Missouri Nurse Winter 2022/2023

M I S S OU R I N URS E The Official Publication Of The Missouri Nurses Association

Wi n te r 2022/2023

human trafficking The Invisible

Tragedy to Humankind

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www.mi ssour i nur ses . org M I S S OU R I N URS E

BOARD OF DIRECTORS President Caryl Goodyear, PhD, RN, NEA-BC, CCRN-K, FAAN VICE President of Advocacy Sarah Oerther, Ph.D., RN, ANEF VICE PRESIDENT OF COMMUNICATION Robin Murray, DNP, MSN, RN, CNE VICE PRESIDENT OF FINANCE M. Scott Sullivan, MHA, RN, MSN, NE-BC MEMBER SERVICES DIRECTOR Dedee Culley, RN EDUCATION DIRECTOR Jeana Wilcox, PhD, APMHCNS-BC

In this issue:

Welcome Letters ................................................................................................................ 3

Nurse Advocacy Day - Save the Date . .............................................................................. 5

Welcome New Members . .................................................................................................. 6

Human Trafficking: The Hidden Tragedy of Humankind ............................................... 8

Missouri Nurses Association at a Glance ....................................................................... 14

PRACTICE DIRECTOR Maria Shade, MSN, RN

Put Your OWNMask on First: Incorporating Brain Science into Self-Care Practices . .. 16

BOARD LEADERSHIP FELLOW Vanessa Loyd, DNP, PhD, RN Laurie Sparr, DNP, APRN, FNP-C

Missouri Nurses Foundation .......................................................................................... 18

Missouri Nurses Association Political Action Committee ............................................ 20

MONA STAFF EXECUTIVE DIRECTOR Heidi N. Lucas, MPA Outreach Manager Jack Seigel, MSW

Regulatory Reduction for Nurse Practitioners in Missouri .......................................... 22

2023 APRN Conference Information . ............................................................................ 25

ADMINISTRATIVE aSSISTANT JoAnn Busby MWMSD SUPPORT STAFF CHIEF EXECUTIVE OFFICER, Multistate division Jill Kliethermes, MSN, RN, FNP-BC professional development Director Sara Fry, BS Communications & Graphic Design Manager Travis Gallup

MONA Regions Have Changed ....................................................................................... 26

Dues Tax Deduction . ...................................................................................................... BC

The purpose of The Missouri Nurse , the official publication of the Missouri Nurses Association, is to disseminate information regarding policies, positions and activities of the association and to provide a forum for discussion of nursing issues relevant to its members. The Missouri Nurse attempts to select authors who are knowledgeable in their fields. However, it does not warrant the expertise of any author, nor is it responsible for any statements made by any author. This publication is peer reviewed; however, Special Column sections are written by editorial invitation only and are not peer reviewed. The Missouri Nurse encourages readers to submit articles and information for publication. Requirements and deadlines are available on the association website at missourinurses.org or by emailing marketing@missourinurses.org. The Missouri Nurse reserves the right to edit manuscripts. The association reserves the right to utilize published articles in a variety of formats and for the purpose of the organization. The Midwest Multistate Division is accredited as a provider and with distinction as an approver of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation, for the periods of January 2021 to July 2025 (Provider) February 2021 to July 2025 (Approver).

Finance Director Karen Harris

Events Planner Assistant JoAnn Busby

Administrative Coordinator Becky Kniest EDITORIAL ADVISORY BOARD Janice Putnam, PhD, RN, Chair Susan Hinck, PhD, RN Kelly Skinner, DNP, RN, FNP-C Andrea Garner, PhD(c), DNP(c), MSN, RN Mary Ellen Heft, MSN, BA, BSN, RN-BC Glenna Mahoney, DNP, RN, SANE

The Missouri Nurse (ISSN 0026-6655). Copyright© 2023, Missouri Nurses Association

Annual Subscription Price (2 Issues): $12/year - MONA Members (included in dues) | $25/year - Non-Members

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T he Missouri Nurses Association had an exciting election season this year. We ramped up our advocacy work to put more nurses in front of more legislators. We held eight Legislative Picnics all over the state. These events were a massive success and really upped nurses profile with legislators. Our PAC has also been very active this election cycle. The Legislative Candidate Survey was updated to reflect current legislative priorities and to assure it functions as an educational tool for candidates. The Committee was very pleased with the responses, with an overwhelming majority of candidates indicating strong support for our legislative priorities and specifically stating their support of Full Practice Authority for APRNs. Candidates were selected for endorsement based on their voting record (for incumbents) and other interactions with the candidates including their survey responses. We endorsed an unusual number of primary candidates because of the numerous contested races that had implications for some of our legislative champions. MONA’s endorsement is widely sought and many candidates released a statement and posted on their websites/social media almost immediately after they were notified. In the State Senate we made 15 general election endorsements and all 15 of our candidates were successful. We took a particular interest in ensuring Reps. Nick Schroer and Tracy McCreery won their elections to the State Senate. Both will continue their strong support for Missouri nurses. In the House we made 64 general election endorsements and 63 of our candidates won election to the Missouri House. We should note that Rep. Patty Lewis was re-elected in the 25th district so we will continue to have an RN in the Missouri Legislature. That means MONA-PAC had a 98.7% winning percentage in the 2022 general election. That is amazing and it would not have been possible without your generous donations. Members sent money, attended events, made phone calls, reached out to friend and family, posted on social media and more. All of these activities helped MONA PAC support our nursing champion candidates through the election. Regardless of election results, there is always more work to be done. The 2023 legislative session is just a few short weeks away. We are rolling out an aggressive legislative plan for next session. We are partnering with our friends at the Association of Missouri Nurse Practitioners and Missouri Association of Nurse Anesthetists to make sure we have nurses at the Capitol every week during legislative session. We want to make sure that nursing issues remain front and center in the minds of legislators. Keep an eye out for an event calendar for next session. As always, thank you for your membership. If we all work together as one strong voice, there is nothing we can’t accomplish.

Heidi N. Lucas, MPA MONA EXECUTIVE DIRECTOR

from the STATE DIRECTOR

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A s I write this, our first big blast of cold air is rolling in suggesting that, yes, winter is truly here. Although I love the warmth of summer and the fall coolness, winter, as cold as it is, offers us a time to reflect, to value warmth and seek comforting things in our lives. Because it’s cold, winter brings us inside closer to our loved ones doing cozy activities like enjoying cozy hot drinks by a fire. Sitting by my fire, I am reflecting on my need to be more aware of global health concerns and to understand health and illness from different perspectives. Not everyone is privileged enough to enjoy hot drinks by a fire like me. Not everyone has accessible health care. And not everyone has caring family and friends to rely on in times of need. One health challenge that is alarmingly present in our country and the world is human trafficking. It is alarming to me because I cannot imagine living a life where you are a victim of continual abuse without the usual privileges of freedom. In this issue there is an article, Human Trafficking: The Invisible Tragedy to Humankind, that brings us the perspective that human trafficking (HT) is a concerning healthcare issue and may even be a health crisis. The Polaris Project (https://polarisproject.org/) suggests that people in situations of trafficking rose by 12 percent between 2016 and 2021. Over 27 million people in the world are living as victims of HT. We have an opportunity to learn about HT and act. As the article suggests, up to about 80% of HT victims seek healthcare but are we, as healthcare providers, aware of the victims? Do we assess for HT? Low identification rates, which can be as low as 2%, may just well be related to our lack of education for assessing and understanding how to therapeutically communicate with HT victims. Even though there are no validated assessment tools, there is a tool to use that is suggested by US Department of Health and Human Services. Nurse researchers need to validate tools and interventions so we can expertly help the people victim to this abuse. Let’s work together to help victims out of the cycle of abuse. It takes a caring perspective to recognize the psychological and physiological abuse and to take action to help. In addition to reading the article in this issue, please access recorded education about human trafficking on the Missouri Nurses Association (MONA) website. MONA offers a series, four 1-hour sessions, about HT. Please take advantage of listening to the experts and learning what action you can take. Visit the MONA website at missourinurses.org, click on Education, then choose Human TraffickingWebinar Series. Let’s all be alarmed that this is an issue that needs our attention and caring action.

Caryl Goodyear, PhD, RN, NEA-BC, CCRN-K, FAAN MONA PRESIDENT

From the MONA PRESIDENT

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SAVE THE DATE 37th Annual Missouri Nurses Association Nurse Advocacy Day

March1, 2023 CAPITOL PLAZAHOTEL

415W. McCarty Street, JeffersonCityMO 65101

VISIT THE MONA WEBSITE FOR FULL DETAILS IN JANUARY! WWW.MISSOURINURSES.ORG

Welcome to the

Those who joined from 05.01.2022 – 11.30.2022

JoAnn Franklin Deborah Freemantle Jessica Galloway Katlyn Gann Berenice Garcia Bethany Garnett Hannah Gerling Ryan Gillies Kelsey Glassmaker Courtney Glaus Tara Goosey Jacquelyn Green Jessica Gregory Leigh Grinter Miriam Grither Monika Grosshart Gina Gualberto Trellena Guccione Bailee Guerrero Vallie Guillory Megan Gunter Donna Hall Taucha Hanchey Catherine Hanners Elizabeth Hart Jessica Hatcher Michelle Heger Jarrod Hemmer Carissa Henbest Shana Hensel Katherine Henslee Jocelyn Hewitt Elizabeth Harris Paula Harrison

Christine Davis Taylar Dayton Tara Demand Julia Dent Megan Devorss Mistie Dickenson Joseph Dickerson Bailey Diehl Julia Dill Andrea Dixon Holly Doogs Sonal Doshi Rozlyn Drew Starla Dunn Joan Dutton April Edgar Sheila Edwards Susan Eitel Jennifer Elbert Shirley Emerson Margaret Ernst Sherry Espinoza Melinda Estes Carolyn Evans Rosalind Ewing Amanda Fagre Bethany Feken Joshua Fender Amanda Ferreiro Jessie Fiacco Christine Flores Miranda Floyd Rebekah Flynn Angie Franke

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Candace Calton Barb Carrender Laura Castaneda Jennifer Caudill Dawn Cavender-Erangey Janet Chance-Hetzler

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Gerlie Rose Belda Rebecca Bender Brenda Bennett Natalie Bethel Julie Bethurem Diane Bibb Dominique Bigelow Margaret Bjelica Gillian Blackwell Ashley Blanchard Alexa Boatright Alyssa Bonnier Lisa Boone Lindsay Boxdorfer Dexie Boyer Ashley Brace Malayla Bradford Donna Bresler Brandy Broadway Sarah Brown

Ciera Chang James Ching Tiffiny Cicero Karla Clubine Gabby Cobbett Virginia Cogdill Denise Cohen Robin Connors Katie Constant Lacie Crabill Lisa Crabtree Lindsey Crain Yunhee Cruse Alexis Curran Rebecca Dalton Nathan Daniel Katherine Darnell Sara Davis

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Lou Hill Patricia Hinds Kara Hinrichs Sara Hoffmann

Michelle Loeffler Millie Logan Keri Lorbert Joan Magee Rebecca Maggard Amy Maher Allison Mallette Ross Garnet Manliguez Deborah Manne Wendy Manno Tamar Maragh Savannah Martin Marcimiliana Martinez Teresa Matt Samantha Mayse Laura McDonald Karrish McKernon Ashlynn McQuiggan April Meador Felicia Menefee Tara Messer Elizabeth Messer Holly Miller Lindsey Mines Takedria Mingo-Berry Oleg Mironchenko Shirley Mitchell April Dream Moncada Gail Montgomery-Edwards Amanda Moore Meghan Myers Yevgeniya Mykhaylevska

Adeana Petrillo Naomi Phillips Maria Poepsel Amy Poindexter Jason Portell Mary Ann Potter

Barbara Stegemann Christine Strange Robin Sypolt Theresa Szczygiel Enneman Irene Tad-Awan

Courtney Holloway Elizabeth Holmes Dixie Hopkins Shaul Horwitz Sarah Hyman Ajoke Ilori Breann Jackson Danielle Jackson Rachael Jenkins Carrie Jenkins Alyssa Jercick Debora Jimenez Kalene Jochems Erma Johnmeyer Rachel Johnson Salat Jones Nichole Jones Patti Judy Elizabeth Kahrs Bridget Kargel Kristin Keller Amanda Kennedy Brenda Kerns Danielle Kerr Christine Kiefer Robyn Killam Penelope Kimball Angela Knapp Sabrina Knoch Melody Knoff Jennifer Koeb Stephanie Kolesar Sheryl Kyle Casey Lairmore Beth Lamkemeyer Cheryl Lane Julie Lane Anessa Langford Teneka Langston Brittany Lanham Katherine Larson Sara Larson Emmy Le Sarah Leal Leslie Lehmer Sara Lewis Keana Lindsey

Alexandra Tegeler Margaret Temperly Angela Thomas Amy Thompson Wokie Tinyan Jamie Tremble Tasma Troutmam Dedera Tucker Queen Usi Barbara Vancil Irina Vesolowski

Deborah Prior Keri Pruneau Haley Quillen Mary Randell Darcie Raney Ellen Ray Kelly Raymond Carole Reese Tempestt Richard Lorraine Richardson Summer Rister Ashlea Ritter Angela Robbins Stephanie Roberts Patrick Robinson Nancy Robinson Sydney Roder Rebecca Rodman Bailey Russo Ashley Russo Christina Samaritoni Brooke Sargent Heather Savage Racheal Schauman Jessica Schedler Cathy Schloss Lucinda Schmidt Samantha Schraml Chassidy Schroder Kerry Scott Janet Severine Syeda Shah Colten Sharp-Ebert Heather Shearburn Maria Shirshekan Cristy Skaggs Kate Skrade Laura Slamp Christopher Smith Dawn Smith Diane Spence Patricia Spiegle Shelbi Rodman Shaylie Rogers Heather Routh

Clay Veurink Angela Voga Traci Wagoner Sandra Wake

Jennifer Walker Tucker Walker SeanWalker Ashley Walker-Ellis MeaganWard Stephanie Wattenbarger Theresa Waxler

Nicole Webb Gina Weddle Kelly Weingartz

Elaine Welch Teresa Wells Christina Wendt DawnWheelhouse DavidWhite Margaret Williams Hallie Willis Danny Willis Debra Wilson Suzanna Wilson Cindy Woltkamp Roselie Woodard Jennifer Woolery Gabrielle Worley Marilyn Yarbrough Jennifer Zabel Michael Zappulla Nicole Zorc Keri Winegar Tara Winward Alexandra Wolf

Ryan Napier Lisa Nelson Tonia Nerini Christina Newkirk Hayley Newman Tammy Nichols Jeannine Nickell

Jennifer Noble Mary Northern Tracy Olson Jenny Oltman Babette Orlich

Hayley Ott Sarah Page

Natasha Parker Sheena Parrigon Shana Parrish

Vikk Partee Yesica Peck

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Pee r Rev i ewed

Human Trafficking: The Hidden Tragedy of Humankind

Margaret Bjelica, DNP, RN, ACNS-BC, CRRN

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Background H ealth care providers pride and treating clients. However, one overlooked health care challenge is the reality of human trafficking (HT). HT has become recognized as a major global issue (Grubb & Bennett 2012; Weitzer, 2014). Often called modern day slavery, this US $30 billion-dollar worldwide endeavor has made its way into every social and economic realm of society and is increasingly becoming perpetrated by organized and sophisticated criminal enterprises (CdeBaca & Sigmon, 2014; Greer et al., 2020; Helton, 2016; Weitzer, 2014). In modern day slavery, victims become a renewable commodity who can be bought and sold exponentially and exploited to their fullest potential (Helton, 2016). Although definitions of HT vary, many countries including the USA, have adopted the Palmero Protocol’s definition (Barner et al., 2014; Chaffee & English, 2015; Grubb & Bennett, 2012; Helton, 2016). The Palermo Protocol, enacted by the United Nations in 2000 defines HT as “the recruitment or transportation of people through means such as threat, coercion, or deception, for the purposes of exploitation” (Doherty et al., 2016, p. 464). Although sex and labor make up the majority of HT, organ retrieval, trafficking for ransom, forced begging, illegal adoption, health care exploitation, and forced participation in armed conflicts are also regarded as HT (CdeBaca & Sigmon, 2013; Chaffee & English, 2015; Greenbaum & Bodrick, 2017; van Reisen et al., 2017). In organ trafficking or trafficking for ransom, men, women, and children may be abducted, tortured, sexually violated, sold or killed for the purpose of extortion). The purpose of this paper is to inform health care providers themselves in being experts when it comes to accurately assessing

Recruitment Phase The recruitment phase begins when the trafficker initially targets a victim who has a noticeable vulnerability such as emotional neediness, low self esteem, or economic need (Helton, 2016; Peterson, 2019). Acting on these vulnerabilities, the trafficker lures the victim into HT by false hopes and promises for steady work and solid income (Kehl, 2020). Recruitment of potential victims using social media and private messaging has made it easier for the trafficker to identify victims (Moore et. al., 2017; Peterson, 2019). Traffickers learn how a victim’s mind works and what they want in life (Carville, 2015). Broken young girls are often preyed upon because they need a ‘daddy figure’. It is here that the trafficker starts developing a relationship with a victim (Carville, 2015). Initially the trafficker, who may be a family member, discovers what their victim’s vulnerabilities are (Carville, 2015). This information may be obtained through casual conversations with the victim, parents, or friends. Whether or not traffickers are actual family members, they are very skilled at mixing with other adults, and are often accepted as trusted honorary family members.

about how victims are recruited, their characteristics, and how to identify victims who are being trafficked. Victim Recruitment As awareness of HT grows, there is better recognition of how HT victims are recruited and controlled (Chaffee and English, 2015). Grooming or the ‘Game’ as one trafficker puts it, is a preparatory process in which the trafficker gradually gains a person’s trust with the intent to exploit them (Carville, 2015; Peterson, 2019). The trafficker overcomes a victim’s resistance and then elicits their cooperation in the abuse (Moore et al., 2017; Peterson, 2019). A victim who is well groomed is less likely to disclose the abuse to others. At the same time, being well-groomed increases the likelihood victims will become physically and emotionally dependent on the trafficker. Traffickers work to build trust with their victims, while simultaneously discrediting the trustworthiness of friends and family. Although traffickers constantly adjust the tactics they use to traffic and exploit victims, there are generally three phases in the grooming process (Greer et al., 2014). These phases are recruitment, initiation, and indoctrination (Helton, 2016).

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Initiation Phase The initiation phase begins when the trafficker starts pretending to be in love with the trafficked victim (Carville, 2015). Bringing gifts, being a friend, beginning a romantic relationship, or providing drugs and alcohol may all be means of seduction (Carville, 2015; Moore et. al., 2017; Peterson, 2019). However, as one trafficker emphasized, there is no love in the sex trade. It is merely a manipulation tactic (Carville, 2015). This stage, often called the boyfriend phase, is so realistic that even family and friends do not suspect the manipulation (Peterson, 2019). By slowly isolating the victim from friends and family, the trafficker begins to play a major role in the victim’s life. Through controlling messages victims receive, traffickers are in better positions to psychologically manipulate victims. (Helton, 2016; Peterson, 2019). Furthermore, traffickers will often recruit same-age peers to normalize these manipulative acts for victims. Indoctrination phase Abuse begins in what is called the indoctrination, or sales phase (Peterson, 2019; Helton, 2016). The victim is manipulated into believing that prostitution is an acceptable way to make a living. Even through victims have multiple sex partners, the trafficker reassures them that they will always be loved (Carville, 2015). The abuse is subtle at first and may begin with requests for illicit images (sexting). These in turn, can be used to blackmail the victim (Peterson, 2019). In other cases, victims are told that services provided, such as money spent on drugs, must be repaid. Once a trafficker gets a victim addicted to methamphetamine or heroin, the trafficker makes them engage in sexual acts to pay for the next fix (Helton, 2016).

Characteristics of Human Trafficked Victims Underserved and vulnerable populations are at a higher risk to become HT victims (Barnert et al., 2017; Kehl, 2020). Victims in these populations include women and children, people with disabilities, elderly, gay, transgender, and bisexual persons. Victims are generally women and children who come from low income, poverty-stricken areas with little access to education and employment opportunities. Due to a higher incidence of running away from home, adolescents are more vulnerable to becoming victimized. Higher incidences of HT are also found in Indigenous people, who live in poverty and rely on the welfare system. The average age of entry into HT is pre-to-mid teens (Chaffee & English, 2015; Leary, 2016). Teen brains are highly sensitive to pleasures and rewards which makes young victims susceptible to grooming tactics (Peterson, 2019). Becoming independent of parents, the importance of peer relationships, sexual experimentation, in combination with impulsivity, risk taking behaviors, and a sense of invulnerability, make it easy for teens to be preyed upon (Moore et. al., 2017). The undeveloped prefrontal cortex in the teenager, which aids in making major decisions and foreseeing consequences, makes the teen more vulnerable to HT coercion techniques of flattery, attention, affection, or gifts (Greenbaum & Bodrick, 2017; Peterson, 2019). This is especially true when the minor lacks a loving homelife (Peterson, 2019). Challenges in Identifying Trafficked Victims Victims are difficult to identify and often hesitant to disclose their imprisonment due to the hidden criminal structure of HT (Helton, 2016). Often it is the health care

provider who first encounters the victim. Statistics vary, but it is estimated that between 28% to 87% of trafficked victims in the United States visit a health care provider while in captivity for a broad range of physical and psychological conditions (Chaffee & English, 2015; Grace et al., 2014; Scanlon & Krausa, 2016). However, even though victims have encounters with health care providers during their captivity, few are identified at that time. This may be partially due to professionals’ lack of awareness, education, and intervention protocols (Helton, 2016). Several factors contribute to the under-identification of victims. Although studies show that health care providers place importance on knowing about HT, providers are unaware of the magnitude of HT, and lack the education needed to identify and intervene on the victim’s behalf. (Grace et. al, 2014; Greenbaum & Bodrick, 2017; Helton, 2016; Moore et. al., 2017). Despite the fact there are HT screening tools, these instruments lack the validation needed to provide evidence-base practice guidelines (Chaffee & English, 2015; Doherty et al., 2016). In addition, protocols on how to intervene once a suspected human trafficked victim is identified are lacking (CdeBaca & Sigmon, 2014). Identifying young trafficked victims is often complicated because children lack the verbal skills and maturity to disclose their situation (Greenbaum & Bodrick, 2017). Furthermore, the child’s abuse symptoms may be so nonspecific that they may be misinterpreted by the heath care provider. During clinic visits, traffickers maintain such strict control the victim may not have the opportunity to identify themselves as being trafficked (CdeBaca & Sigmon, 2014). Victims may withhold or falsify information due to a distrust of authority figures and may be unaware of their rights or of the existence of

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protective laws (Barnert et al., 2017; CdeBaca & Sigmon, 2014; Moore et al., 2017). Unfortunately, when victims do disclose their trafficked status, they are often treated as criminals, illegal immigrants, prostitutes, or juvenile delinquents. Even when victims are recognized, they may refuse help. This may be due to loyalty to their traffickers or lack of awareness of their own victimization (Chaffee & English, 2015; Greenbaum & Bodrick, 2017). Children have fewer life experiences and lack insight into manipulation methods, as claiming the victim is worthless, or that it is the child’s fault they are in this predicament, all tactics used to increase victim’s dependency on the trafficker (Greenbaum & Bodrick, 2017). A victim’s subsequent To ensure victims are identified during clinical visits, education must go beyond raising awareness and recognizing the signs of human trafficking (CdeBaca & Sigmon, 2014). Training should provide guidance on how to use interviewing techniques to interact with suspected victims and tools to specifically answer questions posed by suspected victims. It is essential providers have knowledge about which community agencies are customized to assist HT victims. Education must include not only HT risk factors (see Table 1), but manifestations of physical and psychological abuse, indications of depression or fearfulness, and signs the victim is being controlled and unable to freely leave the situation (Hornor, 2015; Ronsey & Villano, 2020). It is essential that health care providers are cognizant that victims may present with physical and/ or psychological issues. Ailments stemming from drug use, food and sleep deprivation, physical or sexual feelings of guilt, shame, and hopelessness may also hinder disclosure. Care Implications

Table 1 Risk Factors that Increase Vulnerability to Minor Sex Trafficking (“Family” Mnemonic) Family history of alcohol or drug abuse, violence or mental health illness Adverse experiences for the child such as abuse by either the parents or others

Money issues, underemployment or nonemployment of the parents Involvement of child protective services or law enforcement at any time Lack of support systems or living with people other than the parents Youth with mental health or behavioral issues.

Note. Adapted from Ronsey, L. N. & Villano, C. E. (2020). Recognizing victims of a hidden crime: Human trafficking victims in your pediatric trauma bay. Journal of Trauma Nursing, 27 (1), 37-41. Retrieved from 10.1097/JTN.0000000000000480

violence, high risk sexual activities, or inadequate health care may be clues that the person is being trafficked (see Table 2) (CdeBaca & Sigmon, 2014; Hornor, 2015). Female victims are frequently accompanied by an older male who answer the provider’s questions and is unwilling to leave the victim alone (Hornor, 2015). When concerns arise, it is vital victims are separated from the accompanying person to permit private interviewing. Furthermore, due to indoctrination tactics, victims may lie about their age or present false identification. Victims possessing hotel keys or presenting with branding tattoos are other clues of the trafficking situation. Conclusion Over the last two decades HT has become a global crisis affecting

an estimated 4.5 million sexually exploited victims and generating worldwide over US $30 billion-dollars (Greer et al., 2014; Helton, 2016; Stacey, 2017; Weitzer, 2014). Through a process called grooming, victims are manipulated into becoming cooperating participants in their own abuse (Peterson, 2019). Once trafficked, victims become a renewable commodity who can be bought, sold, and exploited (Helton, 2016). As human trafficking is a closely hidden criminal structure involving many components and players, victims are difficult to identify (Helton, 2016). Oftentimes, victims do not openly disclose their situation, and some may actually take measures to protect their trafficker (Greenbaum & Bodrick, 2017; Moore et al., 2017). Immature victims

Table 2 Health Manifestations Indications that the Victim is being Trafficked

1. 2. 3. 4. 5.

Drug addiction or withdrawal

Pregnancy

Sexually transmitted diseases

Complications from self-induced abortions

Physical injuries

a. Fractures/bruises/contusions b. Cigarettes or other types of burns c. Dental problems such as missing or broken teeth

6. 7.

Depression or post-traumatic stress disorder Suicide ideation or suicide attempts

Note. Adapted from Hornor, G. (2015). Domestic minor sex trafficking: What the PNP needs to know. Journal of Pediatric Health care, 29 (1), 88-94, Box 2. Retrieved from doi: 10.1016/j.pedhc.2014.08.016.

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have fewer life experiences and may distrust authority figures (Moore et. al., 2017). Adding to these disclosure obstacles, the victim often finds themselves in a trafficker-controlled situation during the clinical visit. Being psychologically controlled, the victim may still not deviate from the trafficker’s rules even when the trafficker is not present. It is universally accepted that mandated awareness and educational

programs for health care providers would increase the identification of HT victims (Grace et. al., 2014). Although there are HT screening tools, these instruments lack validation (Chaffee & English, 2015; Doherty et al., 2016). In addition, protocols on how to intervene once a suspected human trafficked victim is identified are lacking (CdeBaca & Sigmon, 2014). While awareness of the HT tragedy is slowly increasing, victims continue

to remain unidentified even during encounters with professionals (Grubb & Bennett 2012; Helton, 2016; Weitzer, 2014). To counter this, it is imperative that appropriate education and evidence-based protocols be developed and evaluated to identify and protect victims. Evaluating educational programs and publicly releasing the results will increase HT victim awareness, recognition, and intervention (Viergever et al., 2015).

References

Barner, J. R., Okech, D., & Camp, M. A. (2014). Socio-economic inequality, human trafficking, and the global slave trade. Societies, 4, 148-160. https://doi.org/10.3390/soc4020148

Barnert, E., Iqbal, Z., Bruce, J., Anoshiravani, A., Kolhatkar, G., & Greenbaum, J. (2017). Commercial sexual exploitation and sex trafficking of children and adolescents. Academic Pediatrics, 17(8), 825-829. https://doi.org/10.1016/j.acap.2017.07.009

Carville, O. (2015). Accused pimp describes ways women get lured into human sex trafficking. The Star, Retrieved from https://www.thestar.com/news/crime/2015/12/18/accused-pimp-describes-ways-women-get-lured-into- human-sex-trafficking.html

Chaffee, T., & English, A. (2015). Sex trafficking of adolescents and young adults in the United States: healthcare provider role. Current Opinion Obstetric Gynecology, (27), 339-344, https://doi.org/10.1097/GCO.0000000000000198

CdeBaca, L., & Sigmon, J. N. (2014). Combating trafficking in persons: a call to action for global health professionals. Global Health: Science and Practice, 2(3), 261-267. https://doi.org/10.9745/GHSP-D-13-00142

Doherty, S., Oram,S., Siriwardhana, C. & Abas, M. (2016). Suitability of measurements used to assess mental health outcomes in men and women trafficked for sexual and labour exploitation: a systematic review. Lancet Psychiatry. 3, 464-471. https://doi.org/10.1016/S2215-0366(16)30047-5

Grace, A.M., Lippert, S., Collins, K., Pineda, N., Tolani, A., Walker, R., et al. (2014). Educating health care professionals on human trafficking. Pediatric Emergency Care, 30(12), 856-861. https://doi.org/10.1097/PEC.0000000000000287

Greer, B. T., Cotulla, G. & Johnson, M. (2020). The routes of human suffering: how point-source and destination-source mapping can help victim services providers and law enforcement agencies effectively combat human trafficking. International Journal of Aerospace and Mechanical Engineering, 14(12), Retrieved from https://publications.waset.org/abstracts/22072/the-routes-of-human-suffering-how-point-source and-destination-source-mapping-can-help-victim-services-providers-and-law-enforcement-agencies-effectively-combat-human-trafficking

Greenbaum, J., & Bodrick, N. (2017). Global human trafficking and child victimization. Pediatrics, 140(6), https://doi.org/10.1542/peds.2017-3138

Grubb, D., & Bennett, K. (2012). The readiness of local law enforcement to engage in US anti-trafficking efforts: an assessment of human trafficking training and awareness of local, county, and state law enforcement agencies in the State of Georgia. Police Practice and Research, 13(6), 487-500. Helton, M. (2016). Human trafficking: how a joint task force between health care providers and law enforcement can assist with identifying victims and prosecuting traffickers. Health Matrix, 26(1), 433-473. https://scholarlycommons.law.case.edu/healthmatrix/vol26/iss1/15

Hornor, G. (2015). Domestic minor sex trafficking: What the PNP needs to know. Journal of Pediatric Health Care, 29(1), 88-94. Retrieved from doi: 10.1016/j.pedhc.2014.08.016

Kehl. M. (2020). Human trafficking in the age of the internet. Utica College, ProQuest Dissertations Publishing, Retrieved from https://search.proquest.com/openview/f7c24a9fb8544f49200f78e6942a541e/1?pq-origsite=gscholar&cbl=18750&diss=y

Leary, M. G. (2016). Dear John, you are a human trafficker. South Carolina Law Review, 68, 413-450.

Moore, J., Kaplan, D. M., & Barron, C. E. (2017). Sex trafficking of Minors. Pediatrics Clinical North America, 64, 413-421. https://doi.org/10.1016/j.pcl.2016.11.013

Peterson, M. (2019). Recognizing the stages of grooming. Fight to End Exploitation, Retrieved http://www.humantrafficking.co.za/index.php/faq/2496-recognizing-the-stages-of-grooming-fight-to-end-exploitation

Ronsey, L. N. & Villano, C. E. (2020). Recognizing victims of a hidden crime: Human trafficking victims in your pediatric trauma bay. Journal of Trauma Nursing, 27(1) 37-41. doi: 10.1097/JTN.0000000000000480

Stacey Diane A. Litam (2017). Human sex trafficking in America: what counselors need to know. The Professional Counselor, 7(1), 45–61. https://doi.org/10.15241/sdal.7.1.45

Scanlon, C., & Krausa, L. (2016). Human trafficking: ministering to the ‘invisible’ victim. Health Progress, Retrieved from www.chausa.org.

Weitzer, R. (2014). New directions in research on human trafficking. The Annuals of the American Academy, 653, 6-24. Retrieved from https://www.academia.edu/6588243/New_Directions_in_Human_Trafficking_Research_2014_

van Reisen, M., Gerrima, Z., Ghilazghy, E., Kidane, S., Rijken, C., & van Stam, G. (2017). Tracing the emergence of ICT-enabled human trafficking for ransom. Research Gate. Retrieved from https://www.researchgate.net/profile/Mirjam_Reisen/publication/326655157_Tracing_the_Emergence_of_ICT-enabled_Human_Trafficking_for_R

Viergever, R., West, H., Borland, R., & Zimmerman, C. (2015). Health care providers and human trafficking: what do they know, what do they need to know? Findings from the Middle East, the Caribbean, and Central America. Frontier Public Health, https://doi.org/10.3389/fpubh.2015.00006

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Employers FIND TALENT Job Seekers GET HIRED

Employers: https://bit.ly/3xp3VdY | Job Seekers: https://bit.ly/3zuc7v4 Visit THE MONA Career CENTER

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at a glance MISSOURI NURSES ASSOCIATION

MONA BOARD AS OF JANUARY 1, 2023

SEPTEMBER 2022 MONA election WINNERS:

PRESIDENT

Caryl Goodyear, PhD, RN, NEA-BC, CCRN-K, FAAN

VICE PRESIDENT OF Communication: Cynthia Aurentz, RN, MSN, DNP, CNE

VICE PRESIDENT OF ADVOCACY

Sarah Oerther, PhD, RN, ANEF

VICE PRESIDENT OF COMMUNICATION

Practice Director: Maria Shade, MSN, RN

Cynthia Aurentz, RN, MSN, DNP, CNE

VICE PRESIDENT OF FINANCE

BOARD LEADERSHIP FELLOW: Heidi Fields, MSN, RN, CPNP-PC

M. Scott Sullivan, MHA, RN, MSN, NE-BC

EDUCATION DIRECTOR

Jeana Wilcox, PhD, APMHCNS-BC

Bylaws Chair: Sandra Wilson, MSN, RN, ACNS-BC, CNE

PRACTICE DIRECTOR

Maria Shade, MSN, RN EAST REGION DIRECTOR

East Region Director: Rhonda Newberry, MSN, RN-BC, CCDS, Paralegal

Rhonda Newberry, MSN, RN-BC, CCDS, Paralegal

West Region Director: Callie Ballenger, MSN, APRN, FNP-BC, NPD-BC

WEST REGION DIRECTOR

Callie Ballenger, MSN, APRN, FNP-BC, NPD-BC

SOUTH REGION DIRECTOR

South Region Director: Dedee Culley, RN ASN

Dedee Culley, RN ASN

Vanessa Loyd, DNP, PhD, RN Heidi Fields, MSN, RN, CPNP-PC BOARD LEADERSHIP FELLOWS

Their time of service will begin January 2023 and end December 2024.

FOR FULL ANNUAL REPORTS AND MEETING MINUTES, VISIT OUR WEBSITE: www.missourinurses.org

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2 OUT OF STATE MEMBERS

REGIONS MONA members by

Northwest

2021

346

2022

361

2021

Northeast

88

2022

96

2021

West Central

432

2022

423

2021

Central

360

2022

362

2021

East Central

1003

2022

949

2021

Southwest

513

NOTICE: Effective January 1, 2023, the Missouri Nurseses Association Regions and chairs are changing. Please see page 26 for details.

2022

481

2021

Southeast

197

2022

194

# of members:

TOTAL members:

2868

0 100 200 300 400 500 600 700 800 900 1000 1100

2022 REGION CHAIRS

Northwest Cal l ie Bal lenger

Northeast Patricia Brawner

West Central Rebecca Saxton

Central Michel le Nolph

East Central Rhonda Newberry

Southwest Dedee Cul ley

Southeast Desma Reno

FOR A CALENDAR OF REGIONAL MEETINGS & EVENTS, PLEASE VISIT: www.missourinurses.org/calendar

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Put Your OWN Mask on First: Incorporating Brain Science into Self-Care Practices

Pee r Rev i ewed

Cynthia Aurentz, DNP, MSN, RN, CNE, RYT Melissa Penkalski, DNP, APRN, CPNP-PC Jeanie Skibiski, DNAP, MHA, CRNA, FAANA, CPPS

Diane Smith, DNP, MSN, RN, CNE Alisha Tuttle, MSN, RN, PMHNP-BC

W e have all heard the pre-flight instructions to put our own oxygen mask on before we help others. This analogy has become the mantra for self-care. Nurses know this intuitively--that taking care of ourselves first means we can help others. It’s what happens AFTER you put your mask on that is critical: You begin to breathe normally again. You have a steady oxygen supply. Your brain functions in a way that helps you make good decisions and troubleshoot problems. You can think clearly enough to put others’ masks on for them so they can breathe. Everyone arrives safely at their destination. After Captain Sullenberger’s Miracle on the Hudson , debriefs and inquiries that allowed for extensive processing were a priority (Peterson, 2019) He and his crewwere not told to hurry back to the airport so they could get the next plane in the air. Nurses aren’t provided with this luxury.We experience repeated high-stress situations with little regard for the need to process. The work environment can feel impossible to keep up with. Add to that the vicarious trauma we experience as part of a ‘normal’ shift, and we are at risk for the degradation of our own health. The nursing shortage can in part be attributed to the inability or

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unwillingness to subject oneself to the type of environment that prevails in nursing. The trauma of COVID, caring for patients who had to suffer and often die alone, and working without enough help highlighted the need for us to better prepare our students for the profession (Goddard et al., 2021). Research on brain science over the past 25 years has improved our understanding of how our brains process trauma. It is important [and possible] to learn ways of letting our brains know that our body is ok. To do so requires a deeper understanding of the effects of trauma (Van der Kolk, 2014). Did you know that people who choose nursing as a profession are more likely than the general population to have past trauma? Personal trauma, combined with the trauma of others, can cause a negative shift in the way we make decisions and solve problems (Felitti et al., 1998). Being trauma-informed means that we understand how to take care of ourselves to avoid compassion fatigue, burnout, or worse--leaving the profession altogether (Missouri Department of Mental Health, 2019). When we are stressed out, either from a traumatic event or from chronic activation of our adrenals, the brain prepares our body for fight or flight. The work of nursing can activate this… day after day, week after week, year after year. Eventually, the prefrontal cortex, the part of our brain that makes good decisions, grows weaker. Simultaneously, the amygdala, the brain center responsible for warning us of danger, strengthens. It becomes the control center, rather than our ‘wise leader’, the prefrontal cortex; therefore, we stay in a chronic stress state, and we lose the ability to effectively self-regulate our emotions. This repeated trauma can cause our response to seemingly small triggers to be out of context with reality (Arnsten et al., 2014). Rear Admiral Aisha Mix, Assistant Surgeon General and CNO of the

USPHS encourages nurses to “become your own priority.” (Turner, 2022). We may seem like the lowest priority when others are counting on us. We channel everything we have into our work and manage to keep our careers afloat, allowing our personal lives to suffer. We, and our loved ones deserve better. The following are some simple, easy tools you can use to feel more grounded and let your brain know you are ok. Practice these techniques when you feel happy, calm, and content. Then, when you feel anxious, overwhelmed, or fearful, you can pull from your stress toolbox, regulate your body temperature, and slow your heart rate. Your brain will sense peace and you will be more likely to feel safe in the moment: 1. Breathe. That’s it. Just breathe. In through the nose and out through the mouth, elongating each breath as you count to four. Do this four times as you visualize building each side of a box. 2. Imagine your emotions when you feel something coming that you don’t want to feel. Start by naming it. Say to yourself, I am feeling anxious, or I am feeling frightened. Imagine those feelings like waves in the ocean. You can’t stop a wave from coming toward you. Don’t try to get rid of the emotion or push it away. Don’t block or suppress it. Alternatively, don’t hold onto it or amplify it. Recognize it for what it is and ride the wave. It will soon be gone. 3. Relax the muscles in your face, from your forehead down to your jaw and chin. Allow the corners of your mouth to turn up ever so slightly. Adopt a peaceful facial expression. 4. Drink ice water or rub an ice cube on your face, along your arm, or on your chest. 5. Take a short walk. Find any way to move your body intentionally.

6. Savor a scent you love and that gives you comfort. 7. Think in categories. Choose something like “football teams”, “musical instruments” or “colors”. Set a timer and mentally list as many things from each category as you can. 8. Count backward from 100. 9. Recite a poem, song, or book passage quietly to yourself or in your head. 10. Practice self-kindness by repeating compassionate phrases to yourself: “You’re having a rough time, but you’ll make it through.” “You’re trying hard and you’re doing your best (ANA, 2022).” Take the time to take care of yourself and “become your own priority”! You may find that you have more reserve to give to those you care about and for. American Nurses Association [ANA]. (2022). Health and Safety. Combatting stress: Health reduction techniques every nurse should try . https://www.nursingworld.org/practice-policy/work environment/health-safety/combating-stress/ Arnsten, A. F., Raskind, M. A., Taylor, F. B., & Connor, D. F. (2015). The Effects of Stress Exposure on Prefrontal Cortex: Translating Basic Research into Successful Treatments for Post-Traumatic Stress Disorder. Neurobiology of stress , 1, 89–99. https://doi. org/10.1016/j.ynstr.2014.10.002 Felitti, V.J., Anda, R.F., Nordenberg, R., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14 (4), 245-258. https://doi.org/10.1016/ S0749-3797(98)00017-8 Goddard, A., Jones, R. W., Esposito, D., & Janicek, E. (2021). Trauma informed education in nursing: A call for action. Nurse Education Today, 101 , Article 104880. https://doi.org/10.1016/j. nedt.2021.104880 Missouri Department of Mental Health. (2019). Missouri model: A Developmental Framework for Trauma Informed Approaches . Missouri Department of Mental Health and Partners. https:// dmh.mo.gov/media/pdf/missouri-model-developmental framework-trauma-informed-approaches Peterson, B. (January 15, 2019). The ‘Miracle on the Hudson’ Flight: 8 Things You Might Not Know, a Decade Later. Condé Nast Traveler. https://www.cntraveler.com/story/the-miracle-on the-hudson-flight-things-you-might-not-know Turner, B. (2022, August 1). Healthcare worker burnout: ‘Become your own priority’. Modern Healthcare . http://bi.gale. com/essentials/article/GALE|A712522932 /b0071fa3342078c5d71c37902a64b048?u=morenetswmstu References

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma . Viking.

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SUPPORT THE NURSES OF MISSOURI, DONATE TODAY! https://missourinursesfoundation.org

The Missouri Nurses Foundation is dedicated to promote and advance the nursing profession and enhance the health and well-being of Missourians. We support nurse led initiatives to improve and promote the health of Missourians by facilitating nursing research through projects and public educational programs. WE NEED YOUR HELP! Help us support nurse-led initiatives to improve and promote the health of Missourians.

The Missouri Nurses Foundation is a 501(c)3 organization. All contributions are tax-deductible as allowed by law. WAYS TO GIVE — One Time, Recurring, or Matching Donation — — 100 for $100 Campaign — — Honor A Nurse — — Nightingale Tribute Memorial and Dedication Gifts — — “Nurses Save Lives” Specialty License Plates —

To give, please visit: missourinursesfoundation.org

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This is an opportunity to invest in the brightest and best! Please join our 100 for $100 campaign, supporting our Early Career Nurse Innovator Award! Help us support nurse-led initiatives that improve and promote the health of Missourians. More information at: http://ow.ly/nS6150BHXvM

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Missouri Nurses Association Political Action Committee Celebrates 2022 Election and Looks to the Future Rebecca Payne McClanahan, Chair of MONA-PAC and Jack Seigel, MONA Outreach Manager

T he 2022 election cycle has been a good one for the Missouri Nurses Association Political Action Committee (MONA-PAC). We have been working for months to elect pro-nursing candidates to the Missouri legislature and election day, November 8, 2022, gave us that opportunity. We celebrate our successes. Based on our endorsed candidates that won their election, MONA-PAC had a 98.7% winning percentage in the general election. These results would not have been possible without activism from nurses. Members donated money, attended events, made phone calls, reached out to friends and family, posted on social media and more – and nurses voted. All of these activities helped MONA PAC support our nursing champion candidates through their successful elections. In the State Senate MONA-PAC made 15 general election endorsements and all 15 of our candidates were successful. Of the 17 senators up for reelection, nine of those elected were incumbents and eight are newly elected, although six of those newly elected to the Senate had served in the House giving them a voting record regarding issues of interest to nurses. Half of the senators are elected each election cycle, with this year being the 17 even-numbered

House And Senate Leadership Elections

districts. We took a particular interest in ensuring Senators-elect Nick Schroer (R-O’Fallon) and Tracy McCreery (D-St. Louis) won their elections to the State Senate. Both will continue their staunch support for Missouri nurses. In the House, we made 64 general election endorsements and 63 of our candidates won election. All 163 seats in the House are elected every two years and 43 House members were termed out, the seat was vacant, or the incumbent did not run for re-election seven incumbents were defeated in the primary election while two incumbents were defeated in the general election. Fifty new House members will assume office in January and nurses must work hard to educate them on nursing issues and assure they are aware of the concerns of their nurse-constituents. Republicans continue to maintain a veto-proof majority in both chambers (111 to 52 in the house, 24 to 10 in the senate).We should note that Rep. Patty Lewis (D-Kansas City) was re-elected in the 25th district so we will continue to have an RN in the Missouri Legislature. Biographies and contact information for all legislators will be available on the Senate and House websites at the start of the legislative session in January 2023. in 2022. One hundred seventeen incumbents were re-elected, and

In addition to general election results, the MONA-PAC also follows the leadership elections in the House and Senate within the party caucuses. Those elected to leadership are especially influential in the legislative chambers as well as within their respective caucuses. The Majority Floor Leader races are crucial as this position decides which bills are brought up for debate and how much time is devoted to legislation, which is especially impactful in the Senate due to the filibuster. The winners of these closely watched races will shape which issues are prioritized next year and the final outcome of major legislation. Official Committee appointments will not be made until after the start of the 2023 session which begins at noon, onWednesday, January 4, 2023. We will focus particular attention on Committees to which our legislation is likely to be assigned. Missouri Nurses Association (MONA) lobbyist, Kyna Iman, has been working hard to build a relationship with each of the presumed leaders to assure they are aware of nurses’ legislative priorities, and she has received a very positive response.

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