The aim of BERT is to de-escalate the potentially violent or harmful situations when called upon

1. Behavioral Emergent Response
Team Capstone Project Writing
 Your name
 College
 date

2. Objectives
 The aim of BERT is to de-escalate the
potentially violent or harmful situations when
called upon

3. Key Terms
 Behavioral emergency- It occurs when behavior of an individual is out of control and
the individual becomes a danger to everybody (Johnson et al, 2011).
 Nursing- It is the promotion, protection and optimization of abilities and health, prevention
of injury and illness and alleviation of suffering from people by diagnosing and treating,
and advocacy of care of families, individuals, populations and communities (ANA, n.d).
 Teamwork- It is work done but many associated people with each individual a part but all
strive for efficiency of the whole by subordinating their personal prominence

4. Overview
 Forming the rapid response team to de-escalate potentially violent and volatile
situations proactively in non-psychiatric units in hospitals allows faster and
earlier management and treatment of these behavioral issues in such patients.
The hospitals may consider coming up with the Behavioral Emergency
Response Team (BERT) to assist the medical staff in hospitals in de-escalating
patients exhibiting potentially violent behaviors proactively
 Behavioral health is a hot topic everywhere and that’s the reason it was chosen
for this project. It makes national news when something catastrophic happens.
With healthcare changing and improving every day, here lies the chance for
improving behavioral health. Behavioral emergencies put patients and staff in
grave danger and potentially cost institutions thousands of dollars in workers
compensation.

5. Background
 One in four American adults suffers from a diagnosable mental disorder in a given year,
with 1 in 17 suffering from serious mental illness (National Institute of Mental Health,
2010).
 Occupational Safety and Health Administration’s (OSHA, 2004) workplace violence
prevention guidelines reveal health care workers face a significant risk of job-related
violence.
 other nurses in other areas in the hospital where they may be dealing with an escalating
patient do not have Crisis Prevention Intervention training and have to maintain their
safety and the safety of the patient. Nurses in non-psychiatric settings are expected to
provide care to patients with mental health and behavioral issues.
 By lacking BERT in a hospital set up, patients with psychiatric behaviours poses danger
to themselves, other patients and the hospital staffs

6. Background: Purpose
 PICO
 Among the adult inpatient hospital population, does having a Behavioral
Emergent Response Team (compared to not having one) decrease the risks of
injuries to patient and or staff?

7. Background: Theoretical Model
 The paper used Lewin’s Change Management theory as basis for building the foundation
for the project
 The model has three stages (unfreeze-change-refreeze). Unfreeze stage is the point at
which the hospital will need to introduce BERT. Change will be the point the health
workers in the hospital will start embracing the new change f using BERT. Refreezing is
the stage where the BERT will be institutionalized into the hospital set up.

8. Review of the Literature:
Methodology
– search started with the most comprehensive database, that is Cumulative
Index to Nursing and Allied Health (CININAH)
– A search of literature by using the database of CINAHL to look for
descriptions of BERT terms produced only an article by Lester (2000).
– The search then continued to search engines such as British Nursing
Index, MEDLINE. Moreover PubMed and NCBI were other major search
engines which assisted some of the relevant articles for the capstone
project
– In data extraction, the factors considered included the following; study
design, performing year, publication years, and characteristics of the
population of the study, the geographical setting, variance and risk
estimates and assessment procedures.
– The dissertation used different sources in the search strategy which
include electronic databases, conference abstracts, hand searching, and
internet

9. Literature Review
Study Comorbidities to Mental
Illness
Hospitalization in Non-
psychiatric Units
Negative attitude and
discrimination to the
mentally ill
Reduces risks of injury to
staff
Zolnierek (2009)    ×
Ross & Goldner (2009) × ×  ×
. Landers & Bonner (2007) ×  × ×
Loucks et al, 2010 ×  × 
Pestka et al, 2012 × × × 
Karshmer & Hales, 1997 × × × 

10. Review of the Literature:
Summary and Conclusion
 The BERT team in hospitals offered solution to the long-standing problem of
the nurses engaged in direct care of patients, and created a valuable resource
for the safety of both staff and patients
 BERT has also contributed to the satisfaction of nurses with their work
 Most studies commented on the nurses knowing that their assistance request
in management of emergent behavioral situations is addressed.
 Moreover, the psychiatry nurses reported satisfaction from the reports of
affirmation of their psychiatry skills by their peers from no psychiatry following
their interventions in situations of behavioral patients
 Another strength of BERT is the broader collaborative efforts it creates
between psychiatry and other medical areas in all disciplines

11. Review of the Literature:
Summary and Conclusion
 Limitations
 The biggest challenge to BERT is how to ensure that a physician responders
and psychiatric nurse are readily available when requested.
 The role of response demand flexibility of the team members to be able to
reach the location of the behavioural emergent need quickly.
 Another challenge is the anxiety the BERT team members have about the
situations they are likely to encounter when called upon.
 Lack consistency and not confident

12. Clinical Relevance
 BERT is relevant and can be applied in hospitals to avert potential
harm, violence and keep the staff and patients safe. An example of
clinical application of BERT is on the medical pulmonary unit since the
unit often has high incidences of comorbid issues of psychiatry (Pestka
et al, 2012).
 Other relevant medical units that BERT can be applied include critical
care and women’s health, medical-surgical units, and the emergency
departments.

13. Recommendations
 The BERT team should be structured in the hierarchy and with better
communication lines clearly outlined. The communication from the medical
unit, to the Behavioral Health service leader, to BERT leader and to the team
members.
 The BERT team should be readily available when called upon in cases of
behavioral emergent issues arise.
 The team members should be qualified, have the proper education and
understand their roles to avoid lack of confidence among team members.
 The BERT team should also have an all-around team working in shifts, both at
night and daytime, to ensure their availability anytime when needed.

14. Conclusion
 In conclusion, BERT is a resource for meeting the growing behavioral
emergencies management and the increasing rate of reported patients’
violence. The paper examined whether having BERT compared to not having
one decreases the risks of injuries to the staff and patients among the adult
inpatient hospital population.
 This research can be further be strengthened by widening the area of research
like many hospitals instead of one, and having large number of samples
 The findings should be availed to relevant journals for publication since there is
limited research in this field. Moreover, it should be disseminated to nurses and
in all medical colleges to understand and embrace BERT. Established
hospitals need to embrace this report and execute some of the suggestions
offered.

15. Thank you
 Questions?

16. References
 ANA. (n.d).What is Nursing? Retrieved March 18, 2015, from http://www.nursingworld.org/EspeciallyForYou/What-is-
Nursing
 Johnson, S., Crittenden, B., Marlier, T., & Action Training Systems. (2011). Behavioral emergencies. United States:
Action Training Systems.
 Karshmer, J. F., & Hales, A. (1997). Role of the psychiatric clinical nurse specialist in the emergency department. Clini-
cal Nurse Specialist, 11, 264-268.
 Landers, J., & Bonner, A. (2007). Evaluating and managing delirium, dementia, and depression in older adults hospital-
ized with otorhinolaryngic conditions. ORL Head & Neck Nursing, 25(3), 14-25.
 Loucks, J., Rutledge, D.N., Hatch, B., & Morrison, V. (2010). Rapid response team for behavioral emergencies. Journal
of the American Psychiatric Nurses Association, 16(2), 93-100.
 Pestka, E. L., Hatteberg, D. A., Larson, L. A., Zwygart, A. M., Cox, D. L., & Borgen, E. E. J. (January 01, 2012).
Enhancing safety in behavioral emergency situations. Medsurg Nursing : Official Journal of the Academy of Medical-
Surgical Nurses, 21, 6.)
 Ross, C. A., & Goldner, E. M. (2009). Stigma, negative attitudes and discrimination towards mental illness with the
nursing profession: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 16, 558-567.
 Shirey, M. R. (January 01, 2013). Lewin's Theory of Planned Change as a strategic resource. The Journal of Nursing
Administration, 43, 2, 69-72.
 Zolnierek, C. D. (2009). Non-psychiatric hospitalization of people with mental illness: Systematic review. Journal of
Advanced Nursing, 65, 1570-1583.