Improving Pediatric Nurses' Knowledge, Accuracy, and Confidence Through Code Documentation Simulation

Published:April 19, 2017DOI:


      • Simulation increases pediatric nurses' accuracy in code documentation.
      • Simulation increases pediatric nurses' knowledge in code documentation.
      • Pediatric nurses' confidence in code documentation increased after simulation.



      Simulation is a successful method to enhance learning, especially how to handle infrequent high-risk events, such as patient codes. However, no studies were found that examined methods for educating nurses in code documentation. The purpose of this study was to evaluate the impact of simulation on nurses' knowledge, confidence, and accuracy of code documentation.


      A one-group pre- and posttest quasi-experimental design was used. Nurses completed a knowledge test and confidence survey before and after participating in two code simulations. Accuracy in documenting the simulated code events was also evaluated. The impact of the simulations on code documentation knowledge pre- and postsession and on the accuracy of code documentation for the two simulations per session was determined by paired-sample t-test and the impact on confidence pre- and postsession was determined by Wilcoxon signed-rank test.


      Forty-eight pediatric acute care nurses from three units participated in nine simulation sessions. There was a statistically significant increase in knowledge test scores from presimulation (M = 3.45, SD = 1.46) to postsimulation (M = 5.68, SD = 0.73) (t[47] = 9.47, p < .001 [one tailed]). Documentation accuracy improved from the first simulation (M = 4.59, SD = 1.63) to the second simulation (M = 6.36, SD = 1.66) (t[43] = 8.33, p < .001). A statistically significant increase in confidence was found following participation in the simulation session (z = –6.206, p < .0001) with a large effect size (r = 0.64). The median confidence level also increased from presimulation (Mdn = a little confident) to postsimulation (Mdn = somewhat confident).


      Simulation can be used to increase nurses' knowledge, confidence, and accuracy with code documentation.

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