By Jana Esden, DNP, APNP, FNP-BC; Associate Professor, Frontier Nursing University
I chose Frontier for my family nurse practitioner education in part due to its mission in serving the underserved. At the time of my graduation, I felt well prepared to serve this population. I have worked in a few different settings from volunteering at evening clinics with long lines and very little resources, to providing care to patients with chronic conditions at a hospital-sponsored free clinic.
My most recent work has been by far the most challenging but also incredibly rewarding. I currently work in a community clinic, serving homeless men at a transitional housing complex. I also see patients transported over from a local warming shelter, which is a facility that provides dinner, breakfast and a sleeping mat for both men and women in our homeless community. These patients have many times not seen a health care provider in years and have multiple uncontrolled chronic conditions. Additionally, most all have a history of adverse childhood experiences (ACEs).
ACEs, which include various types of childhood abuse and household dysfunction, are actually very common. Over half of the U.S. population has suffered least one ACE. Health literature has repeatedly linked ACEs with unfavorable adult health outcomes including mental illness, substance abuse, various chronic illnesses, disability and early death. Toxic stress resulting from ACEs affects brain development in young children and changes the architecture of the brain. These changes influence behavior, learning and overall health. Toxic stress also affects the nervous system, hormone regulation, and even causes alterations in DNA.
In order to provide appropriate care to ACE survivors, it is important for nurse practitioners to be aware of the detrimental effects of childhood trauma on adult health. My role involves preventative care and the management of chronic conditions, but one of my most important jobs is to build trust with patients. Evidence suggests that patients are not offended when asked about past trauma and actually feel relieved to discuss these experiences. I screen all of my patients specifically for ACEs and educate them on how these experiences have influenced their journey into adulthood and have impacted their current situations and overall health. I screen all patients for anxiety, depression, and substance abuse, and I encourage them to attend cognitive behavioral therapy with one of our trauma-informed counselors.
I have discovered that many of my patients have not had a provider whom they felt really cared about them prior to coming to our small clinic. If we build relationships and trust with our patients, we have more opportunity to help them in improving their health. Caring for these patients has been professionally fulfilling for me. My sincere hope is that all of our students are able to find a niche – a certain population or a specific focus – that really calls to them. I have found this in my work with the underserved.
Dube, S. R., Cook, M. L., & Edwards, V. J. (2010). Health-related outcomes of
adverse childhood experiences in Texas, 2002. Preventing Chronic Disease
Health Research, Practice, and Policy, 7(3), 1-9.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards,
V.,…Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American Journal of Preventative Medicine, 14, 245–258.
Jackson, A. M. & Deye, K. (2015). Aspects of abuse: consequences of childhood
victimization. Current Problems in Pediatric and Adolescent Health Care,
Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood
experiences on health, mental health, and substance use in early adulthood: a cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect, 37, 917-925.
Oral, R., Ramirez, M., Coohey, C., Nakada, S. Walz, A., Kuntz, A.,…Peek-Asa, C.
(2016). Adverse childhood experiences and trauma informed care: the future of health care. Pediatric RESEARCH, 79 (1), 227-233.
Rose, S. M. S.-F., Xie, D., & Stineman, M. (2014). Adverse childhood experiences
and disability in U.S. adults. PM&R, 6, 670-680.
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