ER Nurses Should Assess Patients for In-home Firearm Risks

Nurses should be more involved in identifying patients at risk of injury from firearms at home so that appropriate intervention can take place. This was the conclusion of a recent study by the Emergency Nurses Association (ENA).

The study “Emergency Nurses’ Perception of Risk for Firearm Injury and Its Effect on Assessment Practices: A Mixed Methods Study,” used a quantitative survey and qualitative focus groups. It explored nurses’ perceptions about the dangers of access to in-home firearms to their patient population. The researchers also wanted to understand how their perceptions influenced their ability to screen, assess, counsel and provide discharge education for at-risk patients.

The US firearm problem

Patients injured by firearms constitute a large part of those treated in emergency rooms in the US – over 81 000 nonfatal gunshot wounds 2014. Firearms were involved in 73% of all homicides and 50% of all suicides in the US during 2015. This is why the ENA has, for a long time, advocated for firearm safety and injury prevention – which includes strategies to identify those at risk and to encourage safe storage of firearms.

“There are specific patient groups that are at high risk from in-home access to firearms, specifically pediatric patients, patients with suicidality, and patients who are involved in an intimate partner violence situation. We need to be assessing for access in those situations,” explained Lisa Wolf, the director of ENA’s Institute for Emergency Nursing Research.

ER nurses concerned about violence

The study, however, showed that only about one-third of the ER nurses surveyed asked patients about access to firearms, even where it would be highly relevant.

only about one-third of the ER nurses surveyed asked patients about access to firearms

Furthermore, the nurses expressed concerns about how to bring up the topic, which could appear intrusive and possibly elicit a violent reaction. It was also important to them whether another staff was available to complete the risk assessment and do the discharge education and counseling. 

“Given the high levels of violence directed at health care providers, especially emergency nurses, it is not unreasonable to fear violence from patients who may or may not have firearms with them,” said Wolf. “Our participants felt it was a real challenge to assess for access to firearms in the home in a way that did not feel confrontational.”

Education and preparation necessary

It appeared that nurses who had received firearm prevention and safety education, and felt prepared to manage the questioning and follow-up action, would be more likely to ask patients about firearms. Also important to the nurses was the availability of staff to complete further assessment and the necessary counseling.

The researchers recommended that emergency nurses should be educated on the importance of assessing for firearms in the home and in techniques they can be used to do this in a non-judgemental and non-confrontational manner.

Furthermore, emergency departments needed to address concerns about violence in the ER setting. They should also increase awareness of resources available to health care providers, patients, and families to ensure proper safety measures when firearms are kept in homes.

Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.

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