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.
References
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, 45, 86-93.
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.
Carrie Belin is an experienced board-certified Family Nurse Practitioner and a graduate of the Johns Hopkins DNP program, Johns Hopkins Bloomberg School of Public Health, Georgetown University School of Nursing, and Johns Hopkins School of Nursing. She has also completed fellowships at Georgetown and the University of California Irvine.
Angie has been a full-scope midwife since 2009. She has experience in various birth settings including home, hospital, and birth centers. She is committed to integrating the midwifery model of care in the US. She completed her master’s degree in nurse-midwifery at Frontier Nursing University (FNU) and her Doctorate at Johns Hopkins University. She currently serves as the midwifery clinical faculty at FNU. Angie is motivated by the desire to improve the quality of healthcare and has led quality improvement projects on skin-to-skin implementation, labor induction, and improving transfer of care practices between hospital and community midwives. In 2017, she created a short film on skin-to-skin called 
Justin C. Daily, BSN, RN, has ten years of experience in nursing. At the start of his nursing career, Justin worked as a floor nurse on the oncology floor at St. Francis. He then spent two years as the Director of Nursing in a small rural Kansas hospital before returning to St. Francis and the oncology unit. He has been in his current position as the Chemo Nurse Educator for the past four years. He earned an Associate in Nurse from Hutchinson Community College and a Bachelor of Science in Nursing from Bethel College.
Brandy Jackson serves as the Director of Undergraduate Nursing Programs and Assistant Educator at Wichita State University and Co-Director of Access in Nursing. Brandy is a seasoned educator with over 15 years of experience. Before entering academia, Brandy served in Hospital-based leadership and Critical Care Staff nurse roles. Brandy is passionate about equity in nursing education with a focus on individuals with disabilities. Her current research interests include accommodations of nursing students with disabilities in clinical learning environments and breaking down barriers for historically unrepresented individuals to enter the nursing profession. Brandy is also actively engaged in Interprofessional Education development, creating IPE opportunities for faculty and students at Wichita State. Brandy is an active member of Wichita Women for Good and Soroptimist, with the goal to empower women and girls. Brandy is a TeamSTEPPS master trainer. She received the DASIY Award for Extraordinary Nursing Faculty in 2019 at Wichita State University. 
Dr. Sabrina Ali Jamal-Eddine is an Arab-disabled queer woman of color with a PhD in Nursing and an interdisciplinary certificate in Disability Ethics from the University of Illinois Chicago (UIC). Dr. Jamal-Eddine’s doctoral research explored spoken word poetry as a form of critical narrative pedagogy to educate nursing students about disability, ableism, and disability justice. Dr. Jamal-Eddine now serves as a Postdoctoral Research Associate in UIC’s Department of Disability and Human Development and serves on the Board of Directors of the National Organization of Nurses with Disabilities (NOND). During her doctoral program, Sabrina served as a Summer Fellow at a residential National Endowment of the Humanities (NEH) Summer Institute at Arizona State University (2023), a summer fellow at Andrew W. Mellon’s National Humanities Without Walls program at University of Michigan (2022), a Summer Research Fellow at UC Berkeley’s Othering & Belonging Institute (2021), and an Illinois Leadership Education in Neurodevelopmental and related Disabilities (LEND) trainee (2019-2020).
Vanessa Cameron works for Vanderbilt University Medical Center in Nursing Education & Professional Development. She is also attending George Washington University and progressing towards a PhD in Nursing with an emphasis on ableism in nursing. After becoming disabled in April 2021, Vanessa’s worldview and perspective changed, and a recognition of the ableism present within healthcare and within the culture of nursing was apparent. She has been working since that time to provide educational foundations for nurses about disability and ableism, provide support for fellow disabled nursing colleagues, and advocate for the disabled community within healthcare settings to reduce disparities.
Dr. Lucinda Canty is a certified nurse-midwife, Associate Professor of Nursing, and Director of the Seedworks Health Equity in Nursing Program at the University of Massachusetts Amherst. She earned a bachelor’s degree in nursing from Columbia University, a master’s degree from Yale University, specializing in nurse-midwifery, and a PhD from the University of Connecticut. Dr. Canty has provided reproductive health care for over 29 years. Her research interests include the prevention of maternal mortality and severe maternal morbidity, reducing racial and ethnic health disparities in reproductive health, promoting diversity in nursing, and eliminating racism in nursing and midwifery.
Dr. Lisa Meeks is a distinguished scholar and leader whose unwavering commitment to inclusivity and excellence has significantly influenced the landscape of health professions education and accessibility. She is the founder and executive director of the DocsWithDisabilities Initiative and holds appointments as an Associate Professor in the Departments of Learning Health Sciences and Family Medicine at the University of Michigan.
Dr. Nikia Grayson, DNP, MSN, MPH, MA, CNM, FNP-C, FACNM (she/her) is a trailblazing force in reproductive justice, blending her expertise as a public health activist, anthropologist, and family nurse-midwife to champion the rights and health of underserved communities. Graduating with distinction from Howard University, Nikia holds a bachelor’s degree in communications and a master’s degree in public health. Her academic journey also led her to the University of Memphis, where she earned a master’s in medical anthropology, and the University of Tennessee, where she achieved both a master’s in nursing and a doctorate in nursing practice. Complementing her extensive education, she completed a post-master’s certificate in midwifery at Frontier Nursing University.
Dr. Tia Brown McNair is the Vice President in the Office of Diversity, Equity, and Student Success and Executive Director for the Truth, Racial Healing, and Transformation (TRHT) Campus Centers at the American Association of Colleges and Universities (AAC&U) in Washington, DC. She oversees both funded projects and AAC&U’s continuing programs on equity, inclusive excellence, high-impact practices, and student success. McNair directs AAC&U’s Summer Institutes on High-Impact Practices and Student Success, and TRHT Campus Centers and serves as the project director for several AAC&U initiatives, including the development of a TRHT-focused campus climate toolkit. She is the lead author of From Equity Talk to Equity Walk: Expanding Practitioner Knowledge for Racial Justice in Higher Education (January 2020) and Becoming a Student-Ready College: A New Culture of Leadership for Student Success (July 2016 and August 2022 Second edition).