Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-04-06T00:41:51Z No. of bitstreams: 1 Carla Roberta Moreira Da Silva.pdf: 865329 bytes, checksum: b5f3ee55a98d4dc38ce6593deb318134 (MD5) / Made available in DSpace on 2016-04-06T00:41:51Z (GMT). No. of bitstreams: 1 Carla Roberta Moreira Da Silva.pdf: 865329 bytes, checksum: b5f3ee55a98d4dc38ce6593deb318134 (MD5) Previous issue date: 2015-12-07 / Incidents regarding the safety of the patient happen for many reasons and are increased by the inefficiency of the mechanism to register notifications. They enlighten the knowledge, the dimension and the intensity of the problem that afflict hospitals when it comes to mistakes made during the assistance. The prevention of incidents is based on legal and ethic norms and is a challenge for the World Health Organization and the responsible organs. By increasing the notifications, those in charge for the nucleus of patient safety have more information and can set strategies to avoid adverse events. The objective of this work is to present a proposal of a knowledge management model developed to increase the volume of the registrations of notifications regarding incidents of patient safety in public hospitals. To subsidize the proposal of the model, this study was exploratory and the methodology of literature review was applied. In order to complete this research, notifications of patient safety developed by a multi-professional team in 2014 at a public clinic were retrospectively analyzed. This dissertation also presented a descriptive quantitative approach, which occurred through the application of a structured questionnaire on the members of the multi-professional team of the clinic. Data found on the documental research were confronted with the questionnaire results and everything seems to show that if professionals adopted the culture of notifying, as they theoretically showed, the volume of registrations in a one year period would have been more expressive. After analyzing the collected data, a proposal of a knowledge management model was elaborated, which can collaborate with the development of more effective preventive strategies. That is, everyone can benefit from it; the patient will have a safer attendance; the professional will work more systematically; society will reduce extraordinary costs with procedures performed because of unnecessary damages. It is important that the involved people receive constant feedbacks about the benefits of their efforts when it comes to adopting the practice of notifying. / Os incidentes de segurança do paciente ocorrem por vários fatores e são potencializados pela ineficiência do mecanismo de registro de notificações. São as notificações que trazem à tona o conhecimento, a dimensão e a intensidade do problema que aflige os hospitais no que se refere a erros durante a assistência. A prevenção de incidentes é pautada em preceitos legais e éticos e é um desafio para Organização Mundial da Saúde e para os órgãos competentes. Com o aumento das notificações, os responsáveis pelo núcleo de segurança do paciente têm mais informações e podem delinear estratégias para evitar eventos adversos. O objetivo desse trabalho é apresentar uma proposta de modelo de gestão do conhecimento desenvolvido para aumentar o volume do registro de notificações de incidentes de segurança do paciente em hospitais públicos. Para subsidiar a proposta do modelo, este estudo foi exploratório e o procedimento metodológico utilizado foi o levantamento bibliográfico. Para complementar esta averiguação, foram retrospectivamente analisadas as notificações de incidentes de segurança do paciente desenvolvidas pela equipe multiprofissional em 2014 em um ambulatório público de grande porte. Esta dissertação também apresentou uma abordagem quantitativa descritiva que ocorreu mediante a aplicação de um questionário estruturado fechado aos membros da equipe multiprofissional do ambulatório. Os dados encontrados na pesquisa documental foram confrontados com os resultados do questionário e tudo indica que se os profissionais fossem tão adeptos à cultura da notificação como se mostraram em teoria, o volume de registros no período de um ano seria mais expressivo. Após a análise dos dados coletados elaborou-se uma proposta de modelo de gestão do conhecimento que pode colaborar com o desenvolvimento de estratégias preventivas mais eficientes. Neste sentido, todos poderão se beneficiar, o paciente do hospital que terá um atendimento mais seguro, o profissional que executará o trabalho de forma sistemática e a sociedade com a redução de custos extraordinários por procedimentos causados por danos desnecessários. É importante que as pessoas envolvidas na assistência recebam feedbacks constantes acerca dos benefícios de seus esforços no que se refere à adesão à prática da notificação.

[pt] Todos os dias, diversos sistemas são invadidos, muitas pessoas são vítimas de vírus, os mais variados dados são obtidos ilegalmente e muitas empresas ficam de uma hora para outra sem poder operar normalmente. A segurança da informação se ocupa exatamente da proteção dos recursos de informação de empresas e indivíduos. Dentre os diversos assuntos abrangidos pela segurança da informação, o plano de continuidade de negócios (PCN) é o objeto de estudo deste trabalho. Antes confinado à literatura especializada, o PCN ganhou projeção na mídia há pouco mais de dois anos, quando o mundo assistiu perplexo a queda das torres do World Trade Center. O plano de continuidade de negócios tem como objetivo principal evitar, ou reduzir sensivelmente, as perdas das empresas em casos de incidentes que afetem suas operações, além de restaurar suas atividades no espaço de tempo mais breve possível. O objetivo final deste estudo é estabelecer o retrato atual dos planos de continuidade de negócios das empresas brasileiras e propor sugestões para torná-las menos vulneráveis às ameaças internas e externas, sejam novas, antigas ou potenciais. Para atingir o objetivo proposto, foi realizada uma pesquisa com 112 empresas, levantando as percepções de seus executivos, por meio de questionários e entrevistas. A pesquisa demonstra que as empresas não estão preparadas para enfrentar incidentes que possam interromper suas atividades operacionais, estando sujeitas até mesmo à falência. Por fim, é recomendado às empresas que avaliem detalhadamente os riscos aos quais estão submetidas e as conseqüências que os incidentes podem causar. Os impactos podem justificar o investimento em um plano de continuidade de negócios. / [en] Everyday, systems around the world are invaded by hackers, people fall victim to virus attacks, sensitive data are stolen, and firms find their operations screech to a halt. Information Security is responsible for the protection of the information resources of companies and people. The business continuity plan (BCP), one of the many issues that fall under the label of Information Security, is the object of this study. Previously confined to esoteric research journals, BCP gained significant coverage in the mainstream media in the wake of the attacks on the World Trade Center. The primary goal of a business continuity plan is the avoidance, or substantial reduction, of losses that a firm might suffer as a result of security incidents. Put simply, a BCP's goal is to keep firms operating as normal as possible during a disaster and get the firm back to standard operations as quickly as possible. The purpose of this study is to illustrate the current utilization of business continuity plans in Brazilian businesses and suggest how to make them less vulnerable to internal and external threats, regardless of whether they are old, new, or as yet undiscovered. To achieve this objective, 112 companies were selected and the executives could express their perceptions filling the surveys and through interviews. The research demonstrates that firms are not prepared to face incidents which may cause interruptions of their activities. Finally, the research recommends that companies to evaluate carefully the risks involved in their businesses and what consequences the security incidents may cause. The impacts can certainly justify the investments in Business Continuity Plan.

This Master´s thesis examines Investigation of aircraft accidents / incidents, which were caused by human error. My thesis is focused on fixed wing aircrafts with maximum take off weight up to 2500 kg. Practices of Aircraft accident / incident Investigation are described in Annex L13 which is document published by Ministry of Transport of the Czech Republic. This document provides some support for investigators but does not contain methodology which should be used to discover human error by which the accident / incident was caused. This thesis has two major purposes. First purpose is to analyze Final reports of investigations and suggest improvements which can be made. Second goal of this thesis is to create own methodology for investigating the causes of aviation accidents / incidents caused by human factor.

The thesis focuses on creation of precaution „Plan applicable in case of exceptional/unsafe incidents taking place at TJ Tesla swimming pool located in Brno”. The theoretical chapter(s) deal with legislative framework and related bills regarding leak of dangerous substances from buildings. It also deals with protection of population within the Czech Republic with regard to separate measures applicable according to the character of incident. The practical chapter(s) deal with analysis of risks within the premises and define the character of unsafe attributes of the risk sources. The various risks are therefore modelled in order to show the possible range of unsafe effects on population. These models are necessary to define the most effective protective measures applicable while exceptional/unsafe incidents occur. The aim of the thesis is to create the specific precaution plan as well as dispute the way the incidents of unsafe substances of below the legislative limit amount could be handled.

Magister Commercii (Industrial Psychology) - MCom(IPS) / The current crime rate in the Western Cape plays a crucial role in the exposure of police officers to stressful and traumatic events. The intensity and frequency of this exposure, if not treated, could lead to police officers experiencing comorbid disorders such as post-traumatic stress disorder (PTSD). This leads to an increased need for trauma intervention strategies to be offered, to assist police officers who are exposed to trauma in the South African Police Service (SAPS). Although trauma intervention programmes are established within SAPS, a difference in perception about their effectiveness and service offering are presented. The purpose of this study was to investigate the differences in perception toward stress and trauma intervention strategies within the SAPS in the Western Cape. In order to achieve the purpose of the study, the researcher, tapped into the lived experiences of current police officers and Employee Health and Wellness (EHW) staff, employed by SAPS through semi-structured interviews. Through a comparative design, the study will add value to the current body of knowledge, as differences and similarities between two of the primary role players in the trauma debriefing process within the SAPS are explored. The research sample, recruited by means of convenience sampling, consisted of seven EHW staff members who had experience with dealing with stress and trauma-related programmes, and eight visible policing police officers who had experienced some form of trauma-related incident. The researcher made use of an in-depth interview guide as the research instrument for this study, which consisted of audio-recorded semi-structured interviews with the participants. The audio recordings were transcribed, and then analysed by means of thematic analysis. The findings showed that a difference in perception exists between police officers and EHW staff members toward the effectiveness of trauma intervention strategies offered in the SAPS. The findings also suggest that the majority of police officers do not make use of the trauma intervention programmes in the SAPS, in comparison to EHW staff reporting on good attendance by police officers at the service offerings. Similarities in perception between the two groups presented itself in the form of how trauma is defined, the different responses to trauma and coping mechanisms employed by police officers. The implications of this study include a contribution toward policy and structural amendments of the Employee Assistance Programme (EAP) framework within the SAPS, as well as a motivation for implementing a compulsory trauma counselling programme for police officers.

Critical infrastructures are vital services, and attacks on such systems affect people's social and economic well-being. Therefore, operators of such services must have appropriate measures in place to handle IT-related incidents. However, reports show that organisations classified as Operators of Essential Services (OES) do not have appropriate measures to handle IT-related incidents. A case study approach is used in this study to test the usability and the applicability of Wahlgren's Escalation Maturity Model level within various public sector organisations in Sweden regarding their escalation and communication of IT-related incidents. A follow-up semi-structured interview is also conducted with employees at the technical level to determine if the current organisation's maturity level shortcomings are known across different organisational levels. The tool's maturity level scaling attributes are difficult to understand because all organisations in this study achieve the same level of maturity, even though there is a wide range of performance regarding the number of questions answered in the affirmative. The data output generated from the testing of the model can assist organisations in improving their incident escalation activities. However, the lack of precision of the model makes it challenging to apply in the public sector. The results reveal that all the five organisations obtained an escalation maturity level of zero (0), non-existent, regarding escalation of IT-related incidents. As a result, with the current model, the participating organisations will have a difficult task complying with the NIS Directive's security and notification requirements.

No description available.

The construction industry is an exciting and community developing industry, but it is also very much talked about because of the high injury frequency that the industry is characterized by. As a part of preventing accidents at work, the employer conducts systematic work environment work to detect risky parts of the work and to remedy these. Despite the elimination of risks at work, accidents and incidents - so-called deviations in the working environment - occur. Deviations in the working environment must be reported immediately to the employer. Within the company that is subject of this study, the deviations are reported and stored a system called BIA. BIA enables, based on the deviation reports, to create statistical data for the company with respect to different parameters. This report is based on this deviation statistics with regard to accidents and incidents, produced from the reporting tool BIA. The study has investigated in which stages/phases incidents and accidents occur, which work operations that cause incidents and accidents, as well as injury risks and causes of injury behind accidents and incidents. The majority of the company's incidents and accidents occur during construction projects, production and land work. Incidents are caused by work tasks such as excavation work, work at/with passing vehicle traffic and movement within the area. Accidents are caused by work at/by machine, manual handling of material / product and work at/with handheld work equipment. The damage risks in the event of incidents are vehicle accidents, hit by falling or flying objects and stuck or clamped between objects. The causes of injury caused by accidents are damage by self-handled objects, fall at the same level and contact with sharp objects. Fall from height and fall at the same level are the cause of damage in a large part of the accidents. The result of the study also shows that the information given in the event reports in BIA, either lacks of information or that the information is inadequate. / Byggbranschen är en spännande och samhällsutvecklande bransch, men den är också mycket omtalad med anledning av den höga skadefrekvens som branschen karakteriseras av. Som ett led i att förebygga olyckor i arbetet bedriver arbetsgivaren ett systematiskt arbetsmiljöarbete för att upptäcka riskabla moment i arbetet samt åtgärda dessa. Trots eliminering av risker i arbetet, inträffar olycksfall och tillbud – så kallade avvikelser i arbetsmiljön. Avvikelser i arbetsmiljön skall omedelbart rapporteras till arbetsgivaren. Inom det företag som utgör föremål för denna studie rapporteras och lagras avvikelserna i ett system som kallas för BIA. BIA möjliggör att, utifrån avvikelserapporter, skapa statistiskt underlag för företaget med avseende på olika parametrar. Denna rapport är baserad på denna avvikelsestatistik med avseende på olycksfall och tillbud, framtaget ur rapporteringsverktyget BIA. Studien har undersökt i vilka skeden/faser tillbud och olycksfall inträffar, vilka arbetsmoment som föranleder tillbud och olycksfall samt skaderisker och skadeorsaker bakom tillbud och olycksfall. Majoriteten av företagets tillbud och olycksfall inträffar vid anläggningsprojekt, produktion och markarbete. Tillbud föranleds av arbetsmoment som schaktningsarbete, arbete vid/med passerande fordonstrafik samt förflyttning inom området. Olycksfall föranleds av arbete vid/med maskin, manuell hantering av material/produkt samt arbete vid/med handhållen arbetsutrustning. Skaderiskerna vid inträffade tillbud är fordonsolycka, träffas av fallande eller flygande föremål samt fastnat eller klämts mellan föremål. De skadeorsaker som olycksfall innebär är skada av egenhanterat föremål, fall i samma nivå samt kontakt med vasst föremål. Fall från höjd och fall i samma nivå utgör orsak till skada i en stor del av olycksfallen. Resultatet av studien visar också att det saknas information i de händelserapporteringar som inkommer i BIA, alternativt är den tillgängliga informationen bristfällig.

This thesis draws on the climate-conflict research field to explore the question how does climate variability affect interstate conflict? This thesis contributes to various gaps in previous research by studying interstate conflict while most climate-conflict research investigates internal conflict, by using a new operationalization of climate variability as sea ice extent, and by studying an understudied case, the Arctic region. The theoretical argument consists of two parallel processes, a background mechanism focused on long-term climate change and a main mechanism focused on short-term climate variability. Increased climate variability is theorized to increase access to rivalrous resources, thereby increasing their saliency and leading to interstate competition. This increases each state’s utility of fighting, increasing the risk of bargaining failure and hence interstate conflict. The background mechanism theorizes that increased climate change will increase the risk of commitment problems, thereby contributing to bargaining failure and interstate conflict. I test the hypothesis that decreased sea ice extent increases the likelihood of militarized interstate incidents through a large-N quantitative study. Overall, the findings are inconclusive but with a low degree of support for the hypothesis.

Naturvårdsbränning är en åtgärd som avser att återskapa effekterna avnaturliga skogsbränder genom att påverka det ekologiska systemet. Trotsfördelarna föreligger risker, såsom oönskad eskalering och spridning av eld,rök och glöd, vilket kan negativt påverka mark, människor och samhällen.Studiens syfte var att undersöka hur ansvariga inom Länsstyrelsen hanterarrisker genom identifiering av kritiska incidenter utifrån Critical IncidentTechnique (CIT) baserad på intervjuer, samt att bidra till att öka den allmännakunskapen kring åtgärden.Resultatet visade att naturvårdsbränningsansvariga tar stor hänsyn till riskeroch arbetar kontinuerligt för att minimera dem. Dock identifierades treförbättringsområden inom riskhanteringsarbetet: säkerhet under bränningar,kommunikation under bränningar och kommunikation med samhället.Förbättringar inom dessa områden kan minimera risker under bränningar,minska oron i samhället och antalet falsklarm samt öka tryggheten igenomförandet för allmänheten och naturvårdsbränningspersonal vidnaturvårdsbränningar. / Hållbart sambruk av räddningsaktörer i svensk landsbygd