Abstract

Introduction/Background:

Intensive care (ICU) nurses are routinely exposed to traumatic events, such as code blue resuscitations, which contribute to increased stress, burnout, and lower perceived quality of care. A gap analysis of MICU charge nurses and team leaders found that 87% reported that post-code debriefing did not occur and that 40% experienced emotional distress, indicating a need for a brief, structured, emotionally safe reflection process.

Methodology: Using a pre-post design, the CARE tool, adapted from the DISCERN and Post-Code Pause frameworks and validated by three institutional experts, was introduced into practice over six weeks. Nurse champions completed pre-surveys (demographics, Brief COPE, Post-Code Stress, and Nurse Perception of Quality of Care), attended education sessions led by the DNP student, and completed post-surveys and a delayed CDC evaluation after implementation.

Results/Evaluation Plan: CARE's primary goals were not met. Although no CARE debriefings were held, two informal debriefings were conducted, but neither met CARE's criteria. Sixteen champions completed baseline surveys, though only ten completed the post-survey, and mismatched identifier data could not be paired. While the results are descriptive rather than conclusive, the following trends were observed: problem-focused coping declined, avoidant coping increased, and stress and perception scores moved in different directions. Half of the eight CDC evaluations cited simply never getting the chance to debrief; the rest cited a lack of time and a desire for more training.

Conclusion/Significance and Implications for Practice:

Compliance was a major barrier, preventing a full evaluation of CARE's effectiveness. Other limitations included lack of a physician champion, stakeholder support, and a short timeframe. Further work should expand education, identify physician champions, adjust timelines, and improve tracking methods, while maintaining blame-free debriefings distinct from formal case review.

LLU Discipline

Nursing

School

School of Nursing

First Advisor

Kimberly Dunker

Second Advisor

Toby Richards

Third Advisor

Salem Dehom

Degree Name

Doctor of Nursing Practice (DNP)

Year Degree Awarded

2026

Date (Title Page)

8-30-2026

Language

English

Type

Doctoral Project

Page Count

138 p., 1p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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