When the nurse assessment coordinator (NAC) walks into the room, the resident rolls his eyes and unenthusiastically says, “Oh, it’s you. Blue. Sock. Bed.”
The scripted resident interviews can be redundant for many residents, but they do not need to be. While the scripted interviews must be followed exactly as written, the resident experience can be improved greatly. In the RAI User’s Manual, Appendix D provides excellent resources for completing interviews, many of which are incorporated into the tips below. Here are four tips NACs and interdisciplinary team members can utilize to transform the resident interview from a task to an experience.
Be there for the resident.
While your purpose for the visit may be to complete the MDS scripted interviews, that should not be the resident’s overall experience. As you enter the resident’s room, introduce yourself and ask the resident if he or she has time to visit with you. If this time is not convenient for the resident, arrange a time based on the resident’s schedule. Explain the purpose of the visit and help the resident to a comfortable position. If possible, arrange the environment so you are sitting across from or adjacent to the resident at eye level, where the resident can easily see and hear you.
Engage the resident in general conversation. Chatting with the resident helps to establish rapport as well as demonstrates respect. Familiarity with the resident’s routine, values, and preferences can guide this conversation. A couple of examples might be:
“I heard your daughter, Mary, was here yesterday. Did you have a nice visit?”
“It’s going to be nice and sunny today. Are you planning to help water the flowers again?”
If the resident makes a request, address the request to the best of your ability before starting the interview. Whether it is getting a drink of water, a cup of coffee, or giving them time to use the bathroom. Prioritizing the resident’s request before the interview shows respect for the resident.
It is important to remember that the MDS interview is a private discussion. Show your respect for the resident’s privacy by asking her if it is alright to shut the door and arrange curtains as needed. Or, perhaps there is a private lounge or sitting area that might be available. Also, ensure the resident can hear you—hearing aids, if used, should be in place and turned on. If the resident has difficulty hearing, but does not use hearing aids, the use of a hearing amplifier may be beneficial, if the resident agrees to wear it. Take your time and articulate words clearly, but do not speak louder than necessary.
While you may not have the entire interview memorized, you should be very familiar with each of the interview questions. The pain assessment interview starts with the question, “Have you had pain or hurting at any time in the last five days?” It may be helpful to silently read the question to yourself, so you are better prepared to ask the question while paying full attention to the resident. The more familiar the interviewer is with each interview question, the more natural this will feel to the resident. If possible, ask the question while looking at the resident, rather than reading directly from the paper for the entire question. Attempt to make the scripted question sound like you are just asking a question, rather than reading robotically.
Have a designated basket, folder, or clipboard to bring to interviews. Have cue cards and other resources available, such as a hearing amplifier, page magnifier, or a refreshing drink. You need to be prepared when you enter the resident’s room so there is no need to disrupt the interview to leave for supplies.
The resident interviews for the MDS must be completed within the look-back period, which means anything you observe during the interview should be documented to serve as supporting documentation for the MDS. Many of these observations can be completed during the course of the general conversation and scripted interviews. The instructions for C1310, Signs and Symptoms of Delirium, direct the interviewer to observe the resident’s behavior during the Brief Interview for Mental Status (BIMS) for signs and symptoms of delirium. In addition to delirium, also observe for other behaviors—such as hallucinations, delusions, anxiety, and inattention.
During the interview, take note of the room. There is so much information that can be gleaned from an assessment through attentive observation of the environment. Consider this example:
During the resident interview, the NAC observed that the head of the bed was elevated, a wander guard was attached to the bed, and a four-wheeled walker was situated beside the bed. The NAC asked about the head of the bed being elevated, to which the resident explained she prefers to sleep with her head elevated because she gets a little winded if the bed is flat. The NAC and resident discussed when she uses her walker. She reported that she only uses her walker in her room, and the staff bring in a wheelchair when she needs to go longer distances. When asked about the wander guard, the resident reported someone put it there a couple nights ago, and it makes a loud noise if she gets up at night, so she tries not to move when it’s on.
The NAC will document the observations and resident report of preferring the head of the bed elevated to facilitate breathing. The NAC will need to follow up regarding the use of the wander guard. The resident reported that the alarm has caused her to reduce her movement at night due to the alarm, which indicates that this device is a restraint for this resident.
An organized interviewer can also complete additional assessments while visiting the resident. You can ask the resident about his or her vision and supply newspaper in large print sizes. In addition to printed words, be prepared with symbols or numbers. For residents who may have cognitive impairment or literacy concerns, these alternatives enable assessment of visual capabilities.
Being prepared with gloves, a tongue depressor, and a flashlight will allow you to complete the oral and dental assessment. Ask about any troubles with the resident’s mouth, dentures or teeth, swallowing, or other concerns.
Functional limitation in range of motion (ROM) is another area of function that can be assessed during this time. While ROM can also be assessed by observing the resident during usual activities, completing an instruction-led ROM assessment can be very useful too.
Let your visit be enough to meet all the resident’s needs. Ask the resident if there is anything else he or she needs before you go. If there is, take the time to fulfill this need. Whether it is toileting, getting a drink, helping the resident back to bed—if it is safe to complete with one staff member, complete these tasks. If the resident requests a pain medication, report this to the resident’s nurse, and report back to the resident that the nurse was notified and the approximate time the nurse will be there. Do all you can to ensure the entire visit was enjoyable for the resident.
Maya Angelou famously said, “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” When you complete resident interviews, be more than the scripted words you ask. Make the interview an enjoyable experience that the resident looks forward to every time.
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