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A study into the severity of forensic and civil inpatient aggression

Aggressive incidents occur frequently in health care facilities, such as psychiatric care and forensic psychiatric hospitals. Previous research suggests that civil psychiatric inpatients may display more aggression than forensic inpatients. However, there is a lack of research comparing these groups on the incident severity, even though both frequency and severity of aggression influence the impact on staff members. The purpose of this study is to compare the frequency and severity of inpatient aggression caused by forensic and civil psychiatric inpatients in the same Dutch forensic psychiatric hospital. Data on aggressive incidents occurring between January 1, 2014, and December 31, 2017, were gathered from hospital files and analyzed using the Modified Overt Aggression Scale, including sexual aggression (MOAS+). Multilevel random intercept models were used to analyze differences between forensic and civil psychiatric patients in severity of aggressive incidents. In all, 3,603 aggressive incidents were recorded, caused by 344 different patients. Civil psychiatric patients caused more aggressive incidents than forensic patients and female patients caused more inpatient aggression compared with male patients. Female forensic patients were found to cause the most severe incidents, followed by female civil psychiatric patients. Male forensic patients caused the least severe incidents. The findings have important clinical implications, such as corroborating the need for an intensive treatment program for aggressive and disruptive civil psychiatric patients, as well as emphasizing the importance of gender-responsive treatment

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A study into the severity of forensic and civil inpatient aggression

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Critical review of safety performance metrics

Various tools for safety performance measurement have been introduced in order to fulfil the need for safety monitoring in organisations, which is tightly related to their overall performance and achievement of their business goals. Such tools include accident rates, benchmarking, safety culture and climate assessments, cost-effectiveness studies, etc. The current work reviews the most representative methods for safety performance evaluation that have been suggested and applied by a variety of organisations, safety authorities and agencies. This paper discusses several viewpoints of the applicability, feasibility and appropriateness of such tools, based on the viewpoints of managers and safety experts involved in a relevant research that was conducted in a large aviation organisation. The extensive literature cited, the discussion topics, along with the conclusions and recommendations derived, might be considered by any organisation that seeks a realistic safety performance assessment and establishment of effective measurement tools.

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Critical review of safety performance metrics

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Decolonising civic integration: a critical analysis of texts used in Dutch civic integration programmes

European civic integration programmes claim to provide newcomers with necessary tools for successful participation. Simultaneously, these programmes have been criticised for being restrictive, market-driven and for working towards an implicit goal of limiting migration. Authors have questioned how these programmes discursively construct an offensive image of the Other and how colonial histories are reproduced in the constructions seen today. The Dutch civic integration programme is considered a leading example of a restrictive programme within Europe. Research has critically questioned the discourses within its policies, yet limited research has moved beyond policy to focus on discourse in texts in practice. This study presents a critical discourse analysis of texts used in the civic integration programme and demonstrates that they participate in multiple discursive constructions: the construction of the Dutch nation-state and its citizens as inherently modern, the construction of the Other as Unmodern and thus a threat, and the construction of the hierarchical relationship between the two. The civic integration programme has been left out of discussions on decolonisation to date, contributing to it remaining a core practice of othering. This study applies post-colonial theories to understand the impacts of current discourse, and forwards possibilities for consideration of decolonised alternatives.

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Decolonising civic integration: a critical analysis of texts used in Dutch civic integration programmes

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Critical point of view

Much of the discussion about Wikipedia, both in the news and in more scholarly circles, still largely reflects the concerns found in populist perspectives. What’s missing is an informed, radical critique from the inside. The Critical Point of View (CPOV) research initiative, whose material is brought together in this reader, poses different questions than those we have thus far encountered.

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Two sides of the working alliance

The probationer–probation officer working alliance plays an important role in the outcome of probation supervision. This study explored the development of the working alliance between probationers and probation officers in the Netherlands, from the perspective of both probationers and probation officers. More specifically, we explored the significance of different aspects of the working alliance at the start of probation supervision and after a three-month period, as well as the role played by critical incidents during the supervisory process and their subsequent effect on the working alliance. Overall, the study showed that clarity over goals and restrictions was initially the most salient issue for both parties, and that after a three-month period the working alliance evolved into a trusting relationship. Several incidents were identified, probationers identified more positive moments and less negative moments than their PO counterparts. If these types of incidents are managed accordingly by the probation officer, then they can ultimately serve to strengthen the relationship.

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Developing decision support for cybersecurity threat and incident managers

Cybersecurity threat and incident managers in large organizations, especially in the financial sector, are confronted more and more with an increase in volume and complexity of threats and incidents. At the same time, these managers have to deal with many internal processes and criteria, in addition to requirements from external parties, such as regulators that pose an additional challenge to handling threats and incidents. Little research has been carried out to understand to what extent decision support can aid these professionals in managing threats and incidents. The purpose of this research was to develop decision support for cybersecurity threat and incident managers in the financial sector. To this end, we carried out a cognitive task analysis and the first two phases of a cognitive work analysis, based on two rounds of in-depth interviews with ten professionals from three financial institutions. Our results show that decision support should address the problem of balancing the bigger picture with details. That is, being able to simultaneously keep the broader operational context in mind as well as adequately investigating, containing and remediating a cyberattack. In close consultation with the three financial institutions involved, we developed a critical-thinking memory aid that follows typical incident response process steps, but adds big picture elements and critical thinking steps. This should make cybersecurity threat and incident managers more aware of the broader operational implications of threats and incidents while keeping a critical mindset. Although a summative evaluation was beyond the scope of the present research, we conducted iterative formative evaluations of the memory aid that show its potential.

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Developing decision support for cybersecurity threat and incident managers

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Critical Incident Outcome Measure (CIOM)

Critical incident response (CIR) has evolved to require a high level of cultural competence, customization, and adaptability to meet the needs of client organizations while incorporating clinical best practices and current research. The Critical Incident Outcome Measure (CIOM) is a timely and pioneering evidence-based evaluative tool developed by Morneau Shepell over the course of a four-year period. The CIOM tool, based on the Workplace Outcomes Suite (WOS) tool originally developed in 2010, was developed in 2016 [Herlihy et.al., 2018]; beta tests and modifications, along with the publication of a validation paper, were completed in 2017; further feedback was incorporated and an implementation plan developed in 2018; and full program implementation began in 2019.

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Reporting incidents involving the use of advanced medical technologies by nurses in home care

Background: Advanced medical technologies (AMTs), such as respiratory support or suction devices, are increasingly used in home settings and incidents may well result in patient harm. Information about risks and incidents can contribute to improved patient safety, provided that those are reported and analysed systematically. Objectives: To identify the frequency of incidents when using AMTs in home settings, the effects on patient outcomes and the actions taken by nurses following identification of incidents. Methods: A cross-sectional study of 209 home care nurses in the Netherlands working with infusion therapy, parenteral nutrition or morphine pumps, combining data from a questionnaire and registration forms covering more than 13 000 patient contacts. Descriptive statistics were used. Results: We identified 140 incidents (57 adverse events; 83 near misses). The frequencies in relation to the number of patient contacts were 2.7% for infusion therapy, 1.3% for parenteral nutrition and 2.6% for morphine pumps. The main causes were identified as related to the product (43.6%), the organisation of care (27.9%), the nurse as a user (15.7%) and the environment (12.9%). 40% of all adverse events resulted in mild to severe harm to the patient. Incidents had been discussed in the team (70.7%), with the patient/informal caregiver(s) (50%), or other actions had been taken (40.5%). 15.5% of incidents had been formally reported according to the organisation's protocol. Conclusions: Most incidents are attributed to product failures. Although such events predominantly cause no harm, a significant proportion of patients do suffer some degree of harm. There is considerable underreporting of incidents with AMTs in home care. This study has identified a discrepancy in quality circles: learning takes place at the team level rather than at the organisational level.

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Reporting incidents involving the use of advanced medical technologies by nurses in home care

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Cyber incident response decision making

In case of a major cyber incident, organizations usually rely on external providers of Cyber Incident Response (CIR) services. CIR consultants operate in a dynamic and constantly changing environment in which they must actively engage in information management and problem solving while adapting to complex circumstances. In this challenging environment CIR consultants need to make critical decisions about what to advise clients that are impacted by a major cyber incident. Despite its relevance, CIR decision making is an understudied topic. The objective of this preliminary investigation is therefore to understand what decision-making strategies experienced CIR consultants use during challenging incidents and to offer suggestions for training and decision-aiding. A general understanding of operational decision making under pressure, uncertainty, and high stakes was established by reviewing the body of knowledge known as Naturalistic Decision Making (NDM). The general conclusion of NDM research is that experts usually make adequate decisions based on (fast) recognition of the situation and applying the most obvious (default) response pattern that has worked in similar situations in the past. In exceptional situations, however, this way of recognition-primed decision-making results in suboptimal decisions as experts are likely to miss conflicting cues once the situation is quickly recognized under pressure. Understanding the default response pattern and the rare occasions in which this response pattern could be ineffective is therefore key for improving and aiding cyber incident response decision making. Therefore, we interviewed six experienced CIR consultants and used the critical decision method (CDM) to learn how they made decisions under challenging conditions. The main conclusion is that the default response pattern for CIR consultants during cyber breaches is to reduce uncertainty as much as possible by gathering and investigating data and thus delay decision making about eradication until the investigation is completed. According to the respondents, this strategy usually works well and provides the most assurance that the threat actor can be completely removed from the network. However, the majority of respondents could recall at least one case in which this strategy (in hindsight) resulted in unnecessary theft of data or damage. Interestingly, this finding is strikingly different from other operational decision-making domains such as the military, police and fire service in which there is a general tendency to act rapidly instead of searching for more information. The main advice is that training and decision aiding of (novice) cyber incident responders should be aimed at the following: (a) make cyber incident responders aware of how recognition-primed decision making works; (b) discuss the default response strategy that typically works well in several scenarios; (c) explain the exception and how the exception can be recognized; (d) provide alternative response strategies that work better in exceptional situations.

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A study into the severity of forensic and civil inpatient aggression

Critical review of safety performance metrics