Publication Date

Spring 2014

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Colleen O'Leary

Second Advisor

Phyllis Heintz

Third Advisor

Kathleen Gilchrist


Mock code, Simulation, QSEN


Thanks to advances in technology, the survival rate of infants and children with critical illnesses has improved. One consequence has been an increase in the acuity levels of hospitalized pediatric patients, which may heighten the risk of in-hospital cardiopulmonary arrest. Patient safety can be compromised by nurses who do not detect subtle clinical changes in a patient's condition, do not perform accurate interventions, or do not apply critical thinking (failure to rescue). The Institute of Medicine (10M) in 1999 estimated that approximately 100,000 people died each year as the result of poor care.

Patients and families place great trust in nurses, relying on them to take care of their loved ones. Health care education needs to address the safety of patient care, in order to ensure that it is effective and reliable. Simulation education can improve patient care by focusing on the American Association of Critical-Care Nurses Quality and Safety Education for Nurses (QSEN) competencies, and applying quality improvement (Cronenwett, et al., 2007). Patient-centered scenarios, team collaboration, and pediatric advanced life support (PALS) practice guidelines scenarios can be applied through a quality improvement program, by having nurses participate in mock codes (responses) to address core competencies.

For this doctorate of nursing practice (DNP) project, mock codes were conducted at a central Califomia hospital pediatric unit. Participants completed a modified American Heart Association (AHA) PALS pre-test prior to and post-test after participation in the mock code. Soon after the mock codes, the registered nurses (RNs) participated in multiple real codes. RNs who were surveyed stated that the mock code helped their performance in the actual codes that followed, in terms of decreasing their levels of anxiety and enhancing their confidence with regard to feeling well-prepared.


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