Firearm violence is a major public health problem, and nurses are in a position to prevent it and reduce its impact.
“Our life expectancy shortens by 106 days because we choose to live in a society with guns,” said Therese S. Richmond, PhD, RN, FAAN, the Andrea B. Laporte Professor and associate dean for research and innovation at the University of Pennsylvania School of Nursing. “The reality is, this is everybody’s problem. And we need to use data to tell that story and help people understand it.”
True to its roots, the University of Maryland School of Nursing’s 2022 - 23 Dean’s Lecture Series kicked off by delving into subject matter that matters. This year’s Virginia Lee Franklin Lecture, “Shots Fired: Reducing the Impact of Firearm Violence,” presented virtually on Oct. 20, came just four days before the 257th shooting on a school campus in the United States this year, one that left two people dead and seven injured in St. Louis.
During the lecture, Richmond reported on a statistic that has made headlines nationally: Firearms were the No. 1 cause of death for children and adolescents in the United States in 2021. “Firearms killed more children than cancer, than respiratory diseases,” she added. The country’s most recent final data on gun violence, from 2020, indicates that homicide and suicide have hit their highest rates since the early 1990s.
Firearm violence is a major public health problem, Richmond posited, and nurses are in a position to prevent it and reduce its impact. In 1995, Richmond co-founded what is now the Penn Injury Science Center, a Centers for Disease Control and Prevention-funded interdisciplinary research entity, where she continues to direct the Research Core. At the time of the center’s founding, it was the Firearm and Injury Center at Penn, with a mission to create safer communities through the systemic reduction of firearm injury and its repercussions to the individual, family, and society.
Richmond is a renowned researcher and scholar, with more than 140 peer-reviewed publications and 18 book chapters to her name. “Dr. Richmond has focused her research on the intersection of physical and mental health after traumatic injury and its effect on recovery,” said Jane M. Kirschling, PhD, RN, FAAN, the Bill and Joanne Conway Dean of the University of Maryland School of Nursing, in her introduction to the lecture. “She is passionate about deploying nursing science to help prevent injury and violence and improve outcomes, particularly in individuals from vulnerable urban populations – especially those on the margins of society, those with limited resources, and/or those who live in violent communities. Her research and scholarship are firmly grounded in her deep commitment to social justice and to overcoming health inequities.”
Philadelphia, where the University of Pennsylvania is located, is “a city that is haunted by gun violence, much, I believe, as Baltimore is,” Richmond said. In the mid-1990s, when the research center was founded, Richmond said, she and her colleagues found the number of firearm injury patients “disturbing, and we finally said we need to do something.” But, she acknowledges, “you can’t do firearm research without recognizing the political nature of firearm violence in this country.” She told the story of the Penn Injury Science Center’s uphill battle with funding, as Congressional mandates prevented federal agencies from providing the resources necessary to conduct relevant research. After Richmond published research showing that individuals in possession of a gun were more than four times more likely to be shot in an assault than those not in possession of a gun, another legislative mandate was issued indicating funds could not be used to advocate for or promote gun control. “It’s a challenging field to work in,” Richmond added.
Her motivation, however, continues to be human centered. She relayed the story, from when she was a trauma nurse in Washington, D.C. in the late 1970s, a period when the city was plagued by firearm violence, of a patient named Andy who sustained a gunshot wound to the abdomen that brought him to the intensive care unit where Richmond worked. “Statistically speaking, he should have died,” she recalled. He didn’t, and the team congratulated themselves on a success—until Andy returned, furious with the team who ensured he had lived. “They saved his life, but he wasn’t healed,” Richmond explained. “His life would never be the same. I really want people to return to lives that are valuable to them.”
She credits Andy with changing the course of her career, as Richmond then turned her focus toward the research she has conducted to foster safer communities, especially those such as Southwest Philadelphia, where her research among 10- to 16-year-olds exposed to firearm violence in their communities revealed they experience repercussions such as an increased risk of becoming violent offenders, poorer academic performance, and, perhaps most shockingly, premature aging (based on shorter telomeres). “Firearm violence is not evenly distributed across society,” Richmond explained. “It’s a male-dominated disease, and it disproportionally affects young Black boys and men more than any other demographic group.”
Another research study involved examining post-firearm injury mental health, “recognizing that they’re going back to the same neighborhoods they came from with unmet mental health needs,” Richmond said. When asked about their motivation for participation in the study, the most common response revealed a need for human connection, “because they could tell us their story, and they didn’t have that opportunity in the clinical setting,” Richmond added. “We need to reboot what we’re prioritizing in the clinical setting.
“This is a social determinant of health, period. I started as a critical care nurse and have fallen in love with this work in the community. Health systems are not the center of the universe. The work in the community is.”