Call to Action: Empowering Nurses to Confront Human Trafficking
To help nurses identify potential victims, the article lists red flags and the questions to ask.
Because nurses work across healthcare settings, they are exceptionally well positioned to combat human trafficking by identifying victims and providing care, while enhancing awareness, offering resources and fostering a supportive environment.
“My Patient Is a Victim of Human Trafficking,” in American Nurse, reports that 100,000 to 300,000 adults and children are currently being trafficked in the U.S., meaning they are victims of involuntary servitude, debt bondage or sexual exploitation. And while a 2017 study revealed that more than half of labor and sex trafficking survivors accessed healthcare during their ordeals, as many as 97% didn’t receive human trafficking information or resources.
To help nurses identify potential victims, the article lists a series of red flags to watch for and the right questions to ask. The article also introduces the Human Trafficking Process Guide, a step-by-step procedure for nurses to help determine whether a patient is being trafficked and decide if the situation requires mandated reporting.
“To ensure we provide the best care possible for these individuals, we must pursue education about human trafficking, victim identification, and appropriate actions,” the article adds. “We also must disseminate this information widely to our co-workers, our community, and our families.”
Nurses can also access the following valuable AACN resources, which offer practical guidance for supporting human trafficking victims:
- A Q&A with two Texas emergency department nurses who founded Reclaim611, a nonprofit that provides healthcare workers with training to recognize and report human trafficking
- A rapid response nurse’s personal story of assisting a human trafficking victim and how the experience motivated her to become an advocate
- An NTI recorded session featuring a human trafficking survivor who is now a forensic nurse and private investigator. The discussion includes ways to build rapport with survivors and understand the importance of trauma-informed care protocol.
Pantoprazole Helps Shield Ventilated Patients From Bleeding
Despite limitations, the findings are expected to strengthen recent guidance for stress ulcer prophylaxis.
For patients undergoing invasive mechanical ventilation, the proton-pump inhibitor (PPI) pantoprazole significantly lowered the risk of upper gastrointestinal bleeding compared with placebo, with no significant effect on mortality.
“Stress Ulcer Prophylaxis During Invasive Mechanical Ventilation,” in The New England Journal of Medicine, also finds that pantoprazole does not increase patients’ risk of ventilator-associated pneumonia (VAP) or C. difficile infection, as some previous evidence has indicated.
The REVISE trial, conducted in 68 ICUs in eight countries, enrolled 4,821 mechanically ventilated adult patients to receive either 40 mg of pantoprazole or placebo daily for 90 days or until ventilation was discontinued.
Clinically important upper gastrointestinal bleeding occurred in 25 of 2,385 patients receiving pantoprazole (1%), which is significantly fewer than 84 of 2,377 patients (3.5%) in the placebo group, the study adds. Risk of death at 90 days was about 30% for each group, and rates of secondary outcomes, including VAP and C. difficile infection, were also similar.
According to a related article in Medscape Medical News, the REVISE trial findings on the ability of PPIs to prevent stress ulcer bleeding are supported by a recently published systematic review of 12 randomized trials involving over 9,500 critically ill patients. However, the effect on 90-day mortality is less clear and may increase or decrease depending on the severity of a patient’s illness, the review notes.
While both studies have limitations, the findings are expected to strengthen recent guidance for stress ulcer prophylaxis, especially regarding PPIs.
“Physicians, nurses, and pharmacists working in the ICU setting will use this information in practice right away, and the trial results and the updated meta-analysis will be incorporated into international practice guidelines,” lead researcher Deborah Cook, McMaster University in Ontario, Canada, says in the related article.
Guidance on Issues Transgender Patients May Face During Surgery
Assess these patients for airway-related risks caused by gender-affirming procedures.
Transgender and gender-diverse patients entering a surgical setting may have specific health requirements that affect anesthesia and require affirming care and understanding, according to 15 new recommendations.
“Peri-operative Care of Transgender and Gender-Diverse Individuals: Guidance for Clinicians and Departments,” in Anaesthesia, notes that best practices put particular emphasis on potential airway issues that certain gender-affirming procedures could cause, as well as the impact of hormone therapy.
“Healthcare staff should remain educated and updated on the significant disparities in healthcare outcomes these patients face, alongside the specific anatomical, physiological and social factors to be considered to provide safe and dignified care,” the article adds.
Specific recommendations (6-11) related to anesthesia are as follows:
- Airway assessments may be inaccurate based on possible cosmetic procedures.
- A front-of-neck emergency airway may not be possible.
- Surgical vocal pitch-impacting procedures can limit airway options.
- Ideally, chest binders should be removed, because they might cause respiratory concerns.
- Maintaining hormone therapies should be continued perioperatively unless contraindicated. Patients need to be aware of risks and benefits.
- “Processed electroencephalogram monitoring should be used at all times.”
In addition, clinical due diligence includes creating a safe environment for patients to discuss any relevant medical history.
A work group developed the list of recommendations based on clinical experience and literature reviews with the goal of reducing the adverse effects of inaccurate or incomplete medical knowledge and minimizing the potential for gender dysphoria.
“Transgender and gender-diverse patients have low confidence that healthcare workers understand their specific needs and are fearful of encountering prejudice and discrimination … [so] it is important to create an open and inclusive environment with educated staff, where transgender and gender-diverse patients feel they can be free to discuss their past medical history and gender identity.”
An AACN Leadership Podcast, “Transgender Healthcare: Leading the Way,” features an interview with Charlie Borowicz, transgender health program manager at Allegheny Health Network. They discuss the role of nurse leadership in creating affirming patient environments.
Safer Transfusions: New Interventions Lower Risks
Evidence-based interventions significantly lowered premedication for patients receiving blood transfusions.
Staff nurses who used evidence-based interventions significantly lowered premedication for patients receiving blood transfusions, reducing the risk of adverse reactions without compromising patient safety.
“Decreasing Premedication for Blood Transfusions: A Quality Improvement Project,” in AJN: American Journal of Nursing, discusses an algorithm to help clinicians administer premedication such as acetaminophen and diphenhydramine. Developed through extensive research, the algorithm was integrated into the electronic medical records of patients in a pilot hematology-oncology unit.
According to the study, baseline data shows the unit administered 2,646 blood transfusions between October 2022 and February 2023. About 30% of patients received premedication, and the average reaction rate was 1%.
Seven months after implementing the algorithm and electronic order integration in March 2023, premedication use fell to 12.7%, which was a 57.6% reduction from the baseline average. The monthly reaction rate decreased to an average of 0.8% less than the pre-implementation rate of 1%.
The project’s success relied heavily on nurses understanding the algorithm and its role in confirming or questioning the need for premedication. In addition, nurses demonstrated improved knowledge of appropriate premedication use, as measured by pre- and post-intervention surveys.
“Staff RNs provided real-time feedback to colleagues when the guidelines weren’t followed, thereby keeping their peers accountable,” the study adds. “Overall, staff RNs reported feeling empowered by using the evidence-based algorithm to advocate for their patients.”
Listing limitations and challenges, the study notes the project encountered cultural and institutional resistance concerning longstanding clinical practices for premedication use. The project addressed these barriers with education and evidence-based interventions.
“Clinical staff need to be educated on transfusion reactions and the circumstances under which premedication is legitimately required, especially in the current environment,” the study notes, adding that new methods of blood product preparation and storage have helped minimize transfusion reactions.
Updated Guidelines for Brain Death Evaluation
Nursing considerations include providing neurological assessments at least every hour.
A review of the latest recommendations for clinical determination of brain death or death by neurologic criteria (BD/DNC) includes guidance on effective testing for adult and pediatric patients.
“Brain Death: A Review of the Latest Guidelines,” in Nursing2024, notes that “before initiating the BD/DNC process in adult and pediatric populations, the new guidelines stress the importance of taking the time needed to comprehensively rule out reversible states and correct contributing factors, such as metabolic derangements, if possible.” Clinicians need to perform thorough evaluations that find there is no evidence of brain function and the condition is permanent, the review adds.
Nursing considerations include providing clinical assessments at least every hour to monitor closely for any changes in neurologic condition or abnormal vital signs, as well as correcting any metabolic derangements prior to BD/DNC testing. The guidelines stress the nurse’s essential role in communicating with families, particularly in explaining how spinal reflexes could make them believe the patient’s responses are normal and indicate brain activity.
The American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society and Society of Critical Care Medicine joined together to combine and update the adult and pediatric BD/DNC guidelines. The report offers distinct variations when assessing a patient younger than 2 years, even as some processes remain the same. Observational periods should last 48 hours for pediatric patients and 24 hours for all others, during which time there should be attempts to reverse the brain injury effects and adjust for any influencing factors.
Performing an evaluation for BD/DNC should take a head-to-toe approach. Assessments begin with pupillary responses and continue with tests of corneal, oculocephalic, oculovestibular, gag and cough reflexes, facial and motor responses, and finally an apnea test that confirms no spontaneous breathing is occurring.
The guidelines also explain several types of confirmatory tests as well as special considerations such as ECMO support and pregnancy. The report provides a list of conditions that can mimic BD, including drug overdose, Guillain-Barre syndrome or cervical spinal cord injury.
Nurses as Patients
The study found recurring themes based on interviews with 22 nurses.
Nurses admitted to the hospital through the emergency department (ED) report their experiences as patients are different from those of other patients, and it also helps inform their nursing practice.
“The Lived Experiences of Nurses as Patients: A Qualitative Study,” in AJN: American Journal of Nursing, describes interviews with nurse patients that reveal common patterns. They led to recommendations in the areas of communication, compassion and collaboration. “Those of us who are staff nurses can use them to better educate and prepare ourselves in the event that we find ourselves caring for a nurse patient — or become one ourselves,” the study notes.
Based on extended interviews with 22 nurses who were admitted after an ED visit, the study found recurring themes such as whether or not to inform hospital staff about their nursing experience, when to use their nursing knowledge to revise their care, providing their own care during hospitalization, and difficulty in making their medical decisions while ill. “In the course of their care, they may have to take actions or be asked to make decisions that no lay patient would.”
Recommendations for nurses, educators and leaders include recognizing that a nurse patient’s knowledge about their specific condition may not match their expertise, while appreciating that nurse patients know more medical terminology than lay patients and could have increased anxiety from the casual use of jargon.
Nurse patients who were interviewed expressed having significant fear during hospitalization, so nurses should be sensitive to the situation for these patients and collaborate with them when possible. The study also suggests that when they are patients, nurses should advocate for themselves or have a family member or colleague do so.
A Voice for Health Equity
Tina Loarte-Rodriguez is passionate about advancing health equity for nurses, patients and families. A leader in nursing workforce development, she is the author of “Latinas in Nursing,” a compilation of stories of resilience, inspiration and growth. “Nursing is a holistic practice and it’s important to understand that the patient is human – bigger than their diagnosis.”