Post-incident Support Research Articles

A system dynamics approach for cost-benefit simulation in designing policies to enhance the cybersecurity resilience of small and medium-sized enterprises

The small and medium-sized enterprises (SMEs) with limited investment capacity are likely to be lax in enhancing their cybersecurity. Therefore, to strengthen cybersecurity at a national level, governments must intervene in the market by using support or regulatory policies to overcome market failures and address weaknesses. This study reviewed the efficiency of policy options to improve corporate cybersecurity resilience for SMEs that require government support, unlike large companies that can invest in security on their own. To achieve this, a causal loop diagram was created and analyzed from the perspective of system dynamics. The model incorporated government support variables and the decline in capabilities over time into the existing corporate security investment model reflecting the standard framework for cybersecurity from NIST. The simulation scenarios were constructed based on policy options considered by the Korean government. These include 1) pre-incident or post incident support services, and 2) management through tax credits and regulation. The results indicated that incentives, specifically tax credits, rather than regulation, were more effective in strengthening cyber resilience. This study describes the investment and internal capability development of a company affected by government policy, which is an external factor, and changes in profits can be observed by adding the company's profits and costs as variables. This profit variable allows for the comparison of a company's cyber resilience across scenarios. Additionally, if the government provides direct support immediately after a hacking incident, the company can recover more quickly. If these benefits are known and if the reporting of hacking damage is activated, cyber threat visibility will be secured by revealing hacking attacks that have been secretly conducted. Governments can use cyber threat visibility to strengthen national cybersecurity.

Regional Perspective of Using Cyber Insurance as a Tool for Protection of Agriculture 4.0

The digitalization of the agricultural industry is manifested through the active use of innovative technologies in all its areas. Agribusiness owners have to constantly improve their security to meet new challenges. In this context, the existing cyber risks of the agrarian industry were assessed and their classification by possible consequences, such as data theft or alteration, cyber terrorism, cyber warfare, software hacking or modification, the blocking of markets and transactions on them, was proposed. Cyber insurance is an effective tool for minimizing the likelihood of cyber incidents and for comprehensive post-incident support, with the involvement of cybersecurity specialists. An algorithm for cooperation between an agricultural company and an insurance company when concluding a cyber risk insurance contract is proposed, which takes into account the needs and wishes of insurers at each stage of the interaction. To assess the need to use cyber insurance in agriculture 4.0, a methodology has been developed to evaluate the regional characteristics of cybersecurity and the digitalization of agribusiness. The results of the study show a heterogeneous need for this tool in different regions of the world.

Evaluation of a training programme for critical incident debrief facilitators.

Critical incident debriefs are a commonly used occupational health tool for supporting staff after traumatic work incidents. However, there is a dearth of literature evaluating training programmes for debrief facilitators. To evaluate a 5-day training programme to equip healthcare, social care and voluntary, community and social enterprise sector staff to act as post-incident peer supporters and debrief facilitators. A mixed-methods, single-arm, before-and-after study. Data were collected at baseline and post-training. The quantitative outcome measure was 'Confidence'; the sum of two items measuring confidence in (i) supporting peers after critical incidents and (ii) facilitating post-incident structured team discussions. At post-training, quantitative and qualitative feedback regarding experiences and perceptions of the training was also gathered. We recruited 45 participants between October 2021 and January 2022. Confidence in supporting peers following incidents and facilitating post-incident structured team discussions increased significantly following the training, t(35) = -6.77, P < 0.001. A majority of participants reported they would do things differently because of the training and that they found the training relevant, useful and engaging. Summative content analysis of qualitative feedback indicated that participants (i) believed the role plays were an important learning tool and (ii) thought it was important that the trainer was engaging. Some participants would have preferred in-person delivery. Participants valued training in post-incident peer support and debriefing skills. Organizations implementing post-incident support pathways could usefully include this training and ensure optimal uptake and engagement by (i) providing in-person and online delivery options and (ii) including role play as a learning technique.

Workforce safety in the remote health sector of Australia: a scoping review

ObjectivesTo scope the evidence surrounding workplace health and safety risks for the remote health workforce in Australia and to collate the recommendations to address those risks.DesignA five-stage scoping review framework...

Exploring Differences in the Experiences, Perceptions and Reporting of Violent Incidents in Australia by Country of Birth.

Australia's fast-growing migrant population encompasses many groups from culturally and linguistically diverse backgrounds. It is well documented that these groups experience varying pre- and post-migratory challenges. Despite this knowledge, little is known about the extent to which these groups experience and perceive violence and how or whether they seek assistance after such incidents. It is important to identify any potential discrepancies to ensure that services can provide the most targeted supports to victims. Data were collected from the 2016 Australian Bureau of Statistics Public Safety Survey. Using chi-square tests, prevalence, experiences, and perceptions of violence occurring after the age of 15, postincident support, reporting behaviors, and health variables related to violent incidents were compared across three cultural groups arranged by region of birth: born in Australia (BIA), born overseas in main English-speaking countries (BNMESC), and born overseas in non-English-speaking countries (BOC). BOC individuals reported much lower rates of violent victimization compared to BIA and BMSEC individuals. More than two-thirds of each cultural group did not report their most recent experience of violence to police. Violence was most commonly experienced at home, although a higher proportion of BIA individuals experienced violence at an entertainment venue, and a higher proportion of BOC individuals experienced violence outside (i.e., in the street). The contribution of Alcohol/Substances was much higher for BIA and BMESC compared to BOC individuals. BOC individuals experienced more anxiety post-incident, while more BIA individuals sustained physical injuries. A similar proportion of each group sought assistance post-incident, however, more BOC individuals had never told anyone about the incident. Perceptions of the violent incident were generally similar across groups, though fewer BOC individuals perceived the incident to be a crime. Some differences were apparent across cultural groups regarding the prevalence, experiences and reporting of violent incidents. Implications and future research directions are discussed within.

A Qualitative Study of Psychological Outcomes in Avalanche First Responders.

We sought to characterize the mental health morbidity associated with avalanche rescue, and to generate hypotheses as to how such morbidity may be mitigated. Avalanche first responders were recruited through online advertisements, social media, direct outreach, and e-mail solicitation. Thirteen subjects were selected for inclusion. Each subject participated in a semistructured interview. Transcripts were coded and thematically analyzed. Themes identified from interviews fell into three broad categories: long-term effects of rescue participation, assessments of psychological support, and recommendations for change. Symptoms of substance use disorder, depression, anxiety, panic, acute stress disorder, and posttraumatic stress disorder were evident in the interviews, as was evidence of adverse effects on subjects' personal relationships. Many respondents described a deficiency of formal psychological support for avalanche first responders, often limited to after-action debriefs of varying effectiveness. Nevertheless, subjects who received high-quality professional psychological support considered it helpful. Participants' suggestions for improvement focused on formalizing preincident psychological preparation and postincident support. Avalanche responders may experience long-lasting, work-related psychological effects. There is a paucity of effective psychological preparation and support for this population of first responders. Formal psychological support is positively received when available. Further study is required to evaluate particular interventions in this specific population.

Postincident Support for Healthcare Workers Experiencing Occupational Violence and Aggression.

To investigate the relative contributions of workplace type, occupational violence and aggression (OVA) strategies and interventions along with perceptions of the occupational health and safety (OHS) environment on the likelihood of receiving postincident support following the experience of OVA. We used a cross-sectional study design with an online survey to collect data from employees in nursing and midwifery in Victoria, Australia. Survey data collected from 3,072 members of the Australian Nursing and Midwifery Federation (Victorian branch) were analyzed using logistic regression. Of the 3,072 respondents who had experienced OVA in the preceding 12 months, 1,287 (42%) reported that they had received postincident support. Hierarchical logistic regression revealed that the OHS environment was the dominant factor that predicted the likelihood of workers receiving postincident support. Working in a positive OHS environment characterized by higher levels of leading indicators of OHS, prioritization of OHS, supervisor support for safety, and team psychological safety was the stronger predictor of postincident support. Being employed in a workplace that offered training in the management and prevention of OVA also increased the likelihood of receiving postincident support. While training in the management and prevention of OVA contributed to the likelihood of receiving postincident support, a greater emphasis on the OHS environment was more important in predicting the likelihood that workers received support. This study identifies workplace practices that facilitate the provision of postincident support for healthcare workers. Facilitating effective postincident support could improve outcomes for workers, their patients and workplaces, and society in general.

Attachment Insecurity, Responses to Critical Incident Distress, and Current Emotional Symptoms in Ambulance Workers

Ambulance workers are exposed to critical incidents that may evoke intense distress and can result in long-term impairment. Individuals who can regulate distress may experience briefer post-incident distress and fewer long-term emotional difficulties. Attachment research has contributed to our understanding of individual differences in stress regulation, suggesting that secure attachment is associated with effective support-seeking and coping strategies, and fewer long-term difficulties. We tested the effect of attachment insecurity on emotional distress in ambulance workers, hypothesizing that (1) insecure attachment is associated with symptoms of current distress and (2) prolonged recovery from acute post-critical incident distress, coping strategies and supportive contact mediate this relationship. We measured (1) attachment insecurity, (2) acute distress, coping and social contact following an index critical incident and (3) current symptoms of post-traumatic stress, depression, somatization and burnout and tested the hypothesized associations. Fearful-avoidant insecure attachment was associated with all current symptoms, most strongly with depression (R=0.38, p<0.001). Fearful-avoidant attachment insecurity was also associated with maladaptive coping, reduced social support and slower recovery from social withdrawal and physical arousal following the critical incident, but these processes did not mediate the relationship between attachment insecurity and current symptoms. These findings are relevant for optimizing post-incident support for ambulance workers.

Violence in community pharmacy in Australia: incidence and implications

To estimate the frequency, nature and impact of violent incidents in Australian community pharmacies. A sample of Australian community pharmacists. A survey of Australian pharmacists sought to estimate the frequency of exposure to an array of violent incidents in the preceding 12 months. The sample population was drawn from all pharmacists currently registered in Australia, with a proportionate number from each state and territory surveyed. The selected pharmacists were sent a letter of explanation, the questionnaire and the reply-paid envelope. The questionnaire was developed specifically for this study with extensive testing among a small number of community pharmacists. Frequency of violent incidents experienced in the 12 months prior to the survey. Surveys were mailed to 1000 randomly selected pharmacists registered in Australia in 2007. In total, 248 eligible replies were received resulting in a usable response rate of 25%. The majority of respondents (91%) had experienced or witnessed some form of violence in community pharmacy within the preceding 12 months. Of all respondents, approximately one-third (33%) had been subjected to verbal abuse on at least a once-monthly basis. One-fifth of all respondents experienced or witnessed incidents of bullying/intimidation at least monthly, while one-tenth of all respondents had been exposed to sexual harassment/assault at least once-monthly. The impact of violent incidents was significant, with approximately one in ten respondents who had experienced violent incidents having changed employment as a direct result of these violent incidents; the majority of these pharmacists changed to a different community pharmacy (95%). A large proportion of respondents claimed that they either 'sometimes' or 'never' reported violent incidents. Over half of all respondents claimed that they received no post-incident support regardless of the type of violence experienced. Recognising the likelihood of selection bias in responding to the survey, the results nevertheless indicate that violence appears a real and common problem in Australian community pharmacies. The under-utilisation of violence preventative strategies, the lack of violence management by employers, under-reporting of violence and the lack of post-violence support need to be addressed.

Psychological impact upon London Ambulance Service of the 2005 bombings

This study was conducted following the London bombings of 7 July 2005. To assess the psychological impact of the 2005 London bombings on London Ambulance Service (LAS) personnel, risk factors for the development of psychological ill-health and employee awareness of post incident support. A total of 525 LAS personnel involved in the bombings, and a control group of uninvolved staff, were sent a questionnaire 2 months after the bombings. Main outcome measures were the presence of probable post-traumatic stress disorder (PTSD) measured using the Trauma Screening Questionnaire and substantial psychological distress using a tool identical to that used to assess the impact of these bombings on the population of London. Fifty-six per cent of those who responded were involved in the bombings. Overall, including controls, the response rate was 32% (341). Four per cent of respondents reported probable PTSD and 13% reported substantial distress. Probable PTSD was more common in those involved in the bombings (6% overall), those working at the disaster scene and, in particular, at one of the incident locations (where 50% of all probable PTSD cases worked). The majority of staff were aware of the post incident support available and how to access this, particularly if personnel were involved in the bombings. The LAS did not report higher levels of probable PTSD and psychological distress than the rest of the London population; however, those more proximal to the incident were more likely to have been affected in spite of being aware of various staff support measures put in place.

Workplace Violence on Workers Caring for Long‐term Institutionalized Schizophrenic Patients in Taiwan

It has been noted that workplace violence most frequently occurs in psychiatric settings. The purpose of this study was to explore the workplace violence, including violence situation, victims' feeling, and the prevention strategies, on workers caring for long-term institutionalized schizophrenic patients in Taiwan. We conducted a face-to-face, in-depth, and semi-structured interview with 13 health care workers suffering from physical violence and/or sexual harassment by patients in 2002. First, the interviews were taped and/or paper-notes recorded, then transcribed, organized, and analyzed. Results found that all of the victims alleged they did not receive enough post-incident support, and more than a half of the victims could not call others for help during the violence. To avoid further attack, most victims offered prevention strategies which were considered valuable for establishing guidelines. However, some victims regarded workplace violence as inevitable and part of the job. The most common situations of workplace violence were during routine ward inspections, especially when the victims were alone. The most serious psychological harm was post-traumatic stress disorder (PTSD). In conclusion, we recommended a re-engineering of the organization to a supportive and safe working environment for prevention of workplace violence in the study hospital.

The psychological impact of aggression on nursing staff

Aggression and violence towards nursing staff in UK health care is a growing problem. While the National Institute for Health and Clinical Excellence's (NICE, 2005a) guidelines 'The Short-Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Setting and Emergency Department' offer a way forward in managing aggression for healthcare staff, the psychological impact of aggression remains an area of concern. Post-incident review has been identified as an approach to considering untoward incidents of aggression, yet post-incident support and interventions for staff experiencing the psychological effects of aggression remain inconsistent and curtailed in many areas. This article discusses the care of a nurse who experienced post-traumatic stress disorder as a result of aggression in the workplace. The process of assessment and treatment is presented with underpinning theories of trauma used to illuminate the discussion. Practical use of current recommended treatments of cognitive behavioural therapy and eye movement desensitization and reprocessing is offered as a method of addressing a growing problem in UK health care.

Adapting Critical Incident Stress Management to the Schools

The need for school-appropriate applications of critical incident stress management (CISM) is noted in the literature on school crisis response. This paper presents preliminary data suggesting a School Crisis Response Team's (SCRT) usage and team needs. The SCRT was dispatched for a variety of critical incidents. Self-dispatch, followed by dispatches from Student Support Services, and a central Team Dispatcher accounted for the most frequent modes of mobilization. Team members dispatched centrally were more likely to be offered and to use post-incident team support services than were those who were self-dispatched. The paper also describes protocol changes with community partners and the evolving role of the school-based SCRT consultant.

Strategy development in dealing with violence against employees in the workplace.

The creation of health promoting workplaces is a key development in contemporary workplace health. This paper focuses on the issue of workplace violence and the efforts which must be made to address its prevention and to deal with its consequences as a contribution towards developing a health promoting workplace. A critical overview of the issue as it is currently addressed in the international literature is a precursor to the formulation of an inclusive definition of workplace violence. This forms the basis for a framework for the development and implementation of workplace violence policies. The framework takes account of needs assessment, policy formulation in terms of prevention, incident management and reporting, and post-incident support strategies. The needs for effective education and training and good internal and external communications are also explored. The paper concludes by highlighting the necessity for workplaces to take seriously the need for a coherent and well-planned workplace violence strategy.

Managing violence and aggression towards NHS staff working in the community

This paper presents a brief overview of the research project conducted during the preparation of the national guidance document Safer Working in the Community: A guide for NHS managers and staff on reducing the risks from violence and aggression. (RCN and NHS Executive, 1998). An integrated organizational approach was adopted, seeking risk reduction measures at the levels of the organisation, the work team and the individual, and encompassing prevention and preparation before incidents occur, timely reaction when incidents happen, and rehabilitation and learning after incidents have occurred. Five main domains were considered: trust policies and organizational arrangements; normal working practices; emergency action procedures; post-incident procedures, and staff training. Information was gathered from academic, professional and guidance literature, documentation from healthcare trusts, trades unions and professional associations, and interviews with practitioner, managerial and support staff in a wide range of disciplines. Findings indicated that matters requiring particular attention were: commitment of senior management; generation and communication of policies; discrepancies in perception between managers and practitioners; provision for risk assessment; training provision; staffing, resources and equipment; ability to meet patient expectations; sharing of safety information; traceability and communication away from base; accessing help; emergency procedures; incident reporting; post-incident support; and trauma debriefing and counselling.

Violence faced by staff in a learning disability service

This study explores the issue of violence experienced by staff in the learning disability service of an NHS Trust. Based on the literature review a questionnaire survey was sent to all staff employed in the Trust's learning disability service (n = 295). The questionnaire sought: background details of respondents; numerical incidences and types of violence experienced over the previous 12 months; reporting mechanisms; reactions to and impact of violence on individuals and their work; support received. Vignettes provide a rich picture of the types of violent incidences and their impact. The findings show that 81% of staff in the learning disability service had experienced violence in the previous 12 months. Many had numerous experiences of violence. New and inexperienced staff are particularly vulnerable. Training and support systems are, on the whole, limited. Support received from colleagues is generally regarded as more helpful than that of line management. To explore good practice elsewhere, semi-structured interviews were held with individuals working with potentially violent clients in organizations other than the learning disability service. Suggestions are offered for putting in place human resource strategies to reduce the incidences of violence and provide appropriate post-incident support for staff on a continuing basis.