Evidence-Based Teaching Strategies for Undergraduate Nursing Students to Deliver Human Trafficking Content

Baccalaureate nursing programs are challenged to provide innovative and evidenced-based teaching strategies to support critical thinking, student engagement, and student development for the constantly changing healthcare system (Orique & McCarthy, 2015; Yu, Zhang, Xu, Wu, & Wang, 2013). Evidence suggests that only 10% of nursing students are adequately prepared to provide safe and effective nursing care to clients (Shin, Sok, Hyun, & Kim, 2014). Thus, there is a disparity between nursing education and modern day nursing practice (Shinnick, Woo, & Mentes, 2011). Born between 1980 and 2000, the majority of present-day undergraduate students are millennial learners (McCurry & Martins, 2010).   Millennials require constant encouragement and structure; they prefer group activities, digital technology, and appreciate “doing rather than knowing” (McCurry & Martins, 2010, p. 276).  Traditional teaching strategies such as didactic lectures are not effective for today’s undergraduate nursing students and should be replaced with teaching strategies that are experiential and engaging (McCurry & Martins, 2010). The National League for Nursing (NLN) has advocated that nursing education become active, participatory, and experiential. The NLN recommends that nursing education include innovative teaching techniques that focus on practical application of nursing concepts (Crookes, K., Crookes, P., & Walsh, K. 2013). Changes in nursing curriculum and teaching strategies are essential in order to support current nursing practice.

Human trafficking is an emerging problem in the United States of America. As a violation of human rights, human trafficking is considered a modern day form of slavery (Isaac, Solak, & Giardino, 2011). More than 27 million people worldwide and hundreds of thousands of people in the U.S. are living in slavery (U.S. Department of State, 2010). The United States is one of the largest markets and primary destinations for trafficking victims worldwide (Isaac et al., 2011). Furthermore, human trafficking is a multi-billion dollar industry and is the fastest growing and one of the most lucrative crimes in the U.S. (http://www.unodc.org/unodc/en/ human-trafficking/what-is-human-trafficking. Html#What_is_Human_Trafficking). Human trafficking exists in a variety of forms including sex trafficking, forced labor, bonded labor, and child soldiers. Victims include all sexes, races, and ages.

A significant obstacle for the rescue and treatment of trafficking victims is identification (De Chesnay, 2013). Nurses are often the only health care provider that interacts with potential and actual victims. However, most nurses, especially nurse generalists, lack sufficient information and skills regarding how to accurately identify and treat victims (De Chesnay, 2013; Institute of Medicine, 2013).

Undergraduate nursing programs are not effective in preparing students to assess, identify, and treat victims of this emerging problem of human trafficking (Ahn et al., 2013; Grace, Ahn, & Konstantopoulos, 2014; Wong, Hong, Leung, Yin, & Stewart, 2011). According to the Institute of Medicine (IOM), healthcare providers are unaware of the signs and symptoms of human trafficking and are, therefore, unprepared to assess, diagnosis, and treat victims (2013). A critical need for curriculum change within undergraduate nursing programs exits. Effective evidence-based teaching methods must be implemented in order to successfully integrate human trafficking content into nursing curriculum to increase student knowledge, engagement, and skill retention.

The purpose of the project was to improve undergraduate nursing student knowledge about human trafficking using evidence-based teaching strategies.  The first objective was to identify the evidence-based strategies supporting the most effective pedagogy method(s) to increase student learning, critical thinking, and engagement among undergraduate nursing students. Based on the best evidence, human trafficking content was developed, and modified, and then implemented utilizing evidence-based teaching strategies for undergraduate nursing students. The second objective was to determine whether an association existed between exposure to human trafficking material, using an evidence-based multimodal teaching method, and an increase in knowledge. Students’ learning was evaluated for differences in knowledge using a pre- and post-test design.

This project was based on the Rosswurm and Larrabee Evidence-Based Practice Model and Kolb’s Experiential Learning Theory (ELT).  ELT views learning as knowledge created through experience (Kaylor & Strickland, 2015). Kolb’s ELT consists of a four-cycle process: concrete experience, reflective observation, abstract conceptualization, and active experimentation (Kaylor & Strickland, 2015).  For effective learning to occur, learners must experience each stage. ELT is effective for nursing students to develop clinical judgment skills and meets the needs of diverse learners (Kaylor & Strickland, 2015).

The evidence showed that traditional teaching methods unaccompanied by innovative teaching strategies (i.e., problem-based learning, flipped classroom) for undergraduate nursing students is ineffective and limits knowledge retention (Kantar & Massouh, 2015; Popkess & McDaniel, 2011; Shin et al., 2014). Traditional teaching methods consist of didactic lectures without student engagement.    Active learning using mixed methods to deliver content increases student  knowledge, critical thinking, and engagement in undergraduate nursing programs (Crookes et al., 2013; Kantar & Massouh, 2015;  Middleton, 2013; Orique & McCarthy, 2015; Shin et al., 2014). Active learning results in increased knowledge retention and the transfer of learned content and nursing skills to real-life nursing practice (Middleton, 2013).  Active learning includes multiple styles of teaching, engaging all learners regardless of whether a student is a visual, auditory, or kinesthetic learner. Active learning includes problem-based learning, case studies, storytelling, simulation; media formats such as gaming, flipped classrooms, and role-playing (Middleton, 2013).

The project design was an evidence-based education program utilizing a pre- and post- test to measure knowledge acquisition. The goal was to demonstrate an association between exposure to human trafficking content and an increase in knowledge following the teaching session. The target audience was senior level community health nursing students. The teaching session consisted of active learning strategies including case studies, storytelling, and videos focused on sex and labor trafficking. The session included teaching about the health impact that trafficking has in conjunction with the clinical presentation, identification, and treatment of trafficked victims.

The results of the project indicate that there was an association between exposure of human trafficking content provided through active learning, evidence-based teaching strategies and significant changes in knowledge acquisition and confidence levels among senior level nursing students. A paired sample t-test was used to compare the pre-test scores to the post-test scores. This indicated a significant change in knowledge from pre- to post-test (p=.000). The Cohen’s d value was 1.3 indicating a large effect size; therefore, there was significant improvement beyond chance. On the 13-point test, the 95% confidence interval (CI) ranged from a margin of error of 1.6 to 2.6. Paired sample t-tests were used for the two Likert-scale questions which measured self-reported knowledge and confidence for both the pre- and post-tests. The t-tests indicated significant change in both knowledge and confidence level of subject content (p=.000) with a Cohen’s d value of 2.0 and 2.2 respectively. The 95% CI ranged from 1.3 to 1.8. Thus, the findings support the evidence that active learning teaching techniques increase student knowledge and facilitate students to build on previous existing knowledge (Crookes et al., 2013; Kantar & Massouh, 2015; Middleton, 2013; Orique & McCarthy, 2015; Popkess & McDaniel, 2011; Shin et al., 2014).

Use of active learning strategies demonstrated an overall improvement in nursing student knowledge suggesting that nursing graduates can be better equipped to provide more effective nursing care leading to positive patient outcomes. It is recommended that baccalaureate nursing students be educated about human trafficking, using evidence-based active learning teaching strategies, to provide effective nursing care, promote human rights, and support social justice.