Running Head: NURSING AND HUMAN TRAFFICKING 1

Nursing and Human Trafficking

Patricia R. Keneagy

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

April 6, 2017

Honor Code “I pledge..”

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Nursing and Human Trafficking

Human trafficking is growing public health problem around the world. Not only has it

grown to be the second largest organized crime trade in the world, it is expected to grow even

larger than the illegal sale of drugs within the next few years. It is estimated that 800,000 people

are trafficked across international borders each year, 50,000 of these individuals are brought into

the United States. What do they bring with them, and who is providing their medical care? An

abundance of psychological issues, diseases, and histories of abuse amongst other things which

require medical attention. It is the responsibility of the nurse to identify these individuals,

advocate for them, and provide the best care possible to them.

Social Determinants of Health

Social determinants of health are defined to be “factors in the social environment that

contribute to or detract from the health of individuals and communities” (Faw, 2017). These

include, but are not limited to socioeconomic status, access to services, housing, discrimination

and stressors. While there is diversity amongst human trafficking victims, there are social

determinants that affect their likelihood to be abducted and/or exploited. These factors include

race, inclusion in the foster care system, homelessness, and sexual orientation. It is estimated

that one in five children sexually exploited are either homeless or street-involved (Edinburgh,

Pape-Blabolil, Harpin, and Saewyx, 2015). The combination of these determinants and the

children’s exploitation does not lead to favorable health outcomes. Whether due to

unwillingness to seek health care, inability to find healthcare, or inability of the nurse or provider

to obtain enough health history to properly treat the patient; it is difficult to provide effective

care to this population. These patients are extremely vulnerable and may be denied the right to

seek healthcare by those who are exploiting them.

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Evidence-Based Interventions

Between social determinants of health, and other barriers to health, women and children

who are trafficked and exploited face difficulties in receiving adequate health care. One of the

Millennium Development Goals is to promote gender equality and empower women. Through

proper medical attention, care of a nurse, and potential inclusion of law enforcement, we will be

better equipped to reach this Millennium Development Goal as it relates to human trafficking.

The study conducted by Edinburg, et al. resulted in a list of specific questions that could

be used in a clinical setting to illicit open conversation between a healthcare provider and an

exploited youth. The authors found that a majority of the youth encountered had traumatic

responses such as PTSD and associated substance use. Use of these questions and prompts can

assist the nurse in providing medical care, while fostering a caring relationship with these

exploited youths who will largely have trust issues. Ultimately, if the nurse can identify these

patients, use these questions and begin conversation with them, it is possible to begin treatment

and provide beneficial resources.

It is also proven that the provider in the hospital will be unable to provide all of the help

and assistance that an exploited or trafficked patient will need, but should treat all of the

immediate needs that they can. This can include, but is not limited to: physical trauma, sexually

transmitted infections, diagnosis of pregnancy, and mental health assessment (Dovydaitis, T.,

2010). From there, the provider and the patient will develop a plan of care. This may include

the provider contacting child protective services if the patient is a minor. If the patient is not a

minor, the clinician may call the National Human Trafficking Resource Center, but it must be

anonymous without the consent of the patient. This is a moral dilemma that each provider who

comes in to contact with trafficked patient will have to face.

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Global Approach in Addressing “Health for All”

“Globalization is a term used to refer to the increasing economic, political, social,

technological, and intellectual interconnectedness of the world” (Anderson & McFarlane, 2015).

While there are pros and cons to this concept of globalization as it pertains to healthcare, a global

approach would be beneficial in the attempt to eradicate barriers to health. The diffusion of

ideas alone is a major asset to this approach, and allows us to address health for all.

A huge first step towards positive health outcomes for patients who are identified as

trafficked individuals is awareness. “Nurses can take a more active role in human trafficking

awareness by focusing on the training and education of other healthcare professionals within the

hospital and the community” (Edmonson, McCarthy, Trent-Adams, McCain, & Marhsall, 2017).

As it is well known, the primary role of the nurse is to be an advocate for their patient. If

professional nursing organizations were to take on an initiative surrounding provider education

on human trafficking, it would serve as advocacy for trafficked patients nationally, and

eventually world-wide. In a study conducted by Ross, Dimitrova, Howard, Dewey, Zimmerman

& Oram, 2015, only eight percent of surveyed providers reported they had previously attended

training on human trafficking.

Ideas and programs are exchanged once large professional organizations have them in

place and can participate in intellectual exchanges with other organizations of similar specialty.

Proper training of health care providers will lead to more positive health outcomes for these

patients. Another way to get the global community involved in eliminating health barriers for

these trafficked patients is to establish standardized protocol on inclusion of law enforcement.

“Healthcare provider organizations should make available to their staff information about

national and local referral options for survivors of human trafficking” (Ross, et al, 2015). With
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standardization of when to involve law enforcement, it would allow the provider to focus solely

on the health care of the patient with peace of mind knowing that other authorities would further

ensure the patient’s safety outside of the immediate hospital setting. Presently, this situation is a

gray area in which “each clinician will have to make his/her own moral decision regarding the

reporting of suspected trafficking” (Dovydaitis, 2010).

Conclusion

While we have made some progress in identifying trafficked women and children in the

health care setting, there is still much room for improvement in how we do so and we further

provide care. The global approach to provider education in identifying trafficked individuals and

standardized protocols in including law enforcement would greatly aid the ability to deliver

proper and attentive health care to the patient. The role of the nurse is, as always, to advocate for

their patient, and should be specifically highlighted when discussing care of trafficked patients.

Similarly, it is the nurses’ responsibility to educate the patient, and support the interdisciplinary

team. These evolving obligations and experiences will promote the level of care provided to

these patients, allowing for health for all.

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References

Anderson, E. T., & McFarlane, J. M. (2015). Community as partner: Theory and practice in

nursing. Philadelphia: Wolters Kluwer Health.

Dovydaitis, T. (2010). Human Trafficking: The Role of the Health Care Provider. Journal of

Midwifery & Women’s Health, 55(5), 462–467.

http://doi.org/10.1016/j.jmwh.2009.12.017

Edinburgh, L., Pape-Blabolil, J., Harpin, S. B., & Saewyc, E. (2015). Assessing Exploitation

Experiences of Girls and Boys Seen at a Child Advocacy Center. Child Abuse &

Neglect, 46, 47–59. http://doi.org/10.1016/j.chiabu.2015.04.016

Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., & Marhsall, J. (2017). Emerging

Global Health Issues: A Nurse’s Role. Online Journal Of Issues In Nursing, 22(1), 1.

doi:10.3912/OJIN.Vol22No01Man02

Faw, K. (2017). Common definitions [PowerPoint slides]. Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/content/listContent.jsp?course_id=_

2857_1&content_id=_145260_1

Ross, C., Dimitrova, S., Howard, L.M., Dewy, M., Zimmerman, C., & Oram, S. (2015). Human

Trafficking and Health: A Cross-Sectional Survey of NHS Professionals’ Contact With

Victims of Human Trafficking BMJ Open 2015;5:e008682. doi: 10.1136/bmjopen-2015-

008682