The Leading Cause of Death My Patients Never Ask About: Placing Child Firearm Deaths in the Policy Process and Defining a Doctoral Nurse's Part in It
[Student Name]
University of Phoenix
DNP/725: Policy and Regulation in Health Care
Week 1 Assignment
[Instructor Name]
[Date]
The state and scenario are composites written for a model paper.
I am a pediatric nurse practitioner in a primary care practice serving about 7,500 children in a Midwestern state. Families ask me about car seats, water safety and screen time. They rarely ask about firearms, although roughly a third of our families report a gun in the home on our intake form. Our state has no child access prevention law. This paper places that gap in the policy process and defines what a doctoral nurse can do about it.
The Problem in Numbers
Goldstick et al. (2022) examined national mortality data and reported that in 2020 firearm-related injuries became the leading cause of death among U.S. children and adolescents aged 1 to 19, surpassing motor vehicle crashes. Firearm deaths in this age group rose sharply from 2019 to 2020. For a clinician whose daily work includes injury prevention, this is the single largest preventable threat to my patients' lives.
Why a Policy Response
Clinical counseling can help, but it reaches only families who come to visits and who listen. A law that sets an expectation for safe storage reaches every household with a gun and a child. Evidence on such laws will be examined in later weeks; for now, the question is why our state has not acted.
The Multiple Streams Model
Kingdon's multiple streams model describes policy change as the joining of three largely independent streams. The problem stream contains conditions that come to be seen as public problems, often through data, dramatic events or feedback. The policy stream contains proposals developed by experts and advocates and refined over time. The politics stream contains public mood, interest group pressure and changes in elected officials. When the streams converge during a window of opportunity, often opened by an event or an election, a policy entrepreneur can couple them into law.
The data had been clear for two years; what our state lacked was a moment when the problem, the proposal and the politics were in the same room.
The Problem Stream in Our State
The problem stream is strong in data but weak in attention. Child firearm deaths in our state are counted but reported as part of broader statistics, and unintentional shootings of young children are covered as isolated tragedies rather than a pattern. Framing matters: presenting child firearm deaths as a preventable injury problem, like drowning, is more persuasive to many legislators than framing them in terms of gun control.
The Policy Stream
Child access prevention laws exist in many states, so the policy stream contains ready models, including negligence and recklessness versions. Proposals in our state have been introduced twice and died in committee. The policy is available; it has not been coupled with the other streams.
The Politics Stream
Our legislature has been reluctant to take up firearm bills. However, public support for safe storage is broad, including among gun owners, and a new committee chair elected last year has a background in emergency medicine. These shifts suggest the politics stream is moving.
Windows of Opportunity
Windows often open after focusing events. A recent unintentional shooting of a four-year-old in our state drew statewide coverage. Advocates must be ready with a proposal and data when such windows open, since they close quickly.
Nurses in Policy
The national report on the future of nursing for 2020 to 2030 called for nurses to be prepared and supported to engage in policy, including addressing social determinants of health and health equity. The report emphasizes that nurses' trust with the public and their knowledge of patients' lives give them credibility in policy debates (National Academies of Sciences, Engineering, and Medicine, 2021).
What Enables Participation
Hajizadeh et al. (2021) systematically reviewed factors influencing nurses' participation in health policymaking and identified three themes: nursing-related factors, such as knowledge, skills and motivation; management and organizational factors, such as leadership support and opportunities; and a positive work environment. They concluded that empowering programs could increase nurses' policy participation.
Why This Issue Stalls
Firearm policy carries strong identity and cultural meaning in our state, where hunting is common and many families keep guns for protection. Legislators fear being seen as hostile to gun owners. Clinicians, for their part, often avoid the topic with families, unsure whether it is their place to ask. These silences on both sides keep the issue off agendas even when data are clear.
A Nursing Frame
Nurses are trusted across political lines. When a nurse speaks about a child who arrived in the emergency department after finding a loaded handgun in a nightstand, the message is about injury prevention and family safety, not ideology. That frame gives nurses a distinctive voice in an issue where many voices are dismissed as partisan.
Learning From Other States
More than half of states have some form of child access prevention law. Talking with nurse advocates in neighboring states that passed such laws can reveal which arguments, coalitions and compromises worked, shortening our learning curve.
My Role in Each Stream
In the problem stream, I can gather and present data on child firearm injuries from our region's hospitals and share clinical stories, with permission and without identifiers. In the policy stream, I can help refine bill language, for example ensuring it includes storage education at pediatric visits. In the politics stream, I can testify at committee hearings, meet legislators and work with the state nurses association and chapter of the pediatric society.
Building My Capacity
Following the factors Hajizadeh et al. (2021) identified, I will build knowledge through this course, seek a mentor in the state nurses association's policy committee and ask my practice for protected time to testify.
Evidence Gaps to Acknowledge
Research on firearm policy has been limited for decades by restricted federal funding, which means some questions lack strong answers. Acknowledging uncertainty honestly, rather than overstating evidence, protects credibility with skeptical legislators.
Clinical Practice Continues
Policy work complements rather than replaces clinical action. Our practice will begin asking about firearms in the home at every well-child visit and offering cable locks, regardless of what the legislature does.
A Timeline
In the next three months, I will join the nurses association's policy committee and compile regional injury data. Before the next session, I will meet the sponsor and two committee members. During the session, I will testify and mobilize nurses in key districts.
Conclusion
Firearm injuries are now the leading cause of death in American children and adolescents, yet our state has no child access prevention law. The multiple streams model explains why: the problem and policy streams are present, but they have not been joined with political will during an open window. A national nursing report and a review of participation factors show that nurses are needed in policy and can be supported to participate. My role is to strengthen each stream and be ready when the window opens.
References
Goldstick, J. E., Cunningham, R. M., & Carter, P. M. (2022). Current causes of death in children and adolescents in the United States. New England Journal of Medicine, 386(20), 1955-1956. https://doi.org/10.1056/NEJMc2201761
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review. BMC Nursing, 20, Article 128. https://doi.org/10.1186/s12912-021-00648-6
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982
How this DNP 725 Week 1 example is structured
The DNP/725 Week 1 work usually covers the policy process and the role of the doctoral nurse. This paper grounds a policy model in one problem, shows where the process is blocked and names the specific contributions a nurse can make at each stage. Students search this week as DNP 725 Week 1, DNP725 Wk 1 or DNP/725 Wk 1; all three are the same assignment.
DNP/725 Week 1 questions, answered
What does DNP/725 Week 1 usually ask for?
Many sections ask students to describe the policy process, apply a model such as Kingdon's multiple streams and explain the role of the DNP-prepared nurse in shaping health policy.
What is Kingdon's multiple streams model?
A model proposing that policy change happens when three independent streams, problems, policies and politics, come together during a window of opportunity, often with a policy entrepreneur coupling them.
What is a child access prevention law?
A state law that holds adults legally responsible when a child gains access to a firearm that was not stored safely; negligence versions apply when a child could access the gun, while recklessness versions require knowing disregard.
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