The Impact of Using DASH First Element as a Pre-Briefing Tool on Nurse Competency and Learning during Code Blue Simulation: A Mixed-Methods Study
Authors: Villar Ralph C. , Nashwan Abdulqadir J. , Silang John Paul , Hashish Ebtsam Abou , Pugal Kim C. , Mathew Rejo G. , Munirathinam Sathish , Al-Lobaney Nabeel F. , Alikutty Jamsheer P. , Zamora Juan P. , Kappil Azharuddin , Paz Jan Cyril Dela , Abujaber Ahmad 
Published: January 2023

Abstract
Background: Simulation in healthcare is a growing teaching modality that allows undergraduate and graduate nurses to improve their clinical practice, communication skills, critical thinking, and team performance in a real-world clinical setting.
Aim: The aim of the study was to determine if significant associations exist in the groups (control and experimental), the impact on competency performance during a code blue simulation (cardiac arrests in adults), and the learning experiences of nurses when using the 1st element of Debriefing Assessment for Simulation in Healthcare (DASH) as the pre-briefing guide.
Design: This study employed a mixed-methods design for collecting quantitative and qualitative data. The quantitative portion was guided by a quasi-experimental design with a convenient sample of 120 nurses, while to uncover the meaning of the individual’s experience, a qualitative, phenomenological research design was used with a purposeful sample of 15 nurses. We utilized descriptive and inferential statistics for the quantitative data and phenomenological analysis for the qualitative data.
Results: A total of N=120 nurses participated in the study, and 15 nurses from the experimental group were interviewed. There were 60 participants randomly selected for each of the control and experimental groups. The majority of participants in both the control group and the experimental group are males (90.83%). Most of the participants (98.33%) have more than 3 years of nursing experience. Regarding the specialty of nurses in the control group, an equal number were drawn from each of the five nursing specialties. Among the specialties of the nurses in the experimental groups are ED, OPD, CCU, MED-SURG, and PERI-OP. There was a statistically significant difference between the control and experimental groups in competency performance during the Code Blue simulation, p=0.00001. Aside from the age, the years of experience also have a significant effect on the CCEI scores, with p-values of 0.0232 and 0.0239, respectively, in the experimental group. No association was found between gender and specialization to competency performance. Five (5) themes were drawn from this study: (1) setting the tone; (2) reducing stress levels and improving confidence; (3) establishing a safe learning environment; (4) a positive impact on overall perceptions of pre-briefing; and (5) Expectation vs Reality.
Conclusions: Utilizing the 1st element of DASH improves competency performance and learning experience among experienced nurses in code blue simulation. Regardless of experience and specialization, nurses who participated in pre-briefing have better CCEI scores. Furthermore, the impact on the overall perception about pre-briefing promotes learning and engagement among experienced nurses. Despite establishing fiction contract and a safe learning environment, experienced nurses will still have anxiety, stress, and dissatisfaction in the realism of simulation.