Prehospital characteristics of COVID-19 patients in Helsinki – experience of the first wave of the pandemic

Background There is a lack of knowledge how patients with COVID-19 disease differ from patients with similar signs or symptoms (but who will have a diagnosis other than COVID-19) in the prehospital setting. The aim of this study was to compare the characteristics of these two patient groups met by the emergency medical services. Methods All prehospital patients after the World Health Organisation (WHO) pandemic declaration 11.3.2020 until 30.6.2020 were recruited for the study. The patients were screened using modified WHO criteria for suspected COVID-19. Data from the electronic prehospital patient reporting system were linked with hospital laboratory results to check the laboratory confirmation for COVID-19. For comparison, we divided the patients into two groups: screening- and laboratory-positive patients with a hospital diagnosis of COVID-19 and screening-positive but laboratory-negative patients who eventually received a different diagnosis in hospital. Results A total of 4157 prehospital patients fulfilled the criteria for suspected COVID-19 infection during the study period. Five-hundred-thirty-six (12.9%) of the suspected cases received a laboratory confirmation for COVID-19. The proportion of positive cases in relation to suspected ones peaked during the first 2 weeks after the declaration of the pandemic. In the comparison of laboratory-positive and laboratory-negative cases, there were clinically insignificant differences between the groups in age, tympanic temperature, systolic blood pressure, heart rate, on-scene time, urgency category of the call and mode of transportation. Foreign-language-speakers were overrepresented amongst the positive cases over native language speakers (26,6% vs. 7,4%, p < 0,001). The number of cases in which no signs or symptoms of COVID-19 disease were reported, but patients turned out to have a positive test result was 125 (0,3% of the whole EMS patient population and 11,9% of all verified COVID-19 patients encountered by the EMS). Conclusions In a sample of suspected COVID-19 patients, the laboratory-positive and laboratory-negative patients were clinically indistinguishable from each other during the prehospital assessment. Foreign-language-speakers had a high likelihood of having Covid-19. The modified WHO criteria still form the basis of screening of suspected COVID-19 patients in the prehospital setting.

TIDES: examining the influence of temporal individual differences on multitasking in educational simulation

Background The majority of tasks nurses complete in acute care settings are time-sensitive. Due to complex patient needs, nurses’ multitasking behavior is of growing importance. Situations involving multitasking behavior typically require nurses to switch their attention among multiple tasks and patients in a rapid fashion. Research suggests temporal individual differences such as time urgency, polychronicity, and time perspective influence decision-making. The factors suggest that balanced time perspective may facilitate multitasking. Given novice nurses commit errors related to multitasking, we evaluated the relationship between temporal individual differences, cognitive workload, and multitasking behaviors in a simulation setting. Methods A one-group repeated measures design was used to evaluate the relationship between multitasking, demographic factors, cognitive workload, and temporal individual differences. One hundred sixty fourth-year, prelicensure nursing students independently completed two 45-min multiple patients simulations involving care of three interactive patient simulators. Participants completed the Multitasking Preference Inventory, Time Perspective Inventory, Experiences of Time survey, and Time Urgency Scale before simulation. A summary Creighton Simulation Evaluation Instrument score was used to represent multitasking. Participants completed the Task Load Index to represent cognitive workload. We calculated deviation from balanced time perspective and measured its correlation with multitasking. Regression models calculated how much variance deviation from balanced time perspective, demographic factors, and cognitive workload contributed to multitasking. Results Standardized test scores were more predictive of multitasking than deviation from balanced time perspective (β = 0.19, t = 2.48, p = 0.0142). As deviation from balanced time perspective increased, multitasking behaviors decreased (r = − 0.17), participants reported a higher sense of urgency (r = 0.39), and they had more frustration after simulation (r = 0.22). Deviation from balanced time perspective did not influence cognitive workload. Conclusions Nursing students who demonstrate multitasking behaviors tend to have a more balanced time perspective. Knowing students’ deviation from balanced time perspective may help educators anticipate who will need more assistance with multitasking in simulation. Nursing students frequently wait until just before graduation to provide care for multiple patients; including mention of deviation from balanced time perspective in simulation preparation may help senior nursing students become more self-aware and ultimately improve behavioral performance.

The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians

Physicians have a responsibility to discuss do-not-resuscitate (DNR) decisions and end-of-life (EOL) care with patients and family members. The aim of this study was to explore the DNR and EOL care discussion experience among physicians in Taiwan. A qualitative study was conducted with 16 physicians recruited from the departments of hospice care, surgery, internal medicine, emergency, and the intensive care unit. The interview guidelines included their DNR experience and process and EOL care discussions, as well as their concerns, difficulties, or worries in discussions. Thematic analysis was used to analyze data. Four themes were identified. First, family members had multiple roles in the decision process. Second, the characteristics of the units, including time urgency and relationships with patients and family members, influenced physicians’ work. Third, the process included preparation, exploration, information delivery, barrier solution, and execution. Fourth, physicians shared reflections on their ability and the conflicts between law, medical professionals, and the best interests of patients. Physicians must consider not only patients’ but also family members’ opinions and surmount several barriers in decision-making. They also experienced negative and positive impacts from these discussions.

Challenges or Hindrances? Implications of Work Characteristics Appraisals for Employees’ Well-Being

Previous research on the association between job characteristics and employee well-being has returned mixed results. In particular, the possible impact of individual appraisal of these job characteristics has not been well-acknowledged. To address this limitation, we drew on appraisal theory and examined (a) how workers appraise particular job characteristics, and (b) how these appraisals affect the relationships between these job characteristics and well-being (i.e., work engagement and burnout). We tested our hypotheses across two studies. In a cross-occupation survey (Study 1, n = 514), we found that job characteristics of “demands” (time urgency, role conflict, and emotional demands) and “resources” (autonomy, supervisor and colleague support, and feedback) can to some degree be appraised as both challenges and hindrances. In addition, moderation analysis showed that challenge appraisal can mitigate the negative impact of job demands on burnout. Interestingly, the beneficial effects of job resources on employee well-being (i.e., increasing engagement, and decreasing burnout) were weaker if workers appraised a certain resource as hindering. In Study 2 (n = 316 nurses in a hospital), the results generally supported our predictions again. These findings on the effects of appraisal contribute by broadening the theory on job characteristics-outcomes relationships.

A Polling-Based Dynamic Order-Picking System considering Priority Orders

Nowadays, how to offer extremely fast response to customer orders has become a major challenge for warehouse management, especially in e-commerce. Due to the time urgency aspect of some “VIP” orders that need priority processing, one of the most important issues for logistics distribution centres is how to improve the VIP order-picking priority without reducing the common order-picking efficiency. With this consideration, this article put forward a new priority polling model to describe and analyse this problem. We divide orders into priority and common categories according to their time urgency. A mathematical model is established for such a system by applying polling theory, a probability generating function, and an embedded Markov chain. Numerical analysis shows that this priority polling-based picking system can improve the picking efficiency and is well suited to practical operations.

The impact of individual differences on investigative hypothesis generation under time pressure

When decisions are made under time pressure, individuals tend to reduce the number of hypotheses generated to explain and solve problems. This research investigates the extent to which individual differences in (a) domain-specific experience, (b) fluid intelligence, (c) need for closure (NFC), and (d) time urgency moderated the effect of time pressure on investigative hypothesis generation. Korean detectives ( N = 133) participated in simulated investigative scenarios. To induce the perception of time pressure, one group was informed that the task would have to be completed under time pressure ( N = 66), whereas the other group did not receive this instruction ( N = 67); although both groups had the same amount of time). Outcomes included the number and quality of hypotheses generated for solving the case. The quality of hypotheses generated was measured against criteria established by expert detectives. Results revealed that time pressure directly decreased the quantity and quality of hypotheses generated. In the relationships, low time urgency moderated the effect of time pressure on the number and quality of hypotheses generated, also low NFC moderated the impact of time pressure on the number of hypotheses generated. Furthermore, the most experienced detectives were least affected by the negative association between time pressure and the quality of hypotheses generated. The findings suggest lower time urgency, lower NFC and more experience are adaptive ‘protective’ factors against the negative impact of time pressure on hypothesis generation within high stakes and uncertain situations such as rape investigations.

Professional identity neutralizes charismatic leadership tactics in a crisis

Purpose This paper aims to examine the main and the interaction effect of follower’s professional identity and leader’s use of charismatic leadership tactics (CLTs) on follower performance and work engagement during a crisis. Design/methodology/approach The authors performed a 2 × 2 between subjects experiment in which both professional identity and CLTs were manipulated for a group of 320 participants. Findings Professional identity has a main positive effect on followers’ performance and work engagement and works as a neutralizer (counter-effect) moderator in the relationship between CLTs and work engagement during a crisis. Research limitations/implications Participants in the experiments were final-year engineering students and the authors manipulated only two dimensions of crisis, i.e. time urgency and high priority. Practical implications Organizations can strive to select for and develop professional identity amongst their members to survive crisis like situations rather than rely only on charismatic leaders. Originality/value This is the first study to incorporate crisis for examining a neutralizer for CLTs.