Hybrid Effectiveness-Implementation Trial of Nurse-Led Firearm Safety Intervention in the Pediatric Inpatient Setting: The UPLIFT Study
The UPLIFT study is a collaboration between the University of Pennsylania School of Nursing and Children's Hospital of Philadelphia (CHOP) to adapt, implement, and test an existing intervention as part of CHOP's evidence-based gun safety approach.
Firearms are the leading cause of death for children and teens ages 1-19 and approximately 4.6 million children and teens live in a home with a loaded, unlocked firearm. To ensure optimal safety for children who live or spend time in homes with firearms, experts at CHOP have integrated firearm safety counseling and resource distribution into clinical care.
Research shows that safe firearm storage counseling plus free gun lock distribution is a proven preventative measure for children and families in primary care. Incorporating these processes into inpatient care is an important and innovative way to increase the reach of safe firearm storage efforts.
Project Details
- How it works
The uplift study adapts an existing evidence-based secure firearm storage intervention, known as S.A.F.E. Firearm, for the inpatient hospital setting and nurse-led delivery. After adapting the intervention and developing an implementation blueprint, a randomized controlled trial will evaluate effectiveness (parent-reported secure firearm storage), reach (proportion of eligible families who were offered counseling/locks by nurses), fidelity (parent-reported counseling/ locks receipt), and acceptability.
The intervention includes brief counseling on the importance of secure firearm storage, and offering a free cable lock, plus educational materials. This is a universal intervention that will be delivered to all eligible families with an overnight hospital stay on a medical-surgical unit, and does not include screening or documentation about firearm ownership in the electronic health record.
The study has three primary aims:
- Aim 1: Adapt S.A.F.E. Firearm for the inpatient pediatric setting and nurse-led delivery, and develop a bundle of implementation strategies via stakeholder surveys and interviews. Pilot the intervention implementation to refine the approach and optimize measures and data collection procedures (2025).
- Aim 2: Test the effectiveness of the adapted S.A.F.E. Firearm intervention to improve parent-reported secure firearm storage (2026-2028)
- Aim 3: Examine the effect of the implementation strategy bundle on adapted S.A.F.E. Firearm implementation (2027-2028)
- Current work
Year 1 of the project included overall study setup, personnel onboarding, and the creation of advisory panels with the Family Research Partners group for parent perspectives and the Nursing Professional Governance Workgroup. These collaborations are ongoing and continue to provide valuable insights from those who will be directly impacted by the new intervention.
In Year 2, we completed three Aim 1 sub-studies:
- Surveyed CHOP interprofessional healthcare workers about potential barriers and facilitators to nurse-led firearm safety intervention. This included bedside nurses, nursing leaders, social workers, and medical/physician leaders.
- Interviewed a subset of the survey respondents for a deeper dive into potential barriers and facilitators.
- Interviewed parents of recently-discharged patients on their perspectives and preferences for a nurse-led firearm safety intervention for inpatient hospital stays.
Currently still in Year 2, the team is analyzing data from initial sub-studies to determine the optimal implementation approach. Strategies to enhance consistent delivery will include development of a training module for inpatient nurses, a nurse guide for delivery, brief educational videos, and unit-based research team support. Next steps prior to the randomized control trial will be an open pilot to refine the implementation approach and parent data collection procedures.
- Partners
In addition to a robust study team of clinicians, implementation scientists, statisticians, and administrators across CHOP, partners include the CHOP Research Family Partners Program, Nursing Informatics, the Injury Prevention Program (IPP), and Nursing Professional Governance Workgroup .
- Funding
This study is funded by the National Institute of Health's National Institute of Nursing Research (R01NR021259).
