Darunday, Ezra M.

BSN 3B

NCM 117 Asynchronous Activity – April 8, 2022

Topic: Cognitive Disorders
Symptoms Presented by the elderly in the video are:
• Confused with time and place
• Finding hard to complete familiar daily tasks
• Interchanging names or faces
• Disoriented
• Memory loss

Accordingly, to the video the elderly is at Sever Decline stage of dementia.

Nursing Interventions
Orient client. Frequently orient client to reality and surroundings. Allow client to have familiar
objects around him or her; use other items, such as a clock, a calendar, and daily schedules, to
assist in maintaining reality orientation.
Encourage caregivers about patient reorientation. Teach prospective caregivers how to orient
client to time, person, place, and circumstances, as required. These caregivers will be responsible
for client safety after discharge from the hospital.
Enforce with positive feedback. Give positive feedback when thinking and behavior are
appropriate, or when client verbalizes that certain ideas expressed are not based in reality.
Positive feedback increases self-esteem and enhances desire to repeat appropriate behavior.
Explain simply. Use simple explanations and face-to-face interaction when communicating with
client. Do not shout message into client’s ear. Speaking slowly and in a face-to-face position is
most effective when communicating with an elderly individual experiencing a hearing loss.
Discourage suspiciousness of others. Express reasonable doubt if client relays suspicious
beliefs in response to delusional thinking. Discuss with the client the potential personal negative
effects of continued suspiciousness of others.
Avoid cultivation of false ideas. Do not permit rumination of false ideas. When this begins, talk
to client about real people and real events.
Observe client closely. Close observation of client’s behavior is indicated if delusional thinking
reveals an intention for violence. Client safety is a nursing priority.

Source:
Belleza M. (2021). Dementia Nursing Care Management. Psychiatric Nursing. NurseLabs
Black, J. M., & Hawks, J. H. (2005). Medical-surgical nursing. Elsevier Saunders
Darunday, Ezra M. BSN 3B

NCM 117 Asynchronous Activity – April 9, 2022

Topic: Mood Disorders
Two Most Common Mood Disorders are:
• Depressive Disorders. Grief or sadness is a typical response to a traumatic life event or
crisis, such as the death of a spouse or family member, loss of a job, or a major illness.
However, when the depression continues to be present even when stressful events are
over or there is no apparent cause, physicians would then classify the depression as
clinical or major depression. For a person to be diagnosed with clinical depression,
symptoms must last for at least two weeks.
o Postpartum Depression
o Persistent Depressive Disorder
o Seasonal Affective Disorder
o Psychotic Depression
o Depression related to medical conditions, medications, or substance abuse
• Bipolar Disorder. Bipolar disorder is defined by swings in mood from periods of
depression to mania. When someone experiences a low mood, symptoms may resemble
those of a clinical depression. Depressive episodes alternate with manic episodes or
mania. During a manic episode, a person may feel elated or can also feel irritable or have
increased levels of activity.
o Bipolar I
o Bipolar II
o Cylothemia Disorder
o Other unspecified bipolar disorders

Case:
A 51-year-old female with a history of bipolar disorder presented to the ER claiming she
was feeling suicidal. She had jumped from a second-story window and c/o pain in her back and
both ankles. She was alert and oriented, but combative on admission to ED. C-collar in place,
handcuffed to a stretcher. “I was on the floor, my husband was trying to hurt me, so I jumped.”
“I wanted to hurt myself, and I wanted to hurt my husband.” The police reported that the patient
was aggressive towards their husband with scissors and, attempted to cut herself on the wrists.
The patient’s husband has a restraining order against her. “She reported that her husband had
been abusive to her through the years and he recently threatened to kill her.” Her ex-husband
reported she has been deteriorating for 5 weeks, belligerent, aggressive, not sleeping and
drinking wine.
On admission, the patient reported she was depressed, suicidal, and scared. She reported a
recently decreased need for sleep, euphoric mood, and racing thoughts.
Mental status:
Darunday, Ezra M. BSN 3B

• appearance—poor hygiene, disheveled

• motor activity—restless
• affect—agitated
• mood—depressed and anxious
• speech—soft
• thought process—circumstantial
• judgment—poor impulse control, maladaptive
• Insight—poor. Intelligence is below average. Concentration is distracted.

Psych History
• History of manic episodes along with psychotic symptoms
• Decreased sleep, euphoric, bizarre behavior, racing thoughts, and increased activity along
with paranoia
• History of Suicide

The nurses in the above case report expressed concern about caring for the patient and a lack of
knowledge on what to say to her and how to communicate with her. Many people suffer from
bipolar disorder, and it would be beneficial if medical-surgical nurses were more knowledgeable
about the illness and how to care for those who suffer from it.. “Bipolar disorder is a chronic
illness with recurring episodes of mania and depression that can last from one day to months.
This mental illness causes unusual and dramatic shifts in mood, energy and the ability to think
clearly.” “More than 10 million Americans have bipolar disorder.” Bipolar disorder can be
managed successfully with medication
The nurses would have been more at ease caring for the aforesaid patient if they had been
educated about bipolar disorder and the therapeutic communication skills listed below.
Therapeutic Communication Techniques:
1. Use of broad opening statements, which encourages the patient to take the lead in a
conversation.
2. Giving recognition—indicates awareness of an accomplishment
3. Making observations—sharing perceptions of behaviors
4. General leads—implies the nurse is following the course of the conversation and is interested
in hearing more.
5. Reflecting feelings restating content—mirrors feelings and ideas the patient has expressed
and directed it back to the patient.
6. Verbalizing the implied—allows nurse to validate feelings, ideas expressed.
Darunday, Ezra M. BSN 3B

7. Clarifying content—clarifies unclear communication and helps patient clarify own thoughts
or feelings.
8. Offering self/silence—this is the most important technique and it communicates caring and is
the essence of nursing.
9. Presenting reality—assures the patient of what is real to the nurse.
10. Voicing doubt—used to give the patient an opportunity to re-examine negative beliefs about
self or to allay fears arising from distorted perception
Darunday, Ezra M. BSN 3B

NCM 117 Asynchronous Activity – April 15, 2022

Topic: Anxiety Related Disorders
Different types of sexual Disorders – According to DSM 3 there are 3 major types of sexual
disorders

• Gender Identity Disorders. It is a strong persistent cross-gender identification and not

just for any perceived cultural advantages of being the other sex. It involves two criteria
for intersex that differ by age; desire to be the opposite sex or discomfort with his or her
sex.
• Paraphilias. Sexual attraction to unusual objects or sexual activities that are unusual in
nature. E.g. voyeurism, pedophiles, fetishism, sadism or masochism.
• Sexual Dysfunctions. Range of sexual problems that are considered to represent
inhibition in the normal sexual response cycle. E.g. hypoactive sexual disorder, sexual
aversion disorder, and male erectile disorder.

There are interventions to cure sexual disorders, such as;

Paraphilias
• Aversion therapies
• Satiation
• Orgasmic reorientation
• Social skills training
• Alternative behavior competition
• Castration and Drugs that lowers testosterone levels

Sexual Dysfunctions

• Masters and Johnson pioneered research into the understanding human sexual response,
dysfunction, and disorders through the direct observation of anatomical and physiological
sexual responses of human subjects.
o Banning sexual activities and discussion of the couple’s sexual value system
o Sensate focus, or pleasurable touching without intercourse, begins, and couples
are encouraged to communicate their desires to their partner.
o Specify instructions for approaching intercourse are given, according to particular
dysfunctions.
• Anxiety Reduction techniques
• Sensory-Awareness Procedures
• Communication Training
• Couple Therapy
• Other medical/Physical Procedures
Darunday, Ezra M. BSN 3B

Sources:
Rogers, K. (2022, February 12). William H. Masters. Encyclopedia Britannica.
https://www.britannica.com/biography/William-H-Masters
Darunday, Ezra M. BSN 3B

NCM 117 Asynchronous Activity – April 16, 2022

Topic: Substance-Related Disorder
Case:
Karen is a skilled emergency department (ED) nurse in a hospital that treats many trauma
victims. In her personal life, she is struggling with issues of grief and loneliness and feels like
“work is therapy because I can forget for a while.” One day she accidentally goes home with a
discarded opiate. She is an expert on administering pain medications to others and has witnessed
relief in her patients many times after she administers the drugs. That night she is tired and to
wound up to sleep, so she thinks there should be no harm in self-administering the morphine
“just this once” to provide relief and some much-needed sleep. She tells herself she will not do it
again.
A week later, Karen again finds herself with a narcotic in her possession, and she
purposely takes it home to self-inject. Within a short period of time, she is diverting on a regular
basis and realizes she will experience withdrawal unless she injects regularly. Karen finds herself
working extra shifts, volunteering to medicate co-worker patients who need pain medications,
and isolating herself from other staff members to procure and use the drugs. Fellow nurses in the
ED recognize something is wrong, but knowing how highly charged the department’s
environment is, they assume it’s “just stress.” …
Karen’s supervisor, Ann, notices change in Karen’s demeanor and behavior and decides
to closely monitor her practice. Ann also looks for medication irregularities or discrepancies,
record falsifications, and any patterns of complaints by patients. Following the hospital
procedure and investigating the situation, Ann questions Karen about her performance and
behavior. Initially denying that she has a problem when confronted with evidence of her
impaired practice Karen tearfully discloses her SUD. The hospital recommends treatment,
describing her options and that she may be eligible to return to work once she successfully
completes a treatment program, and agrees to an employee assistance program or an alternative
to-discipline program with random monitoring and aftercare. Karen complies and begins
recovery.
Insights:
When a person misuse substance that leads to health issues or problems at work, school, or home
it is called Substance Use Disorder (SUD). People with SUD needs to receive help promptly.
The symptoms of SUD may not always be recognizable, and in this case, nurse with SUD is
unidentified that may continue the practice and may impair him or her and endanger the lives of
the patient.
Nurses with SUD may undergo legal and ethical considerations. As a nurse, it is vital to identify
co-workers’ indicator that he or she needs help. There are three things to watch for; behavioral
changes, physical changes, and drug diversion.
Darunday, Ezra M. BSN 3B

Behavioral Changes may include:

• Changes in performance
• Absents
• Frequent bathroom breaks
• Arriving late or early
• Making too much excuse to errors

Behavioral changes as physical:

• Subtle changes in appearance that worsens overtime
• Increasing isolation from colleague
• Inappropriate emotional response
• Decreased alertness and confusion

When a nurse is suspected with SUD. they may turn to the workplace for access or diversion,
often causing narcotic discrepancies, such as:

• Incorrect drug counts

• Large amount of narcotic wastage
• Numerous correction of medical records
• Frequent reports of ineffective pain relief from patients
• Offers to medicate co-worker’s patient for pain
• Altered verbal or phone medical orders
• Variations in controlled substances discrepancies among shift or days of week.
Source:
Council of State Boards of Nursing, Inc. (2018). A Nurse’s Guide to Substance Use Disorder in
NursingNational.
Darunday, Ezra M. BSN 3B

NCM 117 Asynchronous Activity – April 16, 2022

Topic: Domestic Violence

Reflective Writing: How can you as a health worker help to mitigate domestic violence in
our country.

It has been at least 5 decades since the first domestic violence posed as a significant matter, and
efforts to mitigate domestic violence are made to ensure the safety of every individual
disregarding gender, race, or any cultural entity. Though interventions and focuses are widened
for safety, such as consequences of perpetrators or improving victims’ rights, domestic violence
is still present and indicates a remaining substantial problem in the country.
Health workers are obliged to provide services to communities in terms of early intervention,
education, health promotion, and caring for individuals. But health workers reluctantly considers
domestic violence as a family, personal, or inner conflict of a unit of a community. Means, there
is no need to interfere with these cases. Evidence suggests that the impacts of abuse/violence
have a significant influence on women's and children's health, and that women frequently seek
health-care professionals, including nurses, for health concerns connected to abuse/violence.
While domestic violence remains a serious and frequent aspect of an individual’s intimate
relationships, and women and children suffer health consequences as a result, health workers
have a significant role to play in working toward the prevention and early intervention of
domestic violence.
As a health worker, the Education of communities and professionals is a primary intervention.
Promotion of political action may be possible. Political action involves awareness of current
legislation within the state regarding (a) personal protection orders that are available for
individuals experiencing violence at the hands of their partner—whether in marital, dating, or
gay/lesbian relationships; and (b) mandatory arrest by police if there is evidence that an assault
has occurred. Political action could also be used in the insurance industry, where women who
have experienced domestic violence in the past may be denied health and life insurance plans.
Secondary and tertiary intervention such as early identification of abusive relationship and its
intervention plans may be conducted; (a) emphasizing warning signs that may lead to later
violence, (b) encouraging youth to build trusted relationship to peers, avoid confusion of ‘love’
with power, jealousy, control, and other emotions.
Health care professionals need to become involved in the prevention and treatment of domestic
violence since it is a public dilemma. Planning for intervention is crucial as well as having a
good knowledge of rights as citizen. In a violent relationship, there may not be an immediate
"cure," but success can be characterized as gradual steps toward empowerment.
Darunday, Ezra M. BSN 3B

Sources:
https://www.ojp.gov/ncjrs/virtual-library/abstracts/changing-attitudes-about-domestic-
violence#:~:text=Family%20violence%20became%20an%20issue,did%20the%20criminal%20ju
stice%20system.
https://www.crisisprevention.com/Blog/Domestic-Violence-What-Can-Nurses-Do
https://quod.lib.umich.edu/m/mfr/4919087.0002.105/--domestic-violence-the-role-of-the-health-
care-professional?rgn=main;view=fulltext
Darunday, Ezra M. BSN 3B

NCM 117 Asynchronous Activity – April 16, 2022

Topic: Treatment Modalities

CBT (Cognitive Behavioral Therapy)

Cognitive behavioral therapy (CBT) is one of the most common and best studied forms of
psychotherapy. It is a combination of two therapeutic approaches, known as cognitive therapy
and behavioral therapy. Form of psychological treatment that has been demonstrated to be
effective for a range of problems including depression, anxiety disorders, alcohol and drug use
problems, marital problems, eating disorders, and severe mental illness.
Nursing Responsibilities
• Improve the patient’s medical adherence
• Promoting health and wellness
• Engaging through social relationships by educating family members
Reflection: Having mental disorder means suffering from pessimistic feelings about the future.
By Doing CBT it helps to gain control of an individual’s thoughts and becomes aware of
inaccurate or negative thinking so the situation can be grasp or viewed clearly in a more effective
manner.
ACT (Acceptance and Commitment Therapy)
Acceptance and Commitment Therapy is a behavior change method based on relational frame
theory and is explicitly oriented toward the development of greater psychological flexibility. It is
a type of psychotherapy that emphasizes acceptance to deal with negative thoughts, feelings,
symptoms, or circumstances. It also encourages increased commitment to healthy, constructive
activities that uphold your values or goals.
Nursing Responsibilities

• Provide client simpler way to understand their feelings and thoughts through influence of
actions
• Help client to formulate day-to-day goals and clarifying values
• Help the client to recognize source of stress
• Support client while therapy
Reflection: CBT and ACT are both behavior-based therapies, but they differ primarily in the
view they take around thoughts. Whereas CBT works by helping you identify and change
negative or destructive thoughts, ACT holds that pain and discomfort are a fact of life –
something we must get comfortable with if we wish to live a happy, fulfilled life. For this reason,
ACT encourages you to accept all thoughts rather than trying to change them – both the good
and the bad.
Darunday, Ezra M. BSN 3B

GT (Group Therapies)
Group therapy is the treatment of multiple patients at once by one or more healthcare providers.
This activity outlines the principles of group therapy and explains the role of the
interprofessional team in evaluating, treating, and improving care for patients who undergo
group therapy. This type of therapy is widely available at a variety of locations including private
therapeutic practices, hospitals, mental health clinics, and community centers.
Nursing Responsibilities
• Review the presence and management of issues of patient confidentiality during group
therapy sessions.
• Summarize the management of internal issues that disrupt group therapy sessions.
Reflection: Joining a group of strangers may sound intimidating at first, but group therapy
provides benefits that individual therapy may not. Group members are almost always surprised
by how rewarding the group experience can be. Groups can act as a support network and a
sounding board. Other members of the group often help you come up with specific ideas for
improving a difficult situation or life challenge and hold you accountable along the way.
Diversity is another important benefit of group therapy. People have different personalities and
backgrounds, and they look at situations in different ways. By seeing how other people tackle
problems and make positive changes, you can discover a whole range of strategies for facing
your own concerns.
CAT (Cognitive Analytic Therapy)
Cognitive analytic therapy (CAT) is an integrative, psychological therapy drawing on object
relations theory and social developmental theory. CAT was developed in the context of affective
and personality‐related difficulties but has since been considered for psychosis. It is a talking
therapy that mainly focuses on relationship patterns. It is based on the idea that our early life
experiences influence the way we relate to other people and how we treat ourselves. It
Nursing Responsibilities:
• Promote strong collaborative bond with patient and take lead to develop patient better
understanding of relationship
• Being a facilitator by observing patient and s/o interpersonal interactions
• Let the patient feel protected
Reflection: Cognitive analytic therapy has two elements - the analytic side and the cognitive
side. The analytic side of the therapy involves the exploration of previous events and experiences
that could link to the current issues you are facing. The therapist will aim to help you understand
why events from the past could be affecting you now, and why things may have gone wrong in
the past.
Darunday, Ezra M. BSN 3B

Both cognitive analytic therapy and cognitive behavioral therapy are short-term therapies,
focusing on helping you develop tools so that you can better deal with any future psychological
problems yourself.
Where they differ is largely in their focus. Whereas CBT is particularly concerned with the link
between actions, thoughts, and feelings in the here and now, CAT delves into the past. This
allows the therapist to help the client focus on what their problems and challenges are, how they
started, and especially how they are relational.

DBT (Dialect Behavior Therapy)

Dialectical behavior therapy (DBT) is a structured outpatient treatment developed by Dr Marsha
Linehan for the treatment of borderline personality disorder (BPD). Dialectical behavior therapy
is based on cognitive-behavioral principles and is currently the only empirically supported
treatment for BPD. tries to identify and change negative thinking patterns and pushes for positive
behavioral changes.
Nursing Responsibilities

• Enhance the patient's ability to validate him or herself

• Let patient address trauma history when the patient appears ready
Reflection: Dated, DBT is the only empirically supported method for Borderline personality
disorder. It is important that all patient providers understand when a patient could potentially
benefit from the therapy.
FT (Family Therapy)
Family therapy is a structured form of psychotherapy that seeks to reduce distress and conflict by
improving the systems of interactions between family members
Nursing Responsibilities:

• Let patient bring family together

• Invite meaningful interventions
• Carefully put attention to illness or problems and exploration of concerns
• Notice individual strengths and resources of the family
Reflection: Family therapy can help you improve troubled relationships with your partner,
children or other family members. You may address specific issues such as marital or financial
problems, conflict between parents and children, or the impact of substance abuse or a mental
illness on the entire family
Darunday, Ezra M. BSN 3B

PDT (Psychodynamic Therapy)

Psychodynamic therapy focuses on the psychological roots of emotional suffering. Its hallmarks
are self-reflection and self-examination, and the use of the relationship between therapist and
patient as a window into problematic relationship patterns in the patient's life. It is an approach
that involves facilitation a deeper understanding of one's emotions and other mental processes.
Nursing Responsibilities:

• Act as co-therapist
• Assess patient’s problem-solving approach
• Pay attention to the social and clinical needs of the patient
• Be flexible in meeting the needs of the patient
Reflection: By using psychodynamic therapy, they can help clients get to the root of their
thoughts, emotions, and behaviors. This provides a chance for self-discovery. A client can learn
more about themselves, recognize harmful patterns of emotions or in relationships and alter their
behavior.
Individual Psychotherapy
Individual therapy is one type of psychotherapy in which a trained professional helps a single
person work through personal issues they have been facing. It is an effective treatment for a
variety of emotional difficulties and mental illnesses. Also known as talk therapy, it can help
improve or control symptoms that influence an individual’s well-being.
Nursing Responsibilities
• Reinforce positive behavior.
• Coordinate with other team members.
• Allow patient to take decision.
• Explain about the treatment.
• Develop a trusting relationship.
• Set limits on unexpectable behavior.
• Providing an opportunity for the patient to release tension as problems are discussed
• Assist the patient in gaining insight about the problem
• Provide the opportunity to practice new skills
• Reinforce appropriate behavior as it occurs
• Providing consistent emotional support
Reflection: Individual therapy gives you the chance to explore conscious or subconscious habits,
emotions, and behaviors that could be causing you harm, such as depression, anxiety, self-
criticism, substance abuse, negative relationships, and more. Finding a therapist, you are
comfortable with and cooperating with them can help you get the most out of treatment. When a
person in therapy is open and honest, therapists generally are better able to address each issue
and adjust the treatment approach as needed. Going to therapy might feel difficult on some days.
Darunday, Ezra M. BSN 3B

But it is important to attend each session and complete any homework assigned. Being patient
and sticking to the treatment plan can facilitate long-term success in therapy.
Mentalization-based treatment
Mentalization-based therapy (MBT) is a type of long-term psychotherapy. Mentalization is the
ability to think about thinking. It helps to make sense of our thoughts, beliefs, wishes and
feelings and to link these to our actions and behaviors. Mentalization is a normal capacity that
we all use in everyday life.
Nursing Responsibilities:

• Acts as a co-therapist
• Assess the patient’s problem-solving approach
• Pay attention to the social and clinical needs of the patient
• Be flexible in meeting the needs of the patient
Reflection: During mentalization-based therapy (MBT) sessions it focuses on difficulties in your
current life situation to improve your understanding of yourself and others. You focus on what is
going on in your mind and think about what might be going on in other people’s minds,
particularly in situations that may cause a strong emotional reaction and problematic behaviors.

Milieu Therapy
Milieu therapy is a safe, structured, group treatment method for mental health issues. It involves
using everyday activities and a conditioned environment to help people with interaction in
community settings. Milieu therapy is a flexible treatment intervention that may work together
with other treatment methods
Nursing Responsibilities:

• Help manage the environment, by making sure that a patient’s needs are met
• Get patients their medications
• Set and enforce healthy boundaries
• Educate patients about their health and treatments
• Contribute to a supportive environment
• Encourage patient autonomy and decision-making skills as appropriate.
Reflection: It emphasizes shared responsibility, mutual respect, and positive peer influence. It’s
been used to treat a wide variety of psychological and behavioral conditions. But like many
treatment methods, its effectiveness varies depending on the community and therapists involved.
Darunday, Ezra M. BSN 3B

Sources:
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health
Care (IQWiG); 2006-. Cognitive behavioral therapy. 2013 Aug 7 [Updated 2016 Sep 8].
Available from: https://www.ncbi.nlm.nih.gov/books/NBK279297/

Zhang, C. Q., Leeming, E., Smith, P., Chung, P. K., Hagger, M. S., & Hayes, S. C. (2018).
Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven
Approach. Frontiers in psychology, 8, 2350. https://doi.org/10.3389/fpsyg.2017.02350

Malhotra A, Baker J. Group Therapy. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK549812/

Taylor, P. J., Jones, S., Huntley, C. D., & Seddon, C. (2017). What are the key elements of
cognitive analytic therapy for psychosis? A Delphi study. Psychology and psychotherapy, 90(4),
511–529. https://doi.org/10.1111/papt.12119
May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for
borderline personality disorder. The mental health clinician, 6(2), 62–67.
https://doi.org/10.9740/mhc.2016.03.62
Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family Interventions: Basic Principles and
Techniques. Indian journal of psychiatry, 62(Suppl 2), S192–S200.
https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19
Fonagy P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World
psychiatry : official journal of the World Psychiatric Association (WPA), 14(2), 137–150.
https://doi.org/10.1002/wps.20235
GoodTherapy. (2018). Individual Therapy (Psychotherapy). Retrieved from
https://www.goodtherapy.org/learnabout-therapy/modes/individual-therapy
Bateman, A., & Fonagy, P. (2010). Mentalization based treatment for borderline personality
disorder. World psychiatry : official journal of the World Psychiatric Association (WPA), 9(1),
11–15. https://doi.org/10.1002/j.2051-5545.2010.tb00255.x

Abroms GM. (1969). Defining milieu therapy. DOI:

10.1001/archpsyc.1969.01740230041006
Darunday, Ezra M. BSN 3B