Leadership and Trauma-Informed Care: Working to Support Staff and Teams.

The concept of "trauma-informed care" as a paradigm in public health and human services has evolved over the past 30 years. Can trauma-informed practices be used as a leadership tool to help address staff/colleagues as they grapple with the concerns associated with a complex health care landscape? Trauma-informed care shifts the focus from "What's wrong with you?" to "What happened to you?" This powerful approach to addressing stress might help set the stage for caring and meaningful interactions among staff and colleagues before exchanges become fraught with blame and unproductive or toxic impacts on team-based relationships.

Editor's Choice-The role of the emergency department in the management of acute heart failure: An international perspective on education and research.

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and

Workplace Aggression in Cuban Health Care Settings.

PURPOSE: Workplace aggression (WPA) is an international problem; however, no published reports of WPA in Cuba were found. This research describes WPA in Cuba and identifies prevention strategies for adoption in the United States. DESIGN: A qualitative case study design was used. Procedures included visiting several health care settings in the region of Havana, Cuba. Interviews were conducted with 18 Cuban key informants and digital photographs documented the environment. FINDINGS: WPA is a rare occurrence and typically demonstrates as verbal abuse. The use of illicit substances and prolonged wait times, common U.S. factors associated with WPA, are less problematic in Cuba. DISCUSSION AND CONCLUSION: Primary reasons for the low incidence of WPA may be the caring Cuban culture itself, tolerance for wait times, and less access to illicit and controlled substances. IMPLICATIONS FOR PRACTICE: Adopting Cuba's model to acknowledge WPA risk and implement prevention plans could reduce WPA incidence in the United States.