TONE Monthly
April 2018

Moral Courage, Gun Violence and the Nursing Profession: In Their Honor

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By: Dr. Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN

We are on track in this country to have more mass shootings this year than in 2017 (Gunviolence.org, 2018). That is clearly unacceptable. Although, it’s not about the numbers, it’s about people, and people are not statistics. The numbers speak to the ever increasing plague of gun violence on individuals, families, communities, and our country. Thirty-four mass shootings (Gunviolence.org) in the first month-and-a half of 2018, Meadow, Alaina, and Peter; these are only a few the names of those who have paid the highest of prices for the lack of effective gun control measures and mental health resources in this country, a deadly combination when a lack of resources and control measures collide. Of course, these are not the only two factors in the serious epidemic we are facing, which the students of Parkland have so eloquently captured and challenged us to act; “the time for thoughts and prayers has passed.” It is not that acts of sympathy and empathy don’t help the survivors, but they certainly do not help those victims who paid the ultimate price with their lives. If we can get upstream in this epidemic, perhaps we will need less reactive measures or even be able to eliminate the need for the words “victim” and “survivor” from our language in relation to gun violence.

Table 1. GunViolence.org
2017 Gun Violence Statistics

61,507 Active Shooter Incidents
15,592 Deaths
3,996 Children / Teens killed or injured

19 days in the year without a mass shooting.

What holds the current system in place? What are the barriers to change? Why don’t we change? Is it too hard? I would say no, it is not too hard. What is hard is losing a friend, loved one or child to needless gun violence. There is no change beyond our reach, if only we commit to it, if we are ALL IN on changing our gun control laws and eliminating senseless gun violence from our country with 100 percent commitment and zero excuses, we can make it happen. Nothing about this problem is simple, it is the very definition of complexity, but taking a socio-economic approach based on valuing human life above all else can effect change. Perhaps with such a comprehensive systems approach, we would still be able to hold the hand of Meadow and watch as she grew into an adult and contribute unknown miracles to our world.

It is time to declare that gun violence is a public health crisis, as it meets the definition of a complex and difficult situation that affects the nation’s health and knows no geographic or socioeconomic boundaries. More than 30,000 people of all ages die from gun violence each year across the U.S., similar numbers to deaths from car accidents and even liver disease, but also even more than AIDS (Kodjak, 2017), I respectfully suggest that death from gun violence is a public health crisis. As a public health crisis, we must reevaluate the level of funding with our research funds, as gun violence prevention is one of the lowest funded programs in our country (figure 1, JAMA). To name a thing is to take its power away; we must name this crisis and put a face on it, and we must attack this wicked problem with all our resources.

As a society, we have to face the most difficult questions about all our constitutional rights and our individual human rights to live. Where does someone’s rights begin and another end? Though I am not a constitutional scholar, I believe the founders of this country would be terribly disappointed to know that as Americans we are unwilling to take on this wicked problem to better understand how the second amendment (A well-regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed) translates to the modern world, more than 200 years after its creation. Remembering that any document written at a given point in time may be somewhat static and contextual to that time, it should inform our path forward, but not prevent us from adapting or changing to best serve the people governed by those constitutional precepts. One can’t deny the wisdom of our constitution; however, living documents must grow and change with the times. While we have a duty and moral obligation to uphold and defend the constitution, we also have a responsibility to challenge the thinking of those who came before us. Current legislation prevents the CDC from researching gun violence, let’s begin our duty there. Public health crisis or not, allowing experts in public health to investigate the problem and make evidence-based recommendations is a must.

Perhaps it is not solely about the constitution, perhaps is just about what is RIGHT and JUST. It is right to protect children; it is right to prevent harm to our citizens, and is it right to protect our current and future generations from dying needless and preventable deaths? Is death from gun violence preventable? Do you believe you can impact it? Yes, these deaths are preventable, and yes, you can impact gun violence. It’s not only about closing the gaps in the current laws and regulations in gun control, but also about rethinking guns all together in the context of today’s world. Other countries have accomplished these changes with great success. Are we somehow different in the U.S.; of course we are, but we have more similarities than differences with countries that have enacted laws and made necessary changes − those commonalities are where we should start.

Many national nursing organizations have come together to make recommendations on fire arm safety and gun violence prevention. In her synthesis article, Schnur (2016) makes “recommendations that could help us come closer to finding a cure for gun violence."

Table 2. Shnur Recommendations

1. Increase access to mental health programs for individuals, families, and students from elementary school through college:
a. While the majority of people with mental illness are not violent, serious psychosis and schizophrenia combined with substance abuse could lead to erratic behavior. Funding should be increased to train nurses and health professionals to recognize signs of violent tendencies, as well as community- and hospital-based psychiatric care, housing, and access to medications.3
2. Include a gun safety assessment as part of routine health screenings for all patients:4
a. Several states continue to propose legislation to ban practitioners from documenting gun ownership in the patient’s record. However, the American Academy of Pediatrics endorses counseling parents on gun safety measures.5 This philosophy is also supported in adult dementia and elderly patient populations.
3. Develop and implement Evidence-based Hospital Violence Intervention Programs focusing on:
a. Intimate partner violence
b. Behavioral health including anti-bullying
c. Substance use
4. Improve Community engagement/outreach and education programs with initiatives targeting:
a. Life skills
b. Anger management
c. Conflict resolution
d. Suicide prevention
e. Violence prevention programs: successful research-based community programs that have proven to decrease homicide rates include Cure Violence, Aim4Peace and Wraparound Project.6
5. Gather more data, conduct research and educate families on how to best protect themselves and their families from gun injuries:4 
a. Keep guns away from household members who would not safely use them such as children or people with dementia.”

We can’t solve a wicked problem with naïve eclecticism. An epidemic of this proportion will take all sectors, public, private, non-profit and governmental, working together to solve this crisis. We, as nurses, some 3.9 million strong in the U.S., can be a powerful voice. We have the knowledge and wisdom to work from local, state, and national levels, from grass roots advocacy to legislative action. The American Academy of Nursing has called upon Congress to act; will you join them or will you remain silent? Yes, it is a risk to take action, but not to act is unacceptable. Those with greater expertise will propose possible solutions including universal background checks, raising age limits, making bump stocks illegal, restricting certain types of guns from the general population, mandatory waiting periods, database reporting and many more.

The American Academy of Nursing (2018) recommends the National Commission on Mass Shootings should be charged with identifying strategies for:

  • Creating a universal system for background checks designed to highlight an applicant’s history of dangerousness and require that all purchasers of firearms complete a background check. 

  • Strengthening laws so that high-risk individuals, including those with emergency, temporary, or permanent protective or restraining orders or those with convictions for family violence, domestic violence and/or stalking are prohibited from purchasing firearms. 

  • Banning the future sale, importation, manufacture, or transfer of assault weapons, incorporating a more carefully crafted definition of the term “semiautomatic assault weapon” to reduce the risk that the law can be evaded.

  • Ensuring that health care professionals are unencumbered and fully permitted to fulfill their role in preventing firearm injuries by health screening, patient counseling, and referral to mental health services for those with high risk danger behaviors.

  • Focusing federal restrictions of gun purchase for persons on the dangerousness of the individual and fully funding federal incentives for states to provide information about dangerous histories to the National Instant Check System for gun buyers.

  • Supporting enriched training of health care professionals to assume a greater role in preventing firearm injuries by health screening. 

  • Researching the causes of and solutions to firearm violence.

Figure 1. Funding For Research on Gun Violence Compared To Other Leading Causes Of Death

Funding represents the total funding awarded over the years 2004 to 2015. Dollar amounts have not been corrected for the year in which they were reported. (Note: Funding and mortality rate values are plotted on a logarithmic scale.) (source JAMA)


 
Finally, as someone who grew up in a rural area around all types of firearms and from an early age used and owned firearms, I realize my own biases, comforts, and concerns are only one view of gun violence. Knowing my own opinion and views are just that, we must find a balance in this country, which I believe we can if we are willing to have difficult conversations, be open to change and really listen to one another. The fact is, most everything has a dark side, no matter why it was created or its intended purpose, these are the polarities we must hold and simultaneously consider and learn to manage for the betterment of humanity. Clearly, there is a call to action here, if you have not heard it in this paper, then hear it in the voices of those who have survived mass shooting events and from the voiceless who lost their lives needlessly and now call us to respond to this preventable epidemic in our country.

References:

American Academy of Nursing (2018). Letter to Congress

Gun Violence Archive (2018). Retrieved from http://gunviolencearchive.org/

Kodjak, A. (2018).What if we treated gun violence like a public health crisis. Retrieved from https://www.npr.org/sections/health-shots/2017/11/15/564384012/what-if-we-treated-gun-violence-like-a-public-health-crisis

Schnur, M. (2016). Retrieved from https://www.nursingcenter.com/ncblog/january-2016/is-there-a-cure-for-gun-violence

 

 

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