Leaders from national nursing organizations, nursing schools, and health care simulation vendors convened in early 2019 to discuss simulation in nurse practitioner (NP) education. Nurse practitioner clinical education needs a more standardized, efficient, and sustainable model to prepare NPs to provide quality care in complex health care systems. Currently, a major shortage of clinical sites and preceptors to educate students creates challenges for NP programs and nursing faculty. One strategy used by nursing programs to overcome this challenge is using simulation to provide clinical training for NP students in a safe, controlled environment. There remains, however, a lack of evidence linking these simulation experiences with clinical skills acquisition and program outcomes. Implementing competency-based education through standardized simulations has the potential to demonstrate quality, safety, and accountability across NP education programs. Ultimately, the expansion and acceptance of simulation hours in NP education is dependent on strong and favorable evidence from rigorous, high-quality studies.

Recognition that economic, environmental, and social adversity affects health is not new; adversity may result from social determinants such as poverty, community violence, or poor nutrition; from within the family/caregiving environment; or interactions between these complex environs. However, compelling new research demonstrating the profound impact of cumulative early adversity and toxic stress on development and adult health is leading to the mobilization of global prevention and intervention efforts to attain and assure better health for populations across the world. In this paper, we begin with a global population perspective on adversity and discuss priorities for global health. We then turn to studies of adverse childhood experiences to consider current understanding of how early experiences impact brain development and short- and long-term health. Factors that build resilience and buffer the effects of toxic stress and adversity are described, with emphasis on the foundationally protective role of safe and nurturing caregiving relationships. We discuss the implications of these findings in terms of community health and present a participatory research paradigm as a relationship-based method to improve community engagement in identifying and mitigating the impact of adverse childhood experiences on health.

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) risk, are a significant health issue for young women (ages 16-21), especially African Americans with a juvenile justice history. Studies have found that 44% of young African American women have had at least one STI compared to 24.1% for all young women. The rate of STIs among young women with juvenile justice histories, particularly African Americans, is likely much higher than their non-detained peers. Yet, there are few evidence-based interventions (EBIs) designed specifically for the detained population. In 2014, the Centers for Disease Control and Prevention's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention listed few programs that comprehensively included components related to mental health, intimate relationships and high risk sexual behaviors that would be salient for a detained population. Further, many EBIs have had limited or no long-term protective effect. We propose that interrelated factors (mental health, substance use, trauma and intimate relationships) can effectively decrease risk and increase protective behaviors for the detained population most at risk.

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BackgroundAfrican American women are disproportionately impacted by sexually transmitted infections (STIs), such as chlamydia and gonorrhea, which are known risk factors for human immunodeficiency virus (HIV) infection. STIs, particularly chlamydia and gonorrhea, are even more prevalent among young African American women with a juvenile detention history. The population with experiences with the criminal justice system has greater rates of STIs and is diagnosed more often with mental health issues, often related to sexual abuse or intimate partner violence, compared to peers who have not been detained by law enforcement. Psychosocial factors, especially those related to intimate relationships (ie, the imperativeness of being in a relationship and the power one has in their relationship), have emerged as important explanatory factors for acquiring STIs, including HIV, and a component of risk reduction interventions.ObjectiveTo investigate more comprehensively the relationship between psychosocial risk factors and STIs, including HIV, as it relates to reduction and prevention of these diseases. The long-term goal is to improve the effectiveness of evidence-based interventions with a major focus on intimate relationship dynamics.MethodsThis descriptive study surveys young women (ages 13-17) who have been detained (incarcerated) by a department of juvenile justice. In addition to being female and detained, eligibility criteria include being detained longer than 30 days and being free of cognitive impairments. This study will include young women from one juvenile detention center. The primary outcomes to be measured are STI knowledge, intimate relationship dynamics (ie, imperativeness and power), and high-risk sexual behaviors. High-risk sexual behaviors will be assessed using data extracted from health records.ResultsPreliminarily, we have received assent from 26 primarily young African American women. The majority of participants (81%) had inadequate knowledge about STIs, 52% perceived a lack of power in their relationship, 56% were fearful of negotiating condom use, and 60% were not comfortable refusing sex. Interestingly, a majority of participants (68%) did not perceive a relationship as imperative.ConclusionsWhen enrollment and data collection are completed, it is expected that the primary outcome of intimate relationship dynamics (ie, imperativeness and power) will be associated with high-risk sexual behaviors and having an STI. Further, the findings are expected to provide guidance in developing a risk reduction intervention, for the population in which psychosocial factors related to intimate relationships will be central.