Document Type

DNP - Open Access

Award Date


Degree Name

Doctor of Nursing Practice (DNP)


Graduate Nursing


brain injury, aggression, behavioral emergencies, brain injury violence prevention protocol


Background/Purpose: Patients with brain injuries are often impulsive and experience increased aggression and agitation. Increased behaviors lead to an increase in violent outbursts towards healthcare staff. Implementing an order outlining interventions to reduce agitation in brain injury patients may reduce behavioral emergencies.
Methods: Staff working in orthopedic/neurology, critical care, and rehabilitation inpatient units were educated on preventing agitation in brain injury patients and an order was placed in the patients' charts with guidelines on preventing agitation. The guidelines were implemented for all patients meeting inclusion criteria and the number of behavioral emergencies before and after intervention were compared. Results: At the 5% level of significance, using a student's t-test, statistical significance (p=0.04) was found when comparing the difference in the number of BHRRTs between the brain injury and non-brain injury groups hospital wide. There was not a statistically significant decrease (p=O .18) in BHRR T calls for brain injury patients despite an overall reduction in BHRR T calls for brain injury patients. Discussion: Barriers included staff buy-in due to staffing shortage and differing nursing cultures impacting success of the intervention. These barriers were addressed by thorough education and monthly follow-ups.
Implications for Practice: This DNP Project reduced the average number of BHRRT calls made which has the potential to improve quality of healthcare and care for brain injury patients in rural settings by reducing aggressive episodes.


South Dakota State University


Copyright © 2023 Krystal Weber

Available for download on Saturday, August 15, 2026

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Nursing Commons