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In recent years, the public knowledge of human trafficking has become more relevant, as more stories make the news about victims of near misses and sometimes rescues. Emergency department (ED) healthcare providers are trained in identifying physical child abuse, yet many have not received formal training in identifying potential child human traffic victims. The purpose of this paper is to examine how the application of Watson’s Caring Theory through interactions with patients will help ED healthcare providers to identify and provide adequate assistance for human traffic victims. A succinct description of the search for evidence is also provided.
Keywords: Watson’s Caring Theory, human trafficking, Human trafficking victim identification, healthcare human trafficking identification
Human trafficking seems to be in the news more often, and the precise number of child human traffic victims in the United States is unknown, however, with more resources and education, identification and assistance provided to victims is more common. The issue arises, as to whether healthcare providers are knowledgeable and adequately trained in identifying and providing helpful treatment if a human traffic victim were to come into the ED. Healthcare providers are trained per state requirements in mandatory reporting of child and elder abuse, yet some facilities lack standardized education on human trafficking. The reporting guidelines are different for human traffic victims, as the victim can become more in danger if the healthcare provider does not know the proper steps to take in assisting the victim out of trafficking.
The core concepts of Watson’s Caring Theory are developing caring relationships between people, based on loving kindness, morals and ethics (Watson, 2009). The personal relationships formed help to preserve human dignity, respect each other as a person, reflect on another as a holistic individual, maintain balance within yourself, and being authentic in all interactions (Watson, 2009). Caring Theory also describes caring as all expansive concept that involves the person, environment, and creates a healing environment involving the patient and family (Watson, 2009). Another concept explains that when caring relationships are developed with others, this in return provides change within oneself inspiring kinder, more compassionate nurses, and provides self-satisfaction from the relationships we are a part of (Watson, 2009). When a nurse takes time to listen to patients, acknowledging their concerns and desires, as well as acting upon what is possible within our scope helps develop these relationships and provides a confidential, trusting relationship that a human trafficking victim may be more apt to confide in with the scary truth of their situation.
Watson’s Caring Theory was chosen for human trafficking identification and treatment due to being based on ethics for healing practices, it honors the holistic human, and creates a healing environment and provides a safe relationship for patients (Watson, 2009). The healthcare provider upholds human dignity, maintains caring relationships and integrity all through developing the caring relationships (Watson, 2009). This type of relationship allows for honesty between patients and providers, allowing the confidential sharing of information, and potential requesting for assistance in getting help out of the trafficking lifestyle.
An extensive review of current literature was conducted in pursuit of research regarding the identification of human traffic victims in the healthcare setting. The University of Cincinnati online library was in order to obtain the most up-to-date research concerning this topic. The key search words applied included human trafficking victims, human trafficking, human trafficking identification, and narrowed the research to full-text online, peer-reviewed, scholarly articles, English language, within the last 5 years in order to provide the most applicable literature.
The first article, “Health care and human trafficking: We are seeing the unseen,” used a retrospective cohort study using a paper and online survey approved by the IRBs of the Icahn School of Medicine at Mount Sinai and Columbia University of Medical Center, beginning in May 2012 through December 2013 (Chisolm-Straker, et al., 2016). The surveys distributed to U.S. based human traffic victims and were in English, Haitian Creole, and Spanish languages. To be included in the study, participants that completed the paper surveys were identified as survivors of human trafficking by anti-trafficking advocates and experts, and online surveys were completed by self-identified survivors of human trafficking (Chisolm-Straker, et al., 2016). The number of survivors who declined is unknown. The participants completed the survey that included basic demographics, type of exploitation while being trafficked, medical problems that arose during exploitation, and whether healthcare was wanted and/or provided (Chisolm-Straker, et al., 2016). Those who did receive healthcare were asked the type of healthcare, if the victim was asked a screening question that would specifically identify them as a victim, and whether they had been identified by the provider as a victim and offered assistance (Chisolm-Straker, et al., 2016). The total participants were 173, with 75 completing a paper survey, and 10 in Spanish. The study indicates that 73.4% (n=127) victims wanted to see a healthcare provider, 67.6% (n=117) were able to see a provider, and only 43.6% (n=51) talked with the provider about being trafficked. The screening questions that most accurately identified a human traffic victim were, asking about his/her work 84.3%, asking about his/her living situation 60.8%, asking is anyone was hurting him/her 56.9%, asked if he/she owes employer money 52.9%, asked if he/she was forced to perform sex acts against his/her will 51%, and asked about having ID taken away 47.1% (Chisolm-Straker, et al., 2016). There were limitations of the study, including, the survey questions were designed from a human traffic expert opinion and may not be completely accurate of questions that were truly asked by healthcare providers. Further studies may help to identify the most accurate questions to be most helpful in identifying traffic victims. The survey sample is considerably small compared to the true number of traffic victims that are within U.S. borders, leading to wonder the accuracy of the study. The participants also were given a $10 gift card to participate, and this could have skewed non-survivors to participate. The written survey may have prohibited a poorly literate from taking part of the survey. This article is a Level IV according to Facchiano & Snyder (2012) hierarchy evidence table, due to being a retrospective cohort study reviewing human traffic victim experience with healthcare in the past.
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