Integrating sex-trafficking awareness into women’s health curricula

By Diana M. Drake | 09/22/2016

To improve healthcare for victims, we need to hear their voices.

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Along with rising recognition of the magnitude of sex trafficking around the world, an awareness of the need to provide better care to female victims of sex trafficking in the community where my students practice has steadily increased. I am the program director of the Women’s Health Nurse Practitioner (WHNP) Doctor of Nursing Practice (DNP) program at the University of Minnesota (U of M) School of Nursing. In the last few years, we have worked to integrate sex-trafficking awareness into the program curriculum for advanced practice registered nurse (APRN) students.
 
Diana DrakeThe definition and scope of sex trafficking have been well-defined in the two articles that precede mine in this three-part series titled “Sex trafficking: Knowing the signals and what to do.” In 2012, the authors of another RNL article titled “Stolen lives: What nurses can do to stop sex trafficking” observed that, although sex trafficking is a law enforcement issue, it is also a health provider issue, one that remains under-noticed.
 
As nurses, we often find ourselves in the role of listening to intimate patient stories and needing to have a holistic view of individuals and all components of their lives. Yet studies indicate that healthcare providers in clinics and emergency-care facilities often fail to identify female victims of sex trafficking.
 
Educators of future nurses can greatly increase awareness of the sex-trafficked population among us, including the negative outcomes these victims experience. They are at significantly higher risk for physical abuse and psychological problems. Numerous influential women’s health groups, such as the The American Congress of Obstetricians and Gynecologists, also known as ACOG, and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), have published policy and position statements on sex trafficking that are helping to bring the problem to the forefront, but a healthcare problem remains. At this point, there is not a consensus on evidence-based guidelines to turn to when educating students on direct care of sex-trafficked victims.
 
Integrating care of sex traffic victims into APRN education
To prepare the next generation of APRNs on sex trafficking and providing care for victims, academic nurse leaders who direct WHNP DNP programs need to first bring the issue into sharp focus for faculty members—specifically women’s health nurse practitioners, family nurse practitioners, and nurse midwives—who train these students.
 
Identified below are four key objectives that contribute significantly to educator and student awareness. Although domestic violence and prostitution are topics already addressed by women’s health curricula, detailed information and discussion specific to sex trafficking have not previously been part of this course content. A collaborative approach among faculty members, students, and the community that occurred organically as a result of growing awareness of this public health concern has helped move the topic more fully into APRN curricula for our school.
 
Objective 1: Increase awareness of women’s rights and health from a global perspective
An initial activity for achieving this objective was a collective viewing of the PBS series “A Path Appears: Transforming Lives, Creating Opportunity.” The three-part documentary, which focuses on human-rights violations, gender inequality, and roots of vulnerability from a global perspective, follows Pulitzer Prize winners Nicholas Kristof and Sheryl WuDunna and a team of actors and advocates to Colombia, Haiti, Kenya, and parts of the United States.
 
As part of the first-year women’s health practicum course, WHNP faculty members and students watched the documentary together and discussed—in the classroom and online—its implications. Group reflection on the sobering stories and statistics presented, together with sharing of personal emotions and struggles with the topic, provided simultaneous and informed awareness in a way that a course lecture or textbooks could not. Students and faculty shared in the transformative power of the documentary, the global issue of women’s rights, and how the film’s content impacts the APRN role and healthcare delivery.
 
Objective 2: Connect to the local community
To increase awareness of sex-trafficking issues and improve effectiveness in helping victims, WHNP faculty members and several ARNP students worked in partnership to create a relationship with a local community organization that seeks to educate the public and assist sex-trafficked women trying to leave “the life.” Reaching outside of the more conventional women’s health clinics and developing a partnership with a community-based organization that works with healthcare in context have proven fruitful for students and faculty alike.
 
The community organization selected was founded and initially operated by former sex-trafficked women. A class presentation by a representative of that organization, which was followed by discussion, provided a safe environment that proved to be a pivotal turning point in student awareness and sparked interest in how they could make changes in their own practices in the local community. The presentation and interaction inspired two students to take elective training sessions offered by the organization and to serve as volunteers to help sex-trafficked women.
  
Objective 3. Address sex trafficking in DNP projects
Recognition of the usefulness of this objective came about in the context of my role as a DNP project adviser. Several students were looking for projects that would meet the requirements of the DNP program. After sharing information from a recent public health journal about sex trafficking in our local community, I encouraged these students to consider, as part of a doctoral systems improvement project, if working with sex-traffic victims should be recommended as a high-priority need for inclusion in the APRN scope of practice.
 
Kelsey Lessard, DNP, APRN, CNP, and Megan Fredericksen, DNP, APRN, CNP, WHNP, who have since graduated from the WHNP DNP program at the University of Minnesota and are authors of the first two articles in this series, completed projects that focused on systems improvement for sex-trafficked women. In my role as WHNP program adviser for these students, I brought their work to the attention of the school, and our partnership efforts on sex trafficking were highlighted in Minnesota Nursing magazine, published by the University of Minnesota School of Nursing. WHNP faculty also initiated a study-abroad option that provided these two students with an opportunity to interact with healthcare providers in Salvador, Brazil, who were knowledgeable about sex trafficking. Connecting students firsthand with the issue at both a local and global level was an unexpected and enriching aspect of their DNP scholarship.
 
Objective 4: Integrate student projects into classroom courses
This fourth and final objective—integration of student-produced content into classroom instruction—was first realized at the University of Minnesota when information compiled by a student for a DNP project on sex trafficking was integrated as a pilot project directly into two courses in the DNP program. This content was also implemented at clinic sites where I practice.
 
Informed by her direct relationship to and training with the community organization mentioned above, as well as research findings on the most recent recommendations for practice, the student presented to two classes of APRN students on the topics of healthcare provider awareness and assessment of the sex-trafficked female patient. A survey conducted both before and after the classroom presentation became part of her larger DNP project data and a subsequent manuscript, among a number of other interventions.
 
Summing up
As described in the example above, faculty and student partnerships that lead to improvements in healthcare can be of direct benefit to the APRN education process. In this case, a faculty partnership allowed for the DNP project to be embedded as a pilot study into an existing practicum course. In addition to promoting connectedness to the community, this shared learning environment has resulted in ongoing benefits to a clinic system, student participants, and the APRN course curriculum at the University of Minnesota.
 
The integration of sex-trafficking curriculum at the U of M was dependent on key factors: 1) WHNP faculty initiatives for change, 2) a robust collaborative effort between students and faculty in DNP projects, and 3) opening the classroom to student-led and community-based partnerships.
 
Ultimately, the goal is to improve healthcare delivery to sex-trafficked female patients. More research is needed to provide stronger guidance in APRN training and establish clear evidence-based practice guidelines. Continued work in seeking to address these issues further upstream through policy and legal changes will also positively impact the work of healthcare providers.
 
To improve awareness of sex trafficking and the delivery of healthcare to its victims, we need to hear their voices. Utilizing interactive student experiences and innovative collaborative partnerships to promote understanding by APRN students of sex-trafficking issues can provide a foundation to build on. With passion for women’s healthcare, a community-based motivation, and commitment to thinking outside the box, we have successfully integrated awareness of sex trafficking and improvement of healthcare to those affected by trafficking into our women’s health curriculum. 
 
Part 1 in this series: Greater awareness of sex trafficking needed
 
Part 2 in this series: Prison and sex-traffic victims: A place for help but not a safe zone
 
Diana M. Drake, DNP, APRN, WHNP-BC, is clinical associate professor and director, WHNP DNP program, at the University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.
 
Resources
Human Trafficking, The American College of Obstetricians and Gynecologists, Women’s Health Care Physicians, Committee Opinion, No. 507, September 2011
 
Global Women’s Health and Rights, The American College of Obstetricians and Gynecologists, Women’s Health Care Physicians, Statement of Policy, 2015
 
National Human Trafficking Resource Center
 
Polaris Project
 
U.S. Department of State, Office to Monitor and Combat Trafficking in Persons 
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