Nurses’ Perceptions of Teamwork in Code Blue Teams at Urban Hospitals in West Java, Indonesia

Abstract

Background: Effective Code Blue systems are essential for improving survival outcomes following in-hospital cardiac arrest. Success depends not only on individual clinical skills but also on coordinated teamwork, communication, and organizational support. Limited evidence exists regarding nurses’ perceptions of Code Blue performance in Indonesian hospital settings. Methods: This mixed-methods study investigated nurses’ perceptions of teamwork in Code Blue teams in urban hospitals in West Java, Indonesia. A total of 106 nurses completed a structured questionnaire that measured perceptions of procedural understanding, activation readiness, role clarity, and training adequacy. Quantitative data were analyzed descriptively, and qualitative data from open-ended responses were examined using thematic analysis supported by NVivo. Results: Quantitative findings revealed high levels of perceived readiness: 96.2% of respondents reported knowing how to activate Code Blue, 88.7% had received adequate resuscitation training, and over 85% agreed or strongly agreed that they understood team roles and Code Blue procedures. However, qualitative analysis identified four central themes reflecting systemic challenges: (1) limited equipment and resource availability, (2) inconsistent access to standardized and simulation-based training, (3) communication and coordination barriers during emergencies, and (4) positive teamwork experiences and professional development through Code Blue involvement. These findings indicate a discrepancy between strong perceived individual readiness and insufficient organizational support infrastructures. Conclusion: Nurses expressed confidence in participating in Code Blue responses; however, operational limitations hinder optimal performance. Strengthening Code Blue implementation requires system-level interventions including dedicated response teams, routine simulation training, structured communication protocols, resource reliability, and performance monitoring. Enhancing these components is essential to translating perceived readiness into improved patient outcomes and safety.