Digital Repository Masters Projects Spring 2025 Implementation of Code Blue Role Assignments and Education for Emergency Room Nurses Taresa Higbee Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Higbee, T. 2025. Implementation of Code Blue Role Assignments and Education for Emergency Room Nurses Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. ANNIE TAYLOR DEE NURSING WSU REPOSITORY MSN/DNP -SCHOOLOF- MSN Project Paper Implementation of Code Blue Role Assignments and Education for Emergency Room Nurses Pro1ect Title by Taresa Higbee Studenrs Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 4/14/25 Graduation Date: 04/25/25 Date Taresa Higbee BSN, RN, MSN Student 4/25/25 Student Name, Credentials (electronic signature) Date JoAnn Tolman DNP-L, MSN-Ed, RN, CNE MSN Project Faculty (electronic signature) 04/25/2025 Date Anne Kendrick, DNP, RN, CNE 04/25/2025 Anne Kendrick Date (electronic signature) DNP,RN, CNE MSN Program Director Note: The program director must submit this form and paper. 1 Implementation of Code Blue Role Assignments and Education for Emergency Room Nurses Taresa Higbee, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This project aims to implement pre-determined roles for code blue situations and create additional education using mock code scenarios to improve team dynamics and confidence for emergency room nurses as the code blue responders. Rationale/Background: Currently, the lack of standardization in code blue education and role assignment decreases the overall team dynamics. The American Heart Association (2024) recommends role assignments during a cardiac arrest situation to ensure effective resuscitation. Assigned roles support high-functioning teams and improved outcomes. Methods: Pre- and post-surveys evaluate the effect of team dynamics and nurse confidence on applying pre-determined role assignments and adding mock code practice to education. Predetermined roles are assigned to the emergency department code team based on the scope of practice. Nurses attend an in-service education session about using pre-deten11inedroles, are provided with an infographic visual aid, and apply the education to a mock code practice scenano. Results: The results show that with pre-determined roles and additional education, emergency room nurses are more confident in their ability to respond and improve communication in team dynamics during a code blue event. Conclusions: Adding pre-determined roles and additional mock code education into routine cardiac or respiratory arrest processes, emergency room nurses identified improvements in team dynamics and the overall function of code blue team dynamics. Keywords: in-hospital cardiac arrest, cardiac arrest education, pre-deten11inedroles, roles in cardiac arrest event, American Heart Association. 3 Implementation of Code Blue Role Assignments and Education for Emergency Room Nurses In the high-stakes enviromnent of the emergency room, effective team dynamics can make the difference between life and death. When a code blue begins, the swift coordination of skilled personnel is essential for optimal patient outcomes (Chan et al., 2023). Cardiac arrest teams are the group of people who respond to in-hospital cardiac arrest situations. They are important to prevent hospital death by sudden cardiac an-est. Nurses, physicians, and technicians are part of the team. However, when the reliance is on medical residents to lead these critical events, a significant gap in team communication and role assignment occurs, often leading to confusion and delays in patient care. This project addresses this issue by implementing pre-determined roles for emergency room nurses during resuscitation efforts, supported by additional education through mock code scenarios. The primary aim of this initiative is to enhance team dynamics among emergency room nurses by establishing clear expectations around roles and responsibilities during code situations. Research indicates that predefined roles can significantly improve team perfom1ance and communication, which is crucial in high-pressure environments. For example, a study highlighted that having a designated chest compressor improved the effectiveness of compressions during cardiac arrest events (O'Lea1y et al., 2023). The pre-determined role assignments will not only streamline the response to codes but also reduce the cognitive load on medical residents who are often unfamiliar with the skills of the team members. This project will implement mock codes over two months, allowing emergency room nurses to practice in a realistic setting with clearly defined roles. Pre- and post-surveys will assess the 4 impact of these changes on team communication and overall dynamics. The results may provide infom1ation for future trainings and has the potential to enhance patient care across the facility. The goal of this project is to create a more cohesive and effective emergency response team, ensuring that every member understands their role and can act decisively in critical moments. The team will likely thrive and demonstrate improved patient outcomes during cardiac arrest events through targeted education and strnctured practice in an environment where teamwork and communication will be realistically applied. Statement of Problem Emergency room nurses responding to cardiac arrest events in the department do not have a strncture of clear assigned roles and only have resuscitation quality improvement (RQI) as education for responding to codes. The 2024 American Heart Association (AHA) outlines clear roles as one way to improve team dynamics, and with medical residents usually responding to these cardiac aJ.Testevents, roles are not assigned, or this duty is delayed (AHA, 2024). The delay or lack of role assignment can cause a gap in patient care or create confusion among the team dynamics, decreasing necessary clear communication. The American Heart Association has created a standard for responding to code blue or cardiac arrest events outlining clear roles as contJ.ibuting factors to successful team functioning (AHA, 2024). Although roles may get assigned by the medical resident and the guidelines followed, there is a risk that the delay or lack of role assignment could cause decreased patient outcomes. The lack of pre-detemlined roles in the emergency department nursing staff and supporting education using mock codes causes ineffective team dynamics and confidence due to minimal educational support. The increase in education and pre-determined roles will increase patient outcomes. As mentioned previously, the effectiveness of pre-determined roles improved 5 outcomes with just a chest compressor role; it can be deduced that assigning all roles should improve outcomes (O'Leary et al., 2023). Significance of the Project This project is essential because mock codes will improve job satisfaction, decrease stress related to code blue events, support quality improvement around cardiac arrest, and support improved team function, as noted in high-performing hospitals (Anderson et al., 2021). Considering the standard set by the AHA (2024) and the unique assignment of team lead, creating a standard for pre-determined roles for nursing staff will help support clear role assignment, reduce delays, improve team dynamics, and offioad the medical residents from trying to determine how and who to assign roles to dwing this high-stress scenario. Additionally, adding education in the form of a mock code will improve job satisfaction, support retention, and increase the confidence of the emergency room nurses responding to codes (Chan et al., 2023). Further, this project is in alignment with a parallel improvement process of developing a facility simulation program. With increased simulations, the support of clinical growth will rise, leading to improved adherence to the AHA algorithm (Chan et al., 2023; Pearson et al., 2024). Adding pre-detennined roles will increase staff awareness about what task they are responsible for before a cardiac arrest event occurs and will support a swift response by the team. The team can function with clear roles, as the AHA outlines (Pearson et al., 2024). Adding mock scenarios to RQI education will also increase retention due to improved confidence and competence when participating in code blues (Chan et al., 2023). Emergency room nurses can benefit from the concept of pre-detem1ined roles when a cardiac arrest occurs by eliminating the stress of an inappropriate or no role assignment occurring, which causes confusion (DeGroot & Callis, 2023). Increasing education beyond RQI for emergency room 6 nurses utilizing a mock scenario will allow them to experience the events without risking patient harm. It will support the team in perfom1ing like a high-perfonning facility (Anderson et al., 2021). Nurses will retain more knowledge with the additional education added to their yearly requirements (Bukiran et al., 2014). Adding mock codes will suppo1t more confidence in nursing skills (Hooper et al., 2024). Ultimately, suppo1iing the emergency room nurses who respond to code blue calls by increasing education and assigning roles in a pre-detennined way will improve team functioning and support the outcomes of patients. Review of the Literature Research indicates that improving team dynamics can be supported by a plan utilizing pre-detennined roles or proper role delineation. In addition to identifying clear roles, increasing nursing education in mock scena1ios can improve retention (Bukiran et al., 2014). The literature review supports and identifies best practices for improving cardiac a1Testteam dynamics. The clinical question that guides the review is: For the emergency room nurse, does having predetermined roles during a code with additional educational support using mock codes, compared to no pre-determined roles and no mock code, improve code team dynamics over a 2-month timeframe? Framework Lewin's change theory framework is a three-part, simple-to-follow change model. The three parts are unfreezing, moving, and refreezing. During the unfreezing phase, leaders prepare the team or staff of people to receive the possible change (Bakari et al., 2017). The identification of the problem is made clear. The next step is to implement and begin the action phase of the planned change. In the moving phase, a leader can encourage commitment to the new process, allowing adjustments in behavior. The refreezing phase of the model cements new behavior and 7 completes the adaptation of the new process. (Bakari et al., 2017). According to Lozeau (2020), the moving phase is where planning, initiating, and revising occur. Lewin's change theory guides the MSN project in addressing the lack of assigned roles during cardiac arrests in the emergency room. The nursing staff are willing to engage in the plan to in1plement mock scenarios in education and are eager to attend. The unfreezing phase includes getting buy-in from key stakeholders by presenting the problem and solutions during a unit-based council. The next phase of moving will engage the nurse educators, emergency room managers, and leadership team to allow some time for staff to participate in the education of pre-deten11inedrole assignments via in-services followed by mock code scenarios. Evaluations will occur using pre- and post-survey data. The refreezing phase will occur with repeated mock scenarios to ensure positive behavioral change has occurred and incentivization by nursing leadership. Strengths and Limitations One strength of Lewin's change theory is that it has been used for decades in many organizations to enact change (Lozeau, 2020). However, it is an older model, and there have been arguments that it is outdated and that modern techniques should be used (Bakari, 2017 & Endrejat, 2024). Promoting high-reliability organizations is a nationwide goal within the veteran healthcare administration, and one theme is a reluctance to oversimplify. Therefore, in some scenarios, Lewin's theory could be seen as an oversimplification. However, keeping the theory simple will more likely lead to success and sustainment of the project. Analysis of Literatmre The literature has identified clear roles in cardiac arrest situations, and education with mock scenarios helps support a higher-functioning team (Anderson et al., 2021). The literature aligns with the MSN project and supports clear role identification. The American Heart 8 Association (2024) has recommended these interventions from researched cardiac arrest management and best practices to in1prove outcomes. Overall, research supports increased education and further suppo1is standardized role delineation. Themes show that role assigmnent led to increased team functioning. Mock scenarios support cardiac arrest education. These interventions lead to improved patient outcomes due to improved team functioning per the AHA (2024). These themes align with the MSN project based on the idea that clear roles improve team functioning, improved team functioning improves outcomes, and education supports increased retention. Search Strategies A literature review was conducted to identify the best practices related to highfunctioning hospital cardiac arrest teams. The resources utilized for the literature review included the college libra1y and search engines such as Weber State's Stewart Library, Ebsco Host, CINAHL, and ProQuest. Search terms include cardiac arrest team education, cardiac arrest roles, cardiac arrest education, mock scenarios in cardiac arrest teams, emergency room nurses, pre-detennined roles during a code blue, and improving team dynamics in cardiac arrest. The purpose of this search was to support the identification of how to improve team dynamics in the emergency room during a cardiac arrest event. Synthesis of the Literature The research indicates that to support a high-functioning team, clear roles, swift action, and education support the improvement of team dynamics. The top three themes identified in the literature are: 1) Role assignment supports team dynamics, 2) mock scenarios support team functioning, and 3) high-functioning teams support improved patient outcomes. Role Assignment Supports Team Functioning: 9 The American Heart Association has identified that role assignment supports team functioning (American Heart Association, 2024). In comparison, DeGroot and Callis (2023) found that having pre-detemuned roles removes the need to identify and assign roles, also offloading the team lead of tlus duty (DeGroot & Callis, 2023). Strerk et al. (2022) studied the reasons delays may occur in cardiac arrest situations, and this identified that clear roles support improved team functioning. Further, O'Leary et al. (2023) highlight the value of specialized training for specific roles and suggest that increased training leads to improved performance in intense critical situations. Strerk et al. (2022) highlight the crucial role of the first five minutes in managing cardiac arrest. Rapid, coordinated responses during this time can drastically improve survival rates, stressing the need for targeted training focusing on these initial moments. DeGroot and Callis (2023) also noted that clear role delineation was essential for maintaining team dynamics. Mock Scenarios Support Team Functioning The research review indicated that adding mock scenarios for cardiac arrest teams improves the retention of information and team functioning (Bukiran et al., 2014; Chan et al., 2023). Mock code scenarios are essential to the professional development of high-stakes teams, and the addition of clear debriefing and feedback increases educational opportunities (Hooper et al., 2024; Rueda-Medina et al., 2024). In addition, Anderson et al. (2021) and Pearson et al. (2024) stress the importance of structured, evidenced-based training, including mock scenarios, role delineation, and feedback to improve teamwork. One study even supports the idea that selfefficacy through training can also increase overall team performance in high-stress scenarios such as cardiac arrest situations (Hooper et al., 2024). After the COVID-19 pandemic, the 10 implementation of in situ mock scenarios improved overall team functioning, according to Babu et al. (2021). Positive Team Dynamics Support Improved Outcomes Research also indicates that higher- functioning teams have improved outcomes, and using technology can guide teams (Ehrler et al., 2021; Bentley et al., 2022). In medicine, the goal is always to support the improvement of patient outcomes and ensure that education and systematic approaches are in place and practices are followed to ensure maximum success. Implementing a plan utilizing a pre-determined role or proper role delineation will support team function and lead to improved outcomes (Eda et al., 2021). Another essential aspect mentioned in one study was the criticality of debriefing and providing feedback to enhance learning in highstakes situations such as code blue situations (Rueda-Medina et al., 2024). In addition to clear roles, the addition of nursing education in the form of mock scenarios can improve retention (Bukiran et. al., 2014). The Ame1ican Heart Association (2024) also shows that high-functioning teams are correlated to improved patient outcomes. Summary of Literature Review Findings and Application to the Project The literature indicates that role identification and additional education would improve team dynamics (American Heart Association, 2024). Increasing education helps support information retention and increases staff satisfaction. Assigning roles in advance enhances team effectiveness and reduces confusion. Recent research underscores the importance of team-based training, role clarity, and communication strategies in improving team dynamics and outcomes for in-hospital cardiac arrest (!HCA) management. The findings from recent studies highlight several components for enhancing resuscitation team performance that support this project. The literature suggests that role 11 assignments and role-specific education frequently increase team effectiveness and skill retention. Further, Effective teamwork increases with training and stmctured roles, which this project aims to provide. Additional ways to increase team effectiveness can be improved with the implementation of technology along with educational support (Ehrler et al., 2021). Considering the research, role assignments being pre-detennined would improve the timing and coordination of the first five minutes. The retention of skills declines over time, and the need for regular refresher training is vital to the overall success oftean1 dynamics (Bukiran et al., 2014). Chan et al. (2023) suggest having a framework, drills, evidenced-based protocols, and teambased practice to improve team performance. In sum, the evidence supports the need for predetermined roles and increasing educational opportunities in the form of hands-on mock code scenanos. Project Plan and Implementation The plan to support the change related to individual role assignments during code blue events will begin with the implementation of increased education by increasing the number of mock codes for ER staff. A pre-survey will be completed prior to the initiation of a mock code. Education regarding pre-detennined roles and responsibilities will be provided in a brief inservice presentation using PowerPoint. After education and the assignment of roles, a mock code will occur. After the mock code practice scenario, a post-survey will be obtained to determine the effectiveness of pre-determined roles vs. no pre-determined roles. The target audience is the Emergency room nurses at the Salt Lake City Veterans Affairs Medical Center. Plan and Implementation Process The steps to implement the assignment of pre-determined roles during a code along with increasing education is outlined in this section. A thorough literature review has been conducted 12 to support the plan to add pre-determined roles along with the addition of mock codes to education. The plan begins by holding a meeting with key stakeholders to present evidence on how to improve code team dynamics to nursing executive leaders. Nurse managers and the medical director of the emergency room are among the key stakeholders. The project plan is to assign pre-determined roles for code responders and add mock code practice sessions, which are presented to the stakeholders with the deliverables. The deliverables for the project are a) a presurvey of emergency room nurses on team dynamics, b) an educational presentation via PowerPoint about pre-determined roles for code responders and a flyer, c) a visual aid, and d) a post-survey of emergency room nurses to learn if team dynamics improved. Once the project is approved, implementation begins. The nursing education will be in person, with a visual aid or handout on paper and an electronic copy available on the SharePoint site. The pre-survey will be handed to the nurses in person prior to education. The main target audience is the nursing staff, but the emergency room technicians are included to ensure they support the roles correctly. The educational in-service identifies the roles and responsibilities. The mock code practice scenario will occur after the education. The mock code practice will include educational mock scenarios without predetermined roles and repeated with the pre-determined roles. After the mock code and standard debrief, the post-survey will be provided to nurses and gathered before they leave the educational setting. Pre-and-post surveys provide data on team dynamics and confidence of staff responding to code blue calls before and after mock code practice using pre-determined roles. Emergency room nurses will pa1ticipate in mock code scenarios using pre-determined roles over a period of two months. The post-survey is delivered to emergency room nurses after two months of 13 utilizing pre-determined roles and practicing with a mock code scenario. The purpose of the survey is to identify the subjective improvement in team dynamics during a code blue situation. If the surveys gathered show that pre-determined roles support team communication, then the implementation will expand to other areas in the facility based on leadership buy-in. Interdisciplinary Team Several healthcare professional team members will be needed for the success of the project. The project lead is a registered nurse and MSN student. The lead currently works as the unit nurse educator's supervisor. The project lead will ensure the education plan is followed and ensure the surveys are documented. The physicians are responsible for ensuring they are leading the code and performing interventions. Overall, their duties are not changing, and no education needs to occur. However, they are encouraged to participate in the mock scenarios as they are able. The physicians involved include the code committee chair and emergency room medical director, who will support the project by identifying the roles of the physicians and supporting the mock scenarios taking place in tl1edepaiiment when appropriate. The nurse educator team will need to work together to provide support running mock code blue scenarios and ensure preand post-surveys are completed by the staff participating. Additionally, nurse educators need to ensure the in-services are provided and the messaging is consistent for all emergency room nurses. The emergency room nurses will need to participate in education and engage in the change. Additionally, they will need to participate in mock scenarios, education, and surveys. The nurse management team will need to work with the educators for accountability. The emergency room technicians will also need to understand the roles and be educated about the roles they will be assigned during a code blue situation. Their role is limited to participation in compressions but is paramount to the success of the project. 14 Description and Development of Project Deliverables Pre-Survey. The pre-survey titled pre-role implementation survey obtains information from the ED nurses on the team dynamics of communication and role clarity following a mock code blue that does not have pre-determined roles. There are additional questions related to confidence. The goal is to evaluate pre-intervention data to support the idea that pre-determined roles and additional education are supportive of improved team dynamics and nurse' confidence. (see Appendix A). PowerPoint Education Presentation. The presentation is titled Power Point Presentation: Cardiac Arrest Pre-Detennined Roles. This presents evidence for the need to change to using pre-detem1ined roles for the code blue responders and how the roles are assigned (see Appendix B). Evidence for the education comes from the American Heart Association (2024). Pre-determined Role Visual Aid. This informational one-page visual aid is a representation of each role that is pre-detennined and serves as a guide or quick reference while the education is being implemented. This is titled Educational Handout Flyer for Pre-Detem1ined Roles. It will be posted in the ED in the break room and by the charge nurse desk (see Appendix C). Evidence for this visual aid comes from The American Heart Association (2024) but is modified to fit the needs of the VA's emergency room. Post-Survey. The post-survey will follow the second mock code blue scenario after education has been provided. This survey is titled Post-Role hnplementation Mock Code Survey. The post-survey obtains infonnation from the ED nurses about their experience of team dynamics after the implementation of pre-determined roles ( see Appendix D). Timeline 15 The timeline for this project is over 2 months in the emergency room (see Appendix E). During The first week, expectations are to be communicated by the nurse educator and nurse manager. The second through fourth week is the pre-survey, followed by educational in-service and the implementation of mock codes. Immediately following the education and mock code, a post-role-implementation survey will be obtained from the emergency room nurses. Surveys will be obtained following every mock code that occurs. The pre-role implementation survey will be given to staff prior to the education but following a mock code. Additionally, the post-role implementation survey will be obtained after education has been provided and a mock code is done using the pre-determined roles. The fifth week evaluation of the project will be analyzed. The sixth week will be the timeframe to reinforce and follow up on any staff that has not received the communication, education, and participation in mock codes. The seventh and eighth weeks will be follow-up mock scenarios using pre-determined roles to solidify the project and ensure the change is being implemented as practice. Project Evaluation The evaluation of the effectiveness of the project will be done using both formative and summative methods. For formative evaluation, the pre-surveys show a baseline of the nurses' perception of team dynamics and confidence in perfonning their role effectively during a code situation. Fonnative evaluation will be obtained after mock code practice by asking each team member if they can remain focused on their role from the beginning of the code, creating a shared responsibility to cany out the individual assigned roles. Additionally, the nurse educator running the mock code scenario and the educational in-service will maintain an attendance roster to ensure all staff have educational support. Finally, the project leader will ask participants for 16 feedback on the educational flyer to learn if it is an effective reminder following the education to increase the implementation of pre-detern1ined roles. For summative evaluation, the post-surveys of the nurses will identify if the application of pre-detern1ined roles to a mock code improved the team dynamics and their confidence to perforn1 well. It is anticipated that the team's dynamic improves with pre-determined roles due to less delays with role assignment, and the team lead can focus on the code. Ethical Considerations The assignment of pre-detennined roles requires ethical considerations for the code responders. Ethical considerations include ensuring all code team members can participate in the roles within their scope of practice guidelines. To ensure the role aligns with the appropriate scope of practice, team members will work collaboratively to validate assignments with appropriate licensure. Assignment of pre-determined roles ensures ethical considerations for code responders by removing possible bias from the code team leader. When mock code scenarios are being run, there will be an option for people to request 1: 1 education if group settings cause distress or concern. All survey responses are anonymous, voluntary, and no names are tracked. The only tracking is a basic roster of attendance to the mock code, which is a facility educational requirement. Discussion Implementing pre-detem1ined roles and additional mock code education for emergency room nurses on code teams addresses the lack of stmcture around code blue role assignment, improves team dynamics, and increases nurse confidence during code blue events. This project is cmcial in improving team dynamics, reducing confusion, and ultimately improving patient outcomes. 17 Evidence-based Solutions for Dissemination The plan for dissemination is a poster presentation at Weber State to peers and faculty, sharing the importance and value of the project by highlighting the problem, plan, and solution. Dissemination will also occur at the facility level in a staff meeting for the emergency room nurses. In addition, the presentation highlights evidence-based research. How the project may impact the emergency room nurses and the nurse's confidence and tean1 dynamics. Significance to Advance Nursing Practice In1plementing pre-detennined roles and mock code education has several important factors, such as leading to a more organized and efficient response during cardiac arrest events. By having clear preassigned roles, each team member knows their responsibilities; this minimizes the cognitive load on the team leader and reduces delays in patient care. This approach may decrease stress and anxiety in these high-pressure situations, leading to improved job satisfaction and retention among emergency room nurses. Additionally, education through mock codes allows nurses to practice and refine their skills in a controlled environment, which can boost their confidence and competence. This hands-on experience is valuable as it prepares emergency room nurses for real-life scenarios while removing the risk of patient harm. The improved team dynamics and communication fostered by this initiative can lead to better patient outcomes, aligning with the standards set by the American Heart Association (2024). The addition of this education and hands-on skills will support the development of the nurse's practice. When a nurse is more confident and competent it can positively in1pact their overall skills (American Heart Association, 2024; Anderson et al., 2021; Eda et al., 2021). Implications 18 For future implementations, the project will expand beyond the emergency room to other departments within the hospital. The expansion and hospital-wide implementation will create a standardized approach to code blue events across the facility, supporting staff and team dynamics. Furthermore, incorporating regular refresher courses and continuous education can help maintain the skills and knowledge gained from the initial training. The biggest barrier will be the balance of providing the education and getting busy staff nurses to be able to attend the education. There will be multiple educational events, staff meeting presentations, collaboration with unit managers to ensure scheduling is prioritized, and a roster for tracking to ensure the staff has attended education. Recommendations The feedback provided is related to the overall clarity of the goals of the project. Gaps identified are related to the pre-determined roles. There is only one study with one predetermined role that identified improvement in patient outcomes and increased team functioning (O'Leary et al., 2023). Additionally, the survey and education are directed at the emergency room nurses, it may add valuable information to survey all providers in the mock code scenarios. However, this is only applicable to nursing and may expand to the entire interdisciplinary team after the first two months. Conclusions In conclusion, implementing pre-determined roles and mock code education for emergency room nurses is a step toward improving team dynamics and patient outcomes during cardiac arrest events. This project solves the current education and role assignment gaps while providing a structured and supportive environment for nurses to develop their skills. 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Advances in Simulation, 7(1), 1-29. https://doi.org/10. l 186/s41077-022-00225-0 24 Appendix A Pre-Survey Pre-Role Implementation Survey 1 - Strongly Disagree/ 2 - Disagree/ 3 - Neutral / 4 - Agree/ 5 - Strongly Agree 1. The closed-loop communication was effective and clear. 1 2 3 4 5 2. You understood your roles, responsibilities, and expectations. 1 2 3 4 5 3. You knew who the leader of the code was. 1 2 3 4 5 4. You have confidence in the ability of the team to perform well. 1 2 3 4 5 5. You feel confident in your ability to speak up if you notice a discrepancy or error in the algorithm/Rhythm identification? 1 2 3 4 5 25 Appendix B PowerPoint Education P1·esentation: Cardiac Arrest Pre-Determined Roles 1 Why Pre-Determined Roles • According to the American functioning. Heart Association. (2024) Defined roles improves team • An outside study exam,ned the improvement of outcomes when the chest compressor was pre-determined identifying improvement in outcomes (O'Lear1 et al., 2023) • With an increase 1n simulations. the support of clinical growth will rise, leading to improved adherence to the AHA algorithm (Chan et al.. 2023, Pearson et al.. 2024) Adding predeterm,ned roles will increase staff awareness about what task they are responsible for before a cardiac arrest event occurs and will support a swift response b)' the team. The team can function with clear roles. as the AHA outlines (Pearson et al.. 2024) 2 26 3 ... ···e) :~ ·-/ e) ~,,;;?;~ e) 27 5 28 Appendix C Pre-Determined Role Visual Aid ERPre-determined roles for cardiac arrest Airway Team: RT 1 and MD Zoll monitor Rhythm support Ensure adequate CPR • Access/Medications Ensure ACLSalgorithm followed Pharma:y if after hours RT2: AaG .id iSTAT.-Airw__,,.,,,,,.ay) • Obtain ABG/Run iStat as needed. TEAM LEAD ER NP/PA ACLSalgorithm Physician supporting Code • • • • ldentifyau5<! (H's& T's) • BrainstDrm/Hands-on/procedural • Ensure dole! loop communication Identify Rhythm/Al§Jrithm Ensure ali,3rithm is fol lowed Re-assesscorr~a algorithm with pulse checks 29 Appendix D Post-Survey Post-Role Implementation Mock Code Survey 1 - Strongly Disagree / 2 - Disagree / 3 - Neutral / 4 - Agree / 5 - Strongly Agree 1. The closed loop communication was effective and clear. 1 2 3 4 5 2. You understood your roles, responsibilities, and expectations. 1 2 3 4 5 3. You knew who the leader of the code was. 1 2 3 4 5 4. You have confidence in the ability of the team to perform well. 1 2 3 4 5 5. You feel confident in your ability to speak up if you notice a discrepancy or error in the algorithm/Rhythm identification? 1 2 3 4 5 30 Appendix E Timeline Week 1-4 Communication and process implementation. • Week 7-8 Follow-up mock code scenarios • Week 5-6 Evaluation and reeducation. •