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code blue, COVID-19, personal protective equipment, safety, simulation



  1. Shelton, Charity L. DNP, RN, NE-BC


Abstract: Simulation is an innovative teaching tool that is widely used to improve nursing practice. The recent COVID-19 pandemic has revealed new areas of learning for nurses who care for patients in acute healthcare settings. Particularly, the COVID-19-positive patient who experiences a medical emergency, such as a code blue, needs nurses who are skilled in safely delivering lifesaving interventions. This article provides a review of the literature on the use of simulation to improve nurses' response to a code blue emergency with patients with COVID-19. This review includes literature on using simulation to enhance donning and doffing of personal protective equipment. No previous literature discussed conducting a code blue rescue with a patient who has COVID-19. On the basis of the literature reviewed, simulation should be considered as a tool to improve code blue outcomes, confidence of nurse responders, and compliance in proper donning and doffing of personal protective equipment. This article offers implications for further research on the use of simulation to advance knowledge about best practices for nurse response to COVID-19 code blue.


Highlights: * Simulation is a tool that improves code blue outcomes, such as improving early recognition of cardiac emergencies and time to first compressions.


* The COVID-19 pandemic has left nurses with increased fear and anxiety when caring for patients with COVID-19.


* Simulation provides a safe environment for nurses to practice donning and doffing of personal protective equipment in preparation of a COVID-19 rescue.


Key Points: * Simulation helps nurses deliver quality interventions in a code blue emergency.


* Self-confidence of nurses caring for patients with COVID-19 must be addressed so quality of care can be delivered.


* Simulation of COVID-19 code blue should be used as a training tool to improve outcomes for the patient and safety for nurses.