Loading [MathJax]/jax/output/SVG/jax.js
Research article Special Issues

Examining psychosocial risks and their impact on nurses' safety attitudes and medication error rates: A cross-sectional study

  • Received: 16 October 2024 Revised: 06 January 2025 Accepted: 11 February 2025 Published: 20 March 2025
  • Introduction 

    Employee exposure to specific risks often increases work-related stress, negatively impacting their effectiveness and potentially leading to illnesses, mistakes, or accidents.

    Objective 

    We aimed to determine the psychosocial risks experienced by nurses in tertiary hospitals and their association with attitudes toward safety and the occurrence of medication errors.

    Methods 

    A cross-sectional study was conducted between September 30, 2022 and December 31, 2023 in four Greek tertiary hospitals (Evangelismos, Nikaia “Agios Panteleimon”, University Hospital of Larissa, and “G. Papanikolaou”). The study involved 514 nurses aged 20–67, employed for at least 12 months, fluent in Greek, and completing questionnaires on stress, burnout, and medication errors. The questionnaire used in the study included demographic information of the nursing staff (age, gender, marital status, work experience, and education level), characteristics of the nursing unit (medical, surgical, long-term care unit, Intensive Care Unit), the COPSOQ III (Copenhagen Psychosocial Questionnaire Version III), the HSOPSC (Hospital Survey on Patient Safety Culture), and the questionnaire for Investigating Nursing Errors in Medication Administration.

    Results 

    Nurses exposed to psychosocial risks, such as bullying and high demands, reported increased medication errors. Supportive work environments with sufficient staffing and collaborative culture significantly mitigated these risks. Factors such as “Staffing” and “Handoffs” partially mediated the relationship between demands and errors. Thus, targeted interventions to reduce bullying and enhance teamwork are essential. Continuous education emerged as crucial for improving safety and performance.

    Conclusion 

    The study underscores the necessity of social support, job autonomy, and work-life balance as critical factors in reducing stress and improving the quality of care. Specific strategies are proposed to enhance nurses' mental health and improve working conditions.

    Citation: Vasileios Tzenetidis, Aristomenis Kotsakis, Mary Gouva, Konstantinos Tsaras, Maria Malliarou. Examining psychosocial risks and their impact on nurses' safety attitudes and medication error rates: A cross-sectional study[J]. AIMS Public Health, 2025, 12(2): 378-398. doi: 10.3934/publichealth.2025022

    Related Papers:

    [1] Robert Stephen Cantrell, Chris Cosner, Yuan Lou . Evolution of dispersal and the ideal free distribution. Mathematical Biosciences and Engineering, 2010, 7(1): 17-36. doi: 10.3934/mbe.2010.7.17
    [2] Minus van Baalen, Atsushi Yamauchi . Competition for resources may reinforce the evolution of altruism in spatially structured populations. Mathematical Biosciences and Engineering, 2019, 16(5): 3694-3717. doi: 10.3934/mbe.2019183
    [3] Jinyu Wei, Bin Liu . Coexistence in a competition-diffusion-advection system with equal amount of total resources. Mathematical Biosciences and Engineering, 2021, 18(4): 3543-3558. doi: 10.3934/mbe.2021178
    [4] Andrea Pugliese, Abba B. Gumel, Fabio A. Milner, Jorge X. Velasco-Hernandez . Sex-biased prevalence in infections with heterosexual, direct, and vector-mediated transmission: a theoretical analysis. Mathematical Biosciences and Engineering, 2018, 15(1): 125-140. doi: 10.3934/mbe.2018005
    [5] Nancy Azer, P. van den Driessche . Competition and Dispersal Delays in Patchy Environments. Mathematical Biosciences and Engineering, 2006, 3(2): 283-296. doi: 10.3934/mbe.2006.3.283
    [6] Zhilan Feng, Robert Swihart, Yingfei Yi, Huaiping Zhu . Coexistence in a metapopulation model with explicit local dynamics. Mathematical Biosciences and Engineering, 2004, 1(1): 131-145. doi: 10.3934/mbe.2004.1.131
    [7] Yang Kuang, Angela Peace, Hao Wang . Special issue: Resource explicit population models. Mathematical Biosciences and Engineering, 2019, 16(1): 538-540. doi: 10.3934/mbe.2019025
    [8] Bethan Morris, Lee Curtin, Andrea Hawkins-Daarud, Matthew E. Hubbard, Ruman Rahman, Stuart J. Smith, Dorothee Auer, Nhan L. Tran, Leland S. Hu, Jennifer M. Eschbacher, Kris A. Smith, Ashley Stokes, Kristin R. Swanson, Markus R. Owen . Identifying the spatial and temporal dynamics of molecularly-distinct glioblastoma sub-populations. Mathematical Biosciences and Engineering, 2020, 17(5): 4905-4941. doi: 10.3934/mbe.2020267
    [9] Azmy S. Ackleh, Shuhua Hu . Comparison between stochastic and deterministic selection-mutation models. Mathematical Biosciences and Engineering, 2007, 4(2): 133-157. doi: 10.3934/mbe.2007.4.133
    [10] Muntaser Safan . Mathematical analysis of an SIR respiratory infection model with sex and gender disparity: special reference to influenza A. Mathematical Biosciences and Engineering, 2019, 16(4): 2613-2649. doi: 10.3934/mbe.2019131
  • Introduction 

    Employee exposure to specific risks often increases work-related stress, negatively impacting their effectiveness and potentially leading to illnesses, mistakes, or accidents.

    Objective 

    We aimed to determine the psychosocial risks experienced by nurses in tertiary hospitals and their association with attitudes toward safety and the occurrence of medication errors.

    Methods 

    A cross-sectional study was conducted between September 30, 2022 and December 31, 2023 in four Greek tertiary hospitals (Evangelismos, Nikaia “Agios Panteleimon”, University Hospital of Larissa, and “G. Papanikolaou”). The study involved 514 nurses aged 20–67, employed for at least 12 months, fluent in Greek, and completing questionnaires on stress, burnout, and medication errors. The questionnaire used in the study included demographic information of the nursing staff (age, gender, marital status, work experience, and education level), characteristics of the nursing unit (medical, surgical, long-term care unit, Intensive Care Unit), the COPSOQ III (Copenhagen Psychosocial Questionnaire Version III), the HSOPSC (Hospital Survey on Patient Safety Culture), and the questionnaire for Investigating Nursing Errors in Medication Administration.

    Results 

    Nurses exposed to psychosocial risks, such as bullying and high demands, reported increased medication errors. Supportive work environments with sufficient staffing and collaborative culture significantly mitigated these risks. Factors such as “Staffing” and “Handoffs” partially mediated the relationship between demands and errors. Thus, targeted interventions to reduce bullying and enhance teamwork are essential. Continuous education emerged as crucial for improving safety and performance.

    Conclusion 

    The study underscores the necessity of social support, job autonomy, and work-life balance as critical factors in reducing stress and improving the quality of care. Specific strategies are proposed to enhance nurses' mental health and improve working conditions.



    In recent years, multi-agent consensus control has been recognized as a vital element of distributed collaborative control for applications such as distributed computing, unmanned aerial vehicle formation, and intelligent transportation systems. Researchers have shown significant interest in this area, and a wide range of control mechanisms have been explored in the past few years. These control mechanisms include adaptive [1,2,3,4], fault-tolerant [5], impulse [6,7], and sliding mode [8] methods.

    In practical systems, the stability of the system state is susceptible to disruption from unexpected factors, including nonlinear dynamics and system uncertainties. Existing research has primarily focused on continuous-time systems, where the state information of intelligent agents is continuously transmitted between nodes, leading to significant network usage and energy consumption. However, the development of event-triggered control solves this problem by avoiding constant communication. Earlier studies on event-triggered control that can be found have investigated centralized, distributed, and self-triggered event-triggered control techniques [9,10,11]. One researcher proposed an adaptive event-triggered control scheme for strongly connected networks that dynamically adjusted the triggering time interval on the basis of sampled data [12]. Another mechanism using a dynamic event-triggering mechanism was proposed to reduce communication resource wastage compared with traditional event-triggering mechanisms [13]. Others have assumed that system parameters such as the efficiency factor of the executor, external disturbances, and precursor control input signals are all unknown and introduced a fault-tolerant control to obtain sufficient conditions for consistent tracking [14]. However, these findings primarily investigate traditional event triggering mechanisms. In [15,16], researchers proposed a dynamic event-triggered mechanism, which can significantly reduce the number of triggers and conserve communication resources. researchers respectively proposed centralized and distributed dynamic event-triggered mechanisms in [15,16], while scholars suggested both centralized and distributed mechanisms in [17], verifying their superiority.

    However, the rapid growth of network information technologies has also led to a rise in cyber attacks. Among them, denial-of-service (DoS) attacks are the most common, being relatively easy to execute in the attack space. These attacks usually target the controller or exhaust the resources of the target system directly, resulting in the system being unable to provide normal services or communication. In some cases, these attacks cause the system to crash. Therefore, countering DoS attacks has received significant research attention. Researchers studied the multi-agent systems(MASs) under DoS attacks in given attack frequency and upper bounds on attack duration [18,19]. Compared with linear systems, nonlinear MASs are more widely used in real life. Among these, a secure controller based on event triggering was proposed to solve the lead-following consensus problem of second-order nonlinear systems [20]. This is more common than linear systems. Another proposal was for an event-triggered adaptive fault-tolerant control strategy, which reduced the computational cost of heterogeneity [21]. For nonperiodic DoS attacks, the upper bounds of network attacks, actuator failures, attack duration, and frequency are obtained. Another method uses a security mechanism employing a prediction-based switching observer scheme to address the issue of invalidation in event-triggered mechanisms during attack intervals [22]. A novel framework for observer-based event-triggered containment control, taking into account the occurrence of DoS attacks, has also been introduced [23]. This framework establishes a resilient event-triggered controller, using a specially designed observer. The goal is to achieve consistent control of MASs in the presence of DoS attacks.

    Based on these observations, we aim to explore the security consensus problem of nonlinear MAS with external disturbances under DoS attacks in this paper. Our contributions are as follows.

    1) In this paper, a nonlinear system with external disturbances is considered, and the effects of the nonlinear dynamics and uncertainty of the system are eliminated by designing an adaptive scheme and state-feedback control gains by updating the laws of the adaptive parameters online.

    2) Compared with [22,23], a dynamic variable is introduced to adjust the triggering instances under DoS attacks. Therefore, the event-triggered mechanism proposed in this paper is more flexible and can effectively save communication resources. In addition, continuous communication between agents is not required to determine whether a trigger condition satisfies the trigger condition.

    Notation R is the set of real numbers, and RN×N is the set of N×N real matrix. represents a Euclidean norm of vectors or matrices. The superscripts A1 and AT represent the inverse and transpose of matrix A. λmax(A) is the maximum eigenvalue, and λmin(A) is the minimum eigenvalue of matrix A. D+() denotes the righthand derivative of a function, and is Kronecker product. diag{A1,,An} is the diagonal matrix. is the intersection of sets, and denotes the union of sets.

    For a given MAS, the digraph G is (V,E), where V={1,2,,N} is the set of nodes, and EV×V represents the edge set of followers. The information exchange between each node can be described by the adjacency matrix A and the Laplacian matrix L. A=[aij]RN×N if agents i and j communicate with one another, aij=1; otherwise aij=0 and L=[lij]Rn×n where L=DA, The degree matrix D=diag(di) with di=Ni=1aij. In this paper, we assume that the agents are linked by a balancing topology, i.e., aij=aji. If the agent i communicates with the leader, then bi=1; otherwise, bi=0.

    For a leader-following system, the dynamics of the leader are described by the equation

    ˙x0=Ax0+f(t,x0(t)). (2.1)

    The ith follower system is

    ˙xi=Axi+Bui(t)+f(t,xi(t))+wi. (2.2)

    In the preceding, x(t)Rn are positions of the agent, ui(t)R is the control input, ARn×n and BRn×p are system matrices, f(x) is a nonlinear function, and wi is the uncertainty input satisfying

    wiςi1|u|+ςi2|x|+γi, (2.3)

    where ςi1<1, ςi2 and γi are unknown constants.

    Lemma 1. If the nonlinear function f(t,xi(t)),i=1,2,..., is continuously differentiable in a region SR2 and xi(t0)S, then for any xi(t0)S, the following formula is satisfied:

    f(xi(t),t)f(xi(t0),t)=f()xi×(xi(t)xi(t0)), (2.4)

    where f()=f(xi(t0))+Δ(xi(t)xi(t0)), 0<Δ<1.

    Assumption 1. If there is a continuously differentiable function f(t,xi(t)) and the highest order s{1,2,N}, there exist bounded positive scalars δix, such that

    |f(zi)xi|δixxis, (2.5)

    where xis=|xi|s+|xi|s1++1,s1. We also need some assumptions to ensure that the purpose is achieved.

    Assumption 2. A,B can be stabilized, and the digraph G is strongly connected.

    Next, we define the position errors ei(t):

    ei(t)=Nj=0,jiaij(xi(t)xj(t))+bi(xi(t)x0(t)). (2.6)

    According to Definition 1, we have

    ˙ei(t)=Nj=0,jiaij(˙xi(t)˙xj(t))+bi(˙xi(t)˙x0(t))=Nj=0,jiaij(A(xixj)+B(uiuj)+[f(t,xi(t))f(t,xj(t))]+(wiwj))+bi(A(xix0)+Bui)+wi+bi[f(t,xi(t))f(t,x0(t))]=Nj=0,jiAaij((xixj)+bi(xix0))+Baij(uiuj)+aijf(zi)xi(xi(t)xj(t0))+aij(wiwj))+bi(Bui+wi))+bi[f(zi)xi(xi(t)x0(t))]=Nj=0,jiA(aij(xixj)+bi(xix0))+f(zi)xi[aij(xi(t)xj(t0))+bi(xi(t)x0(t))]+aij(B(uiuj))+(wiwj))+bi(Bui+wi)). (2.7)

    We also have

    ˙e(t)=(L+L0)(Bu(t)+w(t))+(A+f(zi)x)e(t), (2.8)

    where e(t)=[e1(t),e2(t),,ei(t)], f(zi)x=diagNi=1[f(zi)xi], L0=diagNi=1[bi]. L is defined as

    lij={Nk=1,kiaik,j=iaij,ji. (2.9)

    , then Eq (2.8) can be expressed as

    ˙e(t)=(A+ΔA)e(t)+ˉL(Bu(t)+w(t)), (2.10)

    where A=[IN×N000], ˉL=[0L+L0], ΔA=[000f(zi)x].

    Definition 1. MAS (2.1) and (2.2) are said to have consensus if each agent's position state in the system satisfies

    limtxi(t)x0(t)=0,i=1,2,,N. (2.11)

    The distributed adaptive control input is

    ui(t)=kiei(t)ˉeiΨi(t), (2.12)

    where ˉei=Nj=1ajieji,aii=ai0+Nj=1,jiaij. ki is the control gain determined based on the linear matrix inequality(LMI)

    (A+ˉLBK)TP+P(A+ˉLBK)0, (2.13)

    where P=[P00N×N0N×NIN×N]>0,K=diag[ki],andP0 is a positive definition matrix. Ψi(t) is defined as

    Ψi={11ςi1(ςi1|kiei|+ςi2|xis|+γi|ei|+2ˆδix|e|2xis|ei|2),ei00,ei=0 (2.14)

    where ˆδix is the estimate of unknown parameters δix. The following describes the updated laws for the adaptive parameters:

    dˆδidt=|ei|2xis. (2.15)

    Since δi is an unknown constant, defined as ˜δi(t)=ˆδi(t)δi, the adaptive error systems are described by

    d˜δidt=dˆδidt. (2.16)

    It follows from Eq (2.12) that

    u(t)=ke(t)ˉeΨ(t), (2.17)

    where k(t)=[k1(t),k2(t),]T and ˉe=[ˉe1,ˉe2ˉen]. According to Eqs (2.11) and (2.15), we have

    ˙e(t)=(A+ˉLBK)e(t)+ΔAe(t)ˉL(BˉevΨ(t))ˉLw(t). (2.18)

    Next, we define the event trigger time series as {tjk} for the jth agent. Therefore, the next triggering time tik+1 for the ith agent can be expressed as

    tik+1=inf{t>tik|Hi(t)0}. (2.19)

    The function Hi() is given by

    Hi()=θiχi(t)+αiqi(t)2ηiei(t)2, (2.20)

    where θi>0, αi,ηiRn>0. qi(t) is defined as the measurement error according to Eq (2.6):

    qi(t)=ei(tik)ei(t). (2.21)

    χi(t) satisfies

    ˙χi(t)=βiχi(t)+ηiei(t)2αiqi(t)2, (2.22)

    where βi>0, initial value χi(0)>0 could be randomly selected, and ti0=0.

    Remark 1: The internal dynamic variable updates according to internal variables such as self-feedback, measurement error, and neighborhood error. In comparison with the conventional static triggering strategy [22,23], the dynamic event triggered control protocol we proposed can more effectively reduce network communication and save resources.

    A DoS attack aims to block the communication channels so the targeted system cannot exchange information normally. Communication channels are not the only things affected by DoS attacks because the attacks can damage communication equipment along with hindering data transmission, measurement, and control channels simultaneously. DoS attacks are extremely destructive to the system, but their energy consumption requires attackers to replenish energy supplies after the attack is over, which takes time. Therefore, the time series can be split into two sections based on whether a DoS assault was launched. In the absence of the DoS attack, the system functions and communicates properly. However, in the presence of a DoS attack, communication is cut off, and the controller stops functioning. Here, we assume that the time interval of DoS attacks is {tm}mN, where tm is the moment of the DoS attack, and [tm,tm+Δm] is the mth DoS time interval, and Δm is the time duration of the mth attack. The DoS attack interval is the same for all multi-agents. Thus, the set time instants where communication is blocked (the interval of the DoS attack) are

    Ξa(t0,t)={mN[tm,tm+Δm]}[t0,t]. (3.1)

    Similarly, the sequence of time intervals without attacks is given by

    Ξs(t0,t)=[t0,t]Ξa(t0,t). (3.2)

    Because of the recovery mechanism, the MAS cannot immediately restore communication after the end of a DoS attack, and due to the event-triggering mechanism, there is an upper bound for the time when the two events occur consecutively. We assume that they can exist at the same time. Therefore, the actual DoS attack lasts longer, and consequently, the mth DoS attack's actual time frame may be described as [tm,tm+ˉΔm]. The new time period of the DoS attack is as follows:

    ˜Ξa(t0,t)={mN[tm,tm+ˉΔm]}[t0,t] (3.3)
    ˜Ξs(t0,t)=[t0,t]˜Ξa(t0,t) (3.4)

    Assumption 2. Define na(t0,t) as the number of attacks in the period [t0,t], so the attack frequency Fa(t0,t)>0 satisfies

    Fa(t0,t)=na(t0,t)tt0. (3.5)

    Assumption 3. Define Na(t0,t) as the total time interval of the DoS attack in the period [t0,t]. The constants T00,F00,0<1T1<1,0<1F1<1 are such that

    |Ξa(t0,t)|Ξ0+tt0T1and (3.6)
    Na(t0,t)F0+tt0F1, (3.7)

    where 1T1 is the attack strength.

    Lemma 1. Previous research considers Eq (2.1) and this DoS attack model under Assumptions 2 and 3 [18]. If the Lyapunov function V1(t),V2(t) satisfies

    {˙V1(t)l0V(t)+τ0t˜Ξs˙V2(t)l1V(t)+τ1t˜Ξa, (3.8)

    where l0,l1,τ0,τ1 are positive constants. T1,F1 defined in Assumption 3 satisfies

    1T1<l0ηl0+l11F1<η2lnκ+(l0+l1)ρ, (3.9)

    where 0<η<l0 is the time to restore communication. ρ>0, κ1 is a constant satisfying

    {κV2((tm+ˉΔm))V1(tm+ˉΔm)0κV1(tm)V2(tm+1)0. (3.10)

    Thus, we say that V(t) are bounded.

    Remark 2: Lemma 1 gives an upper bound on DoS attack frequency and duration, ensuring that the Lyapunov function remains stable over the entire time span [18].

    Remark 3: The DoS attack considered in this paper mainly attacks the communication channels between agents. Thus, when the DoS attack comes, there is no information interaction between neighboring agents, and the event-triggering control is not triggered. In addition, we consider a DETC. Compared with the traditional event-triggering control, we introduce a dynamic variable that uses communication resources more effectively. In the simulation section below, we compare our method with the traditional event-triggering mechanism.

    In this section, we prove system stability. Our presentation has two sections: the stability study of the MAS (2.1) and (2.2) under a DoS attack and the proof of non-Zeno behavior.

    Theorem 1. For the MAS (2.1) and (2.2) under DoS attacks, we consider Assumption 1 and the controller (2.12). If the LMI (2.13) satisfies (A+ˉLBK)TP+P(A+ˉLBK)ξiP, where ξiRn=σiηi,σi>1, then a feasible solution exists and the MAS is said to achieve leader-following consensus.

    Proof of Theorem 1. The system stability proof is also divided into two parts. The communication of the system is damaged under a DoS attack, but the system is not always in an impassable state. The proof is divided between DoS attacks and non-DoS attacks, as per the prior section. When there are non-DoS attacks in the system, we consider the Lyapunov function

    W(t)=V(t)+Ni=1χi(t)=eT(t)Pe(t)+Ni=1κ1i~δ2i+Ni=1χi(t). (4.1)

    It follows from Eqs (2.20)–(2.22) that

    ˙χi=βiχiθiχi. (4.2)

    The preceding implies that

    χi(t)χi(0)e(βi+θi)t>0, (4.3)

    which leads to W(t)>0.

    The derivative of W is

    ˙W(t)=eT[(A+ˉLBK)TP+P(A+ˉLBK)]e+2eTPΔAe2eTPˉLˉeΨ(t)+2eTPˉLw(t)+Ni2κ1i˙˜δi˜δi+Ni=1˙χi(t). (4.4)

    According to Eq (2.3), the condition in Assumption 1, and the control protocol in {Eq (2.12)}, we have

    ˙W(t)eT[(A+ˉLBK)TP+P(A+ˉLBK)]e+2Ni=1|e|2f(zi)xi2Ni=1|e|2Ψi+2Ni=1|e|(ςi1|u|+ςi2|x|+δi)+Ni2κ1i˙˜δi˜δi+Ni=1˙χi(t)eT[(A+ˉLBK)TP+P(A+ˉLBK)]e+2Ni=1δix|e|2xis2Ni=1|e|2(1ςi1)Ψi+2Ni=1|e|(ςi1|kiei|+ςi2|x|+δi)+Ni2κ1i˙˜δi˜δi+Ni=1˙χi(t). (4.5)

    Choosing Ψi(t) as in Eq (2.15), we obtain

    ˙W(t)eT[(A+ˉLBK)TP+P(A+ˉLBK)]e2Ni=1δix|e|2xis+Ni2κ1i˙˜δi˜δi+Ni=1˙χi(t)eT[(A+ˉLBK)TP+P(A+ˉLBK)]e+Ni=1˙χi(t). (4.6)

    On the other hand

    Ni=1ξieTi(t)Pei(t)λmax(P)Ni=1ξiei(t)2. (4.7)

    Based on the condition in Theorem 1, Eq (2.22), and Eq (4.6), we have

    ˙W(t)Ni=1(ξiηi)ei(t)2Ni=1αiqi(t)2Ni=1βiχiNi=1ηi(σi1)ei(t)2Ni=1βiχi, (4.8)

    then

    ˙W(t)(σM1)Ni=1ξiei(t)2Ni=1βiχil0W(t)+τ0, (4.9)

    where l0=min([(σM1)/λmax(P)],1, βm)>0, σM=max[σi], βm=min[βi], τ0=Ni=1κ1i~δ2i, l0,andτ0 are positive constants.

    When there are DoS attacks in the system, then communication and control channel blockages exist. In this case, the control input becomes 0, ui(t)=0, so the Lyapunov function can be expressed as

    V(t)=eT(t)Pe(t)+Ni=1κ1i~δ2i. (4.10)

    Similar to (4.4), (4.10) can be written as

    ˙V(t)V(t)+2Ni=1δix|e|2xis+2Ni=1|e|(ςi2|x|+δi)l1V(t)+τ1, (4.11)

    where l1=1, and τ1=2Ni=1δix|e|2xis+2Ni=1|e|(ςi2|x|+δi). According to the conditions of (3) and Assumption 1, we know that τ1 has an upper bound. From Lemma 1, we know that the system stabilizes in a limited time under a DoS attack. The proof is completed.

    Next is the proof of no Zeno behavior. We assume that there is a positive constant T0 such that limktik=T0. Based on the property of limit, we know that for any ε0>0, there exists N(ε0) such that tik(T0ε0,T0+ε0),kN(ε0). This means tiN(ε0+1)tiN(ε0)<2ε0.

    According to (4.11), W(t) gradually decreases to 0, Then ξmλmin(P)ei(t)2V(t)<W(t). Therefore, we have

    ei(t)W0ξmλmin(P)=ϖ0. (4.12)

    Because ei(t) and qi(t) are bounded, the Dini derivative of qi(t) is

    D+qi(t)˙qi(t)=Nj=1aij(˙xi(t)˙xj(t))+bi(˙xi(t)˙x0(t))A+ΔAei(t)+ˉLBNj=1(ui(t))+ˉLwi(t)ˉAϖ0+ˉLBM1+LM2=ˆW0, (4.13)

    where ˉA=A+ΔA. According to Eqs (2.3), (2.12), and (2.14), we obtain ui(t). wi(t) has an upper bound, and M1,M2 is their upper bound.

    Since only the trigger condition in {Eq (2.19)} is met and the event is triggered when qi(t) is reset to 0, then qi(t)ηiαiei(t)2+θiαiχiθiαiχi,tik,k=1,2, which implies that

    qi(tik)θiαiχi(tik)=θiαiχi(0)eβi+θi2tik, (4.14)

    then, we can obtain

    tiN(ε0+1)tiN(ε0)1ˆW0θiαiχi(0)eβi+θ12tiN(ε0+1). (4.15)

    If ε0>0 is a solution of

    1ˆW0θiαiχi(0)eβi+θi2TO=2ε0eβi+θi2ε0, (4.16)

    then

    tiN(ε0+1)tiN(ε0)1ˆW0θiαiχi(0)eβi+θi2(T0+ε0)=2ε0. (4.17)

    As a result, the aforementioned assumption is false, concluding the evidence that the agent i does not have Zeno behavior.

    To show the efficacy of the proposed control strategy, we present a simulation example in this section. Our simulation uses MASs composed of six agents as shown in Figure 1, where agent 1 is the leader, and others are followers. The system is

    ˙xi(t)=Axi(t)+Bui(t)+(sin(xi(t))+1.5cos(2.5t))+wi
    Figure 1.  Graph G in the example.

    The system parameters are set as

    A=[0I3A1A2],B=[0I3]
    A1=[00002ϕ2000ϕ2],A2=[02ϕ02ϕ00000]
    ςi1=0.1×1+i2,ςi2=0.5×1+i2

    In this example, we consider the flight of an aircraft, ϕ=0.002 is the angular velocity of the aircraft, and I3 represents the identity matrix of 3 × 3.

    αi=87.5,βi=0.004,θi=3.5
    ηi=[0.210.1050.1050.210.210.105]

    Figures 2 and 3 show the response curves and consistency errors of the system state for all agents. They show that the followers' states converge toward those of the leader as time progresses. Figures 3 and 4 show the control input curves and event trigger time instant for all agents. There are four times DoS attacks, with T0=3,F0=4. The duration of the DoS attack is |Ξa(0,40)|=3.5. In Table 1, we can see that the dynamic event-triggered mechanism proposed in this paper has far fewer triggering instances in the same time than the other two literatures [22,23], which can effectively save communication resources. In addition, continuous communication between agents is not required to determine whether a trigger condition satisfies a trigger condition. Considering the static event-triggered control protocol, we have

    tik+1=inf{t>tik|qi(t)2ρei(t)20}
    tik+1=inf{t>tik|qi(t)ϱei(t)0}
    Figure 2.  The control input's response curves.
    Figure 3.  The consensus errors' response curves.
    Figure 4.  Position's response curves.
    Figure 5.  Event trigger time instant for all agents.
    Table 1.  Compared with the traditional triggering protocols in [0, 40 s].
    Agent i 1 2 3 4 5 6
    [22] 260 1897 1914 1704 1635 1861
    [23] 1632 1899 1917 1694 1633 1869
    Our DETC 50 65 70 106 42 6

     | Show Table
    DownLoad: CSV

    where ρ and ϱ are positive constants. Our DETC effectively reduces communication frequency.

    In this paper, we propose a dynamic event-triggered adaptive control approach to address the leader-following consensus problem for nonlinear MASs experiencing DoS attacks. We have presented a distributed control strategy and adaptive update laws to ensure system stability in the presence of uncertainties. The Lyapunov stability theory is used to derive conditions for achieving consensus. The DoS attacks considered here mainly target the MASs' communication channels. In reality, there are other types, scales, and levels of DoS attacks. Formulating mathematical models of these other types of DoS attacks and solving these models is the direction of our future research.

    The authors declare they have not used Artificial Intelligence (AI) tools in the creation of this article.

    This research was funded in part by National Natural Science Foundation of China under Grant 62273109, in part by the Guangdong Basic and Applied Basic Research Foundation under Grant 2023A1515010168, Grant 2019A1515010830, in part by the Key Special Foundation for General Universities in Guangdong Province under Grant 2022ZDZX1018, and in part by the Maoming Science and Technology Plan Foundation under Grant 2022S043.

    The authors declare there is no conflict of interest.


    Acknowledgments



    We would like to thank you for following the instructions above very closely in advance. It will definitely save us lot of time and expedite the process of your paper's publication.

    Authors' contribution



    Conceptualization: M.M. and V.T.; methodology: M.M.; formal analysis: A.K; investigation, methodology, review: V.T; resources: V.T.; data curation: V.T.; writing—original draft preparation: V.T.; writing—review and editing: V.T, M.G and K.T.; supervision: M.M; project administration: V.T and M.M.; All authors have read and agreed to the published version of the manuscript.

    Conflict of interest



    Maria Malliarou is a guest editor of AIMS Public Health Special Issue. She was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

    [1] Leka S, Jain A (2010) Health impact of psychosocial hazards at work: An overview. Biblioteca responsável : who-44428.
    [2] Koinis A, Saridis M (2014) Work-related stress and its impact on the professional and personal life of healthcare professionals. Rostrum of Asclepius/Vima tou Asklipiou 13.
    [3] Velázquez M (2017) Comparative study of the psychosocial risks prevention enforcement by the European labour inspectorates. Psychosocial risks in labour and social security law: A comparative legal overview from Europe . North America, Australia and Japan: 31-52. https://doi.org/10.1007/978-3-319-63065-6_3
    [4] Da Costa BR, Vieira ER (2010) Risk factors for work-related musculoskeletal disorders: A systematic review of recent longitudinal studies. Am J Ind Med 53: 285-323. https://doi.org/10.1002/ajim.20750
    [5] Huber M, Knottnerus JA, Green L, et al. (2011) How should we define health?. BMJ 343: d4163. https://doi.org/10.1136/bmj.d4163
    [6] Niebrój LT (2006) Defining health/illness: Societal and/or clinical medicine?. J Physiol Pharmacol 57: 251-262.
    [7] Krishnan KS, Raju G, Shawkataly O (2021) Prevalence of work-related musculoskeletal disorders: Psychological and physical risk factors. Int J Environ Res Public Health 18: 9361. https://doi.org/10.3390/ijerph18179361
    [8] Brennan EJ (2017) Towards resilience and wellbeing in nurses. Br J Nurs 26: 43-47. https://doi.org/10.12968/bjon.2017.26.1.43
    [9] Garcia CL, Abreu LC, Ramos JLS, et al. (2019) Influence of burnout on patient safety: Systematic review and meta-analysis. Medicina (Kaunas) 55: 553. https://doi.org/10.3390/medicina55090553
    [10] Wazqar DY, Kerr M, Regan S, et al. (2017) An integrative review of the influence of job strain and coping on nurses' work performance: Understanding the gaps in oncology nursing research. Int J Nurs Sci 4: 418-429. https://doi.org/10.1016/j.ijnss.2017.09.003
    [11] Bambi S, Foà C, De Felippis C, et al. (2018) Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors. Acta Bio Medica: Atenei Parmensis 89: 51-79.
    [12] Khamisa N, Oldenburg B, Peltzer K, et al. (2015) Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health 12: 652-666. https://doi.org/10.3390/ijerph120100652
    [13] Sitzman K (2017) Theory-guided self-care for mitigating emotional strain in nursing: Watson's caring science. Int J Human Caring 21: 66-76. https://doi.org/10.20467/HumanCaring-D-17-00009.1
    [14] Kowitlawkul Y, Yap S, Makabe S, et al. (2019) Investigating nurses' quality of life and work-life balance statuses in Singapore. Int Nurs Rev 66: 61-69. https://doi.org/10.1111/inr.12457
    [15] Cicolini G, Comparcini D, Simonetti V (2014) Workplace empowerment and nurses' job satisfaction: A systematic literature review. J Nurs Manag 22: 855-871. https://doi.org/10.1111/jonm.12028
    [16] Flinkman M, Leino-Kilpi H, Salanterä S (2010) Nurses' intention to leave the profession: integrative review. J Adv Nurs 66: 1422-1434. https://doi.org/10.1111/j.1365-2648.2010.05322.x
    [17] Kim H, Kim EG (2021) A meta-analysis on predictors of turnover intention of hospital nurses in South Korea (2000–2020). Nurs Open 8: 2406-2418. https://doi.org/10.1002/nop2.872
    [18] Chakraborty S, Mashreky SR, Dalal K (2022) Violence against physicians and nurses: A systematic literature review. Z Gesundh Wiss 30: 1837-1855. https://doi.org/10.1007/s10389-021-01689-6
    [19] Carton AM, Steinhardt K, Cordwell J (2022) Exploring factors which contribute to the resilience of nurses working in the neonatal care unit: A grounded theory study. Intensive Crit Care Nurs 68: 103137. https://doi.org/10.1016/j.iccn.2021.103137
    [20] Navajas-Romero V, Ariza-Montes A, Hernández-Perlines F (2020) Analyzing the job demands-control-support model in work-life balance: A study among nurses in the European context. Int J Environ Res Public Health 17: 2847. https://doi.org/10.3390/ijerph17082847
    [21] Morello RT, Lowthian JA, Barker AL, et al. (2013) Strategies for improving patient safety culture in hospitals: A systematic review. BMJ Qual Saf 22: 11-18. https://doi.org/10.1136/bmjqs-2011-000582
    [22] Weaver SJ, Lubomksi LH, Wilson RF, et al. (2013) Promoting a culture of safety as a patient safety strategy: A systematic review. Ann Intern Med 158: 369-374. https://doi.org/10.7326/0003-4819-158-5-201303051-00002
    [23] Elkin PL, Johnson HC, Callahan MR, et al. (2016) Improving patient safety reporting with the common formats: Common data representation for patient safety organizations. J Biomed Inform 64: 116-121. https://doi.org/10.1016/j.jbi.2016.09.020
    [24] Waterson P, Carman EM, Manser T, et al. (2019) Hospital Survey on Patient Safety Culture (HSPSC): A systematic review of the psychometric properties of 62 international studies. BMJ Open 9: e026896. https://doi.org/10.1136/bmjopen-2018-026896
    [25] Campione J, Famolaro T (2018) Promising practices for improving hospital patient safety culture. Jt Comm J Qual Patient Saf 44: 23-32. https://doi.org/10.1016/j.jcjq.2017.09.001
    [26] Stavropoulou C, Doherty C, Tosey P (2015) How effective are incident-reporting systems for improving patient safety? A systematic literature review. Milbank Q 93: 826-866. https://doi.org/10.1111/1468-0009.12166
    [27] Upadhyay S, Stephenson AL, Weech-Maldonado R, et al. (2022) Hospital cultural competency and attributes of patient safety culture: A study of U.S. hospitals. J Patient Saf 18: e680-e686. https://doi.org/10.1097/PTS.0000000000000901
    [28] Mesfin D, Woldie M, Adamu A, et al. (2020) Perceived organizational culture and its relationship with job satisfaction in primary hospitals of Jimma zone and Jimma town administration, correlational study. BMC Health Serv Res 20: 438. https://doi.org/10.1186/s12913-020-05319-x
    [29] Tsai Y (2011) Relationship between organizational culture, leadership behavior and job satisfaction. BMC Health Serv Res 11: 98. https://doi.org/10.1186/1472-6963-11-98
    [30] Körner M, Wirtz MA, Bengel J, et al. (2015) Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams. BMC Health Serv Res 15: 243. https://doi.org/10.1186/s12913-015-0888-y
    [31] Mannion R, Davies H (2018) Understanding organisational culture for healthcare quality improvement. BMJ 363: k4907. https://doi.org/10.1136/bmj.k4907
    [32] Sandlin D (2007) Improving patient safety by implementing a standardized and consistent approach to hand-off communication. J Perianesth Nurs 22: 289-292. https://doi.org/10.1016/j.jopan.2007.05.010
    [33] Leonard M, Graham S, Bonacum D (2004) The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 131: i85-90. https://doi.org/10.1136/qshc.2004.010033
    [34] Schnock KO, Dykes PC, Albert J, et al. (2017) The frequency of intravenous medication administration errors related to smart infusion pumps: A multihospital observational study. BMJ Qual Saf 26: 131-140. https://doi.org/10.1136/bmjqs-2015-004465
    [35] Keers RN, Williams SD, Cooke J, et al. (2013) Causes of medication administration errors in hospitals: A systematic review of quantitative and qualitative evidence. Drug Saf 36: 1045-1067. https://doi.org/10.1007/s40264-013-0090-2
    [36] Westbrook JI, Li L, Hooper TD, et al. (2017) Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: A cluster randomized controlled feasibility study. BMJ Qual Saf 26: 734-742. https://doi.org/10.1136/bmjqs-2016-006123
    [37] Armitage G, Knapman H (2003) Adverse events in drug administration: A literature review. J Nurs Manag 11: 130-140. https://doi.org/10.1046/j.1365-2834.2003.00359.x
    [38] Ferner RE, Aronson JK (2006) Clarification of terminology in medication errors: Definitions and classification. Drug Saf 29: 1011-1022. https://doi.org/10.2165/00002018-200629110-00001
    [39] Parry AM, Barriball KL, While AE (2015) Factors contributing to registered nurse medication administration error: A narrative review. Int J Nurs Stud 52: 403-420. https://doi.org/10.1016/j.ijnurstu.2014.07.003
    [40] Rodziewicz TL, Hipskind JE (2020) Medical error prevention. StatPearls Treasure Island (FL): StatPearls Publishing.
    [41] Lesar TS (2002) Prescribing errors involving medication dosage forms. J Gen Intern Med 17: 579-587. https://doi.org/10.1046/j.1525-1497.2002.11056.x
    [42] Wilson K, Sullivan M (2004) Preventing medication errors with smart infusion technology. Am J Health Syst Pharm 61: 177-183. https://doi.org/10.1093/ajhp/61.2.177
    [43] Serembus JF, Wolf ZR, Youngblood N (2001) Consequences of fatal medication errors for health care providers: A secondary analysis study. MedSurg Nurs 10: 193.
    [44] Lisby M, Nielsen LP, Mainz J (2005) Errors in the medication process: Frequency, type, and potential clinical consequences. Int J Qual Health Care 17: 15-22. https://doi.org/10.1093/intqhc/mzi015
    [45] Dimant J (2002) Medication errors and adverse drug events in nursing homes: Problems, causes, regulations, and proposed solutions. J Am Med Dir Assoc 2: 81-93. https://doi.org/10.1016/S1525-8610(04)70166-8
    [46] Cohen MR, Smetzer JL, Tuohy NR, et al. (2007) High-alert medications: Safeguarding against errors. Medication Errors . Washington (DC): American Pharmaceutical Association 317-411. https://doi.org/10.21019/9781582120928.ch14
    [47] Kotsakis A, Avraam D, Malliarou M, et al. Psychosocial factors in evidence-based management interventions and policymaking: The COPSOQ III Greek validation study (2024). [Preprint]. https://doi.org/10.21203/rs.3.rs-4888710/v1
    [48] Burr H, Berthelsen H, Moncada S, et al. (2019) The third version of the Copenhagen psychosocial questionnaire. Saf Health Work 10: 482-503. https://doi.org/10.1016/j.shaw.2019.10.002
    [49] Kotsakis A, Nübling M (2018) Employability in the 21st Century. The Greek COPSOQ v. 3 Validation Study, a post crisis assessment of the Psychosocial Risks . Leuven, Belgium: Conference Book 63.
    [50] Malliarou M, Kotsakis A (2023) Psychosocial work environment during the COVID-19 pandemic. Front Public Health 11: 1272290. https://doi.org/10.3389/fpubh.2023.1272290
    [51] Kapaki V, Souliotis K Psychometric properties of the hospital survey on patient safety culture (HSOPSC): Findings from Greece: InTech Rijeka (2018). https://doi.org/10.5772/intechopen.69997
    [52] Abdou HA, Saber KM (2011) A baseline assessment of patient safety culture among nurses at student university hospital. World J Med Sci 6: 17-26.
    [53] Mitsis D, Kelesi M, Kapadothos T Risk factors for pharmaceutical errors by nurses in intensive care units (2014)53: 55-64. Available from: https://www.researchgate.net/publication/310617569_Risk_factors_for_pharmaceutical_errors_by_nurses_in_intensive_care_units.
    [54] Hayes AF (2009) Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Commun Monogr 76: 408-420. https://doi.org/10.1080/03637750903310360
    [55] Preacher KJ, Hayes AF (2004) SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 36: 717-731. https://doi.org/10.3758/BF03206553
    [56] Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40: 879-891. https://doi.org/10.3758/BRM.40.3.879
    [57] Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51: 1173-1182. https://doi.org/10.1037/0022-3514.51.6.1173
    [58] Sobel ME (1982) Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol 13: 290-312. https://doi.org/10.2307/270723
    [59] England N, Improvement N The NHS patient safety strategy. Safer culture, safer systems, safer patients (2019). https://www.improvementacademy.org/wp-content/uploads/2022/04/Report-template-NHSI-website-for-PSC-Page.pdf
    [60] Hoenders R, Ghelman R, Portella C, et al. (2024) A review of the WHO strategy on traditional, complementary, and integrative medicine from the perspective of academic consortia for integrative medicine and health. Front Med (Lausanne) 11: 1395698. https://doi.org/10.3389/fmed.2024.1395698
    [61] MacPhee M, Dahinten VS, Havaei F (2017) The impact of heavy perceived nurse workloads on patient and nurse outcomes. Adm Sci 7: 7. https://doi.org/10.3390/admsci7010007
    [62] (2021) Systems EOOH, PoliciesState of health in the EU France: Country health profile 2021. OECD Publishing.
    [63] Ball JE, Bruyneel L, Aiken LH, et al. (2018) Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. Int J Nurs Stud 78: 10-15. https://doi.org/10.1016/j.ijnurstu.2017.08.004
    [64] He J, Staggs VS, Bergquist-Beringer S, et al. (2016) Nurse staffing and patient outcomes: A longitudinal study on trend and seasonality. BMC Nurs 15: 60. https://doi.org/10.1186/s12912-016-0181-3
  • Reader Comments
  • © 2025 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(963) PDF downloads(99) Cited by(0)

Figures and Tables

Tables(6)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog