Maximization delays decision-making in acute care nursing.

The maximization personality trait refers to the tendency to face decision-making situations along a continuum from exhaustively analysing all the options (maximize) to choosing the one that exceeds a subjective threshold of acceptability (satisfy). Research has revealed the influence of maximizing on decision making, although little is known about its possible role in high risk and high uncertainty situations. A sample of 153 active Spanish nurses, with an average experience of 11 years, completed a maximization questionnaire and responded to written vignettes depicting time-demanding decision making in which three options were offered, representing delayed action, non-action, and immediate action. Two vignettes presented critical situations related to acute care during the COVID-19 pandemic, whilst two vignettes presented non-nursing scenarios. People high in maximization took longer to choose and were more likely to choose non-action. No relationship was found between maximization score and the subjective experience of the person making the choice. Maximization had no significant correlation with years of experience nor perceived expertise. Greater perceived expertise was associated with lower indecision and greater confidence. When participants answered nursing vignettes, they took longer to respond, but chose less delayed action and more immediate action. Our results suggest that maximization plays only a relative role in acute care decision-making in nursing, as compared to contextual variables and expertise. They also support a domain general approach to this personality trait. Findings are consistent with Nibbelink and Reed's Practice-Primed Decision Model for nursing.

Immunosenescence and inflammation characterize chronic heart failure patients with more advanced disease.

BACKGROUND: Chronic heart failure (CHF) is characterized by an inflammatory status with high levels of cytokines such as IL-6. We hypothesized that patients with CHF may develop immunosenescence due to inflammation and that this may be associated with a worse stage of the disease. METHODS AND RESULTS: We compared the immunological features of 58 elderly CHF patients (ECHF), 40 young CHF patients (YCHF), 60 healthy elderly controls (HEC) and 40 healthy young controls (HYC). We characterized leukocyte and lymphocyte subpopulations by flow cytometry, and IL-6 concentration by ELISA. The extent of CHF was classified according to functional and/or morphological criteria: New York Heart Association functional class, AHA/ACC heart failure stages, left ventricular ejection fraction, and left ventricular hypertrophy. CHF patients showed an increased number of leukocytes, neutrophils and monocytes, but a decreased number of lymphocytes. CHF patients had significantly lower levels of B-cells and CD4+ T-cells, increased NK-cells in YCHF, and increased CD8+ T-cells only in ECHF. CHF was associated with high differentiation in CD4+ and CD8+ T-lymphocyte subsets. Aging of T-lymphocyte subpopulations and high IL-6 levels were associated with a worse clinical status. IL-6 also correlated positively with the number of highly differentiated T-lymphocytes and with their accelerated aging. CONCLUSIONS: We conclude that CHF patients show a higher degree of immunosenescence than age-matched healthy controls. T-lymphocyte differentiation and IL-6 levels are increased in patients with an advanced clinical status and may contribute to disease impairment through a compromised adaptive immune response due to accelerated aging of their immune system.