Was ist das eigentlich? Cyberrisiken verständlich erklärt

Es wird viel über Cyberrisiken gesprochen. Oftmals fehlt aber das grundsätzliche Verständnis, was Cyberrisiken überhaupt sind. Ohne diese zu verstehen, lässt sich aber auch kein Versicherungsschutz gestalten.

Beinahe alle Aktivitäten des täglichen Lebens können heute über das Internet abgewickelt werden. Online-Shopping und Online-Banking sind im Alltag angekommen. Diese Entwicklung trifft längst nicht nur auf Privatleute, sondern auch auf Firmen zu. Das Schlagwort Industrie 4.0 verheißt bereits eine zunehmende Vernetzung diverser geschäftlicher Vorgänge über das Internet.

Anbieter von Cyberversicherungen für kleinere und mittelständische Unternehmen (KMU) haben Versicherungen die Erfahrung gemacht, dass trotz dieser eindeutigen Entwicklung Cyberrisiken immer noch unterschätzt werden, da sie als etwas Abstraktes wahrgenommen werden. Für KMU kann dies ein gefährlicher Trugschluss sein, da gerade hier Cyberattacken existenzbedrohende Ausmaße annehmen können. So wird noch häufig gefragt, was Cyberrisiken eigentlich sind. Diese Frage ist mehr als verständlich, denn ohne (Cyber-)Risiken bestünde auch kein Bedarf für eine (Cyber-)Versicherung.

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Nursing CNAMB : CCI Certified Ambulatory Surgery Nurse Practice Tests

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Exam Number : CNAMB
Exam Name : CCI Certified Ambulatory Surgery Nurse
Vendor Name : Nursing
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CNAMB test Format | CNAMB Course Contents | CNAMB Course Outline | CNAMB test Syllabus | CNAMB test Objectives


- Perioperative Patient Assessment and Diagnosis
- Informed consent or waivers
- surgical
- anesthesia
- blood
- photographs
- visitors

- Collect, analyze, and prioritize patient data
- vital signs
- pain exam
- allergies
- lab values
- other medical conditions
- medical conditions for which they would need clearance
- previous relevant surgical management
- chart review
- NPO status
- family history of anesthesia problems

- Use age and sociocultural appropriate health test techniques to evaluate patient status
- interview
- observation
- communication barriers
- Conduct medication reconciliation
- preoperative meds
- home meds
- alternative/herbal meds
- medical marijuana
- alcohol use
- recreational drug use

- Conduct physical exam
- skin integrity
- mobility
- body piercings
- implants/foreign objects
- Antibiotic stewardship
- Pain management
- ERAS
- multi-modal
- regional blocks

- Advance directives ( DNR, AND (Allow Natural Death) processes)
- Selection criteria
- BMI
- ASA
- sleep apnea
- infectious disease
- age

- Pre-surgery risk exam
- medications
- previoussurgeries
- special needs
- comorbidities
- preop instructions

- Discharge needs
- home care
- durable medical equipment
- transportation
- care giver
- medications
- rehab
- Approved nursing diagnoses
- North American Nursing Diagnosis Administration [NANDA]
- Perioperative Nursing Data Set [PNDS]

- Preoperative Plan of Care
- Physiologic responses: Risk of infection
- Physiologic responses: Altered tissue perfusion
- Physiologic responses: Thermal regulation
- Behavioral responses

- Transcultural nursing theory
- cultural and ethnic influences
- family patterns
- spirituality and related practices
- Identify and plan for expected patient outcomes/postoperative needs
- responsible supervision
- transportation
- sleep apnea

- Community networking and institutional resources
- supplies
- equipment
- patient transfer agreements
- courierservice
- emergency services
- Conduct site preparation
- hair removal
- skin antisepsis
- Preoperative patient preparation
- IV
- removal of jewelry
- hair removal

- Intraoperative Care
- Optimize physiological responses of the patient
- Normothermia
- Infection prevention/control
- Perfusion
- Surgical procedure
- Wound healing
- Monitor and maintain patient and personnel safety
- Maintain the dignity, modesty, and privacy of the patient

- Utilize ergonomics and proper body mechanics in performing patient care.
- Chemical
- Fire
- Hazardous materials
- Radiation
- Smoke plume
- Energy generating devices
- Positioning
- Potential complications
- Patient/personnel safety
- Ergonomics/body mechanics

- Optimize patient care based on behavioral responses
- comfort
- anxiety
- pain management
- sociocultural and/or ethical issues
- Select procedure-specific protective materials and equipment
- lead aprons
- laser goggles
- smoke evacuators
- extinguishers

- Identify and control environment factors
- humidity
- noise
- temperature
- traffic
- Maintain a sterile field using aseptic technique
- Ensure the sterility of surgical products and instrumentation
- expiration date
- package integrity
- Aseptic technique
- Wound classifications

- Verify and document specimens with surgical team
- Prepare, label, and transport specimens
- Confirm, present, and prepare implants
- Prepare explants for final disposition
- Monitor and evaluate the effects of pharmacological and anesthetic agents
- Assist with anesthesia management
- induction
- airway protection
- extubation
- cricoid pressure

- Adhere to Universal Protocol
- time out
- WHO checklist
- National Patient Safety Goals (NPSGs)
- Manage patient hemodynamic needs
- fluid replacement
- Prepare, label, and administer moderate and local sedation/analgesia with appropriate monitoring
- capnography
- pulse oximeter

- Communicate patientstatus and changes to interdisciplinary healthcare providers
- Utilize effective communication for continuity of patient care
- hand-off
- debrief
- Methods and requirements for reporting to interdisciplinary healthcare providers
- critical lab values
- medical condition
- medications
- allergies
- implants/implantable devices
- read back orders

- Information technology
- software applications
- security
- HIPAA
- Barriersto communication
- patient
- family
- team
- chain of command

- Interdisciplinary services for care coordination
- nutrition
- wound care
- social work
- referrals
- transportation
- convalescent center
- physical therapy
- Evaluate patient status to facilitate transfer to the next level of care
- PACU
- home
- rehab facility
- hospital
- 23-hour observation

- Document patient care
- Provide and document post-discharge follow-up communication according to regulatory guidelines
- Assist with management of:
- airway
- pain
- hemodynamic monitoring
- Pain management
- ERAS
- multi-modal
- regional blocks

- Select appropriate methods and products for processing
cleaning
disinfecting
packaging
sterilizing
transportation
storage
- Cleaning products and techniques
- manual washing
- ultrasonic
- Packaging techniques
- crates
- peel packs
- wraps

- Transportation of equipment, instruments, and supplies
- Perform and document disinfection procedures
- high-level disinfection
- decontamination
- Handle and dispose of hazardous materials
- chemo drugs
- radioactive materials
- Handle and dispose of biohazard materials
- blood
- tissue

- Perform and document sterilization procedures including biological and chemical monitoring
- load parameters
- steam sterilization
- low- temperature sterilization
- Perform and document immediate use steam sterilization (IUSS)
- Quality assurance testing
- washer-disinfector
- sterilizer
- Perform nursing interventions based on age-specific needs
- Coordinate members of the interdisciplinary healthcare team during internal/external emergency situations

- Preparation for and management of medical emergencies:
- Malignant Hyperthermia (MH)
- Preparation for and management of medical emergencies:
- Anaphylaxis
- Cardiac arrest
- Hemorrhage
- Roles ofthe interdisciplinary healthcare team during internal/external emergency situations
- triage
- FEMA
- EMS
- community resources

- Preparations for and management of environmental hazards and natural disasters
- fire
- toxic fumes
- natural disasters
- terrorism
- power outage
- active shooter

- Acquire equipment, supplies, and personnel
- Coordinate and document preventive maintenance of equipment
- Monitor availability and sterility of supplies
- Perioperative resource management
- equipment
- supplies
- staffing
- Supervise, educate, and mentor healthcare team members
- Delegate perioperative tasks to appropriate personnel within their scope of practice

- Supervise non-OR personnel
- vendors
- students
- visitors
- family
- Adjunct roles, assigned staff, and responsibilities
- medication safety
- laser safety
- employee health
- Privacy officer
- Facility officer
- Risk manager
- infection prevention

- Role of non-perioperative personnel
- vendor
- students
- visitors
- family
- medical records
- admissions
- Scope of practice for the interdisciplinary team per regulatory agencies: Nurse Practice Act
- Monitor and assist with implementation of cost-containment measures
- Implement environmental sustainability practices
- reprocessing
- recycling
- Waste management
- reprocessing to include single-use devices
- supply standardization

- Ensure use of Personal Protective Equipment (PPE)
- Oversee environmental cleaning
- spills
- room turnover
- terminal cleaning
- physical plant
- Track biological implants
- order
- reconstitute
- storage
- use/waste
- Radiation safety
- dosimetry badges
- time
- distance
- shielding
- lead protection

- Protect patient confidentiality
- Advocate for and protect patients rights
- Report unanticipated events and good catches
- Perform functions within scope of practice
- Comply with regulatory and accreditation guidelines
- life safety
- Local
- state
- federal regulatory requirements
- FDA
- CDC
- CMS
- OSHA
- DEA

- Demonstrate competency in perioperative nursing practice
- Acknowledge personal bias and limitations and seek assistance as needed
- Utilize standards and recommended practices
- AORN
- APIC
- AAMI
- IAHCSSM
- ASPAN
- Demonstrate evidence-based practice
- hand hygiene
- safe injection practices
- surgical attire

- Accreditation standards and organization guidelines
- AORN Guidelines for Perioperative Nursing
- Perioperative
- Explications for the ANA Code of Ethics for:
- Nurses
- ASPAN
- APIC
- AAMI
- EBP
- Hand hygiene
- Safe injection practices
- Surgical attire

- Identify and take appropriate action regarding behaviors that undermine a culture ofsafety
- disruptive behavior
- Participate in professional development activities
- shared governance
- staff education
- committees
- certifications
- advanced degrees
- professional Organizations

- Risk management
- eventreporting
- good catch
- disclosure of unanticipated events
- recalls
- Safe Medical Device Act
- Quality improvement processes
- research
- data collection
- evidence-based practice
- performance improvement
- CMS quality measure
- reimbursements



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Warum sind Cyberrisiken so schwer greifbar?

Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

Nicht kriminelle Ursachen

Höhere Gewalt

Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

Menschliches Versagen/Fehlverhalten

Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

Technisches Versagen

Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

Kriminelle Ursachen

Hackerangriffe

Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

Physischer Angriff

Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.

Erpressung

Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:

Cyber-Kosten:

  • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
  • Krisenkommunikation / PR-Maßnahmen
  • Systemverbesserungen nach einer Cyber-Attacke
  • Aufwendungen vor Eintritt des Versicherungsfalls

Cyber-Drittschäden (Haftpflicht):

  • Befriedigung oder Abwehr von Ansprüchen Dritter
  • Rechtswidrige elektronische Kommunikation
  • Ansprüche der E-Payment-Serviceprovider
  • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
  • Vertragliche Schadenersatzansprüche
  • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
  • Rechtsverteidigungskosten

Cyber-Eigenschäden:

  • Betriebsunterbrechung
  • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
  • Mehrkosten
  • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
  • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
  • Cyber-Erpressung
  • Entschädigung mit Strafcharakter/Bußgeld
  • Ersatz-IT-Hardware
  • Cyber-Betrug