Quality and Safety Education for Nurses (QSEN) has provided a theoretical framework for patient care delivery for the past fifteen years. COVID-19 has required us to rethink how we incorporate QSEN competencies, especially in our long-term care environments. The first three competencies of QSEN involve patient-centered care, teamwork, and evidence-based practice. How can you accomplish this in the face of a novel virus in the middle of a pandemic?
According to QSEN, competencies, Patient-Centered Care means “Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.” It is a long-held belief in American nursing that our clients have the right to self-determination. They can refuse medicine, refuse our counsel, and engage in choices we feel are not in their best interest as long as they are not an imminent threat to themselves or others. I have had clients refuse life-saving medications, labs, X-rays, and even basic hygiene measures. We apprise individuals of the risks they are engaging in, but we must respect their ultimate decisions. Our Declaration of Independence and Constitution are among the guiding frameworks for the Patient-Centered Care competency part of QSEN. The United States Declaration of Independence asserts that all men are created equal, that they are endowed by their creator with certain unalienable rights. That among these are life, liberty, and the pursuit of happiness. The belief that all life is precious and individual liberty should be preserved has fundamentally driven our nursing care for over a century. Now, let’s consider the impact of COVID-19 on this first competency of QSEN.
How much control do our clients and their family members have in long-term care settings in the middle of a pandemic? Many clients are quarantined to their individual rooms and are not allowed out for any reason. Families are not permitted entrance to our buildings, and clients no longer have access to many services like haircuts, podiatry, dentistry, or physical therapy to name a few. The average life expectancy upon admission to a nursing home is two years. We understand that between 50% and 60% of people will die within the first year of admission. One of my residents said to me “Solitary confinement is worse than death for me. I probably won’t live much longer anyway.” She was deeply hurt that she could not hug her daughter (or anyone else for that matter). She misses the weekly visit from her family, but especially human touch. Before COVID-19, our goal was to keep our clients’ minds, hearts, and bodies engaged with activities, society, and their families. We encouraged family visits and resident interactions. The COVID-19 pandemic has fundamentally changed how care is delivered.
The other QSEN competencies have become more challenging to meet in the face of our current pandemic as well. To learn more about this book, this presentation. Together we can still work to creatively find ways to protect our clients and meet QSEN competencies.