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Course Name

Clinical Improvement Project II CAPSTONE

Graduation Year

12-2026

Faculty Advisor

Dr. John Bressan

Abstract

Improving Nurse Confidence and Perceived Readiness for Early Code Blue Response

Purpose

In many acute care units that are predominately dealing with chronic conditions, cardiac arrest is a low frequency, high stakes event. The purpose of this project is to improve early cardiac arrest response by increasing nurse confidence and perceived readiness to initiate high-quality CPR prior to Rapid Response Team (RRT) arrival.

Background

Over the past three years, there has been a significant increase in Code Blue events on the Surgical Acute Telemetry Unit. Initial management observations noted that staff response lacked clear role delineation, immediate pulse identification, and initiation of CPR. Limited opportunities for hands-on simulation and kinetic practice led to role confusion, delays in pulse recognition, and inconsistent utilization of the ZOLL monitor’s feedback during actual cardiac arrest events.

Significance to Nursing

Delayed recognition and response results in compromised care for the patient contributing to inequitable outcomes among vulnerable patient populations. The current 2025 American Heart Association (AHA) guidelines recommend immediate recognition of cardiac arrest within 10 seconds and initiation of high-quality CPR with correct rate and depth and minimal interruptions (Wigginton et al., 2025).

Methods

The intervention includes three primary components: a baseline assessment, participation in the existing SMCS Code Blue education program, and a mock Code Blue simulation followed by structured debriefing.

Prior to the educational session, participating nurses completed an electronic baseline survey assessing self-reported confidence, preparedness, and knowledge related to early Code Blue response. The educational component consists of SMCS’s existing two-hour Code Blue course which combined didactic instruction and hands-on skills practice covering five core content areas: high-quality CPR, bag-valve-mask ventilation, crash cart familiarity, airway adjunct placement (OPA and NPA), and operation of the ZOLL monitor. The educational content focused on actions nurses can independently perform prior to Rapid Response Team arrival, including recognition of pulselessness, initiation of chest compressions, defibrillator pad placement, and utilization of ZOLL feedback to improve CPR quality.

Following completion of the course, nurses completed a post-education survey to evaluate immediate changes in confidence and perceived readiness. After 50% of Surgical-Acute nurses completed the course, participants engaged in a mock Code Blue simulation within the unit environment. Simulations utilized a mannequin and standardized clinical scenario focused on the initial response to cardiac arrest. Nurses were expected to assess the patient, recognize pulselessness, initiate CPR, apply defibrillator pads, and perform assigned Code Blue roles.

Following simulation, debriefings were conducted and focused on reinforcing strengths, identifying opportunities for improvement, clarifying role expectations, and promoting reflective learning in a psychologically safe environment.

Results

Through analysis of the pre- and post-intervention survey and participant reports, there was an increase in knowledge and confidence. Correct knowledge of compression rate increased from 74% to 88%, chest compression depth 68% to 93%, and compression to ventilation ratio 90% to 99%. Additionally, combined participant reports of confidence(“Confident”/ “Extremely Confident”) increased in performing skills such as CPR (63% to 88%) and defibrillator usage and proper placement (38% to 86%). After the code blue simulation, there was high confidence in specific skills such as CPR and BVM, 75% and 71% (“Confident”/ “Very Confident”), respectively.

Implications for Nursing Practice

This quality improvement project demonstrates the benefits of combining education and simulation-based learning in improving nurse confidence and perceived readiness in a Code Blue scenario. Providing structured educational courses followed by simulation results in increased knowledge and confidence, empowering bedside nurses to initiate high-quality Code Blue Management prior to RRT arrival.

References

American Heart Association. (2020). Highlights of the 2020 American Heart Association

guidelines for CPR and ECC. https://cpr.heart.org.

Nguyen, D. D., Spertus, J. A., Kennedy, K. F., Gupta, K., Uzendu, A. I., McNally, B. F., & Chan, P. S. (2024). Association between delays in time to bystander cpr and survival for witnessed cardiac arrest in the United States. Circulation: Cardiovascular Quality and Outcomes, 17(2), e010116. https://doi.org/10.1161/CIRCOUTCOMES.123.010116

Oermann, M. H., VanRiel, Y. M., Wagner, R. W., Whittington, K. D., Baker, M., Stieve, D. E., Crane, P. C., & Vermeesch, C. A. (2024). Maintenance of cpr skills among nursing students trained using resuscitation quality improvement program. Resuscitation Plus, 20, 100782. https://doi.org/10.1016/j.resplu.2024.100782

Raper, J. D., Khoury, C. A., Marshall, A., Smola, R., Pacheco, Z., Morris, J., Zhai, G., Berger, S., Kraemer, R., & Bloom, A. D. (2024). Rapid cycle deliberate practice training for simulated cardiopulmonary resuscitation in resident education. The Western Journal of Emergency Medicine, 25(2), 197–204. https://doi.org/10.5811/westjem.17923.

Wigginton, J. G., et al. (2025). Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16_suppl_2). https://doi.org/10.1161/cir.0000000000001376

Keywords

Code Blue, Simulation-based education, Nurse Confidence, Perceived Readiness, Psychological Safety, Quality Improvement

Improving Nurse Confidence and Perceived Readiness for Early Code Blue Response: A Quality Improvement Project

Included in

Nursing Commons

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