Hybrid Effectiveness-Implementation Trial of Nurse-Led Firearm Safety Intervention in the Pediatric Inpatient Setting: The UPLIFT Study

The UPLIFT (Uniting Pediatric Nurses as Leaders in Firearm Injury Prevention: A Hybrid Trial) study is a collaboration between the University of Pennsylvania 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. 

Research shows that secure firearm storage counseling plus free gun lock distribution in pediatric primary care can improve the likelihood of locked firearm storage. Incorporating counseling and lock distribution into inpatient care is an important and innovative way to expand the reach of firearm safety efforts. 

Project Details

How it works

The UPLIFT study is a 5-year project that will adapt 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 both effectiveness (parent-reported secure firearm storage) and implementation (nurse-documented intervention delivery.)

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 both the inpatient pediatric setting and nurse-led delivery (the "what"), and develop a bundle of implementation strategies (the "how") via stakeholder surveys and interviews. Pilot the intervention implementation to refine the approach and optimize measures and data collection procedures (2025-2026).
• Aim 2: Test the effectiveness of the adapted S.A.F.E. Firearm intervention to improve parent-reported secure firearm storage and additional firearm safety behaviors (2027-2028).
• Aim 3: Examine the effect of the implementation strategy bundle on implementation outcomes, including reach, fidelity, acceptability, and maintenance across intervention units (2027-2028)
   

Current progress

Year 1 (2024-2025) of the UPLIFT study included overall study setup, personnel onboarding, and the creation of advisory panels with the Research Family Partners Program for parent perspectives and the Nursing Professional Governance Steering Council for nurse and nurse leader perspectives. These collaborations continued through Year 2 (2025-2026) to provide valuable insights from those who will be directly impacted by the new intervention, and included focus groups, feedback sessions, and design studios.

In Year 2, the team completed three sub-studies for Aim 1:

1. Surveyed CHOP interprofessional healthcare workers about potential barriers and facilitators to S.A.F.E. Firearm delivery by inpatient medical-surgical nurses. This included clinical nurses, nurse leaders, social workers, and medical/physician leaders.
2. Interviewed a subset of the survey respondents for a deeper dive into potential barriers and facilitators.
3. Interviewed parents of recently discharged patients for their input and preferences related to S.A.F.E. Firearm delivery during inpatient hospital stays.

The team analyzed data from the initial sub-studies to finalize adaptations and determine the optimal implementation approach. Year 2 (2025-2026) involved developing strategies to enhance consistent delivery include a training module for inpatient nurses and associated materials (e.g., workflow guide, brief educational videos), an electronic health-record based reminder/documentation tool, and champions, plus unit-based research team support. One inpatient unit was selected for an open pilot to refine the implementation approach and parent data collection procedures.

Year 3 (2026-2027) will begin with a review of the pilot findings to make any remaining changes and prepare the systems, processes, and support for the units that will be randomized to adapted S.A.F.E. Firearm and the implementation strategy bundle. Then, the randomized controlled trial will begin and run through Year 4 (2026-2027).
 

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 (part of the Clinical Research Support Office), the Injury Prevention Program (IPP), Epic Research, and the Nursing Professional Governance Steering Council.

Funding 

The UPLIFT study is funded by the National Institute of Health's National Institute of Nursing Research (R01NR021259). 

Watch a video featuring Dr. Katelin Hoskins and a Day in the Life of the UPLIFT Study.