani, S., Fasler, K., Tschan, F., Semmer, N. K., & Marsch, S. (2013). Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: A randomized controlled trial. BMC Emergency Medicine, 13(8), 1-9.
- Kunkel, C., Kopp, W., & Hanson, M. (2016). A Matter of Life and Death: End-of-Life Simulation to Develop Confidence in Nursing Students. Nursing Education Perspectives (Wolters Kluwer Health), 37(5), 285.
- Machado, R., Albuquerque, C., & Alves Oliveira, S. (2017). Education Strategies Through Simulation For Training In Cardiopulmonary Resuscitation Treatment. International Archives Of Medicine, 10.
- McNally, B., & Ong, M. (2013). Cardiac arrest systems and survival after sudden cardiac arrest. Resuscitation, 84(3), 265-266.
- Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., De Caen, A. R., Bhanji, F., . . . Leary, M. (2013). Cardiopulmonary resuscitation quality: Improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation, 128, 417-428.
- Mora, A., Benjamin, B., Blough, B., Christensen, B., Duewall, J., & Columbus, C. (2015). Formalized Resident Training in Code Blue Execution in a Simulation Lab Improves Immediate Post-Code Survival. Chest, 148(4), 462A.
- Mora, A., Smith, A., Robertson, S., Renfro, C., & Columbus, C. (2015). Does Simulation Training in Obstetric Code Blue Improve Code Team Comfort Levels?. Chest, 148(4), 476A.
- Oermann, M. H., Kardong-Edgren, S. E., Odom-Maryon, T., & Roberts, C. J. (2014). Effects of Practice on Competency In Single-Rescuer Cardiopulmonary Resuscitation. MEDSURG Nursing, 23(1), 22.
- Oh, P., Jeon, K., & Koh, M. (2015). The effects of simulation-based learning using standardized patients in nursing students: a meta-analysis. Nurse Education Today, 35 (2015), e6-e15.
- Reiter, D., Strother, C., & Weingart, S. (2013). The quality of cardiopulmonary resuscitation using supraglottic airways and intraosseous devices: A simulation trial. Resuscitation, 84(1), 93-97.
- Roh, Y., Lee, W., Chung, H., & Park, Y. (2013). The effects of simulation-based resuscitation training on nurses’ self-efficacy and satisfaction. Nurse Education Today, 33 (2013), 123- 128.
- Sarasnick, J. A., Pyo, K. A., & Draper, a. J. (2017). Using Simulation and Case Studies Combined to Improve Student Knowledge: A Retrospective Study. Nursing Education Perspectives (Wolters Kluwer Health), 38(3), 126.
- Seung, M., & Park, Y. (2015). Comparison of complications secondary to cardiopulmonary resuscitation between out-of-hospital cardiac arrest and in-hospital cardiac arrest. Critical Care, 19(Suppl 1), P419.
- Simko, L., Henry, R., McGinnis, K., & Kolesar, A. (2014). Simulation and mock code: A safe way for nursing students to learn. Journal Of Nursing Education And Practice, 4(7).
- Simpson, E. (2016). In-hospital resuscitation: recognising and responding to adults in cardiac arrest. Nursing Standard, 30(51), 50.
- Sodhi, K., Singla, M., & Shrivastava, A. (2015). Institutional resuscitation protocols: do they affect cardiopulmonary resuscitation outcomes? A 6-year study in a single tertiary-care centre. Journal of Anesthesia, 29(1), 87.
- Thompson, M. L., Cook, A. M., & Flannery, A. H. (2017). Use of simulation training to prepare pharmacy residents for medical emergencies. American Journal of Health-System Pharmacy, 74(6), 424.
- Williams, K., Rideout, J., Pritchett-Kelly, S., McDonald, M., Mullins-Richards, P., & Dubrowski, A. (2016). Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses. Cureus.
- Young Sook, R., Issenberg, S. B., & Hyun Soo, C. (2014). Ward Nurses’ Resuscitation of Critical Patients: Current Training and Barriers. Evaluation & The Health Professions, 37(3), 335-348.
- Zimmerman, E., Cohen, N., Maniaci, V., Pena, B., Lozano, J. M., & Linares, M. (2015). Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study. Pediatrics, 136(5), 905-911.