Mel Chapman, age 67, has a history of cardiovascular disease and has been admitted to hospital due to unstable angina.

Chapman’s daughter is sitting beside his bed reading while his heart is being monitored. The nurse comes in to do her morning assessment. Realizing the patient has no pulse, she calls a Code Blue and springs into action.

This is the scenario 40 Brock University Nursing students faced Thursday, Dec. 5 as part of a Code Blue Simulation which took place in the Nursing lab with high-fidelity simulation mannequins.

“Code Blue is the term used by health care professionals to alert the emergency system that a patient has no pulse,” explains Assistant Professor Sheila O’Keefe-McCarthy, who led the workshop. “This code alerts the emergency response team to come and start resuscitation measures.”

For the fourth consecutive year, the Brock University – Loyalist College Code Blue Simulation team came together to provide this non-mandatory experiential education opportunity to students enrolled in the collaborative Nursing program.

“Code blues are an unfortunate reality that nurses must be prepared to manage at any given moment,” says fourth-year Nursing student Kristen Balanowski. “Prior to the simulation workshop, I was uncertain how I would react in the event of a code blue. Now, I feel considerably more prepared to respond.”

The Code Blue is a high-impact, low-stakes workshop designed to simulate what should happen in an organized approach to cardiac resuscitation with emphasis on knowledge, skill development, correct techniques, communication and reflection.

“Basic life support skills are expected of all nurses,” says O’Keefe-McCarthy. “Graduates are tested on it during their National Council Licensure Examination. What is most important about this simulation is before the actual emergency team gets to a patient, there are critical minutes that can determine whether a person survives or not. That is what this code blue simulation targets.”

The workshop required students to go through a series of mini work stations that broke down resuscitation efforts before building up to the actual simulation, a teaching method O’Keefe-McCarthy explains as scaffolding.

“Scaffolding is a pedagogy approach that builds the bridge to knowledge whereby building blocks for memorable and sustained learning are utilized,” she says.

The work stations focused on four areas:

• recognizing vital signs absent in the patient, alerting the emergency system and starting compressions
• airway management through use of an Ambu-bag and intubation
• different immediate medications in a code blue and a talk about defibrillation and pad placement
• requirements of effective documentation and cross-team communication during a code blue

Following the work stations, students began the short cycle simulation where they went through a code blue scenario and repeated the roles they were given until they got it right.

“Going into the simulation knowing that it was strictly a learning opportunity with no judgement was crucial to me,” says fourth-year Nursing student Elizabeth Dobell. “Learning about code blues are fundamental in nursing practice, but being ‘book smart’ is completely different to what I experienced in this simulation, which involved group collaboration.”

To add emphasis to the need for a collaborative communication effort among all the team members, a family member, role-played by graduate students, was added to challenge the students to interact with the family member while trying to resuscitate the patient.

“The role-played family member is an effective, non-traumatic way to help Nursing students be cognitively sensitive to the emergency while also caring for the patient’s family member,” says O’Keefe-McCarthy. “It is imperative that students know how to communicate the option to the family, that it is their right to stay in the room if they choose to. This also means dealing with the added human element of possible panic and distress from family.”

To nurture leadership and experiential education, the workshop was often stopped in the moment to ask questions and discuss what was happening.

“I found the simulation to be extremely helpful in expanding and reinforcing my understanding of code blue procedures,” says fourth-year Nursing student Kathleen Foley. “This simulation allowed me to put together all of the individual components of running a code and make that experiential jump in a controlled and supportive learning environment.”

Following the simulation, several students reported feeling confident in their knowledge and skills as they move on to the next stage of their education.

“Reflecting on my experience with this simulation, I am confident that as a fourth-year Nursing student, I will be a valuable team member in my pre-grad placement,” says Arash Pouralborz. “To have been able to use a combination of all my knowledge from my Nursing education in one scenario made me realize how much I have grown.”