Creating Buy-In from Nurse Leaders to Implement Inpatient Education and Screening for Human Trafficking: A Quality Improvement Initiative

BACKGROUND: Human trafficking is an under-recognized healthcare issue affecting an estimated 20 to 40 million individuals globally. Professional nursing organizations, healthcare regulatory bodies and legislators have declared the need for education and screening practices. A quality improvement initiative designed to create buy-in from nurse leaders to create and implement education, screening and a protocol to guide care of human trafficking victims who may present to inpatient and clinic settings at the organization was developed to bridge gaps in knowledge and inform evidence-based practice. METHODS: Literature review informed the development of an education intervention presented to nurse leaders using multi-modal learning strategies. National Academy of Medicine criteria for safe, high quality, patient-centered care was used to determine need for the quality improvement initiative. Victimology paradigm guided development of the content and the educational initiative was implemented using a framework recommended by subject matter experts Miller, Chisolm-Straker, Duke and Stoklosa (2019). A brief educational intervention was deployed in effort to engage a voluntary participant group of 191 nurse leaders with purpose to create endorsement for policy and practice change. INTERVENTION: Brief education about human trafficking and the need for education, screening and a protocol to guide care was deployed to the participant group using multi-modal strategies. Pre and post assessment surveys were conducted to detect any changes in knowledge about human trafficking as a healthcare issue and any changes in attitudes related to implementation of standardized education and screening practices with a protocol to guide care of victims. CREATING BUY-IN THROUGH EDUCATION: HUMAN TRAFFICKING 7 RESULTS: Data was analyzed using two statistical methods for increased understanding of results. The primary statistical analysis method, a two-tailed student’s t-test assuming unequal variances found statistical significance for four of the eight survey items. Three knowledge questions and one attitude question evidenced a statistically significant increase in knowledge and support related to the quality improvement intervention. Two attitude questions related to support for education and screening for human trafficking evidenced near statistical significance. The secondary statistical analysis method, randomized and equal sized samples, yielded no statistical significance for any of the survey items. Significant differences in response rates to the pre and post assessment surveys along with homogeneity of the target population may have impacted the results of data analysis. CONCLUSIONS: The quality improvement initiative demonstrated some ability to meet all of identified aims. Statistical significance was noted for a number of survey items, but the primary focus items, endorsement for education and screening practices for human trafficking, did not achieve statistical significance. Unanticipated tacit knowledge about human trafficking within the participant group along with existing attitudes of support for education and screening for human trafficking may have affected survey results. Despite lack of statistical significance related to nurse leader buy-in for education and screening practices, overwhelming positive feedback from the participant group and support for the quality improvement initiative demonstrated a high degree of clinical significance