Publication Date


Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Arlene Spilker

Second Advisor

Lisa Walker-Vischer

Third Advisor

Patricia Beebe


in situ, mock code, pediatric, simulation, nursing


The purpose of this quality improvement project was to use in situ simulation-based mock codes to evaluate the effectiveness of participants’ actions and perceived confidence, and to potentially reinforce and improve knowledge retention, skill acquisition, and confidence levels of nursing staff with regards to pediatric emergencies. Simulated drills were evaluated with a tool focused on high-performance teams and team dynamics as outlined by American Heart Association Pediatric Advanced Life Support 2016. Twenty-four simulated drills were conducted from January to February 2019. Each hour-long session was composed of pre-briefing, simulated drill or scenario, and debriefing and took place in empty patient rooms in pediatrics or PICU. Participants’ self-confidence and knowledge were surveyed with a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) before the study began and after each session in which they participated. The pre- and post-survey tools were the same and results were aggregated. Statistical significance for survey questions “I need more knowledge” (p=.001) about codes and “I need more experience” (p=.006) with codes suggested that nurses felt more knowledgeable and more experienced after participating in the session. Evaluation of the simulated drills show improved role identification for first rescuers roles (48%) and improved time to arrival of the code cart after it was called (65seconds-165seconds in 15 sessions).


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