Overview and Summary: Gun violence from a public health perspective

Gun violence in all of its forms has become a significant public health crisis in the United States. It poses a serious threat to the well-being and safety of individuals and communities, and its impact extends beyond just physical injuries. Gun violence can result in loss of life and permanent disability, as well as long-lasting psychological and emotional trauma for survivors, witnesses, and even healthcare providers who care for the victims (Centers for Disease Control and Prevention [CDC], 2021; Monuteaux et al., 2019). Nurses play crucial roles in addressing the current crisis, including direct patient care, education about safe storage, development of research agendas, and evidence-based advocacy for policy changes. As a forensic nurse scientist who has conducted research quantifying health risks facing vulnerable populations, and who previously worked clinically in emergency and trauma, I have seen firsthand the damage, destruction, and toll that gun violence inevitably leaves in its wake. Additionally, having worked with and examined issues specific to vulnerable populations, I firmly believe that nursing care, patient education, and advocacy by nurses can influence individual outcomes related to violence, trauma, and/or victimization.

Across all clinical specialties, recognition of gun violence as a public health issue and the role of nurses in addressing it must be better understood. Gun violence encompasses a wide range of incidents, including homicides, suicides, and accidental shootings that occur across the lifespan. Each year, thousands of individuals are killed or injured by firearms, and the ripple effects of gun violence are long lasting (CDC, 2021; Gramlich, 2023). Those who evaluate the impact of gun violence through a public health lens generally consider it preventable (Gramlich, 2023; Roszko et al., 2016). Consequently, research has been undertaken to highlight the social determinants of gun violence, such as poverty, lack of access to education, and community violence, all of which have been shown to contribute to a higher risk of gun violence (CDC, 2021; Fowler et al., 2017). As with other diseases and conditions, nurses can address these determinants by providing education, support, and referrals to social services.

Safety and well-being are paramount concerns for all people, families, and populations. The role of nurses and the nursing profession in addressing gun violence is the overarching theme connecting the articles presented in this issue of OJIN. These four articles contribute to the growing body of evidence that can guide the nursing profession toward best practices that will ultimately promote healthy outcomes and safety for patients, families, and communities. The authors of these articles explore various strategies, models, and ideas aimed at reducing harm, increasing education about safe gun storage, preventing school shootings, inspiring action, and maximizing the role of nurses in reducing gun violence. Each article offers a unique perspective on addressing critical issues that affect our society.

In the article, Nursing’s Role in Firearm Violence Prevention by Hallowell and Cogan, the authors suggest nurses can successfully apply the harm reduction model to reduce gun violence. This innovative approach offers a blueprint for mitigating risks and promoting safety through community-wide education. The harm reduction model maximizes individual rights while at the same time minimizing the potential for adverse effects to promote positive health outcomes. The model finds a balance between the personal freedom of gun ownership and the collective goal of safeguarding lives through properly storing weapons and ammunition. Using this model can put nurses in a position to make a significant difference in preventing firearm violence in their communities by assessing risk factors, providing education, advocating for policy change, and referring patients to available resources. Highlighting the importance of patient education and counseling for firearm violence prevention, the authors ask nurses across all clinical settings to identify and address the underlying factors contributing to gun violence, including poverty, racism, discrimination, and barriers to healthcare and education. Nurses provide more direct care than any other profession within healthcare and thus are positioned to be effective agents in the prevention of firearm violence.

The article by Idowu titled, Supporting School Nurses: Training Resources to Identify Risks and Mitigate School Shooting Incidents, addresses one of the most pressing concerns in our society: preventing school shootings. This article identifies school nurses, who serve a diverse array of student concerns within schools, as being critical in the prompt mitigation of risks that may lead to mass school shootings. By holding specific positions within the school environment, these nurses may be able to identify students experiencing individual and family risk factors (such as toxic stress, bullying, and mental health issues) associated with an increased likelihood of violent acts. Nurses also have a role in all phases of emergency response, including prevention. Gaining a better understanding of whether school nurses are adequately prepared and self-efficacious to prevent a school shooting incident effectively remains uncertain and is an area for further research. Encouragement is given to all school nurses to find and complete specialized education, training, and emergency preparedness, to meet the needs of their school community in preventing violence, identifying risk behaviors while working to mitigate the risks of active shooting incidents by nurss will help create safer environments for students, teachers, and staff.

In Firearm Safety & Mental Health: A Call to ARMS (Assess and Reduce Means to Suicide), by Tudhope, the author explores a strategic approach for nurses to enhance patient care and well-being through patient assessment and screening while providing education about the safe storage of firearms. As frontline healthcare providers, nurses play a pivotal role in ensuring patients' safety and health, especially those at risk of self-harm and suicide ideation. This article discusses ARMS – Assess & Reduce Means to Suicide, as an outline and framework for nurses to engage in assessment, screening, and education to better respond to firearm violence risk during a suicide crisis. Promoting safe storage practices by nurses using ARMS in conjunction with cultural humility may help reduce firearm deaths.

The article Pediatric Firearm Safety: A Call to Action for Nurses by Schoenewald, is a strong appeal that challenges all nurses to be proactive in addressing the issue of pediatric firearm injury and death from various intervention points at the individual (micro), community (meso), state and national (macro) levels. Historically, nurses have been involved with regulations, laws, and policies that improve overall public health and numerous examples of successful legislation are given. These examples encourage nurses at all levels to engage in education, research, policy development, and practice that advocates for firearm safety, especially among the pediatric population. Leveraging the widespread and unique opportunities nurses have to interact with the critical stakeholders of patients, families, and communities, in addition to local, state, and federal policies, the profession can create meaningful change in preventing firearm-related deaths. Identifying the micro, meso, and macro levels in addition to the nurse roles from direct care registered nurses (RN) to advance practice nurses (APRN), nurse educators, researchers, and policymakers, examples are given to champion gun safety initiatives. At the micro level, nurses can improve gun safety through parent and patient education. At the meso level, nurses and APRN providers can create and implement programs at the local community and statewide levels. Educators, researchers, and policymakers at the macro level can design and participate in research to determine the best products used to keep patients safe. As with many public health issues, nurses have the opportunity and obligation to intervene and support pediatric firearm safety initiatives across practice levels offers actionable steps to keep the pediatric population safer from injury and death.

All four articles convincingly affirm that nurses and the nursing profession have an important role when dealing with gun violence, whether at the bedside, in schools, as advanced practice nurses, researchers, educators, policymakers, or administrators. Notably, nurses can advocate for policies to reduce gun violence and improve access to mental health services by using their expertise to inform and contribute to policy discussions. An approach that fits well with these four articles and offers practical guidance is trauma-informed care (TIC) which is an approach that recognizes the widespread impact of trauma on individuals and aims to create an environment that promotes healing and resilience (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). It is particularly relevant in the context of gun violence, where survivors, witnesses, and providers often experience complex trauma that affects their mental, emotional, and physical well-being. In conjunction with the information presented in the articles, TIC is another means to treat and intervene with individuals affected by gun violence by understanding trauma's psychological, physical, and emotional aspects (Menschner & Maul, 2016; SAMHSA, 2014).

TIC involves developing trustful relationships by creating a safe and non-threatening environment where individuals feel comfortable sharing their experiences so that appropriate care and support can be provided. Building rapport by nurses with all individuals involved in gun violence requires showing empathy and demonstrating respect to help them feel validated and understood (Dowdell & Speck, 2022). Including victims, survivors, and witnesses in the care process, listening to their preferences and inclusion in decision-making helps to restore a sense of control and empowerment is central principle of TIC (SAMHSA, 2014). Through assessments of victims, survivors, and witnesses emotional and mental health, nurses can provide appropriate referrals for counseling, therapy, or support groups in addition to education on healthy coping strategies and resilience-building techniques (Menschner et al., 2016; SAMHSA, 2014).

In the United States there is often fierce debate regarding firearm availability, gun violence, and the existence of or lack of laws. Simply put, there is disagreement about the right to bear arms by law-abiding citizens (second Amendment to U.S. Constitution), and the government's responsibility (state, federal) to restrict gun access. As the argument continues, the reality remains that guns and firearms are not going away any day soon. This leaves nurses, APRNs, and providers to work together to effect change by using strategies for raising public awareness and education about gun safety and safe storage. Harnessing the synergy of nurses who are being called to action combined with a harm reduction model using TIC provides opportunities to promote person-centered health, safety, and well-being (Dowdell & Speck, 2022; Menschner et al., 2016; SAMHSA, 2014). By implementing the information found in these four articles with TIC principles, nurses can significantly contribute to protecting, healing, and helping individuals, families, communities, healthcare systems, and organizations affected by gun violence.


Elizabeth Burgess Dowdell, Ph.D., RN, AFN-C, FAAN
Email: elizabeth.dowdell@villanova.edu

Professor & Coordinator Undergraduate Research at the Louise Fitzpatrick College of Nursing, Villanova University


Centers for Disease Control and Prevention. (2021). Fast facts: Firearm violence prevention. Firearm Violence Prevention. https://www.cdc.gov/violenceprevention/firearms/fastfact.html#:~:text=A%20firearm%20injury%20is%20a,charge%20to%20fire%20a%20projectile

Dowdell, E. B., & Speck, P. M. (2022). Trauma-Informed care in nursing practice. American Journal of Nursing. 122(4), 30-34. https://doi.org/10.1097/01.naj.0000827328.25341.1f

Gramlich, J. (2023, April 26). What the data says about gun deaths in the U.S. Pew Research Center. https://www.pewresearch.org/short-reads/2023/04/26/what-the-data-says-about-gun-deaths-in-the-u-s/

Fowler, K. A., Dahlberg, L. L., Haileyesus, T., Gutierrez, C. & Bacon, S. (2017). Childhood firearm injuries in the United States. Pediatrics, 140(1). 1-12. https://doi.org/10.1542/peds.2016-3486

Menschner, C., & Maul, C. (2016). Key ingredients for successful trauma-informed care implementation. Robert Wood Johnson Foundation. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

Monuteaux, M. C., Azrael, D., & Miller, M. (2019). Association of increased safe household firearm storage with firearm suicide and unintentional death among US youths. Journal of the American Medical Association Pediatrics, 173(7), 657–662. https://doi.org/10.1001/jamapediatrics.2019.1078

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. U. S. Department of health and Human Services. https://scholarworks.boisestate.edu/cgi/viewcontent.cgi?article=1006&context=covid

Roszko, P. J., Ameli, J., Carter, P. M., Cunningham, R. M., & Ranney, M. L. (2016). Clinician attitudes, screening practices, and interventions to reduce firearm-related injury. Epidemiologic Reviews, 38(1), 87-110. https://doi.org/10.1093/epirev/mxv005

Citation: Dowdell, E.B., (September 30, 2023) "Overview and Summary: Gun violence from a public health perspective" OJIN: The Online Journal of Issues in Nursing Vol. 28, No. 3, Overview and Summary.