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2. Mary comes to the urgent care clinic with a broken nose. She appears to be a young
teen, perhaps 13 or 14, but says she is 21 years old. She is disheveled and very quiet,
answering only with a few words and keeps her eyes downcast. There is a couple
(man and woman) who appear to be in their 30s accompanying the girl to be
treated. They continue to stare at her and refuse to leave her side. Your attending
physician colleague is busy transferring a trauma patient. What are your next steps
in specific order?
1. According to Stewart and DeNisco, human trafficking victims visit emergency departments
showing signs such as “someone with them who appears to be controlling them, fear, traumatic
injuries, discrepancy of behavior and reported age” (Stewart, 2019, p. 79). Mary shows all of
these signs of being a human trafficking victim. As the nurse practitioner seeing her in the
emergency department, I would first separate her from the controlling couple accompanying her
(Stewart, 2019). After separating them, I would assure Mary of the privacy, confidentiality, and
safe space that I have provided to reduce barriers to communication and care delivery (Stewart,
2019). I would then ask questions such as “Where do you live? Are you free to come and go?
Have you been threatened or harmed? Have you been forced to have sex or perform sex acts?”
(Stewart, 2019, p. 79). Upon answering of the questions, if I still strongly believed Mary was in
danger and was a human trafficking victim, I would contact social services and law enforcement
to help ensure her safety (Stewart, 2019). Ordering lab studies would be next. The lab tests
would include a complete blood count, STD testing, ova and parasites, hepatitis B and C, and
tuberculosis (Stewart, 2019).
2. The first priority is to ensure the young woman is not in physical danger from her injuries. A
complete assessment should be performed to determine if there are further injuries and evidence
of sexual activity and trauma. Stewart and DeNisco (2019) advise lab work to rule out STDs,
HIV and other communicable diseases as well as substance abuse screen. According to Stewart
and DeNisco (2019) and Leslie (2018), warning signs of possible human trafficking include
traumatic injury, fear, withdrawn behavior including poor eye contact, apparently controlling
persons who resist leaving the client alone, questionable health and social histories. Ideally, the
young woman should be assessed and interviewed separately from the couple and Leslie (2018)
suggests asking open-ended questions about living situation, threats to family or individual, and
if someone has made them have sex to obtain money, food or shelter. Follow up questions
should focus on the client’s ability to move about freely within and outside of the home
environment, access to money and personal belongings, including identification documents, and
ability to communicate with family or friends who do not live with the client (Leslie, 2018).
Social services and local law enforcement agencies should then be involved to assistance in
obtaining shelter for the client as well as follow up services including further medical and
psychological care (Stewart & DeNisco, 2019). At no time should the client be left alone for
fear of elopement.

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