Amanda Gorman begins The Hill We Climb, the poem written for the inauguration of President Joseph R. Biden, with “When day comes, we ask ourselves, Where can we find light in this never-ending shade? The loss we carry, a sea we must wade.”1 The US is in the midst of an epidemic of gun violence, which is only one of many epidemics across the nation that have been highlighted during the COVID-19 pandemic. I ask how often can I wake up to news of yet another mass shooting? How much can we as a nation endure these events over and over again? We hear about collective resilience as a society, but does that correctly describe the resultant impact of these rampant acts of violence? I read from Psalms 119:28, “My soul is weary with sorrow; strengthen me according to your word” and pray for change. More than prayer is needed. As human beings, these senseless killings linger within the mind and soul and must find an outlet within an acceptable context and action. The alternative is to allow the unreleased feelings to slowly eat away at the individual and eventually devour the soul of the nation. Why am I expressing what some might call “dark” thoughts? Because, it is too easy to dismiss the existence of a state of affairs, and it is much harder to acknowledge and address the reality of the situation.
Concepts in nursing
Nursing is difficult. Despite seeming differences in people, nursing functions within a framework of holistic care and caring for individuals, families, communities, and populations. Four foundational concepts guide nurses in practice: person (recipient of care), environment (situation and setting in which nursing occurs), health (person's state of well-being), and nursing (attributes, characteristics, and actions of nurse providing care).2 Nurses become experts at interconnecting these concepts and are unable to avoid confronting today's events because patients bring emotions and reactions with them to every encounter. Some patient behaviors are open and obvious, whereas others are private and hidden. Nonetheless, the individual's response to internal and external factors influences their behavior and impacts their overall health. Nurses must consistently recognize this phenomenon. Gun violence is prevalent in our society, and news of mass shootings is easily accessible.
Assessing patient safety
How can nurses assess the impact of gun violence on a patient's state of well-being to help them achieve optimal levels of well-being? One roundabout way is to ask a certain question at every visit, which has become standard in many electronic health record systems, often as part of the intake for vital signs. If the question is asked at all or in a rotelike manner, the patient more than likely will not provide an accurate response. For example, one version of this is asking “Do you feel safe at home or in your personal life?” Asking patients outright about owning a gun or having firearms in the home places the healthcare provider (HCP) in a tenuous position based on state law and may create a sense of confusion in the patient with concerns about what their answer might lead to or what they should subsequently do. HCPs, including nurses, are obligated to counsel patients on specific safety measures, like wearing a helmet when cycling, and encourage healthier lifestyle behaviors and outcomes. A conversation about guns and their implications for a healthy environment is a more serious discussion and is one that many HCPs are hesitant to initiate directly.3 What do we do?
Decision to act
Gorman ends The Hill We Climb with “When day comes, we step out of the shade, Aflame and unafraid. The new dawn blooms as we free it, For there is always light, If only we're brave enough to see it, If only we're brave enough to be it.”1 If only we are brave enough!
Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN
Editor-in-Chief [email protected]
1. Gorman A. The Hill We Climb: An Inaugural Poem for the Country
. New York, NY: Viking; 2021.
2. Fawcett J. Analysis and Evaluation of Nursing Theories
. Philadelphia, PA: F.A. Davis Company; 1993.
3. McCourt AD, Vernick JS. Law, ethics, and conversations between physicians and patients about firearms in the home. AMA J Ethics