Gun violence is a major public health crisis in the United States that contributes to individual/family, community, and societal anguish and suffering. The lost lives and staggering disabilities associated with intentional and unintentional shootings resulting from homicides, suicides, and accidental gun firings have led to collective suffering and, at times, heart-broken rage as people attempt to mobilize for change and make sense of the polarizing discourse surrounding gun ownership responsibilities and rights. Nurses and other health professionals experience this suffering as well, personally and professionally. Many nurses struggle to make sense of the carnage and to strategize effective interventions that might sway policy decisions and individual or group behaviors. It is important to note that some nurses are also gun owners, and given this background, they likely have more knowledge of safe gun ownership practices in the home and may have differing perspectives from those who choose to avoid firearms.

Conversations about gun rights and gun control may be tricky and yet, nurses striving to provide holistic, comprehensive patient safety education need to be able to navigate these discussions. Betz et al1 advises that there are unintended undertones to the term "gun violence" and the connotations may negatively affect conversations. They suggest that gun violence may be interpreted as a proxy for gun control, a significant concern for those who focus on perceived constitutional rights around gun ownership. Betz et al1 note that "firearm injury" is the term most used within academe and public health publications programs because of its general neutrality. This neutral stance is useful when working toward mutual understanding and a shared narrative.1 Nurses are advised to consider this approach when interacting with colleagues and care recipients and use the terms "firearms injury" and "firearms safety" to demonstrate sensitivity and respect for unknown or differing patient values and preferences.

There are other opportunities to modify word choices to ameliorate potential knee-jerk responses to difficult conversations related to terminology often used when in conversation about firearms. Betz et al1 offer language options around firearms and ownership and storage; suicide; and, community violence. Their examples include, but are not limited to, querying, "do you prevent access of your firearms by unauthorized individuals?" rather than "are your firearms locked up?"1^(p2108) The authors also recommend "die by suicide" instead of "commit suicide."1 Other examples may be particularly useful to the nurse who is working to broaden the comprehensiveness of holistic assessment to include surveying and educating about firearms and associated risks.

Branas et al2 report that the homicide by gun rate in the United States is 25% greater than that found in other high-income countries and the gun suicide rate is 8 times higher. They comment that the initial response to these rates is to call for law enforcement and law creation to curtail the violence. The problem with this singular intervention approach is that firearm laws are elusive, political, and unpredictable. There are examples of different evidence-based approaches that offer the possibility of reducing gun-related violence. Many of these initiatives may be of interest to nurses in search of a broader and more stratified approach addressing firearm harm and risk.

Health care professionals, including nurses, must pursue gun-related violence reduction goals by supporting programs that have demonstrated success in violence reduction either directly or in association with affecting change in circumstances that promote enhanced safety. Examples of such programs include nonprofit, community-building programs; public transportation improvements and environmental remediation projects; and improved housing conditions and enhanced green space initiatives.2 Branas et al2 note that home foreclosures are associated with suicide events and accessible mental health interventions demonstrate suicide reductions as do early childhood education programs that incorporate home visits. These activities are likely of interest to nurses, and research findings suggest that supporting these types of initiatives may correspond to fewer gun violence events.2 Certainly active involvement in potentially mitigating upstream causes of gun violence, including improving social and structural inequalities, may prove to be more rewarding to nurses than relying on the nonpartisanship needed for important firearm laws.

One recent study surveyed pediatric advanced practice nurses' knowledge of gun safety as well as related health promotion strategies and other preventive interventions.3 This quantitative study was designed in response to the increased number of unintentional shootings of toddlers. Most of the total respondents (n = 54) shared that they asked parents about guns in the home, typically during the initial visit.3 A majority observed that their respective workplaces did not have teaching plans or policies specific to gun safety.3 Those respondents who were gun owners were found to be more likely to screen for guns and educate about safe firearm storage. The implications of the study findings support that there is a need to standardize patient, family, and public education about firearm screening and safety in the care delivery setting. This may be another opportunity suited to the interests and passions of the nurse who is passionate about delivering holistic care and interested in contributing to safe home environments.

Reducing gun violence in the United States will undoubtedly take time and will certainly take effort and resources. While nurses are encouraged to get involved in policy building and legislator elections, there are opportunities to affect change and increase awareness during the day-to-day events of holistic nursing practice. Cox4 offered an interesting analogy that compared tobacco product reduction and cessation to gun safety efforts. She observed that smoking in the back of airplanes was established, permitted practice approximately 30 years ago on domestic US flights. Many nurses routinely smoked in nurses' lounges at that time. These smoking practices are no longer permitted and nurses smoke with far less frequency. However, these changes were incremental and took significant effort, including policy building.

Nurses should anticipate that firearms safety legislation will take time to develop and will be gradual in its development. In the meantime, there are opportunities for nurses to contribute to public safety efforts specific to firearms by influencing bullying, promoting mental health service accessibility, and advocating for community services and environmental improvements.4 Nurses and other providers who own firearms may be able to contribute to the knowledge of those who know little about guns. These nurses, in partnership with interprofessional colleagues, are encouraged to look for opportunities to promote firearm safety, teach appropriate gun storage technique, and mitigate circumstances that contribute to violence against others and against self.

REFERENCES