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Abstract

Objective: Psychological safety is increasingly recognised as central to mental health, wellbeing and post-traumatic growth. To date, there is no psychometrically supported measure of psychological safety combining psychological, physiological and social components. The current research aimed to develop and establish the neuroception of psychological safety scale (NPSS), informed by Polyvagal Theory. Method: The study comprised of three stages: (1) item generation, (2) item reduction, and (3) assessment of factor structure and internal consistency. Exploratory and confirmatory factor analysis was conducted from two samples who completed a survey online (exploratory n = 342, confirmatory n = 455). Results: Initially, 107 items were generated. Item reduction and exploratory factor analysis resulted in a 29-item NPSS with subscales of compassion, social engagement and body sensations. The NPSS was found to have a consistent factor structure and internal consistency. Conclusion: The NPSS is a novel measure of psychological safety which can be used across a range of health and social care settings. This research provides a platform for further work to support and enhance understandings of the science of safety through the measurement of psychological, relational and physiological components of safety. The NPSS will help shape new approaches to evaluating trauma treatments, relational issues and mental health concerns. Research to establish the convergent, discriminant and concurrent validity of the NPSS and to explore its use with diverse community and clinical populations is underway.

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... Notably, it ensures flexible adaptation to changing environmental demands via fine-grained activation and inhibition of the myelinated vagus nerve without necessitating co-activation of the sympathetic nervous system. Importantly, it has been suggested that social embeddedness (being positively appraised by others), psychological feeling states related to others (compassion) and bodily sensations (physiological signals indicating a relaxed and calm state) contribute to the perception of safety (Morton et al., 2021), ultimately resulting in stronger vagal activity. Second, the dorsal vagal (motor) complex constitutes the oldest system responsible for (defensive) freezing responses to threat and plays a minor role in mammals. ...
... Moreover, elevated safety perception was related to higher sleep quality. This pattern of result is compatible with recent theorizing suggesting that feeling safe is associated with psychological, social and physiological entities (e.g., Brosschot et al., 2018;Morton et al., 2021) and generally confirms valid assessment of this variable. ...
... Although we provide evidence for the validity of this rating and ensured a proper understanding of the meaning of safety, a broader assessment would allow a more balanced operationalization of this concept and enable evaluation of scale reliability. Questionnaire measures of safety (Gilbert et al., 2008;Morton et al., 2021) are available and could be adapted to capture momentary episodes of safety within future EMA research. Fourth, assessment was restricted to three consecutive (week)days and the majority of the sample was female. ...
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Feeling safe has been suggested to reflect a state of beneficial autonomic regulation, which might facilitate physical and mental health. We aimed to examine the relationship between the perception of safety in everyday life and cardiac activity (heart rate, heart rate variability) via ecological momentary assessment (EMA). Sixty participants volunteered in a 3-day EMA protocol with parallel recordings of the ECG and subjective ratings of safety. Higher experienced safety in everyday life was associated with better sleep quality, being at home (vs. other locations), being surrounded by close others, as well as more positive and less negative social interactions, thus suggesting valid assessment. Moreover, perceived safety was positively associated with heart rate variability, although this association vanished when controlling for heart rate. Conversely, perceived safety was significantly negatively associated with heart rate, even after controlling for heart rate variability. Findings suggest that feeling safe is associated with attenuated cardiac activity and this effect is probably mediated by sympathetic nervous system activity.
... A mixed-method approach was used to find the answers to these research questions. Neuroception of psychological safety scale (NPSS) by Morton et al. (2021) was used to collect quantitative data from four different districts of Punjab state of India. The focus group technique was used to collect qualitative data. ...
... A mixed-method approach was used to find the answers to research questions. Neuroception of psychological safety scale (NPSS) by Morton et al. (2021) was used to collect the quantitative data from four different districts of Punjab state of India. NPSS included 29 items with a 3-factor structure described as body sensations, compassion, and social engagement. ...
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A growing body of research has focused on understanding the nature of psychological safety (PS) and recognizing factors contributing to it. Psychological safety describes an individual’s perceptions of the consequences of taking interpersonal risks in a particular context. This study aimed to examine the following research questions: What is the level of PS among Indian school teachers? What are the factors affecting the PS of teachers? And what type of support is expected by teachers to enhance their PS? A mixed-method approach was used to find the answers to these research questions. Neuroception of psychological safety scale (NPSS) by Morton et al. (2021) was used to collect quantitative data from four different districts of Punjab state of India. The focus group technique was used to collect qualitative data. Participants for this study were selected using convenient and purposive sampling. Quantitative data for this study was drawn from 100 school teachers and for qualitative data, 10 participants with extremely low scores and 10 participants with extremely high scores on NPSS were selected for two focus groups to find out the factors contributing to PS of teachers. The results showed that Indian school teachers had an average level of PS. The findings also implied the importance of PS for teachers and revealed that organizational culture, leadership, and teamwork are important factors contributing to PS for teachers.
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Anger has always been included in the repertoire of basic emotions. In 5- to 12-month-old infants viewing facial expressions of happiness, fear, and anger, the right fusiform face area, which is related to N290 event-related potentials (ERP) component, was found to be larger in amplitude in response to fearful and happy faces than to angry ones, while the posterior cingulate cortex/precuneus, which is related to the P400 and the Nc ERP components, was found to be larger in response to angry faces than to happy and fearful ones. These effects emerged at 5 months and disappeared at 12 months. This evidence may suggest a sensitive period related to the development of safety. According to polyvagal theory, the development of the feelings of safety is accomplished through neuroception, a neural reflexive mechanism, capable of distinguishing between safe, dangerous, and life-threatening features. A neuroception of safety supports the ventral vagal complex (VVC) and the social engagement system in safe contexts; alternatively, a neuroception of danger, or life threat, favors recruitment of the sympathetic nervous system (SNS) or the dorsal vagal complex (DVC), respectively. Unsafety detection may preferentially promote the emergence of SNS self-protective strategies related to anger to avoid the predominance of DVC self-protective strategies related to fear. Assessment of feelings of safety through neurophysiologically-informed psychometric tools is recommended, and the experience of safety, psychotherapy, and drugs may promote the decrease of unmyelinated-to-myelinated cardioinhibitory fiber ratio of the parasympathetic nervous system and the emergence of VVC, through a process of activity-dependent myelination.
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Objective Although resilience is a key topic in clinical theory and research, few studies focused on biobehavioral mechanisms that underpin resilience. Guided by the biobehavioral synchrony frame, we examined the dynamic interplay of physiological and behavioral synchrony as marker of risk and resilience in trauma‐exposed youth. Methods A unique cohort of war‐exposed versus control children was followed at four time‐points from early childhood to preadolescence and child posttraumatic stress disorder (PTSD) repeatedly assessed. At preadolescence (11–13 years), mother and child were observed in several social and nonsocial tasks while cardiac data collected and measures of respiratory sinus arrhythmia (RSA) and RSA synchrony computed. The social interactive task was microcoded for behavioral synchrony and the second‐by‐second balance of behavioral and physiological synchrony was calculated. War‐exposed preadolescents were divided into those diagnosed with PTSD at any time‐point across childhood versus resilient children. Results Group differences in behavioral synchrony, RSA synchrony, and their interplay emerged. PTSD dyads exhibited the tightest autonomic synchrony combined with the lowest behavioral synchrony, whereas resilient dyads displayed the highest behavioral and lowest autonomic synchrony. Hierarchical Linear Model analysis pinpointed two resilience‐promoting mechanisms. First, for resilient and control dyads, moments of behavioral synchrony were coupled with decreased RSA synchrony. Second, only among resilient dyads, moments of behavioral synchrony increased child RSA levels. Conclusion Findings specify mechanisms by which biobehavioral synchrony promotes resilience. As children grow, the tightly coupled mother–child physiology must be replaced by loosely coordinated behavioral attunement that buttresses maturation of the child's allostatic self‐regulation. Our findings highlight the need for synchrony‐based interventions to trauma‐exposed mothers.
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ABSTRACT Aims: Nurses are at the forefront of public health emergencies facing psychological pressures ensuing from the loss of patients and potential risk of infection while treating the infected. This study examines whether inclusive leadership has a causal relationship with psychological distress and to assess the mediation effect of psychological safety on this relationship in the long run. The hypotheses are developed and interpreted with the help of theoretical underpinnings from job demands resources theory and the theory of shattered assumptions. Design: Three-wave longitudinal study Methods: Questionnaire was used to carry out three waves of data collection from 405 nurses employed at five hospitals in Wuhan during the COVID-19 outbreak between the months of January to April, 2020. Partial least square structural equation modeling (PLS-SEM) was used to analyze data while controlling for age, gender, education, experience and working hours. Results: Results supported the hypothesized relationships where inclusive leadership indicated significant inverse causal relationship with psychological distress, and a positive causal relationship with psychological safety. Mediation effect of psychological safety was found significant, while the model explained 73.9% variance in psychological distress. Conclusion: Inclusive leadership, through its positive and supportive characteristics, can pave way for such mechanisms that improves the psychological safety of healthcare workers in the long run and curbs psychological distress. Impact: This is the first longitudinal study to examine the relationship between inclusive leadership and psychological distress in healthcare and also examines the mediating mechanism of psychology safety There is scarcity of empirical research on factors that determine and affect behavioral mechanism of healthcare workers during traumatic events and crisis Clinical leaders and healthcare policy makers must invest in and promote inclusive and supportive environment characterized with open and accessible leaders at workplace to improve psychological safety; it helps reduce levels of psychological distress. Keywords: Inclusive Leadership, Psychological Safety, Psychological Distress, COVID-19, Public Health Emergencies, Job Demands Resources, Nurses, Nursing Management, Trauma, Crisis
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Background: Over 100 million Americans lack affordable access to behavioral health care, and among these, military veterans are an especially vulnerable population. Military veterans require unique behavioral health services that can address military experiences and challenges transitioning to the civilian sector. Real world programs to help veterans successfully transition to civilian life must build a sense of community, have the ability to scale, and be able to reach the many veterans who cannot or will not access care. Digitally based behavioral health initiatives have emerged within the past few years to improve this access to care. Our novel behavioral health intervention teaches mindfulness-based CBT and narrative therapy using peer support groups as guides, with human facilitated asynchronous online discussions. Our study applies natural language processing (NLP) analytics to assess effectiveness of our on-line intervention, to test whether NLP may provide insights and detect nuances of personal change and growth that are not currently captured by subjective symptom measures. Objective: To study the value of natural language processing (NLP) analytics in assessing progress and outcomes among combat veterans and military sexual assault survivors participating in novel online interventions for post traumatic growth. Methods: IBM Watson and Linguistic Inquiry Word Count tools were applied to the narrative writings of combat veterans and survivors of military sexual trauma who participated in novel online peer supported group therapies for post traumatic growth. Participants watched videos; practiced skills such as mindfulness meditation; told their stories through narrative writing; and participated in asynchronous, facilitated online discussions with peers. The writings, including online postings, by the 16 participants who completed the program were analyzed after completion of the program. Results: Our results suggest that NLP can provide valuable insights on shifts in personality traits, personal values and needs, as well as emotional tone in an evaluation of our novel online behavioral health interventions. Emotional tone analysis demonstrated significant decreases in fear/anxiety, sadness, and disgust, as well as increases in joy. Significant effects were found for personal values and needs such as needing/desiring closeness and helping others, and for personality traits of openness, conscientiousness, extroversion, agreeableness and neuroticism (aka emotional range). Participants also demonstrated increases in authenticity and clout (confidence) of expression. NLP results were generally supported by qualitative observations and analysis, structured data and course feedback. Conclusions: The aggregate of results in our study suggest the effectiveness of our behavioral health intervention and that NLP can provide valuable insights on shifts in personality traits, personal values and needs, as well as measure changes in emotional tone. NLP's sensitivity to changes in emotional tone, values and personality strengths suggest efficacy of NLP as a leading indicator of treatment progress. Clinicaltrial:
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Background: Psychological safety is a dynamic team-level phenomenon which exists when team members believe that it is safe to take interpersonal risks. In healthcare teams, the presence of psychological safety is critical to delivering safe care. Scholars have highlighted a need for alternative measures which compliment survey-based measures of psychological safety in healthcare teams. Methods: The exploratory phase of this study raised concerns about whether current survey measures could provide a sufficient understanding of psychological safety within healthcare teams to inform strategies to improve it. Thus, previously validated psychological safety surveys and a meeting observation measure were adapted for use in healthcare teams. First, two group feedback sessions were held with 22 healthcare professionals, as well as a systematic literature review. Then, the members of eleven healthcare teams in Ireland and The Netherlands (n = 135) took part in the pilot test of the adapted composite measure. Results: The final composite measure has two parts: a team meeting observation measure and an adapted survey. The observation measure has 31 observable behaviours fitting seven categories: voice, defensive voice, silence behaviours, supportive, unsupportive, learning or improvement-oriented and familiarity type behaviours. The survey part consists of 19 items in three sub-dimensions related to; the team leader, other team members and the team as a whole. Three additional items capture the perceived representativeness of the observed team meeting compared to other similar meetings. Final adaptations were made in order to integrate the observation and survey measure. Conclusions: The resulting composite measure combines the strengths of observational and survey measures and is tailored for use in healthcare teams. It is uniquely co-developed with healthcare professionals and grounded in the psychological safety and healthcare literature. This composite measure can enable longitudinal research on psychological safety and inform future research to develop and test interventions to improve psychological safety.
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Objectives The importance of personalized and dignified care is increasingly being recognized in health care policy and practice. Despite the known impact of clothing on social identity and self‐expression, the impact of hospital clothing on patient well‐being has been widely overlooked. Patients are often required to wear hospital clothing, commonly a backless gown, during medical procedures and surgeries. The impact of wearing patient clothing on well‐being, during this time of vulnerability, was explored. Design A sequential multi‐method approach consisting of two studies. Methods Two studies were carried out to consider the impact of the hospital gown on well‐being among adults with and without chronic health conditions. The first study consisted of conducting in‐depth, semi‐structured interviews (n = 10) with adults living with a lifelong chronic health condition (congenital heart disease). The second study was a cross‐sectional online survey exploring adults' views (n = 928) and experiences of wearing the hospital gown. Results Qualitative analysis identified the following master themes: (1) symbolic embodiment of the ‘sick’ role, (2) relinquishing control to medical professionals, and (3) emotional and physical vulnerability. Quantitative analysis of the online survey data indicated that adults often reported wearing the hospital gown despite a lack of medical necessity. Its design was considered to be not fit for purpose and lacking in dignity. Conclusions The implications of these findings for health policy and practice are discussed, emphasizing the importance of challenging cultural norms in health care since dehumanizing aspects of care, as symbolically represented by the hospital gown, may adversely impact on patient well‐being. Statement of contribution What is already known • Getting dressed is a form of self‐expression, which contributes to the construction of social identity, yet few studies have explored the impact of wearing hospital clothing on patient well‐being. • The few studies on hospital clothing that exist suggest it is predominantly associated with feeling depersonalized, stigmatized, and devitalized, being in the ‘patient role’, low status, and a lack of control and privacy. • However, previous studies include a variety of hospital clothing including pyjamas (Edvardsson, 2009) and dressing gowns (Topo & Iltanen‐Tähkävuori, 2010), whereas in the United Kingdom, a 'one‐size‐fits‐all' backless gown, held together with ties at the back, is most commonly used. What this study adds • This study furthers understanding about the lived experience of wearing hospital clothing for people living with a chronic health condition (congenital heart disease) and without. • Wearing hospital clothing (most commonly the hospital gown) was associated with symbolic embodiment of the ‘sick’ role, relinquishing control to medical professionals, and emotional and physical vulnerability for people living with a chronic health condition. • Findings from a wider sample, drawn from the general population, suggest that the hospital gown is often being used despite a lack of medical necessity often leaving patients feeling exposed, self‐conscious, vulnerable, uncomfortable, cold, embarrassed, and disempowered. These findings are exacerbated for people living with a long‐term health condition and women. • Together, these studies suggest that the current design of the hospital gown is not fit for purpose and impacts negatively on patient well‐being.
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Empirical studies in psychology commonly report Cronbach's alpha as a measure of internal consistency reliability despite the fact that many methodological studies have shown that Cronbach's alpha is riddled with problems stemming from unrealistic assumptions. In many circumstances, violating these assumptions yields estimates of reliability that are too small, making measures look less reliable than they actually are. Although methodological critiques of Cronbach's alpha are being cited with increasing frequency in empirical studies, in this tutorial we discuss how the trend is not necessarily improving methodology used in the literature. That is, many studies continue to use Cronbach's alpha without regard for its assumptions or merely cite methodological papers advising against its use to rationalize unfavorable Cronbach's alpha estimates. This tutorial first provides evidence that recommendations against Cronbach’s alpha have not appreciably changed how empirical studies report reliability. Then, we summarize the drawbacks of Cronbach's alpha conceptually without relying on mathematical or simulation-based arguments so that these arguments are accessible to a broad audience. We continue by discussing several alternative measures that make less rigid assumptions which provide justifiably higher estimates of reliability compared to Cronbach’s alpha.. We conclude with empirical examples to illustrate advantages of alternative measures of reliability including omega total, Revelle’s omega total, the greatest lower bound, and Coefficient H. A detailed software appendix is also provided to help researchers implement alternative methods.
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The Cronbach's alpha is the most widely used method for estimating internal consistency reliability. This procedure has proved very resistant to the passage of time, even if its limitations are well documented and although there are better options as omega coefficient or the different versions of glb, with obvious advantages especially for applied research in which the ítems differ in quality or have skewed distributions. In this paper, using Monte Carlo simulation, the performance of these reliability coefficients under a one-dimensional model is evaluated in terms of skewness and no tau-equivalence. The results show that omega coefficient is always better choice than alpha and in the presence of skew items is preferable to use omega glb coefficients even in small samples. http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00769/abstract
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Many patients do not respond adequately to current pharmacological or psychological treatments for psychosis. Persistent persecutory delusions are common in clinical services, and cause considerable patient distress and impairment. Our aim has been to build a new translational personalized treatment, with the potential for wide use, that leads to high rates of recovery in persistent persecutory delusions. We have been developing, and evaluating individually, brief modular interventions, each targeting a key causal factor identified from our cognitive model. These modules are now combined in “The Feeling Safe Programme”. Aims: To test the feasibility of a new translational modular treatment for persistent persecutory delusions and provide initial efficacy data. Method: 12 patients with persistent persecutory delusions in the context of non-affective psychosis were offered the 6-month Feeling Safe Programme. After assessment, patients chose from a personalized menu of treatment options. Four weekly baseline assessments were carried out, followed by monthly assessments. Recovery in the delusion was defined as conviction falling below 50% (greater doubt than certainty). Results: 11 patients completed the intervention. One patient withdrew before the first monthly assessment due to physical health problems. An average of 20 sessions ( SD = 4.4) were received. Posttreatment, 7 out of 11 (64%) patients had recovery in their persistent delusions. Satisfaction ratings were high. Conclusions: The Feeling Safe Programme is feasible to use and was associated with large clinical benefits. To our knowledge this is the first treatment report focused on delusion recovery. The treatment will be tested in a randomized controlled trial.
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Despite the widespread use of exploratory factor analysis in psychological research, researchers often make questionable decisions when conducting these analyses. This article reviews the major design and analytical decisions that must be made when conducting a factor analysis and notes that each of these decisions has important consequences for the obtained results. Recommendations that have been made in the methodological literature are discussed. Analyses of 3 existing empirical data sets are used to illustrate how questionable decisions in conducting factor analyses can yield problematic results. The article presents a survey of 2 prominent journals that suggests that researchers routinely conduct analyses using such questionable methods. The implications of these practices for psychological research are discussed, and the reasons for current practices are reviewed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Over the last few decades, medical and surgical advances have led to a growing population of individuals living with congenital heart disease. The challenges of this condition can reach beyond physical limitations to include anxiety, depression and post-traumatic stress disorder. To date, these psychological outcomes have been neglected; yet, they need not be inevitable. The factors contributing to these difficulties are considered here, drawing on current evidence and neuropsychological theories including the novel application of polyvagal theory. Suggestions for developing psychologically informed medical and social care to improve mental health, wellbeing and recovery and influence policy and training are proposed ( (See supplemental material for video abstract).
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Safety‐seeking behaviors (SSBs) may be employed after exposure to a traumatic event in an effort to prevent a feared outcome. Cognitive models of posttraumatic stress disorder propose SSBs contribute to maintaining this disorder by preventing disconfirmation of maladaptive beliefs and preserving a sense of current threat. Recent research has found that SSBs impact children's posttraumatic stress symptoms (PTSS) and recovery. In this paper, we sought to develop and validate a novel 22‐item Child Safety Behavior Scale (CSBS) in a school‐based sample of 391 pupils (age 12–15 years) who completed a battery of questionnaires as well as 68 youths (age 8–17 years) who were recently exposed to a trauma. Of the sample, 93.1% (N = 426) completed the new questionnaire. The sample was split (n = 213), and we utilized principal components analysis alongside parallel analysis, which revealed that 13 items loaded well onto a two‐factor structure. This structure was superior to a one‐factor model and overall demonstrated a moderately good model of fit across indices, based upon a confirmatory factory analysis with the other half of the sample. The CSBS showed excellent internal consistency, r = .90; good test–retest reliability, r = .64; and good discriminant validity and specificity. In a multiple linear regression, SSBs, negative appraisals, and number of trauma types each accounted for unique variance in a model of PTSS. This study provides initial support for the use of the CSBS in trauma‐exposed youth as a valuable tool for further research, clinical assessment, and targeted intervention.
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Defining embeddedness as a psychological construct that influences individuals to stay, we draw on conservation of resources theory to develop and test a model of the influence of contextual social support resources on both organizational and community forms of embeddedness. In addition to the direct relationship between support and embeddedness, we also assess the mediating influence of organizational and community psychological safety and the moderating impact of need to belong. Using a multisource sample of employees and coworkers (N = 165), we found support for most of the hypotheses. Social support resources emanating from the organization and the community were positively associated with embeddedness in each domain, and psychological safety mediated these relationships. We also found that need to belong was an important boundary condition in the determination of organizational embeddedness. We discuss the theoretical contributions and practical implications of our findings.
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Previous research has documented that, in general, women are more concerned about their personal safety and take more safety precautions than men. However, this study looks beyond gender by examining the association of three overall factors including victimization history, perceived risk of future victimization, and personal control with worry about safety, safety responses, and bystander intervention intentions for 270 men and 821 women. There were four main findings from this study including the following: (a) The two most consistently associated factors with worry about safety, safety responses, and bystander intervention intentions were higher perceived risk of violent victimization and safety efficacy; (b) recent victimization, rather than victimization history, played an important role in safety responses particularly for women; (c) different patterns of factors are associated with different safety responses demonstrating the importance of examining a wide variety of safety responses; and (d) the pattern of factors associated with worry about safety and safety responses do differ by gender but also had some important similarities. Implications for future research and prevention as well as safety planning interventions are discussed.
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In this paper we discuss the identification of defining characteristics in pictorial artefacts based upon a pre-understanding of traumatization, dissociation and recovery, metaphorical processing, and pictorial semiotics. Signs of reduced arousal, increased positive affect and states, self-efficacy, and self-esteem, are considered important parameters when assessing pictorial artefacts conducted in therapy. These signs, related to overcoming traumatization and a re-established experience of safety, as well as the concept of neuroception, should be easily identifiable via the use of appropriately designed assessment tools. We tested this hypothesis on a series of non-clinical material consisting of drawings produced by 122 experienced clinicians. Through the identification of defining concepts in artwork we developed a preliminary assessment tool with the aims of guiding clinicians in identifying perceptions of fright in relation to safety and in facilitating the nurturing of safe states in clients when conducting pictorial artefacts. This tool consists of plain observation and subjective appraisal combined with the identification of seven predefined perspectives; how is the picture made, colour utilization, depiction of states and body positions, which affects/emotions, symbols and secondary metaphors/symbols for the self can be recognised in relation to a neuroception of threat with respect to safety.
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Since the concept of psychological safety was introduced, empirical research on its antecedents, outcomes, and moderators at different levels of analysis has proliferated. Given a burgeoning body of empirical evidence, a systematic review of the psychological safety literature is warranted. As well as reviewing empirical work on psychological safety, the present article highlights gaps in the literature and provides direction for future work. In doing so, it highlights the need to advance our understanding of psychological safety through the integration of key theoretical perspectives to explain how psychological safety develops and influences work outcomes at different levels of analysis. Suggestions for future empirical research to advance our understanding of psychological safety are also provided.
Conference Paper
As an important indicator of employees' psychological contract and organizational trust, psychological safety is a kind of safety awareness based on the psychological climate of certain events in organization, current scholars generally divided it into three levels: individual, group, organizational psychological safety. Its influencing factors can be divided into individual factors, interpersonal factors, leadership features and organizational context four aspects;its main outcome variables conclude the knowledge sharing, voice, innovation, job involvement and job performance. Finally, the study points out the shortcomings of existing research and future research directions.
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This paper examines the effect on aviation safety of cultural differences between Chinese and Western commercial airline pilots. James Reason and Alan Hobbs’ Safety Culture model of a Just Culture, a Reporting Culture, and a Learning Culture was applied to the vertical aspect to measure Safety Culture in a multi-dimensional mode; a comparison of Chinese culture and Western culture on aviation safety was applied to the horizontal aspect to investigate the two different cultures. Qualitative and quantitative methods were used for this research. The interviews yielded five topics: trust, guanxi (relationship) vs. equity and equality, power distances, harmony among people, and sharing information and knowledge. For each of the five topics, questionnaires were developed to investigate the effects of cultural differences on international commercial airline pilots. A major finding was that the cultural differences strongly influence the pilots’ trust and satisfaction with the implementation of a Just Culture, a Reporting Culture, and a Learning Culture in their company. The Western pilots were more satisfied with those aspects of the Safety Culture model than were the Chinese pilots. Leadership that builds trust, includes a high power distance, and allows them to maintain harmony with their colleagues in a Reporting Culture is desired by Chinese pilots. Because it might have generated negative responses from their colleagues, Chinese pilots were more hesitant than were Western pilots to share information and knowledge. Finally, managers’ work histories, communication skills, good examples, team reporting, and incentive programs were suggested as vital for assuring the success of the Safety Culture.
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This paper aims to explore the critical attributes of the concept feeling safe. The safe delivery of care is a high priority; however; it is not really known what it means to the patient to 'feel safe' during an inpatient hospitalization. This analysis explores the topic of safety from the patient's perspective. Concept analysis. The data bases of CINAHL, Medline, PsychInfo and Google Scholar for the years 1995-2012 were searched using the terms safe and feeling safe. The eight-step concept analysis method of Walker and Avant was used to analyse the concept of feeling safe. Uses and defining attributes, as well as identified antecedents, consequences and empirical referents, are presented. Case examples are provided to assist in the understanding of defining attributes. Feeling safe is defined as an emotional state where perceptions of care contribute to a sense of security and freedom from harm. Four attributes were identified: trust, cared for, presence and knowledge. Relationship, environment and suffering are the antecedents of feeling safe, while control, hope and relaxed or calm are the consequences. Empirical referents and early development of a theory of feeling safe are explored. This analysis begins the work of synthesizing qualitative research already completed around the concept of feeling safe by defining the key attributes of the concept. Support for the importance of developing patient-centred models of care and creating positive environments where patients receive high-quality care and feel safe is provided.
This study reviews the literature on e-service quality (e-SQ), with an emphasis on the methodological issues involved in developing measurement scales and issues related to the dimensionality of the e-SQ construct. We selected numerous studies on e-SQ from well-known databases and subjected them to a thorough content analysis. The review shows that dimensions of e-service quality tend to be contingent on the service industry. Despite the common dimensions often used in evaluating e-SQ, regardless of the type of service on the internet (‘reliability/fulfilment’, ‘responsiveness’, ‘web design’, ‘ease of use/usability’, ‘privacy/security’, and ‘information quality/benefit’), other dimensions are specific to e-service contexts. The study also identifies several conceptual and methodological limitations associated with developing e-SQ measurement such as the lack of a rigorous validation process, the problematic sample size and composition, the focus on functional aspects, and the use of a data-driven approach. This is the first study to undertake an extensive literature review of research on the development of e-SQ scales. The findings should be valuable to academics and practitioners alike.