Emergency Nurses Launch Firearms Injury Prevention Program

Online education resources identify, assess, and counsel patients at risk for harm.

The Emergency Nurses Association (ENA) is giving emergency nurses tools and information they can use to help patients at risk for firearm injuries or death.

The Firearms Injury Prevention Education program, funded in part by the American Academy of Pediatrics, features a webinar, online course, and a podcast series focused on identifying patients who might be in danger and the steps emergency nurses can take to assess, educate, and provide follow-up care to those individuals.

"We did a study published about a year ago that looked explicitly at how emergency nurses assessed for firearm safety and access to lethal means during the ED visit, and what we found was that the vast majority of emergency nurses were not asking [about firearm access], and there are a variety of reasons for that," Lisa Wolfe, PhD, RN, CEN, FAEN, FAAN, director of ENA's Institute for Emergency Nursing Research, said in a podcast launching the program. "But a prime one is that there's a lack of comfort in having that conversation."

The American Medical Association has issued educational material for physicians discussing firearm safety with patients, but there were no guidelines for emergency nurses, Wolfe said. So the ENA included a webinar in the new program for ED nurses to ask across different patient groups about firearm safety to assess for lethal means.

"The conversation is different with parents of a child who comes into the emergency department; it's different with adolescents; it's different with people who come in with behavioral health complaints, like depression and suicidality," she said.

Other high-risk groups are geriatric patients and patients who present to the emergency department for domestic violence or intimate partner violence, she said.

"The presence or absence of access to lethal means in those populations makes a really big difference in the risk assessment for those patients and, therefore, how you would intervene or pull resources in for that," she said.

Universal screening is not the purpose of these conversations, said Emmy Betz, MD, MPH, associate professor of emergency medicine and director of the Firearm Injury Prevention Initiative at the University of Colorado School of Medicine.

"This is not suggesting that you have these lengthy conversations with … people who are there for ankle sprains or sort of other things that that probably have nothing to do with firearms," Betz said in the podcast. "At the same time … we have the privilege of really of intersecting with patients who are in very vulnerable states and are going through some kind of mental health crisis like a divorce or worsening substance abuse, or maybe they're involved in domestic violence."

The webinar and learning modules help nurses identify age-specific risk factors; triage and assessment guidelines; discharge education; and tips on approaching firearm accessibility within the context of injury prevention and safety, ENA said.

'This is not about gun control'

The program's goal is first and foremost patient safety, Betz said.

"Anyone who works in the ER understands how important it is that we connect with people where they're at and that we are there to help and to heal, to give hope, but not to dictate to people how they live their lives," Betz said, "and so I hope that people listening to this and the other parts of this program recognize this is not about gun control, it is not about confiscation, it is not about judging people for why they own guns or why they don't, but it is about providing counseling around safer storage or safer access when someone's at risk."

Much like her work at the University of Colorado, the program's core is preventing firearm injuries.

"In the firearm injury prevention initiative that I lead, that's really coming from a space of collaboration and communication," she said, "and listening and working closely with the firearms community—retailers and owners and instructors—to really honor our shared goal of health and security, and respecting diversity of views, and helping people find the solutions that work for their family."