ENA Researchers Find Emergency Nurses Underassess for In-Home Firearms

Study urges improved standards for identifying at-risk patients needing further intervention    

SCHAUMBURG, Ill. (Feb. 11, 2019) – Emergency nurses need better education on the importance of assessing patients for firearms in the home and with how to inquire about the topic in a nonjudgmental, nonconfrontational manner, researchers with the Emergency Nurses Association concluded in a recent study.

The paper, “Emergency Nurses’ Perception of Risk for Firearm Injury and Its Effect on Assessment Practices: A Mixed Methods Study,” highlights the critical need for emergency nurses to identify at-risk patients in order to implement mitigating interventions. The study was published in the January 2019 issue of Journal of Emergency Nursing.

Researchers stated injury from firearms is a significant problem in the United States, accounting for 73 percent of all homicides and 50 percent of all suicides that occurred. What has been unknown are the perceptions of emergency nurses regarding the impact of in-home access on the risk for firearm-related injury and death to their patient populations, and their ability to assess and intervene to ensure patient safety.

The study aimed to explore emergency nurses’ perception of patient risk for firearm injury and in which ways those perspectives affected the process of ED patient screening, assessment, counseling and discharge education. Researchers found that emergency nurses do not ask patients about in-home firearms for several main reasons: they consider it an intrusive question about a personal behavior, there is fear of violent reactions from those in their care, and also uncertainty as to what to do based on the answers they receive.

“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. 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,” said Lisa Wolf, PhD, RN, CEN, FAEN, the director of ENA’s Institute for Emergency Nursing Research. “However, 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.”

Between 22 and 43 percent of ED nurses surveyed for the study reported asking patients about access to in-home firearms, based on their presentation to the emergency department. Additional factors that played a role in inquiries included concerns about how to bring up the topic without appearing confrontational and whether other staff was available to do a risk assessment and offer safety counseling to the patient.

“By asking a few simple questions, emergency nurses have the opportunity to play a key role in reducing the number of injuries related to in-home access to firearms,” said ENA President Patricia Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN. “This study also highlights the importance of recognizing when children have unsupervised access to firearms, and how those situations place them and others at risk for unintentional injuries.”

In addition to improved education on how to perform an assessment of in-home firearms, researchers encouraged emergency department leaders to also increase awareness of resources that are available for health care providers, patients and families to ensure that adequate safety measures are available when firearms are accessible in the home.

ENA has long been an advocate for firearm safety and injury prevention. In December, ENA’s Board of Directors approved the release of a new topic brief which includes strategies for reducing firearm-related deaths and injuries through patient education and encouraging safe storage of firearms.