In the spring of 2017, the staff and Board of Directors of the International Association of Forensic Nurses along with members of the Editorial Board of the Journal of Forensic Nursing (JFN) convened to discuss their strategic goals for the future of the forensic nursing specialty. One of the primary outcomes of that meeting was a strong, shared vision for increasing the conversation around social justice and forensic nursing. This special issue was one of several projects proposed to translate social justice, an abstract idea, into concrete plans of relevance to forensic nursing.
Social justice, a term often misunderstood and defined differently across disciplines, refers specifically to the fair and just distribution of wealth, opportunities, burden, and privilege across society. Current interpretations in the United States and other western countries include some aspects of social mobility. The social justice literature also speaks to human dignity stressing that each person regardless of age, gender, race, ethnicity, economics, or social status is a person who is always an end and never a means to accomplish some objective (Byron, 1998). Importantly, newer conceptualizations, especially those in nursing, also explicitly examine power dynamics that are often the deep root cause of injustice (Anderson et al., 2009).
Social justice has increasingly become part of the conversation in healthcare ethics. That is where it becomes most important to forensic nursing as a specialty. Health inequities that can be, at least in some part, attributed to unequal distribution of resources, inadequate care, racism, or other harmful social structures that result in social injustice. The tenets of social justice demand that vulnerable people be protected from harm and treated in such a way that allows them to achieve their full status in society (Boutain, 2005).
Social justice is an action theory; it transcends discussion. In a practice discipline, we are required to move beyond the definitions and understanding of social justice principles into action that will ameliorate the injustice that our patients and clients experience. Equally important is the insight that decision making is not unilateral. One key aspect of respect for the dignity of the person is the intentional inclusion of persons or groups in discussions or decisions that affect them or their communities. Inclusion calls forensic nurses to stand with those who are most vulnerable and to experience their unique situations from their points of view. Another major tenet in social justice theory is that, given alternatives, the principle that guides action is a preferential option for persons who are vulnerable. Data-based research, meaningful information sharing, in-depth reviews of existing literature, and vigorous dialogue and debate that lead to informed action-all elements and functions of the JFN-are critical to action. These scholarly works will help us to identify problems and determine the very best actions to address inequities for those affected by violence.
The very nature of the work of forensic nurses is grounded in social justice. This issue of the JFN puts the spotlight on multiple matters of great concern to forensic nurses and their clients, including those who experience sexual assault, human trafficking, and incarceration. The challenge to us, as readers and forensic nurses, is to view each of these issues through a social justice lens. How, specifically, can we apply the more abstract ideas and principles of social justice theory in our explicit efforts to improve the lives of individuals, families, and communities? Holland and Henriot (1983) say that there are three specific areas of injustice that must be addressed: antecedents, processes, and results. From there, we can identify points of intervention that fall under the broad categories of awareness, amelioration, and transformation. To that end, the authors featured in this issue provide insight into ways that nurses can create change.
The contributors to this special issue have highlighted some of the most vulnerable populations we seek to serve. The common thread of bringing attention to the needs of these groups of people ties the articles together, but each one offers a unique perspective on the issues at hand. For example, Porta, Johnson, and Finn, using a case study approach, bring attention to male victims of sexual assault, as a way of trying to understand how to increase care-seeking in this highly stigmatized group. Payne uses the same format to explore how sexual assault nurse examiners can provide care to immigrants that is well informed by human rights principles. Meanwhile, Caldwell and Cochrane discuss the importance of infusing social justice in the provision of care to the sexually assaulted patient, through simulated clinical learning experiences designed to promote critical thinking in undergraduate nursing students.
Four articles explicitly address various aspects of incarceration, a topic mired in injustice, inequality, and deeply rooted power imbalances. For example, parental imprisonment places a burden on families and especially on children. As Boch and Ford note, this is a widely discussed but poorly understood area of research and practice. Children in these families are punished by the absence of a parent, and they often experience internalized and externalized behavioral difficulties, potentially contributing to a cycle of incarceration. Action on behalf of justice seeks to overcome or lessen the economic and social burdens of children that are associated with imprisonment of their parents. The care of those who are incarcerated needs to encompass the care of the family back home, and what does that mean for nurses? Research driven by the tenets of social justice is needed to test strategies that support the family of the incarcerated person through promoting family visits, phone calls, and communication. Similar themes can be seen in the work from Baldwin, Capper, Rogers, and Wood who describe a nurse-led pilot project to improve outcomes for women who are pregnant and incarcerated, leveraging the skills of midwifery students in Australia. This kind of approach allows for higher-quality care and also helps to prepare a workforce of nurses who better understand care for a complicated and stigmatized population.
Attention must also be paid to how we develop knowledge in a way that is responsive to inequities. Research and scientific inquiry are a central component of social justice work. Two articles in this issue focus on the process and product of research with criminal-justice-involved persons. Wadams and Park identify the clear need for researchers to make every effort to ensure that their work is not limited by the biases of Western ideological influences, specifically those that inadvertently change how participant experiences in correctional settings are represented in research analysis and dissemination. Meanwhile, Goshin, Colbert, and Carey seek to illustrate where the emphasis has been for nurse-led research teams that are focused on incarcerated populations and where the need for more research is most acute.
Human trafficking, a complex social issue, is the topic of two of the pieces included in this issue. The unique needs of this special patient population are highlighted in Scannell, MacDonald, Berger, and Boyer's case study. Sanchez and Pacquiao then challenge us to view this global problem using an ecological systems model within the context of various social determinants of vulnerability. This perspective requires providers of care not only to understand the patient or client in front of them but also to provide care that acknowledges the undeniable influence of families, communities, institutions, and laws at every level.
In addition to all that is included here, it is as important to address what is missing. Forensic nursing scholars must be more deliberate as they enter into conversations about race, sexual orientation, class, and gender. These are critical aspects of the issues most important to our specialty, and yet we often fail to engage in these debates. This also includes frank discussion about intersectionality and specifically how various forms of discrimination interact to increase vulnerability, especially for those who are affected by violence. We must also be willing to engage fully in all aspects of public policy, to scrupulously document the effect of policy of the people we serve, and to educate legislators and policy makers about the issues most important to us as a forensic nursing community.
When viewed together, the articles in this issue speak to the inherent connection between social justice and the work of forensic nurses. Collectively, the authors challenge us to identify injustice and to explore the important contributions that nurses can-and must-make to not only promote social justice but also advance health equity. It is clear that work in this area is growing and that forensic nurses are rapidly becoming integral to such scholarly discussions. We must do all we can to ensure that we continue this momentum and that we demand research and clinical work that identifies injustice and tests strategies to address health disparities as well as the fair and just distribution of resources. This work must result in assessment of measureable outcomes that explicitly improve inequities related to age, gender, race, ethnicity, and economic or social status.
We are honored to have worked with these authors and the JFN's Editorial Board to initiate this conversation. We would also like to thank the many reviewers who offered their expertise and guidance with manuscript development. All nurses have an ethical obligation to work for social justice, and forensic nurses are in a position to help ensure that all persons receive the dignity and respect they deserve as they navigate the healthcare and legal systems. We hope that this special issue is only a beginning and that forensic nurses will engage fully and rigorously in research, practice, and advocacy that is explicitly informed and guided by the principles of social justice.
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