DPI Project – Proposal Defense PowerPoint and Call

DPI Project – Proposal Defense PowerPoint and Call

DPI Project – Proposal Defense PowerPoint and Call

This project requires using the ATTACHED PowerPoint template to complete the assignment.

Please see the ATTACHED SAMPLE from a previous student

You will need to use the CORRECTED VERSION of Word document from the initial project submission ATTACHED


In this topic, you will participate with your full DPI committee in the DPI Project Proposal Defense call. This meeting requires that you present your revised DPI Project Proposal live in PowerPoint form as it stands at this time.

General Requirements:

Use the following information to ensure successful completion of the assignment:

· While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines.

· You are required to submit this assignment to LopesWrite.


1. Using the “DNP Project Proposal Oral Defense Template” as your guide, create a PowerPoint presentation of your DPI Project Proposal, to be used during your DPI Project Proposal Defense call.

2. Present the revised Project Proposal PowerPoint to your full DPI committee.

You are required to complete your assignment using real-world application. Real-world application requires the use of current evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting.

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    The Impact of implementation of code blue nurse champion for cardiac arrests

    By: Beverly Holland, MSN, MBA, RN, NEA-BC

    DNP 960

    Project lead

    Registered nurse with 34 years in acute care hospital settings

    20 years in leadership roles

    Clinical Education Department director

    Involvement in ministry wide quality improvement, for example:

    Code Blue committee

    New employee orientation and Transition into Practice (TIP) RN onboarding






    Cardiovascular disease is the primary cause of death resulting in 840,768 deaths in the United States (US) in 2017, with 379,133 due to cardiac arrest (Varini et al., 2019).

    An estimated 209,000 in hospital cardiac arrests (IHCA) occur each year in the US, with a survival rate of 24% (Andersen, Holmberg, Berg, Donnino, & Granfeldt, 2019).

    Impacting factors for survival include:

    skilled front line response by bedside nurses

    skilled resuscitation team,

    prompt initiation of cardiopulmonary resuscitation and defibrillation, and

    organizational structures to support resuscitation care (Guetterman et al., 2018).



    Cardiovascular disease (CVD) is a primary cause of death in the United States. In-hospital cardiac arrest (IHCA) events pose a significant risk for patients. Survival and favorable outcomes for IHCA events are highly dependent on factors such as having a skilled resuscitation team in-house, prompt initiation of cardiopulmonary resuscitation (CPR) and defibrillation and established organizational structures to support resuscitation care. The Institute of Healthcare Improvement (IHI) recognizes the need for having a safety measure to assist healthcare professionals at the bedside in the prevention and identification of patient deterioration (IHI, 2008). Current evidence illustrates the variability in cardiac arrest survival in and out of the hospital, demonstrating a substantial opportunity to save lives (Bhanji, Finn, et al., 2015).



    Background (cont.)

    Determinants for survival

    Provider level

    Early defibrillation

    High quality CPR (Bhanji, Donoghue, et al., 2015).

    Nurses as first responders

    Delay in response

    Early initiation of CPR (Bircher, Chan, & Xu, 2019).




    For IHCA, provider-dependent determinants of survival are early defibrillation for shockable rhythms and high-quality cardiopulmonary resuscitation (CPR) (Bhanji, Donoghue, et al., 2015). Nurses are most likely first responders to witness an IHCA and provide treatment (McHugh et al., 2016). Furthermore, when rescuers respond slowly, survival is lower; early initiation of CPR links with improved outcomes for both out-of-hospital and IHCA (Bircher, Chan, & Xu, 2019). Therefore, CPR training for all hospital personnel has been mandatory in hospital systems for decades, facilitating the rapid identification and management of cardiac arrest before the arrival of the cardiac arrest team. DPI Project – Proposal Defense PowerPoint and Call


    Background (cont.)

    Acquisition and retention of resuscitation skills

    Rapid response systems and teams

    Evidence Based Practice (Maglangit, 2015)

    IHI 100,00 Lives Campaign (IHI, 2008)

    Activating RRT

    Delays associated with high mortality

    Early intervention, improves patient outcomes (Readron, Fernando, Maruphy, Rosenberg, & Kyeremantegn, 2018).






    Rapid response systems are considered a powerful tool in patient safety (Jung et al., 2016). A rapid response team (RRT) is an evidence-based practice (EBP) that most hospitals in the country are utilizing (Maglangit, 2015). The RRT is one of the six initiatives that the IHI 100,000 Lives Campaign identified in 2004 (Mate, 2017). Delays in activating RRT calls are associated with high mortality, while early intervention during clinical deterioration can improve patient outcomes (Reardon, Fernando, Murphy, Rosenberg, & Kyeremanteng, 2018). Early RRT calls are associated with decreased mortality, while late calls are associated with increased patient morbidity and mortality (Jones, Moran, Winters, & Welch, 2013). Early requests for assistance allow identification of patients at risk of deterioration and target interventions to improve patient care (Maharaj, Raffaele, & Wendon, 2015). Recognition of altered physiological observations to complex process involves knowledge and experience (Guinane, Bucknall, Currey, & Jones, 2013).

    Issues of delayed response and failure to notify the RRT are related to the inability to recognize patients’ deterioration and be associated with environmental factors. According to Jenkins, Astroth, and Woith (2015), recognition and addressing barriers can improve rapid response’ system safety culture and can have a positive impact on cardiac or respiratory arrests and mortality outside the intensive care unit (ICU). These barriers are related to perceptions that one has the necessary skills and abilities to perform or face issues or challenges related to navigation of the intra-professional and inter-professional hierarchies that lead to delays in activating the team when the patient condition deteriorates (Jenkins et al., 2015). Other possible system failures identified are multiple factors including delays in diagnosis and misdiagnosis (on physician’s side), inadequate interpretation of clinical symptoms, incomplete treatment, inexperienced staff, and patient management in appropriate clinical areas (Bagshaw et al., 2010 as cited in Jenkins et al., 2015).



    Background (cont.)

    Clinical nursing staff often provides suboptimal CPR during IHCA

    Due to inadequate skills retention (Maiken, Castren, Nurmi, & Niemi-Murola, 2016; McHugh et al., 2016; Saramma, Raj, Dash, & Sarma, 2016)

    Delay in recognition of clinical deterioration (Andersen et al., 2019)

    Survival is lower; early initiation of CPR links with improved outcomes for both out-of-hospital and IHCA (Bircher, Chan, & Xu, 2019).

    Perceived low level of confidence in ability to perform CPR

    Infrequent opportunities to perform CPR

    Lower proficiency, leading to hesitancy (Makinen et al., 2016)





    The incidence of IHCA in the medical-surgical setting poses distinct challenges for acute care nurses. Considering that early interventions could save lives, issues concerning delays in calling the RRT do exist. The recognition of physiological observations and response to complex processes involves knowledge and experience, and early intervention and escalation of care are essential (Guinane et al., 2014). The clinical staff is often providing suboptimal CPR due to inadequate skills retention (Makinen et al., 2016; McHugh et al., 2016; Saramma et al., 2016), recognition of clinical deterioration leading to delay initiating CPR (Andersen et al., 2019), and hesitation to start CPR, which is associated with perceived low level of confidence in their ability to perform (Adcock et al., 2020; Makinen et al., 2016).


    Background (cont.)

    Nurses’ self-efficacy with a timely response to IHCA is a critical link to the delivery of American Heart Association (AHA) basic life support (BLS) recommendations with the outcome of survival of cardiac arrest (Makinen et al., 2016).









    Background (cont.)

    History at project site:

    Rolling 12-month data for IHCA indicates that 44.6% of cardiac arrests occurred outside of the ICU

    59.60% occurred in the medical-surgical division (i.e., outside of ICU and Progressive Care Unit (PCU)) equating to 5.16 per 1,000 discharges.

    For the month of May 2020, the incidence rate per discharges of IHCA in the medical surgical areas/units was 6.08 per 1,000 discharges.

    Survival to discharge rate of 29%, better than the national average of 24.8%; however, only 38% of non-ICU codes had a rapid response within the previous 24 hours.






    Background (cont.)

    Contributing factors:

    Code Blue committee:

    Appropriate patient placement outside of ICU

    Patients are sicker than their level of care placement

    Delay in recognition of patient deterioration resulting in the delayed activation of the rapid response team (RRT)

    Failure to rescue in medical-surgical patient population



    The project site Code Blue committee notes appropriate patient placement as a factor outside of ICU IHCA; patients are sicker than their level of care placement. Whenever the RRT is activated, patients are treated then transferred to a higher level of care. However, as noted in previous slide, only 38% of codes occurring outside of the ICU had a rapid response within the previous 24 hours. Clinical staff outside of the critical care areas may not have the exact knowledge, skills and experience in treating critically ill patients, however, they are instrumental in implementing a timely and appropriate intervention to prevent deterioration and reduce mortality and morbidity because timely deployment most often depends on staff nurses (Massey et al., 2017). Currently, there exists a nursing practice issue of failure to rescue in the medical-surgical patient population (i.e., a delay in recognition of patient deterioration resulting in the delayed activation of the RRT).

    The rationale for many of these strategies on implementing a timely and appropriate intervention is to prevent patients from deteriorating through providing education, informing staff of data, and providing them with the necessary skills (Massey et al., 2017). Due to their proximity to patients and familiarity with their clinical conditions, bedside nurses are ideally positioned to alert the RRT for anticipatory response and intervention (Connell et al., 2016). They are the first caregivers to identify the subtle changes in the patient’s condition, indicating clinical deterioration. They must be educated and trained to activate preemptively and proactively the rapid response system (RRS) (Jenkins, Astroth, & Woith, 2015).




    Background (cont.)

    Code blue nurse champion



    The literature is sparse on code blue nurse champion roles; however, Banks and Trull (2012) employed a process improvement strategy implementing code blue nurse champions. The strategy educates code blue champions by using simulations and a communication framework. Educators collaborated with experienced code leaders to develop a framework for the tasks, roles, and priorities of code management. Each person was responsible for a specific task to provide a focused approach to a potentially chaotic situation (Banks & Trull, 2012). Team training included the application to simulated realistic patient situations allowing individuals to practice as a team. The champions then use their education to improve practice in their departments (Banks & Trull, 2012). The authors note findings demonstrated that nurses’ report increased confidence and competence in managing a code blue situation, and patient outcomes reflect the improvement in skills. The results of code blue champions on each unit reported a 74% survival rate compared to the national average of 44% (Banks & Trull, 2012).




    Problem statement

    The purpose of the project is to compare the impact of the implementation of the code blue nurse champion role in a select nursing medical-surgical division patient care department on nurses’ self-efficacy to initiate cardiac resuscitation and survival of IHCA.

    The focused education for the code blue nurse champion role includes IHI rapid response education (IHI, 2008) and participation in cardiac arrest in situ simulation scenario (Liaw, Rethans, Scherpbier, & Piyanee, 2011).



    Importance of project

    Survival depends on early recognition (Chang et al., 2018).

    Literature indicates that adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016).

    Interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation (Connell et al., 2016).

    When a nurse has self-confidence, recognizing, and responding appropriately to an emergency is increased (Horowitz, 2018).

    Adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016).





    Patient safety is a hospital priority. Survival of cardiac arrest event depends on early recognition of the event and immediate response including activation of a “code blue” team and initiation of high-quality CPR (Chang et al., 2018). An integrative review of the literature revealed that CPR skills retention and poor-quality CPR remain a major challenge in the clinical setting. The findings have consistently demonstrated that the quality of CPR is directly related to survival outcomes. Literature indicates that adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016). CPR training helps individuals learn and apply cognitive, behavioral, and psychomotor skills then develop the self-efficacy to provide CPR when necessary (Bhanji, Finn et al.,2015; Horowitz, 2018). Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. It is crucial that nurses keep their knowledge and skills up to date, as well as attitudes to resuscitation are very important (Tiscar-Gonzalex, Blanco-Blanco, Gea-Sanchez, Molinuevo, & Moreno-Casbas, 2019). Many times, nurses lack the confidence to identify a deteriorating patient. When a nurse has self-confidence, recognizing, and responding appropriately to an emergency is increased (Horowitz, 2018). Adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016). DPI Project – Proposal Defense PowerPoint and Call







    Theoretical foundations

    Bandura self-efficacy (BSE) theory

    Bandura (1982) defined confidence as “the perception that one is competent and capable of fulfilling particular expectations’” whereas self-efficacy is the personal judgment of “how well one can execute courses of action required dealing with prospective situations” (p. 122).

    Confidence is important as it may influence the degree of self-efficacy experienced

    Individuals are more likely to engage in behaviors if they have confidence in their ability to perform the task (Bandura, 1995).




    Applying this theory, Participants that have received the training will potentially respond to patient deterioration with more confidence.



    Theoretical foundations

    The Transtheoretical Model (TTM)

    Health behavior change involves progress through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination

    Focus on the individual’s decision making

    Model of intentional change

    Key assumption: people do not change behaviors quickly and decisively; instead, change in behavior, especially habitual behavior, occurs continuously through a cyclical process (Boston University School of Public Health [BUPH], 2019).

    Based on the processes of change in TTM, behavioral change in the attitude stage facilitated by raising awareness, discussing relevant events and cases, and providing effective models, media campaigns, and group discussion opportunities (Keshmiri et al., 2017).






    For nurses to move from the pre-contemplation to the termination stage, education needs to be effective, focusing on the harmful effects of “failure to rescue” [current state] and identify with the positive benefits of timely initiation of cardiac resuscitation.



    Clinical questions

    Does the implementation of a code-blue nurse champion role, as a cardiac arrest first responder, improve nursing self-efficacy to initiate cardiac resuscitation and survival of IHCA patients when compared to current practice among adult medical surgical patients in an acute care hospital in California over four-weeks?

    Q1: Does educational training consisting of IHI rapid response education, and cardiac arrest in situ simulation for code blue nurse champion nurses’ increase self-efficacy in responding to cardiac arrest?

    Q2: Does the implementation of a code blue nurse champion role increase survival of IHCA?




    This project is based on the following overall question—


    Sub questions include…



    Quantitative methodology

    Statistical analysis to analyze data

    Objective measurements; used to test or confirm theories and assumptions (Fain, 2017).

    Cause and effect relationship; convey numerically what is seen in research; arrive at specific, observable conclusions (Klazema, 2014).

    One Group quasi-experimental design

    Assess the effectiveness of implementation of the code blue nurse champion role to improve IHCA survival

    Identify if the additional training makes a difference in nurses’ timely recognition of patient deterioration and if appropriate action impacts the survival of IHCA



    In other words, Discover through statistical analysis quantifiable, objective data related to the implementation of code blue nurse champion role on nurses’ self-efficacy to respond cardiac arrest and survival of IHCA. DPI Project – Proposal Defense PowerPoint and Call



    Specifics on Methodology: PICOT

    P=Acute Care Registered Nurses’; Hospitalized patients experiencing IHCA

    I=Code blue nurse champion role

    C=Current practice

    O=Improved nurse knowledge, self-efficacy [attitude] towards CPR; improved IHCA survival

    T=Over six weeks timeframe



    Specifics on methodology: Variables

    Characteristics of Variables




    Specifics on methodology: Population and Sample


    Voluntary convenience sample of RNs (at least 16) from medical-surgical department, 4S

    Equal representation from night shift (1900 to 0730) and day shift (0700 to 1930)

    To achieve the effect size of 0.80 and an alpha level of significance of 0.05, twenty-five subjects are required

    IHCA patients during project timeline

    Hispanic ethnicity represents a high proportion of the population

    Cardiovascular disease (CVD) is a leading cause of death among Hispanic adults (Balfour et al, 2016).

    Hispanic population, compared to the non-Hispanic population, less than 10 percent of affected Hispanic patients are effectively managing their disease (e.g., use of anti-hypertensive medications) (Carlson et al., 2019) leading to higher US health care costs and hospitalization.





    Specifics on methodology : Instrument

    Nursing Knowledge and Attitude in Cardiorespiratory Arrest (CAEPCR) questionnaire (Tiscar-Gonzalez et al., 2019)

    Three distinct sections

    Demographic data

    Knowledge of CPR

    Attitude / Self-efficacy


    Three Delphi rounds


    Piloted on a test-retest basis with a convenience sample of 30 RNs (Tiscar-Gonzalez et al., 2019); psychometric characteristic evaluated by 347 nurses




    The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory

    Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic

    information, theoretical and practical understanding, and attitudes of ethical issues.

    The questionnaire was designed using the Delphi technique (three rounds). The

    questionnaire was adjusted and it was piloted on a test-retest basis with a convenience

    sample of 30 registered nurses. Psychometric characteristics were evaluated using

    a sample of 347 nurses using Cronbach’s alpha. Descriptive analysis was performed

    to describe the sociodemographic variables and Spearman’s correlation coefficient

    to assess the relationship between two scale variables. Pearson’s chi-squared test used to study the relationship between two categorical variables. Wilcoxon Mann

    Whitney test and the KruskalWallis test were performed to establish relationships

    between the demographic/work related characteristics and the level of understanding. DPI Project – Proposal Defense PowerPoint and Call


    Cronbach’s alpha for the internal consistency of the attitudes questionnaire was 0.621.

    The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly

    affected their attitudes. Their responses raised a number of bioethical issues.

    Conclusions. CAEPCR questionnaire is the first one which successfully linked knowledge

    of cardiopulmonary resuscitation to the attitudes towards ethical issues Health

    policies should ensure that CPR training is mandatory for nurses and all healthcare

    workers, and this training should include the ethical aspects.





    Specifics on methodology: Instrument (cont.)

    Electronic Medical Record (EMR)

    Source of data for cardiac arrest events

    Queried based on an internal report from hospital operator for activation of code blues

    Code blue documentation record embedded in the EMR as a scanned document

    Process is determined to be sound based on random audits of actual code blue events and cross validation with internal operator report




    Specifics on methodology: Intervention

    Code Blue Nurse Champion role education:

    Rapid response education (IHI, 2008)

    Includes rapid response team (RRT) composition, role, and purpose, patient physiological changes and early warning signs of deteriorating status, when to call RRT, how to call RRT, and the SBAR (Situation, Background, Assessment, and Recommendation(s)) communication that should be used during calls.

    In situ simulation—cardiac arrest scenario

    Focused on responding to a deteriorating patient, specifically on cardiac arrest

    team roles, prioritizing actions, and effective communication, inclusive of the role of RRT.

    Scenario is based upon AHA BLS and ACLS standards for frontline responders (Liew et al., 2011).

    The staff must identify the unresponsive, apneic adult patient, call the code, assess the carotid pulse, and provide high quality CPR. Additional responders arrive with the crash cart and automated external defibrillator (AED), turn on AED and apply pads, analyze rhythm, and safely defibrillate if the AED indicates a shockable rhythm. Responders set up oxygen and suction, appropriately communicate with the code team (e.g., through SBAR format), and prepare to assist physician provider with endotracheal intubation. DPI Project – Proposal Defense PowerPoint and Call





    Specifics on Methodology: data collection (cont.)

    Day of class:

    Each participant receives CAEPCR questionnaire. Instructed to be anonymous

    Seal and place their completed pre and post survey tools in a marked separate envelopes (pre-survey and post-survey) after completion.

    Each envelop is labeled by the project lead with a numerical value (e.g., one to 16, depending on the number of participants); identical numbers for pre and post envelops will correlate to associate with same participant.

    Completed survey tools will only be accepted when they are placed in an envelope and are sealed by the participants.

    The surveys will be placed in a locked cabinet in the project lead’s office on hospital property and will only be opened by the project lead during data coding and analysis.

    The data will be entered into a password protected computer for analysis.

    Survey results will not be shared with any personnel not directly associated with the development and implementation of the project. After the study is completed, survey results will be shredded and disposed of in a protected hospital bin. DPI Project – Proposal Defense PowerPoint and Call





    Specifics on methodology: Data collection (cont.)

    IHCA data:

    Provided by Quality Management Specialist; internal reports on documented code blue activations, initiated by the hospital operator.

    Data extracted from the electronic health record (EMR) including scanned code blue documentation records.

    Data is compiled in an excel spread sheet.

    Data points include inpatient location, date and time of cardiac arrest, and outcome of arrest (i.e., survival or expired). Only cardiac events occurring within the project site’s nursing department on a single medical-surgical unit will be included.

    Quality Management Specialist to provide project lead raw data; no PHI included.




    Specifics on methodology: data analysis

    CAEPCR tool

    Descriptive statistics for categorical variables (gender, age, years of experience as RN, last completed CPR course, frequency of performing CPR, recommended frequency of renewal, able to attend a real CPR event). DPI Project – Proposal Defense PowerPoint and Call

    Knowledge section

    Scores range from zero to 11—reflective of correct answers

    Paired one tail t test to analyze data—difference between paired scores and ranking difference

    Attitude (self-efficacy) section

    Likert scale one (strongly disagree) to five (strongly agree)

    Total scores maximum of 60

    Paired one tail t test to analyze data–difference between paired scores and ranking difference



    Specifics on methodology: data analysis (cont.)


    Data extracted by Quality Management Specialist

    Percentage rate

    Numerator survival of IHCA

    Denominator total IHCA during project timeline

    Data analysis using one tail paired t test for dependent means






    Specifics on methodology: data analysis (cont.)

    Dependent variables

    Nurses knowledge of CPR

    Nurses attitude (self-efficacy)

    Survival of IHCA

    One-way multivariate analysis of variance (MANOVA) will be used to determine whether there are any differences between the dependent groups






    Adcock, S., Kuszajewski, M. L., Dangerfield, C., & Muckler, V. C. (2020). Optimizing nursing response to in-hospital cardiac arrest events using in-situ simulation. Clinical Simulation in Nursing. doi: 10.1016/j.ecns.2020.05.006

    Andersen, L. W., Holmberg, M. J., Berg, K. M., Donnino, M. W., & Granfeldt, A. (2019). In-

    hospital cardiac arrest: A review. Jama, 321(12), 1200-1210. doi:10.1001/jama.2019.1696

    Bandura, A. (1982) Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122–147.

    Bandura, A. (1995). On personal and collective efficacy in changing societies. In A. Bandura

    (Ed.) Self-efficacy in changing societies, pp. 1–45. Cambridge University Press, New York, NY.

    Banks, D., & Trull, K. (2012). Optimizing patient resuscitation outcomes with

    simulation. Nursing2019, 42(3), 60-61. doi:10.1097/01.NURSE.0000411419.36903.65

    Balfour, P. C., Ruiz, J. M., Talavera, G. A., Allison, M. A., & Rodriguez, C. J. (2016).

    Cardiovascular Disease in Hispanics/Latinos in the United States. Journal of Latina/o Psychology, 4(2), 98–113.  doi:10.1037/lat0000056

    Bircher, N. G., Chan, P. S., & Xu, Y. (2019). Delays in cardiopulmonary resuscitation, defibrillation, and epinephrine administration all decrease survival in in- hospital cardiac arrest. Anesthesiology: The Journal of the American Society of Anesthesiologists, 130(3), 414-422. doi:10.1097/ALN.0000000000002563

    Bhanji, F., Donoghue, A. J., Wolff, M. S., Flores, G. E., Halamek, L. P., Berman, J. M., Sinz, E. H., & Cheng, A. (2015). Part 14: Education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 132(18_suppl_2), S561-S573. doi:10.1161/CIR.0000000000000268



    References (cont.)

    Bhanji, F., Finn, J. C., Lockey, A., Monsieurs, K., Frengley, R., Iwami, T., Lang, E., Ma, M.

    H.,Mancini, M. E., McNeil, M. A., Greif, R., Bili, J. E., Nadkarni, V. M., & Bigham, B. (2015). Part 8: Education, implementation, and teams: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation, 132, 242-268. doi:10.1161/CIR.0000000000000277

    Boston University School of Public Health. (2019, September). The transtheoretical model.

    Retrieved from


    Brennan, E. E., McGraw, R. C., & Brooks, S. C. (2016). Accuracy of instructor assessment of

    chest compression quality during simulated resuscitation. Canadian Journal of Emergency Medicine, 18(4), 276- 282. doi:10.1017/cem.2015.104

    Carlson, B., Hoyt, H., Gillespie, K., Kunath, J., Lewis, D., & Bratzke, L. C. (2019). Predictors of

    Heart Failure Readmission in a High-Risk Primarily Hispanic Population in a Rural Setting. Journal of Cardiovascular Nursing, 34(3), 267-274. doi:10.1097/JCN.0000000000000567

    Cheng, A., Nadkarni, V. M., Mancini, M. B., Hunt, E. A., Sinz, E. H., Merchant, R. M., … &

    Bigham, B. L. (2018). Resuscitation education science: educational strategies to improve outcomes from cardiac arrest: A scientific statement from the American Heart Association. Circulation, 138(6), e82-e122. doi:10.1161/CIR.0000000000000583

    Connell, C. J., Endacott, R., Jackman, J. A., Kiprillis, N. R., Sparkes, L. M., & Cooper, S. J.

    (2016). The effectiveness of education in the recognition and management of deteriorating patients: A systematic review. Nurse education today, 44, 133-145. doi:10.1016/j.nedt.2016.06.001

    Fain, J. A. (2017). Reading, understanding, and applying nursing research. FA Davis




    References (cont.)

    Gonzalez, B. S., Martinez, L., Cerda, M., Piacentini, E., Trenado, J., & Quintana, S. (2016, March). Assessing practical skills in cardiopulmonary resuscitation: Discrepancy between standard visual evaluation and a mechanical feedback device. Medicine, 96, e6515. doi:10.1097/MD.0000000000006515

    Greer, J. A., Haischer-Rollo, G., Delorey, D., Kiser, R., Sayles, T., Bailey, J., … & Ennen, C. S. (2019). In-situ interprofessional perinatal drills: The impact of a structured debrief on maximizing training while sensing patient safety threats. Cureus, 11(2). doi:10.7759/cureus.4096

    Guetterman, T. C., Kellenberg, J., Krein, S., Lehrich, J., Harrod, M., Kronick, S., … & Nallamothu, B. K. (2018). Nursing roles for in-hospital cardiac arrest response: A qualitative study. Circulation, 138(Suppl_2), A180-A180.

    Guinane, J. L., Bucknall, T. K., Currey, J., & Jones, D. A. (2013). Missed medical emergency team activations: Tracking decisions and outcomes in practice. Critical Care and Resuscitation, 15(4), 266.

    Halm, M., & Crespo, C. (2018, November). Acquisition and retention of resuscitation knowledge

    and skills: What’s practice have to do with it? American Journal of Critical Care, 27(6), 513-517. doi:10.4037/ajcc2018259

    Horwitz, R. (2018). Improving nurses CPR skills, knowledge, and confidence using a resuscitation quality improvement program (doctoral dissertation, Chatham University). Retrieved from https://s3.us-east-2.amazonaws.com/chathamlibsp/gradcapstones/2018/Horwitz.pdf

    Institute for Healthcare Improvement. (2008). Measures: Deploy rapid response teams.

    Retrieved June 23, 2020 from: http://www.ihi.org/resources/Pages/Measures/MeasuresRapidResponseTeam

    Jenkins, S. H., Astroth, K. S., & Woith, W. M. (2015). Non-critical-care nurses’ perceptions of

    facilitators and barriers to rapid response team activation. Journal for Nurses in Professional Development, 31(5), 264-270. doi:10.1097/nnd.0000000000000168

    Jones, D., Moran, J., Winters, B., & Welch, J. (2013). The rapid response system and end-of-life care. Current Opinion in Critical Care, 19(6), 616-623. doi: 10.1097/MCC.0b013e3283636be2





    References (cont.)

    Jung, B., Daurat, A., De Jong, A., Chanques, G., Mahul, M., Monnin, M., … & Jaber, S. (2016). Rapid response team and hospital mortality in hospitalized patients. Intensive Care Medicine, 42(4), 494-504. doi: 10.1007/s00134-016-4254-2

    Keshmiri, F., Rezai, M., Mosaddegh, R., Moradi, K., Hafezimoghadam, P., Zare, M. A., … & Shirazi, M. (2017). Effectiveness of an interprofessional education model based on the transtheoretical model of behaviour change to improve interprofessional collaboration. Journal of Interprofessional Care, 31(3), 307-316. doi:10.1080/13561820.2016.1276051

    Klazema, A. (2014). Types of quantitative research for students and researchers. Udemy.

    Liaw, S. Y., Rethans, J. J., Scherpbier, A., & Piyanee, K. Y. (2011). Rescuing A Patient In

    Deteriorating Situations (RAPIDS): a simulation-based educational program on recognizing, responding and reporting of physiological signs of deterioration. Resuscitation, 82(9), 1224-1230. doi:10.1016/j.resuscitation.2011.04.01

    Makinen, M., Castren, M., Nurmi, J., & Niemi-Murola, L. (2016). Trainer’s attitudes towards

    cardiopulmonary resuscitation. Emergency Medicine International, 2016(Article ID: 3701468), 1-6. doi:10.1155/2016/3701468

    Maglangit, C. L. (2015). Rapid response team education in improving bedside nurses knowledge

    and skills. Retrieved from http://epublications.regis.edu/cgi/viewcontent.cgi?article=1726&context=theses

    Massey, D., Chaboyer, W., & Anderson, V. (2017). What factors influence ward nurses’

    recognition of and response to patient deterioration? An integrative review of the literature. Nursing Open, 4(1), 6-23. doi:10.1002/nop2.53

    Mate, K. (2017, October). Forward momentum: It’s time for an age-friendly health system. In Forward Motion Gaining Momentum for an Aging Society. Grantmakers in Aging Annual Conference (Vol. 19). Retrieved from https://www.giaging.org/documents/1230pm_Friday_Kedar_Mate_GIA_Age_Friendly.original.1508423823.pdf

    References (cont.)

    McHugh, M. D., Rochman, M. F., Sloane, D. M., Berg, R. A., Mancini, M. E., Nadkarni, V. M., … & American Heart Association’s Get With The Guidelines-Resuscitation Investigators. (2016). Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients. Medical care, 54(1), 74.doi:10.1097%2FMLR.0000000000000456

    Panchal, A. R., Norton, G., Gibbons, E., Buehler, J., & Kurz, M. C. (2020). Low dose-high frequency, case based psychomotor CPR training improves compression fraction for patients with in-hospital cardiac arrest. Resuscitation, 146, 26-31. doi:10.1016/j.resuscitation.2019.10.034

    Reardon, P. M., Fernando, S. M., Murphy, K., Rosenberg, E., & Kyeremanteng, K. (2018).

    Factors associated with delayed rapid response team activation. Journal of Critical Care, 46, 73-78. doi:10.1016/j.jcrc.2018.04.010

    Saramma, P. P., Raj, L. S., Dash, P. K., & Sarma, P. S. (2016). Assessment of long-term impact of

    formal certified cardiopulmonary resuscitation training program among nurses. Indian Journal of Critical Care Medicine, 20(4), 226. doi:10.4103%2F0972-5229.18004

    Sullivan, N. (2015). An integrative review: Instructional strategies to improve nurses’ retention of cardiopulmonary resuscitation priorities. International Journal of Nursing Education Scholarship, 12(1), 37-43. doi:10.1515/ijnes-2014-0012

    Tíscar-González, V., Blanco-Blanco, J., Gea-Sánchez, M., Molinuevo, A. R., & Moreno-Casbas, T. (2019). Nursing knowledge of and attitude in cardiopulmonary arrest: Cross-sectional survey analysis. PeerJ, 7, e6410. doi:10.7717/peerj.6410

    Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., … & Djousse, L. (2020). Heart disease and stroke statistics – 2020 update: A report from the American Heart Association. Circulation, 141(9), e139. doi:10.1161/cir.0000000000000757





    Practice Hours Completion Statement DNP-960

    I, Beverly Holland, verify that I have completed 10 clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and preceptor/mentor.




    Variable Variable Type Level of Measurement
    Code Blue Nurse Champion Role Independent Nominal


    Patient survival IHCA Dependent Ratio


    Nurses’ self-efficacy (attitude) Dependent Ratio



    Nurses’ knowledge Dependent Ratio


    Variable Variable


    Level of


    Code Blue Nurse Champion Role Independent Nominal


    Patient survival IHCA Dependent Ratio


    Nurses’ self-efficacy (attitude) Dependent Ratio



    Nurses’ knowledge Dependent Ratio