1. Narayan, Mary MSN, RN, HHCNS-BC, CTN-A


It's time to move beyond the usual polarized responses to gun violence.


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Bring up the topic of gun violence and what to do about it, and most people respond vehemently, aligning themselves within polarized camps. One side heatedly presses for the preservation of Second Amendment rights, and the other fiercely retorts that we need gun control.

Figure. Mary Narayan... - Click to enlarge in new windowFigure. Mary Narayan

Despite the call to action issued by almost 50 nursing organizations after the Sandy Hook Elementary School killings in Newtown, Connecticut, as well as editorials in multiple nursing journals supporting gun control measures and better access to mental health services, reader responses to blog posts and editorials and on chat rooms suggest that many nurses question if nursing organizations should enter this debate.


What if we approach the issue using nursing values and ethics? Can such a perspective help us explore the issue more deeply, moving us beyond the dichotomy of Second Amendment rights versus gun control? Could a nursing perspective help us better evaluate what should be done about gun violence?


The first tool that nurses have is our commitment to basing policies, procedures, and practices on evidence. We know that practices based on mere belief or opinion have often proven to be misguided once we've examined the outcomes scientifically. We believe in testing our opinions (hypotheses) using research methodologies that show us what works, what doesn't, and what causes which outcomes. When scientific research demonstrates a better way, we don't base our practice on our traditions or beliefs. We look for what's indicated by the preponderance of evidence-by research published in peer-reviewed journals that has been validated by other studies.


A significant body of research has accumulated on the relationship between gun ownership, types of firearms and ammunition, ways of obtaining firearms, gun safety education, and gun violence. For instance, the Johns Hopkins Bloomberg School of Public Health sponsored a conference in January 2013 and published the proceedings in Reducing Gun Violence in America: Informing Policy with Evidence and Analysis. Reports in the document are based on multiple studies about the incidence of gun violence; the populations most at risk for being perpetrators or victims; the health care costs related to gun accidents and injuries; and the relationship of gun ownership to the incidence of suicide, homicide, domestic abuse tragedies, and injury. This document also suggests evidence-based solutions that promote societal safety while maintaining gun rights.


Another tool nurses have is our long history and experience promoting public health. Public health nurses have faced the tension that occurs when an individual's rights conflict with the health of a community. Public health nurses and officials encountering grave threats-the spread of tuberculosis, severe acute respiratory syndrome (SARS), and other contagious diseases-sometimes restrict the liberties of disease victims to prevent outbreaks in the larger society. Inherent in public health measures is the need to balance the rights and liberties of citizens who have done nothing wrong with the rights of the population at large to health and safety.


Nurses' final tool to evaluate the gun violence issue is the resources we use to guide the way we think and act as nurses. For instance, the American Nurses Association's Nursing: Scope and Standards of Practice not only reminds us of the profession's historical influence on public health issues, but calls on nurses to promote societal health by using science and evidence to influence policy and practice. The Code of Ethics for Nurses with Interpretive Statements states that nurses have a responsibility to educate themselves about threats to their communities' health and safety, identifying them and advocating for solutions: "The nurse supports initiatives to address barriers to health, such as [horizontal ellipsis] violence."


My view is that nurses can and should use our rich professional resources to deepen the national dialogue about gun violence. We need to look at the evidence and advocate best practices that promote the health and well-being of all in our communities.