As coeditors for this special issue on trauma-informed care, we are grateful for the opportunity to highlight the work of forensic nurses as it relates to trauma-informed care. We hope that this special issue will serve as a catalyst for future work in the field and that future articles to the journal will address health equity, structural racism, and collective trauma within the context of trauma-informed approaches.

Trauma is the result of an event or circumstances that are perceived to be harmful. Its effects are long-term and pervasive. Trauma-informed care provides a theoretical framework to allow us to provide effective care that acknowledges that patients we care for bring a history of collective lifetime trauma. Generally, six principles are described: safety (physical and psychological); cultural, historical, and gender acknowledgment; collaboration and mutuality; empowerment, voice, and choice; peer support; and trustworthiness and transparency (Substance Abuse and Mental Health Services Administration, 2014).

In forensic nursing practice, many patients have experienced acute trauma, whereas many have been exposed to cumulative trauma. Broad trauma inquiry offers new approaches to screening (Lewis-O'Connor et al., 2019). Such inquiry offers key opportunities for patients to share what they choose in a safe and therapeutic space. Employing trauma-informed care approaches using a universal approach allows us to create that safe, supportive clinical relationship. Many of the articles in this special edition address the ways that we can include trauma-informed approaches in our various practice settings, including in baccalaureate education. This represents substantial progress for our discipline and for the engagement that forensic nurses have with their patients.

Making our practices more trauma-informed is a necessary and laudable first step but will be insufficient without larger structural reforms. Trauma is not only the result of a single event or even multiple events; it also results from a set of circumstances that are known to be harmful. Racism, misogyny, xenophobia, religious discrimination, and other forms of systematic social discrimination are poignant historical realisms that also account for trauma. Our medical systems have been built on White supremacy. Black people (and other non-White groups) were denied meaningful access to health care in the United States until the 1964 Civil Rights Act. A shockingly high percentage of medical students still endorse untrue beliefs about differences between Whites and Blacks (Hoffman, Trawalter, Axt, & Oliver, 2016). Schools of nursing struggle to retain faculty of color (Hamilton & Haozous, 2017). Healthcare providers, including nurses, are currently participating in the inhuman detention of asylum seekers in the United States (Saadi & Payne, 2019). The criminal justice system, in which many forensic nurses practice through either providing health care in carceral settings or providing court testimony, represents both a source of trauma that disproportionately affects Black and Brown people and an area of substantial health inequities (Goshin, Colbert, & Carey, 2018).

Jones (2002) defines racism as "a system of structuring opportunity and assigning value based on phenotype ('race') that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources" (p. 10). Racism negatively affects mental and physical health for all non-White groups in the United States (Abramson, Hashemi, & Sanchez-Jankowski, 2015; Dovidio et al., 2008) and is a significant form of trauma. Other marginalized groups, such as sexual and gender minorities, also experience worse health outcomes than their peers (Lim, Brown, & Justin Kim, 2014). In this special issue, Crowder, Burnett, Laughon, and Driesbach (2019) discuss the impact of both historical trauma and elder abuse on native populations in the United States. We cannot ignore that racism and other systematic forms of discrimination are trauma that impact the health and well-being of individuals and communities. Trauma-informed care offers a framework for promoting equity and improving health outcomes.

Trauma-informed care provides a framework for addressing equity, but we must go beyond changes in individual practice. Nurses often have little individual power within traditional institutional structures; however, collectively, we can have a powerful voice. We should be using our knowledge of the consequences of trauma, our understanding of the full complexities of true trauma-informed practice that centers the needs of our most marginalized patients, and our deep patient care experience to advocate for structural change.

The articles in this special issue provide a blueprint for advancing health delivery using a trauma-informed lens, which has the potential to advance equity for all. Integrating trauma-informed principles into practice, policy, research, and education ensures more meaningful encounters between providers and their patients. We must use the power of our collective voices to demand that our healthcare, criminal justice, and social institutions include true community collaboration and transparency, meaningfully acknowledge the history of White supremacy and community trauma, and earn the label of trustworthiness so that our patients truly have opportunities to heal and thrive.

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