Advancing Health Equity and Social Justice in Forensic Nursing Research, Education, Practice, and Policy: Introducing Structural Violence and Trauma- and Violence-Informed Care.

Initial conceptualizations of violence and trauma in forensic nursing have remained relatively narrowly defined since the specialty's inception. The advent of trauma-informed care has been important but has limitations that obfuscate social and structural determinants of health, equity, and social justice. As forensic nursing practice becomes more complex, narrow definitions of violence and trauma limit the effectiveness of trauma-informed care in its current incarnation. In keeping with the nursing model of holistic care, we need ways to teach, practice, and conduct research that can accommodate these increasing levels of complexity, including expanding our conceptualizations of violence and trauma to advance health equity and social justice. The objective of this article is to introduce the concepts of structural violence and trauma- and violence-informed care as equity-oriented critical paradigms to embrace the increasing complexity and health inequities facing forensic nursing practice.

Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis.

BACKGROUND: Migraine is a disabling neurological disorder and the sixth biggest cause of disability worldwide. The World Health Organization has declared migraine a major public health problem due to a paucity of knowledge about cause and effective treatment options. Both in incidence and severity, migraine disproportionately affects people occupying marginalized social locations (SL). Managed pharmacologically, migraine is treated with daily preventive and as-needed abortive medications. Both come with high literal and figurative costs: intolerable side effects, medication interactions, and prohibitive prices. Cost prohibitive, ineffective, and unsustainable pharmacological treatment options have contributed to high levels of interest in complementary approaches by people with migraine, but little is known about their motivations, patterns of use or access, or how these may vary by SL. METHOD: We conducted focus groups with 30 people with migraine to explore their desires and recommendations for migraine clinicians and researchers. We used qualitative content analysis to identify themes.Outcomes: We identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication as a short-term solution; high personal and economic costs of medication; and desire for more information and access to natural approaches. Across SL, participants expressed keen interest in integrative approaches and wanted better access to complementary modalities. Participants in marginalized SL described reliance on traditional/folk remedies, including engagement with family and community healers, who they described as more affordable and culturally accessible. CONCLUSIONS: Holistic and integrative approaches were preferred over medication as long-term migraine management strategies. However, people in marginalized SL, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches through currently available channels. Engaging with these communities and using a critical lens to explore barriers to access can develop options to make complementary modalities more approachable, while also attending to systemic blind spots that may unintentionally alienate socially marginalized groups.