In 2022 is het tien jaar geleden dat de vigerende Diagnostische ReferentieNiveaus (DRN’s) werden vastgesteld door de NCS (NCS, 2012). Er is in die tien jaar veel gebeurd: er is onderzoek gedaan in binnen- en buitenland, er zijn praktijkervaringen opgedaan en er zijn nieuwe inzichten ontstaan. De geesten lijken nu rijp te zijn voor een volgende stap: een update van de waarden, methoden en aantallen DRN’s. Dit artikel geeft een overzicht van wat er sinds 2012 in Nederland met de DRN’s is gebeurd en hoe de toekomst van de DRN’s er uit lijkt te gaan zien.
Purpose This study aims to enhance understanding of the collaboration between chairs of nurse councils (CNCs) and members of executive hospital boards (BM) from a relational leadership perspective. Design/methodology/approach The authors used a qualitative and interpretive methodology. The authors study the daily interactions of BM and CNCs of seven Dutch hospitals through a relational leadership lens. The authors used a combination of observations, interviews and document analysis. The author’s qualitative analysis was used to grasp the process of collaborating between BM and CNCs. Findings Knowing each other, relating with and relating to are distinct but intertwined processes that influence the collaboration between BM and CNC. The absence of conflict is also regarded as a finding in this paper. Combined together, they show the importance of a relational process perspective to understand the complexity of collaboration in hospitals. Originality/value Collaboration between professional groups in hospitals is becoming more important due to increasing interdependence. This is a consequence of the complexity in organizing qualitative care. Nevertheless, research on the process of collaborating between nurse councils (NCs) and executive hospital boards is scarce. Furthermore, the understanding of the workings of boards, in general, is limited. The relational process perspective and the combination of observations, interviewing and document analysis proved valuable in this study and is underrepresented in leadership research. This process perspective is a valuable addition to skills- and competencies-focused leadership literature.
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The Nociception Coma Scale (NCS) is a pain observation tool, developed for patients with disorders of consciousness (DOC) due to acquired brain injury (ABI). The aim of this study was to assess the interrater reliability of the NCS and NCS-R among nurses for the assessment of pain in ABI patients with DOC. A secondary aim was further validation of both scales by assessing its discriminating abilities for the presence or absence of pain. Hospitalized patients with ABI (n = 10) were recorded on film during three conditions: baseline, after tactile stimulation, and after noxious stimulation. All stimulations were part of daily treatment for these patients. The 30 recordings were assessed with the NCS and NCS-R by 27 nurses from three university hospitals in the Netherlands. Each nurse viewed 9 to 12 recordings, totaling 270 assessments. Interrater reliability of the NCS/NCS-R items and total scores were estimated by intraclass correlations (ICC), which showed excellent and equal average measures reliability for the NCS and NCR-R total scores (ICC 0.95), and item scores (range 0.87-0.95). Secondary analysis was performed to assess differences in ICCs among nurses' education and experience and to assess the scales discriminating properties for the presence of pain. The NCS and NCS-R are valid and reproducible scales that can be used by nurses with an associate (of science) in nursing degree or baccalaureate (of science) in nursing degree. It seems that more experience with ABI patients is not a predictor for good agreement in the assessment of the NCS(-R).
The integration of renewable energy resources, controllable devices and energy storage into electricity distribution grids requires Decentralized Energy Management to ensure a stable distribution process. This demands the full integration of information and communication technology into the control of distribution grids. Supervisory Control and Data Acquisition (SCADA) is used to communicate measurements and commands between individual components and the control server. In the future this control is especially needed at medium voltage and probably also at the low voltage. This leads to an increased connectivity and thereby makes the system more vulnerable to cyber-attacks. According to the research agenda NCSRA III, the energy domain is becoming a prime target for cyber-attacks, e.g., abusing control protocol vulnerabilities. Detection of such attacks in SCADA networks is challenging when only relying on existing network Intrusion Detection Systems (IDSs). Although these systems were designed specifically for SCADA, they do not necessarily detect malicious control commands sent in legitimate format. However, analyzing each command in the context of the physical system has the potential to reveal certain inconsistencies. We propose to use dedicated intrusion detection mechanisms, which are fundamentally different from existing techniques used in the Internet. Up to now distribution grids are monitored and controlled centrally, whereby measurements are taken at field stations and send to the control room, which then issues commands back to actuators. In future smart grids, communication with and remote control of field stations is required. Attackers, who gain access to the corresponding communication links to substations can intercept and even exchange commands, which would not be detected by central security mechanisms. We argue that centralized SCADA systems should be enhanced by a distributed intrusion-detection approach to meet the new security challenges. Recently, as a first step a process-aware monitoring approach has been proposed as an additional layer that can be applied directly at Remote Terminal Units (RTUs). However, this allows purely local consistency checks. Instead, we propose a distributed and integrated approach for process-aware monitoring, which includes knowledge about the grid topology and measurements from neighboring RTUs to detect malicious incoming commands. The proposed approach requires a near real-time model of the relevant physical process, direct and secure communication between adjacent RTUs, and synchronized sensor measurements in trustable real-time, labeled with accurate global time-stamps. We investigate, to which extend the grid topology can be integrated into the IDS, while maintaining near real-time performance. Based on topology information and efficient solving of power flow equation we aim to detect e.g. non-consistent voltage drops or the occurrence of over/under-voltage and -current. By this, centrally requested switching commands and transformer tap change commands can be checked on consistency and safety based on the current state of the physical system. The developed concepts are not only relevant to increase the security of the distribution grids but are also crucial to deal with future developments like e.g. the safe integration of microgrids in the distribution networks or the operation of decentralized heat or biogas networks.
