Journal of American Science 2014;10(5)

http://www.jofamericanscience.org

Effect of Frequent Application of Code Blue Training Program on the Performance of Pediatric Nurses
Ghada Saeed AL-Ghamdi 1; Magda Aly Essawy 2 and Dr. Mohammad Al-Qahtani 3
1

College of Nursing, University of Dammam.

Professor of pediatric Nursing, College of Nursing, University of Dammam
3
Pediatric Medicine, College of Medicine, University of Dammam.
[email protected]

Abstract: Introduction: Code Blue training is essential for nurses, as nurses often discover the patients of inhospital cardiac arrest. Aim: the study aims to investigate the effect of frequent application of Code Blue training
program on the performance of pediatric nurses. Material and Method: Quasi-experimental design was used.
Simple randomization sampling of 22 pediatric nurses who are working in pediatric inpatient departments at King
Fahad Hospital of University composed the study subjects. Observation checklist of pediatric nurses performance
and the training program were developed by the researcher according to American Heart Association guidelines,
2011 and Hospital Policy for Code Blue. The study subjects received the training program for three times in two
weeks interval. Nurses performance of Code Blue was assessed before and after each session. Results: It is
revealed from the present study that frequent Code Blue training program enhances the performance of pediatric
nurses. This upward trend is evidenced by the statistical significant differences in nurses performance before and
after each session of the training program implementation (first session Z=4.109/ p<0.001, second session Z= 4.116/
p < 0.001, third session Z=4.024/ p < 0.001). Additionally, significant differences were demonstrated between the
first and second sessions, and between the second and third sessions [(before Z=4.114/ p <0.001, after Z=3.511/ p
<0.001), (before Z= 3.966 / p <0.001, after Z= 3.542/ p <0.001) respectively]. Conclusion and Recommendation:
the frequent application of Code Blue training program enhances the performance of the pediatric nurses, and it is
recommended from this study that pediatric nurses should attend Code Blue training frequently.
[Ghada Saeed AL-Ghamdi; Magda Aly Essawy and Dr. Mohammad Al-Qahtani. Effect of Frequent Application of
Code Blue Training Program on the Performance of Pediatric Nurses. J Am Sci 2014;10(5):9-17]. (ISSN: 15451003). http://www.jofamericanscience.org. 2
Keywords: Frequent Application; Code Blue Training Program; Performance; Pediatric Nurses
recognition of signs for respiratory distress and
cardiovascular collapse that are present in the
clinically unstable pediatric patient (5-6).
Activating the emergency response system is
an essential link of the chain of survival. In a code
Blue situation, the first nurse responder should start
CPR immediately, while second nurse responder
should activate the emergency response system.
Nurses should know the process of Code Blue
announcement according to the policy of the health
organization (whom to call and what to say) (3).
The prompt initiation of high-quality chest
compressions is an essential part of cardiac arrest
resuscitation. If the infant or child is unresponsive
and not breathing, nurse will take up to 10 seconds to
check for a pulse, brachial in an infant and carotid or
femoral in a child, and if no pulse is detected, chest
compressions should be started (7-8).During cardiac
arrest, effective chest compressions produce a blood
flow to vital organs that will increase the possibility
of return of spontaneous circulation (ROSC) and
improve the childs chance of survival by providing
heart and brain circulation.
Nurses should focus on delivering a highquality CPR by doing compressions within 10

1.Introduction:
Code Blue is a term used over the address
system to call for assistance for patient in full or
impending cardiopulmonary arrest (1). It is a rapid
response system for resuscitation and stabilization of
medical emergency situations that occurs within the
hospital area. A Code Blue is to be initiated
immediately whenever a child or an adult is found in
cardiac or respiratory arrest. It is a team activity; that
is made up of a variety of healthcare professionals
including nurses (2).
Code Blue is a multi-tasked event where
different responsibilities need to be carried out by the
Code team in order to increase the chances of
successful resuscitation. The process of Code Blue
employs the five-part of "survival chain" concepts,
which begin with recognition of cardiac arrest,
activation of the emergency response system,
cardiopulmonary resuscitation (CPR), rapid
defibrillation (3-4).
Early recognition of the pre-arrest state by
nurses is considerably affecting patient outcome and
maximize rates of survival and recovery. Initial
assessment of a child in impending cardiopulmonary
arrest requires nurses to be proficient in rapid

Journal of American Science 2014;10(5)

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seconds of recognition of cardiac arrest, chest

compressions of appropriate rate and depth.
Push fast: push at a rate of at least 100
compressions per minute. Push hard: push with
sufficient force to depress at least one third of the
anterior-posterior (AP) diameter of the chest or
approximately 1 1/2 inches (4 cm) in infants and 2
inches (5cm) in children, allowing complete chest
recoil after each compression, minimizing
interruptions in compressions, provide effective
breaths that make the chest rise, and avoiding
excessive ventilation. (8-9).
A single rescuer uses a compression-toventilation ratio of 30:2. In case of two-rescuer for
infant and child CPR, one should perform chest
compressions while the other keeps the airway open
and performs ventilations at a ratio of 15:2.
Ventilations should be delivered with a minimal
interruption in chest compressions (7).
Bag-mask ventilation is an important
technique during pediatric resuscitation. Effective
bag-mask ventilation requires compound and
coordinated steps, therefore bag-mask ventilation is
not recommended for a lone rescuer, and is provided
only during two-rescuer CPR. (6-8). Children with
sudden witnessed collapse are possibly suffering
from ventricular fibrillation (VF) or pulseless
ventricular tachycardia (VT) and need immediate
CPR and rapid defibrillation. The aim of all health
organizations should be directed to have nurses as
first responders to deliver early defibrillation when
required during resuscitation. Therefore, training
nurses for defibrillation and Automated Electronic
Defibrillation (AED) is a mandatory. Rescuers should
coordinate chest compressions and shock delivery to
minimize the time between compressions and shock
delivery and to resume CPR, beginning with
compressions, immediately after shock delivery (10-12).
In addition, nurses usually perform different
other roles. During Code Blue event nurses must
place the patient on cardiac monitor as soon as
possible to recognize and follow normal and
abnormal cardiac rhythms. When the patient has a
perfusing rhythm, oxyhemoglobin saturation must be
monitored continuously with a pulse oximeter. In a
Code Blue event of a pediatric patient nurses should
estimate the childs weight accurately. Nurses also
should document all intervention by time during the
Code event and initiate vascular access. Thus, there is
an emphasis on the team approach toward Code Blue
event which promote collaboration and effective
communication among the Code team members,
involving nurses physicians respiratory therapist and
other health care providers (10).
The lack of resuscitation skills of nurses and
doctors in resuscitation has been identified as a

contributing factor to poor outcomes of cardiac arrest

victims (10, 13).Poor knowledge and skill retention
following cardiopulmonary resuscitation training for
nursing and medical staff has been documented over
the past 20 years (14). Rebecca, (1996) investigated the
retention of resuscitation skills for nurses, and found
that they significantly declines in 10 weeks, which
suggests that retention of skills quickly deteriorates if
not utilized or updated frequently. Various
international organizations on resuscitation have
emphasized the importance of training on providing
high quality CPR and thus improving survival of
patients undergoes resuscitation situation (15).
It is important to emphasize that Code Blue
training is a vital issue for nurses. Because skills and
knowledge deteriorate significantly if not applied or
regularly updated; retention of nurses skills gained
from Code blue training after a certain period of time
is of a major concern (15), from this perspective, the
current study was carried out.
Aim of the Study
The aim of this study is to investigate the
effect of frequent application of Code Blue training
program on the performance of pediatric nurses.
Hypothesis:
It is hypothesized that the frequent
application of Code Blue training program enhances
the performance of the pediatric nurses.
2. Material and Methods
Research Design:
Quasi-experimental design was used in this study.
Materials:
I. Setting:
This study was conducted in the Pediatric
Medical and Surgical Wards, at King Fahad Hospital
of University, University of Dammamm in Al Khobar
City. The data collection period started in the 1st of
June, (2013) and finished in 29th of July, (2013).
II. Subjects:
Simple randomization sampling of 22 pediatric
nurses who are working in medical and surgical
pediatric inpatient departments composed the study
subjects. They were selected from the previously
mentioned setting.
Inclusion criteria:
- Valid certification of Basic Life Support.
An experience of at least 1year in pediatric
inpatient departments.
Exclusion criteria:

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Nurses with muscle-skeletal problems and

pregnancy that hinder their performance.
III. Tool of the study
One tool was used for data collection in the
present study:

C. Activate the emergency response system.

D. Demonstrate Code Blue procedure.
E. Integrate effective communication techniques.
Content of the training program includes;
A. The process of Code Blue event.
B. Equipments needed in Code Blue event.
C. Assessment and recognition of patient who
needs cardiopulmonary resuscitation.
D. Activating the emergency response system,
Whom to call, what to say?
E. Performing
Effective
cardiopulmonary
resuscitation.
F. Application
of
Automated
Electronic
Defibrillator.
G. Communication during the Code Blue event.
H. Documentation of a Code Blue event.
11- The demographic and occupational data of all
study subjects were obtained by the researcher,
using the study tool. The training manual was
distributed among the participant nurses.
12- The training program was implemented where
all participant nurses received three sessions in
total. Sessions were scheduled and delivered as
one 30-minutes session every two weeks during
a period of six weeks. All the content of the
training program was covered in every session.
13- The training program was carried out using in
situ simulation where a vacant patient room in
surgical pediatric ward was prepared to conduct
the session. Equipments were collected and
assembled for the simulation including: crash
cart with LIFEPAK 12 3D Biphasic Monitor/
Defibrillator and Ambo-bag, vital signs monitor,
little junior CPR manikin, Baby Anne CPR
manikin, Laerdal pocket mask, a projector and
laptop.
14- Participant nurses who were available in the
morning, afternoon and night shifts attended the
sessions in their break times according to a
schedule that was prepared by the researcher
with the collaboration and support of the unit
supervisor.
15- In every session, power point presentation was
delivered by the researcher to reinforce
knowledge and steps of different procedures in
Code Blue situation. Also demonstration and redemonstration on Mock Code Blue using the
CPR manikins were employed by the researcher
to conduct the training program in each session.
16- The performance of pediatric nurses was
assessed by the researcher before and after each
session of Code Blue training program.

Tool: Observation checklist of pediatric nurses

performance:
The tool was developed by the researcher
according to American Heart Association guidelines
of Basic Life Support (BLS), 2011(9) and King Fahad
Hospital of University Policy of Code Blue(1) to
assess the nurses performance. The tool consisted of
two parts:
Part one: Nurses characteristics:
It included the demographic and occupational data of
participant nurses.
Part two: The nurse performance:
It included the assessment of the nurses performance
as a first, second and third responder to a simulated
Code Blue event. The items in the study tool were
marked as done or not done by the researcher based
on the nurse response.
Method:
1- Ethical approval was obtained from the ethical
committee of University of Dammam.
2- Gatekeeper permission was obtained from
responsible authorities in King Fahad Hospital of
University, University of Dammam in Al Khobar
City.
3- King Fahad Hospital of University Institutional
Review Board requirements were completed and
permission was achieved.
4- A written informed consent was obtained from
the pediatric nurses who participated in the
study.
5- Confidentiality and anonymity of individual
responses were guaranteed.
6- The tool was developed by the researcher.
7- The validity of the tool was asserted by five
experts on pediatric field, the result was 95%.
8- To test feasibility and applicability of the tool,
pilot study was carried out on five nurses and
necessary modification was made accordingly.
9- Reliability of the tool was tested through test and
retest. The correlation coefficient was 0.87.
10- The researcher developed the Code Blue training
program and training manual for pediatric nurses
in accordance of the American Heart Association
guidelines, 2011(9) and the King Fahad Hospital
of University Policy(1). This was achieved under
the following objectives;
A. Comprehend the processes of a Cod Blue event.
B. Prepare the equipment needed in Code Blue
event.

Data Analysis
Scoring system:

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Items in the observation checklist of

pediatric nurses performance were classified into
five categories including a total of 39 items as
follows: recognition of cardiac arrest (7 items),
activation of the emergency response system (3
items), cardiopulmonary resuscitation (19 items),
defibrillation (5 items), and complementary tasks,
such as IV insertion and documentation (5 items). For
each item score one indicates Done and zero
indicates Not done.
Statistical analysis of the data was carried
out by the researcher using the SPSS program for
Windows Version 19. Data was collected, tabulated.
Minimum and maximum, mean and standard

deviation, median and Interquartile ranges were

calculated. Wilcoxon significant test was used. Pvalue of <0.05 was considered statistically
significant.
3. Results
The results of the current study consist of
two parts: Nurses characteristics and Nurses
performance. Part one includes one table showing the
Demographic and occupational data of studied
nurses. Part two includes three tables and two figures
illustrating the mean of total percent scores of
nurses performance.
Part 1: Nurses characteristics

Table (I): Demographic and occupational data of studied nurses.

Nurses' Demographic and Occupational Data
No. (n=22)
Age:

7
9
6

<30 years
30 -40 years
>40 years

%
31.8
40.9
27.3

24 -56
37.2 11.1

Min-max
Mean SD
Education:
Diploma
Bachelor
Years of experience:
<10 years
10-20 years
>20 years

6
16

27.3
72.7

9
8
5

40.9
36.3
22.8
1-29
12.4 9
10.5 (16.7)

Min-max
Mean SD
Median (IQR)
Attendance to previous Code Blue training:
Yes
No
Participating in Code Blue for patients:
Yes
No

Table (I) illustrates the characteristics of the

studied nurses. The age of 40.9% of nurses was
ranging from 30 to 40 years. It was less than 30 years
for 31.8% of them; the age of 27.2% was more than
40 years. About three quarter of the studied subjects
(72.7%) had a bachelor degree, and only 27.2% of
them had diploma degree. The nurses experience
was less than 10 years for 40.9%. It ranges from 10 to
20 years for 36.3%, and 22.7% of them had more
than 20 years of experience. It was noticed that the
majority of nurses (81.8%) did not attend previous
training program for Code Blue and only 18.1% of
them who were attend. On the other hand, more than

4
18

18.2
81.8

15
7

68.2
31.8

half of the nurses (68.1%) reported that they had

participates in Code Blue for patients management.
Table (II) illustrates the mean of total
percent scores of nurses performance categories
before and after the Code Blue training program
implementation. It was shown that there were a
significant differences in recognition category of
nurses performance before and after first session [(Z
=4.055 / p =<0.001], second session [Z =3.559 / p
<0.001], and third session [Z=2.178 /p=0.029]. The
same results were found before and after each session
of the other categories of nurses performance as
following; in activation[first session ( Z=3.659/ p

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<0.001), second session ( Z=2.309/ p =0.021),and

third session( Z=2.333/ p =0.020)], in CPR[ first
session (Z=4.115 / p <0.001), second session
(Z=4.115 / p <0.001), and third session (Z=3.855/ p
<0.001)], in defibrillation [first session ( Z=3.824/ p
<0.001), second session (Z=2.208 / p =0.027), third
session (Z=1.897/ p =0.058)], and in complementary
tasks [(First session (Z=4.164/ p <0.001), second

session ( Z=4.093/ p <0.001), and third session

(Z=2.887/ p =0.004)].
It was found from table (IV) and Figure (2),
that there were significant differences between the
total percent scores of nurses performance in code
blue training program before and after each session
(first session Z= 4.109 p <0.001, second session Z=
4.116 p <0.001, and third session Z=4.024 p p
<0.001).

Part 2: The nurses performance.

Table (II): The mean of total percent scores of nurses performance categories before and after each session of
Code Blue training program implementation
1st session
Items of nurses
performance
Recognition (7 items)
Min-max
Mean SD
Median (IQR)
Activation (3 items)
Min-max
Mean SD
Median (IQR)
CPR (19 items)
Min-max
Mean SD
Median (IQR)
Defibrillation
(5
items)
Min-max
Mean SD
Median (IQR)
Complementary
tasks (5 items)
Min-max
Mean SD
Median (IQR)

Before

After

1-5
2.91.3
2.5 (2)

3-7
5.91.2
6 (1.3)

0-3
1.21
1(1.25)

1-3
2.60.7
3 (1)

0-7
2.92.1
3(3.25)

2nd session

Significant test
(Wilcoxon)

Before

After

1-7
5.11.5
6 (1)

6-7
6.60.5
7 (1)

Z=3.659
p<0.001

1-3
2.50.6
3(1)

9-18
15.22.7
16 (3.5)

Z=4.115
P<0.001

0-5
1.61.6
1.5 (3)

1-5
4.71
5 (0)

0-3
1.10.9
1(1.25)

3-5
4.60.7
5 (1)

3rd session
Significant
test
(Wilcoxon)

Significant
test
(Wilcoxon)

Before

After

Z=3.559
p<0.001

4-7
6.30.9
7(1.25)

6-7
6.80.4
7(0.25)

2-3
30.3
3 (0)

Z=2.309
p=0.021

1-3
2.70.6
3 (1)

4-15
10.53.5
11(5)

15-19
17.41.2
17(1.25)

Z=4.115
p<0.001

6-19
163
17(3.2)

17-19
18.70.6
19(1)

Z=3.855
p<0.001

Z=3.824
p<0.001

2-4
4.52.3
4 (2)

4-5
4.90.3
5 (0)

Z=2.208
p=0.027

3-5
4.70.7
5(1)

4-5
50.2
5(0)

Z=1.897
p=0.058

Z=4.164
p<0.001

0-5
31.2
3 (2)

3-5
4.70.5
5 (0.25)

Z=4.093
p<0.001

3-5
4.50.6
5(1)

Z=4.055
P<0.001

Z=2.178
p=0.029

Z=2.333
p=0.020

Z=2.887
p=0.004

Table (III): The mean of total percent scores of nurses performance of Code Blue training program before
and after each session.
Frequency of nurses performance
1st session
Min-max
Mean SD
Median (IQR)
2nd session
Min-max
Mean SD
Median (IQR)
3rd session
Min-max
Mean SD
Median (IQR)

The mean of total percent scores of nurses performance

Before
After
Significant test (Wilcoxon)
Z=4.109*
5.1-43.6
66.7-97.4
p <0.001
24.911.2
84.69.2
23.1 (16)
87.2 (13.5)
Z=4.116*
41-84.6
82-100
p <0.001
6613.4
93.84.7
69.2 (20.5)
94.9 (5.1)
Z=4.024*
59-97.4
92.3-100
p <0.001
889.8
98.52.3
92.3 (12.8)
100 (2.6)

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Table (IV): The mean of total percent scores of nurses performance according to each two sessions before
and after the implementation of Code Blue training program
Nurses
performance
Before
Mean SD
Median (IQR)
After
Mean SD
Median (IQR)

The sessions of nurses performance

1st session
2nd session
Test of significant
(Wilcoxon)

2nd session

3rd session

Test of significant
(Wilcoxon)

24.911.2
23.1 (16)

6613.4
69.2 (20.5)

4.114
<0.001

6613.4
69(20.5)

889.8
92.3(12.8)

3.966
<0.001

84.69.2
87.2 (13.5)

93.84.7
94.9 (5.1)

3.511
<0.001

93.84.7
94.9(5.1)

98.52.3
100 (2.6)

3.542
<0.001

(Z= 3.966, p <0.001). The same results were shown

regarding to the nurses performance after training
sessions [first and second sessions (3.511, p <0.001),
second and third sessions (3.542 p <0.001)
respectively], as clarified in table (III) and figure (1).

It was illustrated that there was a significant

differences between the mean of total percent scores
of nurses performance according to each two
sessions before the implementation of Code Blue
training program, the first and second sessions (Z=
4.114, p <0.001), and the second and third sessions

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and administering medications within 5 minutes by

the Code team.
The quality of CPR is often poor in the
clinical setting and the lack of resuscitation skills of
nurses and doctors in basic life support has been
identified as a contributing factor to poor outcomes of
cardiac arrest victims (19-20). This was supported by
the findings of the present study, however the mean
of the nurses' performance was poor before the
program implementation as seen in the first session of
training (2.92.1) compared to the improvement that
have been noticed after the third training session
(18.70.6) as clarified in table (II). This could be
related to nurses realization that the prompt initiation
of high-quality chest compressions improves the
victims chance of survival by providing heart and
brain circulation and increase the chance of return of
spontaneous circulation (ROSC)(6). Complete chest
re-expansion improves the flow of blood returning to
the heart and thereby blood flow to the body during
CPR. While incomplete recoil during CPR is
associated with higher intra-thoracic pressures and
significantly decreased venous return, coronary
perfusion, blood flow, and cerebral perfusion (3).
Herlitz et al. (21) reported that patients who received
CPR within 1 minute of collapse were twice as likely
to survive as those who did not. Cooper et al. 22) also
demonstrated that 25% increase in survival was
linked to the initiation of CPR within 3 minutes of
cardiac arrest
Sudden cardiac arrest (SCA) from
ventricular arrhythmias, such as ventricular
fibrillation (VF) and ventricular tachycardia (VT),
occurs in about 5% to 15% of all pediatric cardiac
arrest, where early defibrillation is the first line
treatment (4,23). Early defibrillation is defined as
having appropriate equipment and trained nurses
available throughout hospitals and affiliated
outpatient facilities (25). Therefore, it is important to
integrate early defibrillation into an effective
pediatric resuscitation care (3,26).It was found from
this study that there were a significant differences in
defibrillation mean items before and after the
program implementation in each session [first
session: Z=3.824/ p<0.001, second session: Z=2.208 /
p =0.027, third session: Z=1.897 / p =0.058].
Improvement in nurses' performance could be
explained in the light of nurses understanding that
prompt defibrillation is the definitive treatment for
ventricular fibrillation and ventricular tachycardia.
These results supported by Hamilton,(16) who cited
that nurses who are not often facing Code Blue
events in their clinical practice, should receive
training on AED.
Finally, it was shown from the current study
that the nurses performance was improved in each

4. Discussion
Pediatric nurses have a key role in Code
Blue team, and they are often the first health care
providers who respond to Code Blue events. It was
revealed from the present study that frequent Code
Blue training program enhances the performance of
the pediatric nurses. This upward is evidenced by the
statistical significant differences in nurses
performance before and after each session of the
training program implementation (first session Z=4.1
p <0.001, second session Z= 4.1 p < 0.001, third
session Z=4.02 p < 0.001) as clarified in table (III)
and figure (1). This was supported by Hamilton,16)
who cited that training must be provided as
frequently as needed, where expected nurses roles
and skills during Code Blue are regularly reinforced,
and this will contributes to the enhancement of
performance.
Immediate recognition of cardiac arrest is
one part of the first link in the chain of survival, it
leads to prompt emergency activation and initiation
of CPR, therefore, recognition of sick children should
be comprised in Code Blue training program (17).
Recognition consists of assessing the child to
determine the signs of cardiac arrest which in the
present study involves 7 items that the nurse should
accomplish. It was found from this study that there
were a significant differences before and after the
program implementation in each session of
recognition items [first session: Z=4.055/ p <0.001,
second session: Z=3.559/ p <0.001, third session:
Z=2.178/ p =0.029]. This could be related to the
awareness of nurses concerning the importance of
early identification of cardiac arrest which will affect
the child outcome and maximize rate of survival and
recovery (10).
A prompt activation of emergency response
system will lead to the punctual arrival of Code team.
Ideally, Code team should arrive to the Code location
within 3 minutes to permit early interventions. The
time needed for Code team to arrive to the scene
varies among health institutions and can take up to 6
minutes (18). Such delay could reflect the multistep
process required to activate the team, therefore ward
nurses must be trained and practice the activation of
emergency response system. It was shown from this
study that there were a significant differences before
and after the program implementation in each session
of activation of emergency response system items
[first session: Z=3.659/ p <0.001, second session:
Z=2.309/ p =0.021, third session: Z=2.333 / p
=0.020]. This might be explained in the light of
nurses understanding of the importance of the prompt
activation of the emergency response system, where
delaying in this will cause hindrance of essential
interventions for patient survival such as intubating

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two sessions before and after the implementation of

Code Blue training program as shown in table (IV)
and figure (2), where the significant differences were
demonstrated between the first and second sessions,
as well as between the second and third sessions in a
two weeks interval [(before Z=4.114 p <0.001, after
Z=3.511 p <0.001), (before Z= 3.966 p <0.001, after
Z= 3.542 p <0.001) respectively]. This was parallel
with other authors who stated that skills in Code Blue
are liable to decline as early as two weeks after
training. However, sufficient skills can be achieved
and maintained by frequent training (26-27).

4.

5.

6.

7.
Conclusion
It is concluded from the present study that
application of frequent Code Blue training program
enhances the performance of the pediatric nurses.
This is evidenced by the statistical significant
differences in nurses performance before and after
each session. The increasing enhancement in nurses
performance with frequent training is demonstrated
by the significant differences in nurses performance
between the first and second session and between the
second and third session.

8.

9.

10.

11.

Recommendations
It is recommended from this study that
pediatric nurses should attend Code Blue training
programs frequently (every 2 weeks) and workshops
to promote skills retention.
Further studies
Further studies should be conducted to
explore nurses knowledge and skills during real
Code Blue events so weak points are discovered and
reinforced during training.
Limitations
Circumstances of emergency leave, sick off and
vacations of pediatric nurses at the time of the study
has contributed to the small sample size.

12.

13.

14.
15.

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