Structural violence: A concept analysis to inform nursing science and practice

Abstract

This analysis is meant to elucidate the concept of structural violence and its implications for nursing science and practice. The concept of structural violence, also known as indirect violence, was first identified in the literature by peace researcher Johan Galtung. According to Galtung, structural violence broadly represents harm done to persons and groups through inequitable social, political, or economic structures. Such inequitable structures, such as systemic discrimination based on race, ethnicity, religion, gender, sexual orientation, etc. create conditions within society that directly disadvantage and oppress members of certain groups. This oppression can inflict profound physical, psychological, and socioeconomic harm on individuals, leading to disparate health outcomes. Using techniques for developing conceptual meaning as outlined in Chinn and Kramer (2018), our analysis seeks to specify meanings and applications of structural violence for application to nursing. This analysis draws on literature from clinical, historical, and other social sciences.Databases including CINAHL, PubMed, JSTOR, and PsychInfo were explored for references to structural violence. Structural violence is readily identified in specific contexts where individuals or groups are disadvantaged by socially constructed systems, such as those of race, gender, and economic privilege. Structural violence can result in health disparities and the development of conditions that predispose individuals to health risks. Nurses must be familiar with the concept to address these issues with patients.

A novel conceptual model of trauma‐informed care for patients with post‐acute sequelae of SARS‐CoV‐2 illness (PASC)

“…Health disparities are a function of biopolitical power, proceeding from the impact of social structures that skew towards particular groups—a phenomenon known as structural violence (Burton et al, 2020 ). Under COVID‐19 pandemic conditions, health disparities in the United States have intensified as many vulnerable populations eschewed care due to changed circumstances, fear of discrimination and economic pressures (Mein, 2020 ).…”

“…These include disposition, coping skills, developmental stage and perceived self‐efficacy—qualities that affect how an individual perceives, responds to, manages and evaluates the experiences of COVID‐19 illness and PASC (Dodd et al, 2001 ; Millroth & Frey, 2021 ). Also in this domain are stigmatizing effects, such as those associated with having a communicable disease (COVID‐19) and its visible or invisible sequelae (PASC); and structural stressors, the social and political structures that cause distress by devaluing or excluding those with certain characteristics (Burton et al, 2020 ; DeWilde et al, 2019 ). Both stigma and structural stressors can negatively impact health‐seeking behaviours; access to resources and physical, psychological and behavioural responses to health challenges (DeWilde et al, 2019 ; DeWilde & Burton, 2016 ).…”

Application of trauma‐informed care principles in academic nursing settings during the COVID‐19 pandemic

“…Stereotypes and biases based on race, ethnicity, gender, sexual orientation, 12 and other cultural identities are pervasive sources of trauma at individual, structural, and historical levels. 13 A trauma‐informed approach acknowledges the contributions of cultural, historical, and gender issues to trauma and seeks to move past stereotypes and biases to provide policies, protocols, and processes responsive to the cultural needs of individuals. Cultural awareness, responsiveness, and understanding are critical to increasing the effectiveness of trauma‐informed services.…”

“…Health disparities are fueled by structural inequities related to multigenerational discrimination and barriers related to gender identity, race/ethnicity, geographic location, and socioeconomic factors. 13 The disproportionate impact of COVID‐19 on marginalized groups underscores the critical role that structural inequities play in health care access and outcomes. 18 This necessitates an urgent need for structural, multilevel changes to improve health care access and health outcomes.…”

Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective

“…Trauma can be direct or immediate, as when an individual experiences abuse or violence, but also indirect, as in the case of historical, structural, or vicarious trauma (Burton, Lee, et al, 2019). Historical trauma results from ongoing or multigenerational damages to a population, whereas structural trauma derives from social structures that disempower those with certain characteristics (Burton et al, 2020; Mohatt et al, 2014). Vicarious trauma occurs when an individual is traumatically affected by witnessing or learning of someone else's experience (Burton et al, 2019; Horvath et al, 2020).…”