Nursing mental health and community concepts - Nursing: Mental Health and Community Concepts. 8.3 Treatments for Bipolar Disorders Bipolar disorder is often a lifelong illness, and episodes of mania and depression typically recur. Between episodes, many people with bipolar disorder are free of mood disruption, but some people have lingering symptoms. Long-term, continuous treatment can help ...

 
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The Code of Ethics for Nurses With Interpretive Statements states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” [1] This chapter describes nurses’ legal and ethical responsibilities while protecting the safety and rights of clients receiving mental health care. 11.3 Schizophrenia. There is a spectrum of psychotic disorders, and schizophrenia is one of the disorders on the spectrum. Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. It also affects the person’s ability to recognize their symptoms as problematic, referred to as a “lack of insight.”.1.5 Boundaries. Boundaries are limits we set as individuals that define our levels of comfort when interacting with others. Personal boundaries include limits in physical, sexual, intellectual, emotional, sexual, and financial areas of our lives. Boundaries promote psychological safety in relationships at work, home, and with partners by ... Learning Objectives. Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. Moods shift from abnormally elevated moods called manic episodes to abnormal low moods of depression. See Figure 8.1 [1] for a depiction of the shifts in mood that occur with bipolar disorder. II Glossary. Active listening: Communicating both verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with them. Motivational interviewing (MI): A communication skill used to elicit and emphasize a client’s personal motivation for modifying behavior to promote ...According to the American Psychiatric Association, mental illness is a health condition involving changes in emotion, thinking, or behavior (or a combination of these) associated with emotional distress and problems functioning in social, work, or family activities. [2] Mental illness is common in the United States.Nov 1, 2022 · In 2018 an estimated 17.4 million (32.9%) adults with disabilities experienced frequent mental distress, defined as 14 or more reported mentally unhealthy days in the past 30 days. Frequent mental distress is associated with poor health behaviors, mental health disorders, and limitations in daily life. [10] Taking care of your mental health is equally as important as taking care of your physical health. Those living with a mental illness or disorder — whether ongoing or temporary — of...Nursing: Mental Health and Community Concepts. 2.4 Motivational Interviewing Patient education and health promotion are core nursing interventions. Motivational interviewing (MI) is a communication skill used to elicit and emphasize a client’s personal motivation for modifying behavior to promote health. MI has been effectively used for ...Omega-3 is used as an adjunct to treat clients who demonstrate recurrent self-harm. Affective dysregulation (e.g., depressed mood, mood lability, anxiety, anger): Treated with low-dose antipsychotics and mood stabilizers. Some guidelines apply to medications prescribed to clients with personality disorders for safety reasons.Nursing: Mental Health and Community Concepts. 1.1 Introduction. Learning Objectives. Describe basic concepts related to mental health care. Establish a safe environment for …Nursing: Mental Health and Community Concepts. A person’s personality is a relatively stable pattern of thinking, feeling, and behaving that evolves over their lifetime. It is unique to each individual and influenced by their experiences, environment (surroundings and life situations), and inherited characteristics. ... Since the early years of the profession, nursing leaders such as Florence Nightingale and Lillian Wald have recognized the role of nurses in controlling the influence of environmental factors on health. Nurses have long appreciated that a healthy environment impacts the physical and mental health of individuals, families, communities, and populations. [1] Community Health. Community health nursing is based on several underlying concepts such as encouraging healthy living, preventing illness, promoting rehabilitation, evaluating the effectiveness of community resources, and advocating for improved overall community health. [8],[9] In this manner, community health nurses pursue health equity.Mental Health Awareness Month is celebrated every May to raise awareness about mental health issues and reduce the stigma surrounding them. This month is an excellent opportunity f...Nurses support the emotional, mental, and social well-being of all clients experiencing stressful events and those with acute and chronic mental illnesses. [1] This chapter will review stressors, stress management, coping strategies, defense mechanisms, and crisis intervention. NCSBN. (n.d.).Anxiety disorders are a common mental health problem. Research indicates 19% of adults and 31% of adolescents have an anxiety disorder in the United States. [ 1 ] The percentage of adults with an anxiety disorder associated with various levels of anxiety are estimated as mild (43%), moderate (33%), and severe (23%).NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing: Mental Health and Community Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Nursing: Mental Health and Community Concepts [Internet]. The goals of crisis intervention are the following: Identify, assess, and intervene. Return the individual to a prior level of functioning as quickly as possible. Lessen negative impact on future mental health. During the crisis intervention process, new skills and coping strategies are acquired, resulting in change. Mental health concepts will concentrate on adaptive/maladaptive behaviors and specific mental health disorders. Community resources will be examined in relation to specific types of support offered to racial, ethnic, economically diverse individuals and groups. (Prerequisites:Accepted in Nursing-AD program; 10-543-105, Nsg Health Alterations ... Schizophrenia is a mental health condition that affects a person’s ability to function socially in a typical way. People with this condition may hear voices or experience paranoid ...Here are several nursing assessments used to determine an individual’s response to stress and their strategies for stress management and coping: Recognize nonverbal cues of physical or psychological stress. Assess for environmental stressors affecting client care. Assess for signs of abuse or neglect. Assess client’s ability to cope with ...Common findings during a mental status examination for a client with schizophrenia experiencing an acute psychotic episode are described in Table 11.4a. Review information about performing a mental status examination and psychosocial assessment in the “ Application of the Nursing Process in Mental Health Care ” chapter.Cluster B: Disregards right from wrong, lies, gets into trouble, impulsive, overreactive, emotional, and easily influenced by others. Cluster C: Social discomfort, shy, fearful, and lacks self-confidence. Answers to interactive elements are given within the interactive element. Go to:6.7 Stimulants. Stimulant medications are prescribed to treat children, adolescents, or adults diagnosed with attention deficit hyperactivity disorder (ADHD). Stimulants block the reuptake of norepinephrine and dopamine in the synapse and increase the overall level of these substances in the brain, but they have a paradoxical calming effect and ...The “Community Assessment” chapter describes how to assess community health needs and apply the nursing process to community health nursing. This chapter provides an …The Code of Ethics for Nurses With Interpretive Statements states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” [1] This chapter describes nurses’ legal and ethical responsibilities while protecting the safety and rights of clients receiving mental health care. Psychotherapy. Cognitive behavioral therapy (CBT) is used to reduce or eliminate binge eating and purging behaviors. Individuals learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs. [2] Read more about CBT in the “ Treatments for Depression ” section of the “Depressive Disorders chapter. Assessment. The community health nurse typically begins a community health needs assessment by determining what data is already available. [2] As previously discussed in the “Community Health Concepts” section, national, state, county, and local health needs assessments are widely available. Secondary analysis refers to analyzing previously … NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing: Mental Health and Community Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Nurses support the emotional, mental, and social well-being of all clients experiencing stressful events and those with acute and chronic mental illnesses. [1] This chapter will review stressors, stress management, coping strategies, defense mechanisms, and crisis intervention. NCSBN. (n.d.). Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. Moods shift from abnormally elevated moods called manic episodes to abnormal low moods of depression. See Figure 8.1 [1] for a depiction of the shifts in mood that occur with bipolar disorder. Severe bipolar episodes of mania can also include hallucinations or delusions ...Figure 16.7 Nursing Process in Community Health Nursing Assessment. The community health nurse typically begins a community health needs assessment by determining what data is already available. [2] As previously discussed in the “Community Health Concepts” section, national, state, county, and local health needs assessments are widely ...Nursing: Mental Health and Community Concepts. Open Resources for Nursing (Open RN) Book from [Chippewa Valley Technical College][Eau Claire (WI)], 16 Apr 2023 NBK: NBK590040 . Books & documents Free to read . Share this article Share with email Share with twitter Share with linkedin Share with facebook.The relevance of psychology in nursing is that the mind and the body are interwoven, so in order to treat a person’s physical health, a person’s mental health must also be treated....Research studies have demonstrated that nine percent of Americans have a personality disorder. A large proportion of this population also has one or more other mental health disorders. [1] This chapter will describe the signs and symptoms of ten personality disorders and associated treatments. The nursing process will be applied to caring for a client with borderline personality disorder.Identify common nursing problems/diagnoses related to psychosis. Establish a safe environment. Apply evidence-based practice when planning and implementing nursing care. Describe common treatments for psychosis and schizophrenia. Identify appropriate referrals to community resources. Evaluate the effectiveness of interventions.Mental health concepts will concentrate on adaptive/maladaptive behaviors and specific mental health disorders. Community resources will be examined in relation to specific types of support offered to racial, ethnic, economically diverse individuals and groups. (Prerequisites:Accepted in Nursing-AD program; 10-543-105, Nsg Health Alterations ...The difference between physical health and mental health is physical health is only the condition of the body, while mental health is a general state of well-being that allows a pe... The goals of crisis intervention are the following: Identify, assess, and intervene. Return the individual to a prior level of functioning as quickly as possible. Lessen negative impact on future mental health. During the crisis intervention process, new skills and coping strategies are acquired, resulting in change. Community health nursing is based on several underlying concepts such as encouraging healthy living, preventing illness, promoting rehabilitation, evaluating the effectiveness of …1: Foundational Mental Health Concepts. 2: Therapeutic Communication and the Nurse-Client Relationship. 3: Stress, Coping, and Crisis Intervention. 4: Application of the Nursing Process to Mental Health Care. 5: Legal and Ethical Considerations in Mental Health Care. 6: Psychotropic Medications. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), substance use disorder (SUD) is an illness caused by repeated misuse of substances such as alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants (amphetamines, cocaine, and other stimulants), and tobacco. Mental health and community health concepts are discussed while emphasizing stress management techniques, healthy coping strategies, referrals to community resources, and other preventative interventions. Nursing care for individuals with specific mental health and substance use disorders is examined, and the nurse’s role in community health ... The goals of crisis intervention are the following: Identify, assess, and intervene. Return the individual to a prior level of functioning as quickly as possible. Lessen negative impact on future mental health. During the crisis intervention process, new skills and coping strategies are acquired, resulting in change. Nursing: Mental Health and Community Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Nursing: Mental Health and Community Concepts [Internet]. Show details. Contents; About Open RN; Search term. Table 4.7 . Categories of Nursing Mental Health Interventions. Subcategories: Implementation Standard of Care ...Psychotherapy. Cognitive behavioral therapy (CBT) is used to reduce or eliminate binge eating and purging behaviors. Individuals learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs. [2] Read more about CBT in the “ Treatments for Depression ” section of the “Depressive Disorders chapter.Therapeutic communication is a type of professional communication defined as the purposeful, interpersonal, information-transmitting process that leads to client understanding and participation. [2] Read an example of a nursing student using therapeutic communication in the following box. Example of Nurse Using Therapeutic Listening.By recognizing that traumatic experiences are closely tied to mental health, nurses can provide trauma-informed care and promote resilience. Trauma-informed care (TIC) is a strengths-based framework that acknowledges the prevalence and impact of traumatic experiences in clinical practice. TIC emphasizes physical, psychological, and emotional ...10.2 Basic Concepts – Nursing: Mental Health and Community Concepts. A person’s personality is a relatively stable pattern of thinking, feeling, and behaving that …Coping refers to cognitive and behavioral efforts made to master, tolerate, or reduce external and internal demands and conflicts. [1] Coping strategies are actions, a series of actions, or thought processes used in meeting a stressful or unpleasant situation or in modifying one’s reaction to such a situation.Omega-3 is used as an adjunct to treat clients who demonstrate recurrent self-harm. Affective dysregulation (e.g., depressed mood, mood lability, anxiety, anger): Treated with low-dose antipsychotics and mood stabilizers. Some guidelines apply to medications prescribed to clients with personality disorders for safety reasons.15.3 Trauma-Informed Care. Trauma has no age, gender, socioeconomic status, race, ethnicity, or sexual orientation boundaries. Individual trauma. results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and can have lasting adverse effects on ...Learning Objectives. The Code of Ethics for Nurses With Interpretive Statements states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.”. [1] This chapter describes nurses’ legal and ethical responsibilities while protecting the safety and rights of clients receiving mental health care.Mahjong solitaire games have become increasingly popular in recent years, and for good reason. These games offer a variety of benefits that can help with stress relief and improve ...In today’s fast-paced and stressful world, it’s essential to find ways to unwind and take care of our mental health. One activity that has gained popularity recently is color by nu...Standards and Conceptual Approach – Nursing: Mental Health and Community Concepts. The Open RN Nursing Mental Health and Community Concepts textbook …The Open RN project is supported by a $2.5 million grant from the Department of Education to create five free, open-source nursing textbooks. However, this content does not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the federal government. More information about the Open RN grant can be found at cvtc.edu/OpenRN. The first three ... Protected Health Information (PHI) is defined as individually identifiable health information, including demographic data, that relates to the individual’s past, present, or future physical or mental health or condition; the provision of health care to the individual; and the past, present, or future payment for the provision of health care ... Figure 15.4 A Safe Haven For Newborns. Used under Fair Use. Signs of Neglect and Abuse Neglect. Neglect is a situation in which a parent or caretaker fails, refuses, or is unable, for reasons other than poverty, to provide the necessary care, food, clothing, or medical or dental care, which seriously endangers the physical, mental, or emotional health of the child.Learning Objectives. Psychotropic medications are medications that affect the mind, emotions, and behavior. This chapter will review the anatomy and physiology of the central nervous system (CNS) as it relates to mental health disorders and medications and then discuss several classes of psychotropic medications. Be aware that information about ... 4.2 Applying the Nursing Process. The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice ... The synthesis of nursing practice & public health practice applied to promoting and preserving health of the population. 1. CHN is based on recognized needs of the communities, families, groups and individuals. 2. The Community Health Nurse must be understand the objectives and policies of the agencies she represents.Bookshelves. Nursing. Nursing: Mental Health and Community Concepts (OpenRN) 17: Vulnerable Populations. Expand/collapse global location.Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. Provision 3: The nurse promotes, advocates for, and protects the rights, health, and ...Research studies have demonstrated that nine percent of Americans have a personality disorder. A large proportion of this population also has one or more other mental health disorders. [1] This chapter will describe the signs and symptoms of ten personality disorders and associated treatments. The nursing process will be applied to caring for a client …Nursing: Mental Health and Community Concepts. (Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to the interactive activities are provided as immediate feedback.) Case Study: Tiffany is a 24-year-old nursing student who works weekends as a certified nursing assistant.The goals of crisis intervention are the following: Identify, assess, and intervene. Return the individual to a prior level of functioning as quickly as possible. Lessen negative impact on future mental health. During the crisis intervention process, new skills and coping strategies are acquired, resulting in change. Depression is a common illness affecting an estimated 8% of adults in the United States annually. [ 1] Approximately 280 million people in the world have depression. [ 2 ] This chapter will discuss causes and types of depression, treatments for depression, and steps for applying the nursing process when caring for clients with depressive disorders. Nursing: Mental Health and Community Concepts. 8.3 Treatments for Bipolar Disorders Bipolar disorder is often a lifelong illness, and episodes of mania and depression typically recur. Between episodes, many people with bipolar disorder are free of mood disruption, but some people have lingering symptoms. Long-term, continuous treatment can help ... Depression is a common illness affecting an estimated 8% of adults in the United States annually. [ 1] Approximately 280 million people in the world have depression. [ 2 ] This chapter will discuss causes and types of depression, treatments for depression, and steps for applying the nursing process when caring for clients with depressive disorders. Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. Moods shift from abnormally elevated moods called manic episodes to abnormal low moods of depression. See Figure 8.1 [1] for a depiction of the shifts in mood that occur with bipolar disorder. Severe bipolar episodes of mania can also include hallucinations or delusions ...Anxiety disorders are a common mental health problem. Research indicates 19% of adults and 31% of adolescents have an anxiety disorder in the United States. [ 1 ] The percentage of adults with an anxiety disorder associated with various levels of anxiety are estimated as mild (43%), moderate (33%), and severe (23%).Nurses engage in compassionate, supportive, professional relationships with their clients as part of the “art of nursing.”. [1] This chapter will review the nurse-client relationship, therapeutic communication, and motivational interviewing. It will also introduce teletherapy and telehealth. American Nurses Association. (2021).Table 7.4 Antidepressants. Block the uptake of both serotonin and norepinephrine from the cell synapse. Similar to SSRIs but with two neurotransmitters. Impact the receptors of the cell synapse to inhibit or prevent the uptake of serotonin, making the neurotransmitter serotonin stay in the synapse longer. Block the presynaptic receptor for ... 4.2 Applying the Nursing Process. The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice ... 4.2 Applying the Nursing Process. The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice ...Autism spectrum disorder (ASD) is a developmental disorder that affects an individual’s communication and behavior. Although autism can be diagnosed at any age, it is classified as a developmental disorder because symptoms generally appear in the first two years of life. [1] An average of 2.3% of children in the United States have ASD.In recent years, there has been a growing interest in the potential benefits of video games for mental health. One game that has caught the attention of researchers and gamers alik... Table 7.4 Antidepressants. Block the uptake of both serotonin and norepinephrine from the cell synapse. Similar to SSRIs but with two neurotransmitters. Impact the receptors of the cell synapse to inhibit or prevent the uptake of serotonin, making the neurotransmitter serotonin stay in the synapse longer. Block the presynaptic receptor for ... Nursing: Mental Health and Community Concepts. Therapeutic communication has roots going back to Florence Nightingale, who insisted on the importance of building trusting relationships with patients. She taught that therapeutic healing resulted from nurses’ presence with patients. [1] Since then, several professional nursing associations have ...

Learning Objectives. Psychotropic medications are medications that affect the mind, emotions, and behavior. This chapter will review the anatomy and physiology of the central nervous system (CNS) as it relates to mental health disorders and medications and then discuss several classes of psychotropic medications. Be aware that information about .... Cracker barrel oregon tualatin

nursing mental health and community concepts

The Open RN project is supported by a $2.5 million grant from the Department of Education to create five free, open-source nursing textbooks. However, this content does not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the federal government. More information about the Open RN grant can be found at cvtc.edu/OpenRN. The first three ... Therapeutic communication is a type of professional communication defined as the purposeful, interpersonal, information-transmitting process that leads to client understanding and participation. [2] Read an example of a nursing student using therapeutic communication in the following box. Example of Nurse Using Therapeutic Listening. In today’s fast-paced world, it’s important to take a break and give your mind a rest. One way to do that is by playing games, and Microsoft Solitaire Games are a great option. Not...Intimate partner violence (IPV), sexual assault, and rape are crimes with long-lasting effects on victims and are a great cost to society. These crimes happen to both women and men and are often associated with substance use. A recent national survey found that 22 percent of women and 14 percent of men reported experiencing severe physical ...Protected Health Information (PHI) is defined as individually identifiable health information, including demographic data, that relates to the individual’s past, present, or future physical or mental health or condition; the provision of health care to the individual; and the past, present, or future payment for the provision of health care ...V Glossary. Adults at risk: Adults who have a physical or mental condition that impairs their ability to care for their own needs and are at risk for neglect and/or abuse. Assault: Intentionally putting another person in reasonable apprehension of an imminent harmful or offensive contact.Whether they are looking for the rundown on early morning news or checking out what their friends are having for breakfast, Americans reach for their smartphones in mass numbers as... Giving recognition acknowledges and validates the client’s positive health behaviors. Recognition acknowledges a patient’s behavior and highlights it without giving an overt compliment. A compliment can sometimes be taken as condescending, especially when it concerns a routine task like making the bed. Identify common nursing problems/diagnoses related to psychosis. Establish a safe environment. Apply evidence-based practice when planning and implementing nursing care. Describe common treatments for psychosis and schizophrenia. Identify appropriate referrals to community resources. Evaluate the effectiveness of interventions.In today’s fast-paced work environment, promoting mental health in the workplace has become a crucial aspect of ensuring employee well-being. By prioritizing workplace health and s...Establish a safe environment. Apply evidence-based practice when planning and implementing nursing care. Describe common treatments for depressive disorders. Identify appropriate referrals to community resources. Evaluate the effectiveness of interventions. Provide patient education to clients and their family members.Assessment. The community health nurse typically begins a community health needs assessment by determining what data is already available. [2] As previously discussed in the “Community Health Concepts” section, national, state, county, and local health needs assessments are widely available. Secondary analysis refers to analyzing previously …You can volunteer with mental health patients in many ways. Learn what's involved in volunteering with mental health patients and organizations. Advertisement There is an overwhelm...Nurses must understand this potential impact of previous trauma and incorporate patient-centered, trauma-informed care. Trauma-informed care is an approach that uses a lens of trauma to understand the range of cognitive, emotional, physical, and behavioral symptoms seen when individuals enter health care systems.Anxiety disorders are a common mental health problem. Research indicates 19% of adults and 31% of adolescents have an anxiety disorder in the United States. [ 1 ] The percentage of adults with an anxiety disorder associated with various levels of anxiety are estimated as mild (43%), moderate (33%), and severe (23%). Mental health disorders among children are described as “serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day.” [1] One in six children in the United States aged 2 to 8 years (17.4%) has a diagnosed mental, behavioral, or developmental disorder. Behavior problems are more common among children aged 6 to ... Learning Objectives. Delineate adverse childhood experiences. Incorporate trauma-informed care. Assess clients for signs of abuse or neglect and intervene appropriately. Promote safety for victims of abuse, neglect, or intimate partner violence. Describe strategies to remain safe if workplace violence occurs.Mental health is an important part of everyone’s overall health and well-being. Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from ...Nurses support the emotional, mental, and social well-being of all clients experiencing stressful events and those with acute and chronic mental illnesses. [1] This chapter will review stressors, stress management, coping strategies, defense mechanisms, and crisis intervention. NCSBN. (n.d.).Pets are the cute companions we dote over but turns out their nearness also helps our mental health, too. Here's how. Pets can have a huge impact on our mental well-being. Here are...Nurses must understand this potential impact of previous trauma and incorporate patient-centered, trauma-informed care. Trauma-informed care is an approach that uses a lens of trauma to understand the range of cognitive, emotional, physical, and behavioral symptoms seen when individuals enter health care systems..

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