Running a Code

Background Scenario: COVID-19 Code Blue (PEA) Setting: Inpatient unit at a rural hospital: suspected COVID-19

Case Summary: 

A middle-aged (54 yrs) male, George Doulle, arrived in the Emergency Department of a rural hospital for shortness of breath, non-productive cough, decreased appetite, and fever.  He has a past medical history of smoking (35 packs per year) and hypertension.  He is awaiting an assessment from the ER nurse and physician.

Target Learners: Undergraduate students in a medical-surgical nursing course and new graduate nurses

Overall Goal: Expose students to decision-making and team communication around participating in a cardiac arrest code during COVID-19.  

Keywords: CPR, Cardiac dysrhythmia, IPE
 Learning Outcomes


Learning Outcomes

  1. Conducts a focused respiratory assessment when an individual exhibits respiratory symptoms to prioritize the next steps in care.

  2. Communicates relevant priority information to the healthcare team to enhance patient outcomes.

  3. Anticipate modifications required for the care of a patient suspected of COVID-19 based on best practice guidelines.

  4. Determines appropriate PPE for the current clinical situation to ensure personal safety and adherence to principles of control and prevention.

  5. Communicates therapeutically with the patient in an urgent situation to decrease anxiety and promote collaboration with care.

  6. Perform critical interventions in response to assessment findings to prevent further deterioration in clinical status.
Self Assessment Rubric


Self-Assessment Rubric

  The use of this customized learning outcomes rubric, based on self-regulated learning (SRL) theory, allows student self-assessment of the game content and targeted learning outcomes.  Each rubric also describes competency indicators which levelled from the novice to competent learner. Below each learning outcome, users can provide additional comments/reflections/rationale to support scoring. The self-assessments rubric can be used to:
  1. Assess success on preparation for the simulation
  2. Assess performance during the simulation
  3. Guide the post-simulation debriefing in order to identification remedial learning requirements.
Further, the rubric can be used by the simulation facilitator for evaluation purposes or by examining the difference between instructor assessment scores and students’ self-assessment of the understanding of course criteria.
For the Running a Code Learning Outcome Assessment Rubric (word document) – click here

For the Running a Code Learning Outcome Assessment Rubric (pdf) – click here
Game Link

  English Game LinkClick here
  1. The game works best using Google Chrome or Firefox.  The game does not have full functionality when using your cell phone.
  2. You will be shown a video of an interaction between a nurse and a patient, their family and/or other medical staff.
  3. Following each video, you will be asked to select the most appropriate response.
  4. Please note that sound is required to fully understand the interactions within the video.
  5. It is preferred you use Google Chrome or Firefox to maintain optimal audio/visual output.
  6. The game will take approximately 20-30 minutes to complete.
  7. You may complete the virtual simulation game as many times as you like.
Virtual Debrief

The Can-Sim Virtual Simulation Games are an online resource that can be used as either presimulation preparation, stand-alone games, or as a teaching resource in or outside of the classroom. According to The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Simulation Practice (2016), debriefing is a critical aspect of the simulation experience. Debriefing after simulation provides the opportunity for self-assessment and peer evaluation by giving feedback to others. Therefore, it is important that after any simulation, a debriefing should take place. Options for debriefing a virtual simulation game debriefing include:

  1. Embedded feedback debrief: CAN-Sim Virtual Simulation Games (VSG) are designed to provide the player with immediate feedback to selected responses in the form of an Embedded Debrief. Aligned with the game’s learning outcomes, the player is required to answer a series of multiple-choice clinical decisions key points during the game. Upon selecting a response, the player will be shown a video clip portraying the outcome of their chosen response with a written rationale on why their decision was either correct or incorrect. Correct responses will advance the game to the next video and corresponding decision point. 

  2. Self-debrief: Use the provided game-specific Learning Outcomes Assessment Rubric to reflect on perceived self-competence specific to game learning outcomes. It is recommended that completion of the Learning Outcomes Assessment Rubric should be done before and after playing the virtual simulation game. Using the Learning Outcomes Assessment Rubric, reflect on areas of perceived competence and areas needing further improvement. We have provided suggested reading resources to support further learning. 

  3. In-person debrief: This form of debriefing involves a traditional face-to-face debrief with a facilitator. This debrief can be performed in the classroom or lab setting. 

  4. Synchronous online debrief: This involves an online debrief immediately following gameplay guided by a simulation facilitator using a video-conference software (ie. Zoom, Adobe Connect). Similar to an In-person Debrief, the synchronous online debrief uses an online platform.
  5. Asynchronous online debrief – This asynchronous involves a debrief using a discussion board platform where participants post responses to reflective debriefing questions. Other participants and facilitators then respond to reflective postings.


Reflective Questions

Reflective Questions

  1. During COVID-19, best practice guidelines have been adapted to require healthcare providers to pause and consider the potential outcomes of the resuscitation attempt prior to initiating a code. What are your thoughts? Consider ethical, legal, and professional implications?

  2. Family presence during resuscitation has significant positive impacts on grieving and coping as supported by research. In response, it is now commonly integrated into policy and practice. Do you think family presence during resuscitation should continue during a pandemic?

  3. During intubation, you notice the resident remove their face shield prior to intubation as they state they cannot clearly visualize the airway, thus making intubation difficult. How would you respond in this situation?

  4. During a code, personnel are restricted. What challenges should this nurse and healthcare team anticipate with this practice?

  5. You are assigned to initiate the intravenous. You cannot palpate any vein using gloves. As obtaining vascular access is essential in this emergent situation, the physician tells the nurse to remove their gloves and palpate the antecubital vein. How should the nurse respond?



Canadian Heart and Stroke Foundation (2020).  Updated CPR algorithms in COVID-19 Patients.  For document, click here

Driggin, E., Madhavan, M. V., Bikdeli, B., Chuich, T., Laracy, J., Biondi-Zoccai, G., … & Brodie, D. (2020). Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. Journal of the American College of Cardiology75(18), 2352-2371.

NHS Improvement – SBAR Communication Tool.  For document, click here

TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety.  For document, click here

Public Health Ontario (2020).  Universal Mask Use in Health Care Settings and Retirement Homes.  For document, click here

Public Health Ontario (2020).  IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID‑19.  For document, click here

Ramzy, M., Montrief, T., Gottlieb, M., Brady, W. J., Singh, M., & Long, B. (2020). COVID-19 cardiac arrest management: A review for emergency clinicians. The American Journal of Emergency Medicine.




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