Introduction
Human trafficking is a critical and pressing issue in North Carolina and the United States. In 2019, North Carolina became one of the ten states with the highest ranks in human trafficking (Winters, 2020). In 87% of cases, victims get in contact with organizations providing medical services, particularly emergency nursing (Donahue et al., 2019). Besides, trafficking in children is alarming, which requires the involvement of pediatric nurses. Therefore, the role of nurses in recognizing and reporting victims of trafficking is vital.
Importance of Nursing Education
Knowing the key signs that a person has become a victim of human trafficking and correct intervention in the situation can save lives and change the fate of many people. Public hospital councils for nursing should mandate nurses to complete an additional 10 Continuing Education Units (CEUs) to recognize and report trafficked persons, adding this topic to the mandatory list of subjects. Such organizational measures will lead to a sharp change in the negative tendencies that occur due to the ignorance of the problem when victims contact social institutions.
Besides, such measures will help increase crime detection and reduce human trafficking in the future. Education is recommended for emergency nurses and nurses working in pediatric offices in public hospitals throughout the state. At the same time, nurses from other departments must also receive appropriate training. Practical cooperation between departments and disseminating educational information among the population through posters will help overcome this issue.
Relevance of the Problem
Human trafficking is a humanitarian problem; therefore, medical workers will have a chance to cope with it. Practicing nurses are among the few officials who have the opportunity to contact victims of human trafficking freely. Since victims are usually in contact with emergency nurses, these health workers should take responsibility for identifying and reporting victims of trafficking. It is also important to provide victims with all the necessary medical care, prioritize hospitalization, and ensure their safety by limiting visits.
Hospitalization is one of the few circumstances in which the lives of victims of human trafficking intersect with society. According to the study, 87% of human trafficking survivors reported that they visited emergency departments for treatment while in captivity (Donahue et al., 2019). Therefore, there is a need to educate nurses in understanding human trafficking victims’ problems and learning the signs or ‘red flags’ of human trafficking. Scientists note that in this case, health workers will have a better opportunity to recognize and intervene in the lives of trafficked individuals (Donahue et al., 2019). To this end, an online training module, available at HTEmergency.com, was developed based on evidence. Thanks to this online training, health workers who took part in the research doubled their confidence in the identification and correct treatment of victims of human trafficking.
Yet another study reveals another unpleasant but characteristic trend in human trafficking. About half of the victims are under the age of 18, and this crime against children is called domestic minor human sex trafficking (DMHST). Scientists emphasize that most DMHST victims often seek medical attention in the emergency room, while in captivity (Roney & Villano, 2020). Therefore, it is critical to educate nurses on this issue so that they can recognize such cases and provide the right treatment, care, and support.
Economic Benefits for Communities
Government policies to mandate the practice of training nurses to recognize and report trafficked victims will have a positive impact on the financial health of the state’s communities. It is noteworthy that 80% of human trafficking victims are US citizens (Donahue et al., 2017). Often, vulnerable categories of the population, such as women, children, and young people, fall into slavery, being dependent on relatives, and being abducted within their residence area (Donahue et al., 2017). Freed from labor or sexual slavery, victims of human trafficking will gradually adapt to a fulfilling life in society, find employment, and contribute to the development of the state’s economy.
Ethical Rationale
The need to provide nursing education on the broadest possible scale is consistent with a set of ethical principles. These are the principles of autonomy, beneficence, non-maleficence, justice, which ensure that US citizens and non-citizens deserve merciful, humane, and fair treatment. Scientists note that, in addition to general ignorance, victims of human trafficking often do not receive adequate treatment (Long & Dowdell, 2018). Therefore, it is reasonable to follow the Human Traffic Emergency Department’s plan for dealing with victims of trafficking, including obligatory identification of victims in the hospital and the provision of necessary legal and medical assistance. Providing immediate support to victims of trafficking will be the highest expression and protection of these ethical principles.
Policy Brief
It is proposed to send a Policy Brief detailing nursing education in human trafficking to NC Governor Roy Cooper. Mr. Cooper has already expressed concern about this issue by proclaiming January 2020 as Human Trafficking Awareness month in NC (Winters, 2020). The Governor has extensive experience in government work in the past. Hopefully, he will choose to participate and contribute to the implementation of the anti-trafficking plan presented below. According to scientific research, more than 87% of trafficking victims came into contact with a health worker while in slavery and were not identified as victims of trafficking (Long & Dowdell, 2018). Moreover, the same study found that no nurse examined or treated the victim. This state of affairs is a blatant violation of human rights and negatively characterizes the quality of medical services provided in North Carolina. Therefore, nurses must receive the education that will help them recognize and report victims of trafficking and provide them with medical care.
Challenges of Addressing Human Trafficking
Most scientists agree that human trafficking victims suffer from severe physical, emotional, and psychical pain. However, one should also understand the advantages of the current situation, when victims have the opportunity to contact health workers. Because, if the measures taken by the health workers will become too evident to the traffickers, they will do everything to ultimately limit the contacts of their victims with the outside world. Another problem is the lack of awareness of health workers about the signs of human trafficking victims. For example, they are sometimes confused with victims of violence or individuals in prostitution (Long & Dowdell, 2018). Of course, these two listed categories of people also need urgent and direct intervention to protect their human rights (Lutz, 2018). However, at the first stage, there is still a need to correctly identify the problem and the circumstances that the victim faced.
The third aspect is the lack of awareness of nurses in pediatric offices since almost half of the human trafficking victims are children. Some studies indicate that survivors are most likely to come into contact with the emergency department while in captivity. However, since pediatricians work with children as a target group, there is a need to educate them to recognize and provide the necessary medical assistance to victims of trafficking. Finally, the fourth challenge is that health workers do not provide victims of trafficking with the required medical care.
Primary Options and Interventions
It is proposed that, after recognizing a victim of trafficking in persons based on external signs, the health worker should report this to the hotline without informing the victim. Because in some cases, informing or asking permission can either make the situation worse or put the victim’s life in danger. The second important step is placing the victim in a hospital with limited visits. Noteworthy, traffickers usually try to control their victims by negotiating on their behalf and possessing their IDs (Donahue et al., 2017). Therefore, hospitalization will provide the victims with the medical care they need and ensure their safety.
Besides, since several states have legislation requiring health workers to report victims of trafficking, it is proposed that similar laws be introduced in NC. This proposition is not about imposing fines and penalties for not reporting, but about creating a legal obligation (Atkinson et al., 2016). It will help health workers to take the situation more seriously and reduce the level of mistrust towards victims of trafficking. At the same time, education in recognizing victims of human trafficking and the correct provision of medical and legal assistance will make the process smoother and more efficient. Finally, training should extend not only to emergency room nurses but also to pediatric nurses.
Action Plan
The action plan will include the development of legislation to solve the identified problems and the introduction of compulsory training for nurses. It will also be necessary to oblige health workers to develop protocols for working with human trafficking victims. These protocols will prescribe such nuances as limiting visits to ensure safety, disseminating information within the hospital, reporting a victim to the hotline, and agreeing on further actions with the victim.
These protocols should take into account the need for extended hospital stays to provide all necessary medical care and subsequent supportive psychotherapy. The protocol should also include monitoring of how the victims’ life develops in the future. Victims will need social workers’ support for a long time – for example, when seeking a job or obtaining an education. Hence, social and health workers can cross-monitor each other’s performance. Besides, victims of human trafficking, due to their stay in inhuman conditions, can develop chronic diseases (Donahue et al., 2017). Nursing care will require additional labor, time, and financial costs. However, the principles of humanism, mercy, and justice do not allow health workers to step back.
Evaluating the Success: A Top-Down Approach
The effectiveness of the top-down approach is justified because, without direct instructions and the introduction of straightforward job descriptions, nurses and health workers will not follow them. Besides, clear job descriptions will help nurses understand their role and the series of necessary and valid actions. Since adequate work in victims of human trafficking is impossible without understanding the problem and how to solve it, nurses’ education is also mandatory. Equally important is the involvement of nurses working in pediatric and gynecological offices, since, according to statistics, about 80% of victims are enslaved to perform sexual services.
Severe mental and physical injuries that these people receive are a full justification for carrying out all the actions mentioned above. Intervention at the legislative level is required since it will make the problem more realistic, not to ignore it anymore. The plan implementation assessment will be carried out according to reports on the number of people who were recognized as victims of human trafficking and received the necessary support and medical care.
Cooperation with the Community
Several organizations are working to reduce human trafficking in the state and provide assistance to victims. These are Stop Human Trafficking (NC), Project No Rest, and World Relief Triad. These organizations are already providing full aid, but their cooperation with medical institutions in implementing a nursing education program can be beneficial. Project No Rest was chosen for collaboration since it cooperates with the survivors, aiming to help victims and reduce human trafficking. Besides, they disseminate information about the signs or ‘red flags’ showing that a person has become a victim.
Since the project focuses on assisting victims, there is an opportunity to join this process and develop strategies to provide the right assistance from the health workers. Since the organization has extensive experience working with victims, their advice can be extremely useful in developing protocols for working with victims of human trafficking in medical institutions. Moreover, it makes sense to enlist the initiative’s support in assessing the newly developed protocols, indicating weak and strong points.
Therefore, healthcare practitioners will get an opportunity to be guided by practical advice from victims who have come a long way in recovery and from the organization’s team. This approach can resonate with Project No Rest representatives, as it aims to improve the interaction of health workers with victims of human trafficking. Besides, if the state government supports the initiative, compulsory education for nurses and the development of protocols will be carried out in most public health facilities. In this case, health workers will provide the right assistance to the most significant number of victims.
Joint Action Plan
Since Project No Rest and the Compulsory Education and Protocols Initiative have common goals, it will be easy for these initiatives to collaborate. Hence, Project No Rest and the education initiative can join forces to provide the most effective aid. First, as noted above, the educational initiative will need Project No Rest’s support in approving the medical protocol. Secondly, if the education will be based on the educational module developed by Donahue, LaVallee, & Schwien (2017), which is an excellent example of quality education, comments from experts from Project No Rest will still be useful.
Besides, working with Project No Rest staff will help to avoid the overly direct involvement of victims of trafficking. It is sensible, since, despite the need and importance of survivors’ participation in the process, not all are in a sufficiently stable state to take responsibility for the result or possible mistakes. Collaboration with people who survived human trafficking should be an opportunity to participate and make a valuable contribution, but should not be compulsory.
The nurses participating in the educational initiative and Project No Rest team will have a significant role in approving educational programs and protocols. The education initiative will take responsibility for implementing the project within the medical institutions, while Project No Rest team members will evaluate the content of the educational program. If the initiative is successful, the educational initiative will try to contribute to the implementation of the project in as many medical institutions as possible.
Evaluating the Success: A Bottom-Up Approach
The principles of Community-Based Participatory Research (CBPR) will be used to develop a collaborative evaluation plan. The most effective policies are recognizing the community as the unit of identity, facilitating collaborative partnerships based on research, fostering co-learning among partners, and achieving a balance between knowledge and intervention. It will also be necessary to focus on local public health problems, create cyclical and iterative processes, disseminate results among partners, and strive to develop long-term processes. A bottom-up approach will be used to assess the success of cooperation. The initiative’s effectiveness will be measured by changes in the assistance provided and recognizing human trafficking victims.
Strengths and Challenges of the Top-Down and Bottom-Up Approaches
The strengths of the top-down approach are that with the introduction of job descriptions and compulsory education for nurses, they will undoubtedly take action. As a result, more victims of human trafficking will be able to receive aid. Besides, the development of new protocols is more likely to be implemented through direct decree, since the development of protocols is primarily the responsibility of the management of medical institutions. Simultaneously, the strengths of the bottom-up approach are the guaranteed higher quality of the educational modules and the evaluation of the protocols from a practical point of view. Real knowledge of the problem occurs through direct interaction with victims of human trafficking, so the help and cooperation with the Project No Rest team cannot be overemphasized.
Unfortunately, there are also weaknesses in each of the approaches. When implementing the top-down approach, problems may arise related to distrust of the persons who perform the changes. Besides, in this case, there will be few opportunities for direct control, and additional control resources will be needed. With a bottom-up approach, problems will inevitably arise with the implementation of the initiative, since participation will be voluntary. Therefore, there is no guarantee that the work done will have consequences and benefit the service’s final recipient – that is, victims of human trafficking.
Therefore, it is suggested to apply a top-down approach, with elements of the bottom-up approach. In particular, it is recommended that nurses will be required to undergo training in recognizing and reporting victims of human trafficking. They will also have to develop protocols for working with victims, based on information from the educational module. At the same time, it is suggested to seek help from the Project No Rest team, with a request to evaluate and make comments on the content of educational modules and protocols.
Conclusion
Thus, a plan was developed to train nurses in the correct recognition and reporting of victims of human trafficking and provide them with full and timely assistance. Both government officials responsible for the safety and well-being of the state and community organizations that offer assistance to victims will be involved in the implementation of the plan. Such collaboration at all levels will help implement the initiative as effectively as possible and on the broadest possible scale.
References
Atkinson, H. G., Curnin, K. J., & Hanson, N. C. (2016). US state laws addressing human trafficking: education of and mandatory reporting by health care providers and other professionals. Journal of Human Trafficking, 2(2), 111-138.
Donahue, S., Schwien, M., & LaVallee, D. (2017). Human trafficking: emergency department training module. Web.
Donahue, S., Schwien, M., & LaVallee, D. (2019). Educating emergency department staff on the identification and treatment of human trafficking victims. Journal of Emergency Nursing, 45(1), 16-23.
Long, E., & Dowdell, E. B. (2018). Nurses’ perceptions of victims of human trafficking in an urban emergency department: a qualitative study. Journal of Emergency Nursing, 44(4), 375-383.
Lutz, R. M. (2018). Human trafficking education for nurse practitioners: Integration into standard curriculum. Nurse Education Today, 61, 66-69.
Roney, L. N., & Villano, C. E. (2020). Recognizing victims of a hidden crime: human trafficking victims in your pediatric trauma bay. Journal of Trauma Nursing, 27(1), 37-41.
Winters, J. (2020). North Carolina lands on top 10 list for human trafficking, Triad experts say more victims are self-reporting. WFMY News 2. Web.