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31.1 Trauma-Informed Care

TIC is a therapeutic approach that centers on the understanding that trauma can have long-lasting emotional, neurological, psychological, social, and biological effects. It acknowledges that ACEs can significantly impact present and future health. A TIC-informed approach uses six guiding principles to ensure every client interaction is mindful and places the client’s well-being first; the client is not harmed further or retraumatized by working on their past. A trauma-informed approach requires the nurse’s constant attention, caring awareness, and sensitivity.

31.2 The Mental Health Crisis

The U.S. health care system is overburdened with the rise in mental health issues. Mental health services are insufficient to address clients’ needs. Stigma surrounding mental illness can be a barrier to accessing mental health services. As trusted advocates, nurses are uniquely positioned to recognize mental health concerns, provide compassion to clients, and help clients access treatment. Nurses must establish a therapeutic nurse-client relationship. Understanding who the client is, what is occurring in their life, what resources are available to them, and their individual beliefs, supports, and demeanor can help a nurse determine if a client is at risk for ineffective coping and possible progression to crisis.

31.3 The Opioid Epidemic and Substance Use Disorders

Deaths from SUDs, particularly with opioid overdoses, have increased dramatically in recent years. The opioid epidemic has many causes including the notable increase in opioid prescriptions, rise in heroin use, and availability of illicitly manufactured fentanyl. This public health crisis spawns various socioeconomic and health consequences affecting all populations. Public health initiatives must address social determinants of health that cause systematic inequalities, barriers to health care access, and the promotion of stigma. A unified approach is needed to address associated mental disorders and SUDs. Nurses are poised to make a distinct difference in effecting change in vulnerable individuals, communities, and populations impacted by the opioid epidemic. Evidence-based strategies must include early identification, evidence-based interventions, harm-reduction programs, recovery services, and advocacy for policies to combat this public health epidemic.

31.4 Human Trafficking

Every year, millions of men, women, and children are trafficked worldwide. This often-hidden crime can happen in any community and to individuals of any age, race, gender, or nationality. Human trafficking is committed against a person’s will, and the economic sectors that profit the most include agriculture, restaurants, manufacturing, domestic work, entertainment, hospitality, and the commercial sex industry. Language barriers, fear of their traffickers, and/or fear of law enforcement frequently keep victims from seeking help. Health care encounters with nurses may be one of the only channels through which a victim is identified. The nurse’s ability to identify a victim and knowledge of the available resources to assist a victim can be lifesaving for some victims.

31.5 Refugees

Refugees and asylum seekers have left their homes, fleeing persecution due to race, national origin, religion, political opinion, or membership in a particular social group. This population faces many risks and dangers, including disease, malnutrition, violence, labor exploitation, and trafficking. Poor living conditions and inadequate hygiene make refugees vulnerable to many health conditions. Overcrowding, poor water and sanitation conditions, lack of vaccinations, delayed diagnosis, and reduced access to treatment can lead to increased occurrence, severity, and case fatality of infectious diseases. Nurses treating this population should offer screening for infectious diseases and determine vaccination status. Some clients may need additional health education in an appropriate language to understand their options. Specialist client support organizations may also be able to assist.

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