DNP 610 Module 3 Mock Code OSCE Reflection Example

Four Minutes Without a Shock: A Reflection on Leading My First Mock Code

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 610: Principles of Advanced Emergency Nursing I

Instructor Name

Month Day, Year

Four Minutes Without a Shock: A Reflection on Leading My First Mock Code

Description

In the OSCE, I was the team leader for a simulated 58-year-old man with crushing chest pain. His ECG showed ST elevation in the inferior leads. Within three minutes of my initial assessment, he became unresponsive and the monitor showed ventricular fibrillation. Our team of four began compressions, and I called for a shock, which was delivered within about a minute. After two minutes of CPR, the rhythm was still ventricular fibrillation, but nearly four minutes passed before the second shock because I was focused on obtaining intravenous access and ordering epinephrine. I called for "epi," but no one repeated the order, and when I asked later, it had not been given. The patient achieved return of spontaneous circulation after the third shock, and I activated the cardiac catheterization team.

Feelings

When the rhythm changed, I felt a rush of adrenaline and a moment of tunnel vision. As an emergency nurse, I have done compressions and given medications in many codes, but always following someone else's lead. Being the person everyone looked to was different. When the facilitator pointed out the delay in the debrief, I felt embarrassed, because I know the rhythm check sequence well.

Evaluation

Several things went well. I recognized the STEMI quickly, the first shock was fast, compressions were of good quality, and I remembered to activate the catheterization lab after return of circulation.

Two things went poorly. First, the delay before the second shock. Current resuscitation guidelines emphasize minimizing interruptions in compressions and providing defibrillation promptly for shockable rhythms, with rhythm checks every two minutes (Panchal et al., 2020). I let a secondary task, vascular access, pull my attention away from the cycle. Second, my epinephrine order was not confirmed and not carried out, a communication failure.

Analysis

Both problems came from the same source: I was trying to do tasks instead of leading. A team leader's role is to keep the big picture, including the two-minute clock, rhythm checks and the sequence of drugs and shocks, while delegating hands-on tasks. When I focused on access, no one was tracking time.

The epinephrine error reflects a known weakness in team communication. In closed-loop communication, the leader gives a clear order directed to a specific person, the person repeats it back, and the person confirms when it is done. A study of in situ trauma team training found that closed-loop communication was used rarely, fewer than three times per team on average, even though call-outs were common (Härgestam et al., 2013). My order of "epi" to the room, without a name or a dose, was exactly the kind of call-out that no one takes ownership of.

Conclusion

The simulation showed me that clinical knowledge and leadership in a code are different skills. I knew the algorithm but did not manage the team that carries it out.

Action Plan

For my next code, simulated or real, I will do four things. First, assign a timekeeper at the start and ask that person to call out each two-minute mark. Second, delegate vascular access and medications to named team members rather than doing them myself. Third, give every order by name and dose, such as "Maria, give 1 milligram of epinephrine IV now," and wait for the repeat-back. Fourth, verbalize a brief summary every two minutes so the whole team shares the same picture. I will practice these behaviors in the remaining immersion days and ask a classmate to observe and give feedback.

Reflection using a structured cycle helped me move past embarrassment to specific changes (Gibbs, 1988). I expect the four-minute pause to stay with me, and I hope it makes me a better leader.

References

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.

Härgestam, M., Lindkvist, M., Brulin, C., Jacobsson, M., & Hultin, M. (2013). Communication in interdisciplinary teams: Exploring closed-loop communication during in situ trauma team training. BMJ Open, 3(10), e003525. https://doi.org/10.1136/bmjopen-2013-003525

Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O'Neil, B. J., Peberdy, M. A., Rittenberger, J. C., Rodriguez, A. J., Sawyer, K. N., Berg, K. M., Arafeh, J., Benoit, J. L., Chase, M., ... Magid, D. J. (2020). Part 3: Adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16 Suppl. 2), S366-S468. https://doi.org/10.1161/CIR.0000000000000916