by Herman Bailey | Apr 16, 2023 | Essays |
Introduction
Coca cola is a household name worldwide. Together, the companies have taken over and control at least 75% of the global soft drink market. Their success can be partly attributed to the overall operational plans employed by the company to produce and market their products. The company has decided to build a global brand by manufacturing a unique soft drink that gives cola its flavoring and the concentrate in a syrup form to bottlers throughout the world. This unique aspect in the process of production has ensured that competitors and rivals have been unable to replicate the recipe. Coca cola makes it profits charge the bottlers a premium price for the syrup; they then invest part of the proceeds in advertising and marketing which has enabled the company to maintain brand awareness.
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The bottlers are actually responsible for producing and distributing the actual cola. They add carbonated water to the syrup, package the resulting drink and distribute it to the vending machines, restaurants, supermarkets and other retail outlets. The bottlers leave all the advertising to the coca cola company thus ensuring that the brand maintains uniformity and uniquely appeals to the consumer market. In addition, the bottlers must sign an exclusive agreement that prohibits them from distributing competing cola brands. The operational plans set forth by the company to ensure that the process itself works, include selecting appropriate goals and courses of action, which is one of the main functions of management. The decisions about what goals to pursue, what actions to take and how to use resources to achieve the set goals is determined by the executive of the coca cola company then forward to the bottlers.
Processes and Functions of the Organization
Production: unlike majority of the soft drink producers the coca cola company has maintained a hold on the syrup production. To cut costs, competitors have often opted to share the recipe for their drinks with the bottler. This process often reduces the cost of production and distribution of the same syrup. (Kahraman 2005) cites that this process often produces a problem that could cripple the company’s attempts to grow internationally. Sharing the recipe and allowing subsidiaries to engage in the entire process of production reduces costs but also encourages inconsistency as the bottlers can make changes. Despite the stiffer competition in the soft drink industry, the efficiency of the production process has allowed coca cola to not only survive rapid growth but also maintain a strong number one position. The process has ensured high quality products with lower costs of production.
Advertising: advertisement and marketing is centered on the executive company again. For the bottlers this is an easy and profitable process. For the company, this ensures branding where customers all over the world can easily identify with the brand. This is one aspect of the company that rivals have found hard to duplicate. (Rosenberg 2005) this strategy and process of advertisement and marketing for the company to strengthen the competitive position while still ensuring that the subsidiaries preserve their independence. By aligning and coordinating company activities in different activities in different countries, the company can build sustainable competitive advantage in several different ways. The knowledge gained in marketing a product in the European market for example can be used to introduce the market and introduce the same product in African and American markets.
Distribution: a coke distributor and bottler cannot bottle any other cola drink. The agreement with the company prohibits such action. If a bottler would like to diversify into the other cola drinks they must give up the advantage of being part of the coca cola brand. This process has two major advantages for the company. First, it forces the bottlers to enter into exclusive agreements which create a barrier to entry into the industry. Every potential competitor and rival that may want to produce and distribute a new cola product must create their own production network. This is the most difficult part in bringing their soft drink into the market. The highest cost and investment is in ensuring that the drink leaves the market and reaches the consumer easily and within good time. The process protects coca cola’s valuable asset, its distribution network. Second, the amount spent in advertising in the past decade (in 2011 the company spent more than $500 million) has helped company ensure that consumers are most likely to buy a coke rather than a less known cola.
Output processes at the beginning of the input process, the company managers establish the standards which should be adhered to. These targets they will use to evaluate future performance of the entire organization and sometimes part of the organization. The standards set by the coke managers often measure efficiency and quality of the final product. (Cantwell 2014) states that the output process cannot focus on one aspect only. The managers need to be aware of the efficiency of the process and stages that may require improvement and focus, while at the same time improving and maintaining the high quality of the products.
Once managers have established the standards, they move on to measuring the actual output. This is done in two stages that is, the actual outputs that result from the processes of the company. Secondly, the managers measure the process itself again to prove consistency and efficiency. Once the results have been established, they are compared with the standards that they had set previously. Outputs are often very easy to measure because they are tangible. The flow from the raw materials to the final product can easily be measured and compared to the expected output. If the output is much lower than what was set by the executives, it is possible to take corrective action. On the other hand if the outputs and efficiency are too high, it follows that the standards set for the process were much too low. Again the corrective action can be taken, where managers can consequently increase the expected standard to improve performance of the company. According to (Sen 2008) the main reason for poor performance in the company might be hard to quantify. Changes in the environment such as emergence of a new competitor for example in the case of the coke, Cotts in the early 1990’s might be the source of the problem.
Steps In Evaluating The Output Process Plans For Marketing And Development
The plan is a simple pre-emptive attack on the industry rivals. For the past decade, there has been an increase in soft drink producers who are successfully taking over portions of the coke market. The pre-emptive strategy involves moving first to secure an advantageous position. Rivals will then be foreclosed and discouraged from duplicating. There are several steps that will go into the plan and these are:
Step 1: expand production capacity ahead of the market demand. Majority of the coke rivals often expand production capacity when the demand increases. The expansion in anticipation of growing economies especially in Asian and African markets will discourage rivals from following suit. Rivals such as Cotts who may have taken over part of the market in Europe and especially American markets are unable to duplicate the same capacity of production. When the demand grows which is predicted to do so in the next five years with the economies of these continents showing significant growth, the coke company will be in place to take advantage of the same with its own plants filling in the capacity.
Step 2: ensure protection of the raw material sources for high quality products. The coke company has enjoyed exclusivity following the uniqueness of its recipe which has been difficult to duplicate despite several efforts by other companies. Rivals of the company have been relegated to struggling for second best positions. Protection of these raw materials is vital to ensure the number one position.
Step 3: build a strong brand through the psychological images in advertisements and marketing campaigns such as Fanta, bring out the fun and share a coke, the most successful of the campaigns by the company.
The idea is not to totally block rivals as that would be impossible but rather to ensure that the coke company enjoys a “prime” position.
Objectives Of The Company
In the current plan of the company, strategic and financial objectives carry top priority because they enhance key outcomes. The tradeoffs must be made between actions to boost short term financial performance and efforts to build a stronger business position for the long term. The company requires managers who have strong financial instincts to focus on financial performance without compromising the long term competitive payoff. The risks being taken are especially great because coke remains growth oriented which can also be said of its competitors. The objectives are as follows:
To be a low cost producer of the highest quality products that provides the nest value to the customers.
To continue the expansion of Coke linking key markets around the world by merging network, providing service to additional countries, increasing the number of distribution centers, expanding the diversity of products.
To remain the most competitive enterprise in the refreshment industry with quality production of cola, outperforming the rivals in each aspect and remaining number one with the largest market share in the industry.
Systems To Achieve The Objectives
Lowering cost: with the global economy having undergone a drastic downturn, consumers are more and more concerned with the cost of everything they spend on. Items such as beverages and cola drinks are continuously being considered as a luxury. Based on this, the coke company has chosen to become the leading low cost producer. On the other hand, focus on low cost should not come at the detriment of the strongest advantage for coke that is quality beverages. The company hopes to establish a system of interrelationships with suppliers who will continue ensuring that the company receives high quality material at affordable costs. In this case, suppliers will be treated in much the same way as distributors, locking and contracting them to the coke company. This way they enjoy the benefit of a constant market while the company ensures that rivals do not attempt to increase the cost of raw materials.
Expansion: critics such as (Hoang 2007) have grown concerned with the coke company expansion in the past decade. However, each of the plants and distribution centers that have been opened has proven quite beneficial in maintaining the company’s top position in the market. New markets such as Asia and Africa are relatively unexplored. The company expects to open distribution channels and increase the distribution of cola in these markets. However, this will be done with great caution being directed to improving the efficiency of the machinery and equipment in the local bottling plants.
Competitive advantage: to maintain the topmost position in the industry and outperform rivals, focus will be given on developing friendly and easy to associate with campaigns. The company already maintains a strong brand name. One in every five households globally enjoys a cola drink from the coke company on a daily basis. This gives a strong advantage and ensures that strong relationships are maintained with consumers.
Monitoring And Control
The company established and continues to maintain and measure performance at each stage during the input process. Feed forward control analyses each stage in the process of transforming inputs into finished goods and services. Through the feed forward control, the managers can anticipate the problems before they arise. This will be done by ensuring that suppliers maintain the strong and stringiest qualities set forth by the company. With these stringent measures, the company will control the quality of the inputs from the suppliers and thus avoid potential problems during the conversion process. (Burrow 2002) says that the feed forward system provides managers with timely information about changes in the tasks and general environments that may impact the organization later on.
At the conversion stage, concurrent control will be used to give immediate feedback on how efficiently the inputs are being transformed to outputs. Workers and employees will be expected to monitor closely the quality of products being produced in each step. Individual workers will be allowed to push a button stopping the process of conversion should they come across a quality problem. This ensures that the final product will be more reliable.
Finally at the output stage the managers will make use of feedback control to get information from customers. A system will be put in place to monitor the returns from various subsidiaries and also follow up of customer complaints. This system will measure and correlate the decrease in sales of various products and alert managers of any changes in the tastes of the markets they control so that they can increase or reduce the production of specific products. This is the corrective action expected from the information gathered in the market.
Monitoring Quality Standards In The Company
At the forefront of the drive to improve product quality is a technique known as total quality management. The following systems have been put in place to ensure high quality standards:
Breaking down barriers between functions: successful implementation of this requires substantial cooperation between the different functions of an organization. Marketing managers have to cooperate with manufacturing so that customer needs are acted upon.
Working closely with the suppliers: to decrease product defects, managers need to work closely with the suppliers to improve quality.
Identify defects and trace them to their source: a major source of product systems is the operating system. The TQM system will allow the managers to identify defects, find out why they occurred and make corrections so that they do not occur again.
Culture Of Quality
Coke has established a goal of becoming the premier institution in the 21st century. To achieve this, the company has started to make use of the TQM to increase responsiveness to customers, recognizing that ultimately its customer base and customer loyalty determine the future success of the company. Coke has identified the factors that dissatisfy customers. This means that the company is taking customer complaints seriously at every step and finding ways to respond the same. (Kottler 2006 ) states that the former culture where customer complaints were generally ignored because the company enjoyed a strong monopoly are gone, managers have begun examining how they respond to each customer complaints and request.
Improvements On The Process Of Quality Control
Managers could be tasked with the responsibility of reducing the complexity of the work process. Employees are expected to find innovative ways to meet the customer needs in a much more speedily manner. This means that the company must also invested heavily in training and development of its own employees to ensure they have the confidence and skills they need to handle customers.
Healthy and safety assurance
Risk assessment
Hazard identification: the main hazards in the company are chemical exposure during the production of the syrup, accidents while operating heavy machinery within the plants. Exposure to broken bottles and glass.
Personnel at risk: majority of the personnel at risk include employees who world on the factory floor, supervisors and managers who are constantly establishing the
Action Taken For Prevention
As with any manufacturing plant, coke is expected to run a completely safe environment for workers. The workers exposed to chemicals during the e process of manufacture are given suits that prevent exposure. They are further extensively trainee in the handling of the chemicals. Coke is also the one company that runs a full emergency unit including on site paramedics within the plant. For extreme cases, the workers have a plan that allows injured or exposed employees to be airlifted to the hospital.
Only qualified personnel are allowed to handle the heavy machinery and this is only after they have demonstrated skills that they are able to handle the same. Further, the manufacturing and bottling plants include emergency buttons in segments of the floor. In case of an emergency, the button is pressed and the assembly line stops completely allowing for workers to get to safety.
It is important to note that few if any injuries are recorded by coca cola. In fact, as (Frazelle 2002) shows the company enjoys a high ranking status as one of the safest. Regulations and risk assessments are taken quite seriously by management and executives. Whereas some companies may opt to cut corners to curb the costs of safety, coke goes far and beyond what is expected to secure its own workers within the factory and also without the factory.
Review Of Health And Safety
Ensure safety of workers and visitors as well into the factory. Managers of plants are expected to ensure safety of all people within the plant. This means ensuring that each and every individual visiting any of the plants is treated to the same stringent safety measures. They must be properly attired, and properly trained or at least accompanied by an individual who is well trained to handle any emergency on the floor.
All workers are provided with the right information as pertains their work. The company does not just rely on their own training, employees are constantly taken for further training to give them the right skills which they can sue to handle unique situations within the company. These trainings are constantly refreshed with the help of skilled professionals to ensure maximum safety of the employees.
Majority of the companies today have excellent health and safety measures, however, they lack or do not have or allocate enough resources to safety. All coca cola plants are expected to have separate budgets catering to safety. These budgets cannot be compromised for any reason whatsoever. This ensures that the company and plants have enough resources directed towards safety.
References
Burrow, J. (2002). Business Management. Australia, South-Western/Thomson Learning.
Cantwell, J. (2014). Location Of International Business Activities: Integrating Ideas From Research In International Business, Strategic Management And Economic Geography. Basingstoke : Palgrave Macmillan
Frazelle, E. (2002). Supply Chain Strategy The Logistics Of Supply Chain Management. New York, Mcgraw-Hill.
Hoang, P. (2010). Business & Management. Ibid Press.
Kahraman, C. (2005). A Multi-Enterprise View Of Business Activities. Bradford, England, Emerald Group Pub.
Kotler, P., Pfoertsch, W., & Michi, I. (2006). B2b Brand Management. Berlin, Springer.
Rosenberg, M. (2005). In Business: Activities To Bring Business English To Life. Cambridge, Uk, Cambridge University Press.
Sen, M. (2008). Business Management. Jaipur, India, Oxford Book Co
With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.
by Herman Bailey | Apr 16, 2023 | Essays |
Introduction
Socio- emotional development is a discipline that encompasses the experience, management and expression of a child’s emotions and the ability to form rewarding and positive relationships with others (Horvat, 1986). The discipline of socio-emotional development encompasses other inter and intra personal processes. The main characteristics of emotional development include identification and understanding ability of one’s own feelings to read and comprehend accurately the other’s emotional states. Furthermore it does management of strong emotions and its expression in a manner which construct positively, to regulate behavior of another for empathy development of others and to create and maintain relationships. At this point we need to discuss in detail what constitutes socio emotional development in children. This will form the thesis of the discussion.
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According to Hovart (1986), the children first experience, then express and finally perceive emotions before fully understanding it. In the process of learning to recognize, to label, to manage and finally to communicate their own personal emotions and attempt to perceive and understand others’ emotions, children construct skills that help them connect with family, teachers, peers and the community at large. Hovart (1986) further elaborates that these capacities assist children to be skilled in negotiating social interactions which are complete, effectively participate in group activities and relationships and to gain social support benefits which is important to healthy human functioning and development.
According to Hovart (1986), child’s socio- emotional development unfolds in a context which is interpersonal such as that of ongoing positive relationships with nurturing adults who are familiar. It is noted that young children are specifically attuned to emotional and social stimulation. Even new born tend to link stimuli that resemble faces and prefer the voices of their mothers to other women’s voices.
Care giving support which is responsive to the child regulate the emotions of the child and helps in development of a sense responsiveness, predictability and safety in their social environments. Experiences with the members of the family, teachers provide young children with an opportunity to learn about emotional and social relationships through predictable interactions and explorations. Moreover Hovart (1986) observes that working with children in the professional child care settings can assist development of socio- emotional development of toddlers in many ways such as directly interacting with the young children, organizing physical space ,communicating with the child’s family, plan and implementation of the curriculum.
Interaction of a child with adults
Children interaction with the adults forms a regular and frequent part of their daily lives. The interaction gives a healthy socio-emotional development based on a social environment that is supportive created by the adults. Children will first develop the ability to respond both to adults and interact with them through close relationships which are predictable for instance the nurturing adults and the parents inside and outside their homes. In reference to Hovart (1986), children use and construct upon the skills obtained through the close relationships to interact with less adults who are less familiar in their lives. Moreover, through the interaction, the children engage in many different social exchanges such as contact establishment with their relatives and even story telling with their care teachers.
Children relationship with the adults
A close relationship between a child and an adult who provide nurturance consistently strengthen the capacity of children to learn and develop. Similarly, a child’s relationship with the parents, caregivers, family members and their teachers provide social- emotional key concepts. Hovart (1986) points out that these special relationships influences a child’s emerging self sense and understanding of the others. Furthermore, children use adult relationships in many diverse ways. These include; alleviation of distress assistance, reassurance by the adults that they are safe, emotional regulation and for encouragement or social approval.
Hovart (1986) adds that establishment of close relationships with the adults relates to the emotional security of the children, self sense and understanding evolution of the surrounding world.
Child’s interaction with peers
According to Hovart (1986), during early childhood, children interact with others using behaviors considered to be simple such as touching or looking another child. Social interaction of the children increases from repetitive engagement or back and forth routine interactions with their peers to engagement in cooperative activities such as tower of block building together or taking different roles during pretend play.
Hovart (1986) observe that through peer interaction, children explore their own interest in others and get to learn about the social behavior r social interactions. Moreover, peers interaction provide social learning context and solving of problems including social exchange experiences, turn taking, cooperation, and beginning of empathy demonstration. Additionally, peer social interaction allow older children to experiment various roles in different situations and small groups such as relating unfamiliar verses familiar children.
Self identity in relation to others and ability recognition
A child’s Self awareness and of others include response to names, they point at their own body parts when they are asked or name family members. Furthermore, through understanding of people in the social environment, children get to know their roles in the family and the community, become aware of their preferences and characteristics of others (Hovart, 1986).
Understanding of a child that they can make things happen and realizing their abilities form self efficacy of a child (Hovart, 1986). Self efficacy development is exhibited in explanatory behaviors, play or when they act to produce results.
Emotion expression
Children even at their early age express their emotions. They do this through vocalizations, body language and facial expressions. Later in their years, development of their ability to talk and to express themselves helps them get social support. Moreover, temperament play a significant role in emotional expression of the children (Hovart, 1986).expression of negative and positive e emotions amongst children play an important role in social relationships development whereby negative emotions discourage social relationships while positive emotions creates social relations and appeal to partners (Hovart, 1986).
Conclusion
In summary, social emotional development incorporates the child’s ability to initiate secure relationships and maintain them. This is an important development because a child should be able to learn how to approach his or her peers, negotiate problems and issues, take turns and to effectively communicate. After a child has been born, his or her state of unawareness of the surrounding world is imperative. When the child is growing, he/she should explore the surrounding world in order to gauge their emotional and physical development. This process is important and therefore calls the parents and the society to mould the children.
References
Horvat, L. (January 01, 1986). The Role of Pre-School Education and Preparatory Classes in a Bilingual Environment and the Child’s Cognitive and Socio-Emotional Development. Razprave in Gradivo, 18, 121-124.
With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.
by Herman Bailey | Apr 15, 2023 | Essays |
Abstract
The paper examined whether having Behavioral Emergent Response Team (BERT) in a hospital settings, compared to not having one decrease the risks of injuries to patient and or staff among the adult inpatient hospital population. The first introduced the research topic and laid out its overview and background information which conveyed an accurate and broad perspectives on the topic, and a succinct summary of the past research, current application and the importance of the research topic. Different studies analyzed in the paper provided a comprehensive overview of the relevant literature that supports how BERT reduces incidences of potential harm, risks and violence to patients and the staff in the hospital. The paper also identified the strengths and weaknesses and gaps in the body literature. The identified strengths in the literature include boosting of confidence among staff members, reduction of violence or risks in non-psychiatry units in hospitals and increased collaboration among the staff in a hospital. On the other hand, the challenges identify lack of quick response from BERT team in preventing potential harm and inconsistency among the BERT members. The topic is clinically relevant and can be applied in different units in a hospital settings such as emergency, critical, pulmonary, surgical units. Recommendations for application of using BERT in hospital settings include having proper communication channels, BERT is readily available, having qualified staff members and working round the clock.
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Introduction
Behavioral emergencies often take place among the adult in patients when they are potentially harmful to herself/himself or others or is physically aggressive. Despite the fact that they may be very rare, Allen et al (2003) noted that behavioral emergencies are situations of high risk, and, therefore, untrained staff may feel uncomfortable when dealing with these situations or events. The adult patients with the underlying development or psychiatric disorders, those who have side effects of medication, those who have ingested substances are at the highest risk of being violent. Bogert indicated that the triggers of these events could be hospital’s physical environment, change of routine, isolation, hunger, or even pain. The early warning signs of behavioral emergency include yelling, verbal threats or even silence. Moreover, the physical signs may include throwing objects, furrowed brow, crossed arms and pacing.
In events of potential behavioral emergency, the first response is trying de-escalating the situation. The medical professional should speak in calm and quite voice, or even back off and provide personal space to the patient. Similarly, the healthcare professional should try to reduce the discomfort by using rewards or distractions (Delaney, 1994). In an event where de-escalation is unsuccessful, and the patients become violent, the first role of the provider is to be safe by trying to get help and getting away. Therefore, hospitals need to have or need to develop a response team for the violent patients, which may restrain the patient physically in case of emergencies. IHI (2004) asserted that medications can be used in treating medical issues but should not be used for chemical restraint solely.
Overview
Behavior of adult inpatient with psychiatric illness and are hospitalized on the non-behavioral health units according to Jamieson, Ferrell & Rutledge (2008) can be difficult addressing by the staff members. In a hospital set up, they may recognize that responding, assessing and implementing patients care to the individual in a non-behavioral health unit and experiences behavioral health emergency may be outside the scope of the protocol. 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. Jolley et al (2007) pointed out that BERT may comprise of the staff members such as the social workers, RNs, psychiatrists, security staff among others from the behavioral health unit. The staff members in BERT should be experienced in caring for the patients experiencing acute psychiatric disorders and assault behaviors management.
Psychiatric nurses and staff are trained professionals treating many different mental health diagnoses. It is a specialty that often requires de-escalation techniques. All staff working on inpatient psychiatric unit have all had Crisis Prevention Intervention training. They are skilled in specific techniques using little or no restraints to talk down an agitated or escalating patient. Crisis Prevention Intervention training focuses on four stages of escalation: anxiety, defensiveness, acting out and tension reduction.
Psychiatric nurses and staff are trained professionals treating many different mental health diagnoses. It is a specialty that often requires de-escalation techniques. All staff working on inpatient psychiatric unit have all had Crisis Prevention Intervention training. They are skilled in specific techniques using little or no restraints to talk down an agitated or escalating patient. Crisis Prevention Intervention training focuses on four stages of escalation: anxiety, defensiveness, acting out and tension reduction.
However, 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. 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).
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?
Theoretical Framework
The paper used Lewin’s Change Management theory as basis for building the foundation for the project. Change is a common denominator applicable to all organizations regardless of the industry, age or size. World is rapidly changing, and therefore organizations must also quickly change. The change management concept is common in most organizations nowadays but how they manage the change varies enormously depending on the organization’s nature, people involved and the change itself. Kurt Lewin developed on of the cornerstone theories crucial in understanding organization change. This model is also known as Unfreeze-change-refreeze, which refers to a process of change in three stages (Shirey, 2013).
To easily understand Lewin’s theory, the simple example analogy is provided by a cube of ice and what is needed is a cone of ice. To get the cone of ice, the cube of ice is first melted to make it easier for change (unfreeze). The melted ice is then molded into the desired shape of the cone (change) and then solidified while in the desired shape (refreeze). By critically examining change process with stages, the organization is first prepared for what is coming and then plan is made for the transition (Shirey, 2013).
Unfreeze
This is the first stage in the process of change and involves preparation f the organization to understand that change is essential. This can be done by developing messages that are compelling that shows why the current ways of doing things should be changed. The attitudes, values, beliefs and behaviors currently defining an organization should be challenged (Shirey, 2013). For instance, the beliefs that non-psychiatric nurses cannot handle patients showing symptoms of psychiatric disorders must be challenged to incorporate them in the BERT.
Change
From the uncertainty created in the unfreeze stage, the next stage of change is where individuals will start resolving their uncertainties by looking for new and better ways of doing things. They may start believing and acting in ways supporting the new direction. For a change to occur, communication and time are keys to success. People need time to understand the changes better and also to feel being part of the organization (Shirey, 2013). In this case, health workers need to understand how BERT operates, its benefits, who are the members and how it assists in the organization.
Refreeze
After people have embraced new working ways and change has taken shape, the organization can start the refreezing process. Some of the signs of refreezing process include consisted descriptions of jobs, stable chart for the organization among others. This is also the stage where the organization needs to help the organization and the people to institutionalize and internalize the changes (Shirey, 2013). In this case, the nurses will ensure that the introduced changes of alerting BERT in cases of emergencies are used all the time and is incorporated in all units in the hospital.
Background
Nurses working in the non-psychiatric settings are expected to provide care frequently to the patients with issues of behavior management and mental health. According to the National Institute of Mental Health (2010), one in every four adults in America suffer from mental disorders yearly, with one in seventeen having serious mental illness. While reviewing the literature, Zolnierek (2009) observed that several studies suggesting people suffering from mental illness experience increased medical comorbidities that often necessitates hospitalization. Berren et al (1999) in their study indicated that people with mental illnesses tend frequently to receive care in acute/urgent care settings hat individuals without mental illness.
Several factors influence the abilities of the nurses to provide interventions to patients with issues of mental health effectively in non-psychiatric inpatient settings. Several studies have cited two factors that is presence of the negative attitude to the mental ill patients along with the perceptions of the nurses of lack of confidence and competence in identification and management of behavioral symptoms (Brinn, 2000; Ross & Goldner, 2009; Reed & Fitzgerald, 2005; Zolnierek, 2009; Sharrock & Happell, 2006). In addition to the fear of the nurses and lack of confidence, mental ill patients are often perceived as dangerous and unpredictable (Ross & Goldner, 2009).
Violence at workplace is a great matter of concern. The workplace prevention guideline for violence as outlined by Occupational Safety and Health Administration (OSHA) (2004) indicate that the healthcare workers face job-related violence risks. Guidelines of OSHA state that “lack of training of staff in managing and recognizing escalating assaultive and hostile behaviors” places the workers of healthcare at a greater risk for assaults that are related to work (OSHA, 2004p. 7). In defining workplace violence, American Psychiatric Nurses Association (APNA) (APNA, 2008) include verbal, sexual and physical threats and abuse from the peers and the consumers. APNA then recommends establishment of comprehensive programs by the health organizations for prevention and management of workplace violence.
According to APNA (2008) and Roche et al (2009), the actual statistics of the number of injuries of health care workers related to patients’ assaults is unknown. The cases of violence against the healthcare workers may be underreported because of several reasons including the perception that it is part of their job. Roche et al (2009), pointed out that beyond the immediate possible injury, the effects of workplace violence instances can spread distress among the members of staff leading to increasing turnover of nurses and deterioration of the health of staff. The Joint Commissions (2010) sentinel event alert identified the need for the healthcare centers to reduce the risks of patients’ violence to staffs since there are increasing reported violence rates including assaults by the patients.
Different suggestions and solutions have been brought forward by experts in an attempt of addressing the fears of the healthcare workers, and for improving safety of staff and outcomes of patients when caring for the patients suffering from behavioral issues in the non-psychiatric settings. Some of the recommendations include exposing the nurses to patients with issues of mental health, additional nursing education and implementation of the specialised care units or consultative liaison services (Zolnierek, 2009; Atkin, Holmes, & Martin, 2005).
Another solution to the problem is the use of a team response that is modelled in line with the rapid response teams and is adapted to behavioral and mental needs. In United States, Rapid Response Teams have been introduced as a reassure of bringing specialized expertise to the bedside of a patient for earlier intervention and prevention of psychological deterioration of a patient (Donaldson et al, 2009; Scott & Elliott, 2009; Hatler et al., 2009; Wynn, Engelke, & Swanson, 2009). In the literature, the paper found only one team model to be responding to the behavioral issues that need emergent attention just like the Rapid Response Teams, which is behavioral emergency response team (BERT).
Literature Review
There are few research studies done on whether Behavioral Emergent Response Team in hospitals when compared to not having one, could decrease the risks of injuries to the patient and or staff among the patients hospitalized in non-psychiatric units. A search of literature using the database of CINAHL to look for descriptions of BERT teams showed only the result on Lester (2000). The study described BERT as providing psychiatric services for controlling control units of stress. In searching relevant studies and reaches done on the field, the researcher started the search with the most comprehensive database that is Cumulative Index to Nursing and Allied Health (CININAH) (Kennedy, 2009). 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. These search engines were used because they contained most of the peer review articles and books. Assessment of the search strategy used was done to ensure that some relevant studies that could be a great source of information were not left out by being too specific. 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. Most of the literature identified were descriptive in nature with no quantitative study. Therefore, the literature review for this paper will be descriptive of the different research studies identified.
Approximately one in every four adults in United States in a year is affected by mental illness (National Institute of Mental Health, 2008).Moreover, Zolnierek (2009) indicated that the persons who are mentally ill severely suffer chronic medical illnesses at a higher rate compared to the population, in general. This makes it probably that individuals with severe mental illness will seek medical care and be hospitalized. However, when hospitalized on the non-psychiatric units, the behaviors of the individuals with dementia/delirium, bipolar disorder and schizophrenia may confound the medical nurses who are accustomed to dealing with the mental illness cases. Landers & Bonner (2007) suggests that medical or the surgical staff need resources to assist them in meeting the challenges of behavioral issues that are related to the patients’ psychiatric conditions.
In the studies done by Ross & Goldner (2009) and Zolnierek (2009), the central themes discussed are discrimination, negative attitude and stigma towards the mentally ill persons among the nurses. The health care workers tend to label the mentally ill patients as “difficult” and this is influenced by the encounters of the nurse-patient and environmental factors in the hospital (Zolnierek, 2009).
According to Mackay, Paterson, & Cassells (2005) psychiatric nurses are very familiar with the mentally ill patients’ behavioral aberrations. The nurses in the acute psychiatric units commonly observe the patients for any escalating behavior predictors, and then intervene in any negative event. Moreover, these psychiatric nurses control their units’ environments such as activity level, pace and tone in an attempt of creating a therapeutic milieu which prevents the escalation of the patients’ behaviors (Delaney, 1994). Allen et al (2003) also stated that the psychiatric nurses are very familiar with the relevant medical treatments of the behavioral emergencies, and they can correctly report signs and signs warranting interventions pharmacologically.
Behavioral emergency response team (BERT) was created on the premise that these psychiatric nurses who are trained and experienced would transfer their skills to the non-psychiatric units in the hospitals where patients with psychiatric conditions which are demonstrating scary and risky behaviors. Lester (2000) described BERT as an adaptation of the RRT of the hospital for the patients that are medically ill. BERT involves proactive strategies for de-escalating situations that are potentially volatile with the behavioral health patients hospitalized in non-psychiatric units.
Behavioral emergency response team (BERT) is a consultative resource that can be used in non-psychiatric settings when there is the presence of psychiatrist behaviours. The behaviors targeted are those that are potentially threatening or disruptive actions of persons with psychiatric history or for the other patients compromising the wellbeing and safety of staff members, visitors, other patients and selves
Several studies support that having BERT decreases the risks of injuries to staffs and the patients among the adult inpatient hospital population (Loucks et al, 2010; Pestka et al, 2012). Activation of BERT is done when an inpatient unit nurse notifies the behavioral health service unit of a problem. Depending on the nature of the scenario in the unit, one or more team members of BERT will respond, assess the patient and put action strategies depending on the situation to defuse the problem and stabilize the patient (Karshmer & Hales, 1997). Moreover, when the situation has been defused, a team member of BERT debriefs the unit staff by conducting one-on-one teaching as required in such a situation.
In a study done by Loucks et al (2010), the researchers used Iowa Model of Evidence-Based Practice proposed by Titler et al (2001) to aid in their systematic approach of BERT. The model adopted directs decision making from identification of problems, through searching for evidence and appraisal to evaluation of the intervention or practice that is evidence based. The researchers were interested in learning the unit staff nurses responses in terms of their experience and knowledge with the BERT team and their level of comfort when taking care of the psychiatric patients in their units. The research used survey method, in which on-duty nurses were surveyed from the nine units. The survey was done on either short questionnaire or phone interview. From the 39 nurses interviewed, 54%stated they understood BERT clear, 31% reported high level of comfortability in caring for the psychiatric patients, and 36% or 14 nurses had been involved in BERT call and they all believed that the needs of the patients were met (Loucks et al, 2010). From their study, Loucks et al (2010) found that BERT allowed the nurses of the non-psychiatric units’ access the behavioral health nurses that are specially trained to assist in deleterious or potentially dangerous situations. Where previously the nurses approached the care for the mentally ill patients with fear and skepticism, they can now use the gained knowledge from the BERT team members and where necessary.
Summary and Conclusions of Review of Literature
Strengths of BERT
The BERT team in hospitals according to Pestka et al (2012), 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. Apart from enhancing safety, 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 (Pestka et al, 2012).
Challenges facing BERT
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. Moreover, other lack consistency and not confident (Pestka et al, 2012).
Clinical Relevance and Application
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). To begin, staff education should be done on specific guidelines for BERT team such as methods of identifying a patient, team members, communication methods, methods of activating BERT, responsibilities of BERT staff, Floor RN responsibilities.
Other relevant medical units that BERT can be applied include critical care and women’s health, medical-surgical units, and the emergency departments.
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. The aim of BERT is to de-escalate the potentially violent or harmful situations when called upon. BERT should be formed by security staff, psychiatry nurses and the physicians among others. With the increasing cases of patient violence in non-psychiatry medical units, BERT is needed in every hospital. Many studies document improved safety for the staff in hospitals with BERT functioning than hospitals without BERT functioning. Despite its need in hospitals, BERT also has strengths and challenges. Some of the strengths include offering the long-term solution of safety to the health workers, boosting the confidence and satisfaction of the nurses, and lastly enhancement of collaboration between different departments. On the other hand, some of the challenges include ensuring faster response of the team, and availability of the team when needed. Lack of consistency and confidence is another challenge of the initiative. BERT can applied in different clinical set-ups such as pulmonary units, critical care and women’s health, medical-surgical units, and the emergency departments.
Recommendations
In applying or actualizing BERT in a hospital setting, the following recommendations are of great importance.
The BERT team should be structured in the hierarchyand with bettercommunicationlinesclearlyoutlined. Thecommunication from themedicalunit, to the Behavioral Health serviceleader, to BERT leaderandtotheteam
The BERT team should be readilyavailablewhencalled upon in cases of behavioral emergent issues
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.
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