MDS Alert

Published on Tue Apr 16, 2013 PDF

Rule of thumb: Do you know the 5 key elements of active listening?

You have a lot on your plate. But if you’re skimping on resident interviewing, you’re not getting all the crucial data you need for creating an effective care plan and capturing reimbursement-impacting data on the MDS.

Fortunately, there are a few simple techniques that you can use to make your resident interviews more effective, insightful, and ultimately successful. In “Interviewing: More Than a Conversation,” presented by Sheri Kennedy, RN, M.S.Ed., RAC-MT, at Leading Age’s MDS National Conference, Kennedy offers the following tips to improve your resident interviews:

Create the Right Kind of Atmosphere

1. Select a quiet environment. For your resident interview to be effective, you should eliminate all background noise and select a quiet, private setting, Kennedy recommended. At a minimum (and with the resident’s permission), close the door. Also, pay attention to the lighting, particularly to avoid any glaring lights that could bother the resident.

2. Eliminate all distractions. You should minimize any potential distractions — and not just for the resident, but for yourself as well. “With all the projects you need to work on, it can be easy to get distracted when interviewing residents,” Kennedy said. So don’t allow any interruptions like your cell phone.

3. Ensure the resident can hear you. What’s the use of interviewing if the resident cannot hear or understand your questions? First, ensure that you provide proper assistance if the resident needs an interpreter (language or signing), amplifier, or other hearing or communication devices, Kennedy instructed. Beyond these needs, make sure you speak very clearly — “don’t mumble or rush.”

Also, ask the resident where he prefers you to sit so he can see and hear you easily, Kennedy noted.

Build the Resident’s Trust for Insightful Responses

4. Become self-aware. “Stay tuned into your body language,” Kennedy advised. “Nodding your head, smiling, and eye contact will go a long way to let a resident know you are listening.” Don’t cross your arms or legs, which can create “barriers” between you and the resident. “Avoid doing things like checking the time, playing with your cell phone, and fidgeting,” she cautioned.

Remember: At least 60 percent of all communication is non-verbal, so monitor your own non-verbal communication and observe the resident’s body language, too, Kennedy said.

5. Establish rapport. “Demonstrate unconditional positive regard” to establish rapport with the resident, Kennedy recommended. “Respond to issues or feelings that arise.” You can also disclose some personal information about yourself to increase the resident’s comfort.

6. Don’t jump right into the questions. Before you begin asking the resident the interview questions, introduce the topic and explain that you are going to ask a series of questions, Kennedy advised. You can tell the resident that some questions may seem easy, while others may seem hard. Highlight what you will ask, and explain that the resident’s answers will help the care team develop a care plan that is appropriate for him.

For the MDS interviews, you ask specific questions with response choices that you review with the resident. “The structure is important, because we know that general, unfocused questions do not elicit meaningful or valid responses,” geriatrician Debra Saliba, MD, MPH, principal investigator for the MDS 3.0 national testing, said in a Centers for Medicare & Medicaid Services (CMS) presentation on interviewing vulnerable elders.

Control Your Own Responses to the Resident’s Answers

7. Respond the right way. Don’t let the entire interview shut down if the resident becomes agitated or sad. If the resident shows these types of feelings respond to and acknowledge them — “allow emotional expression even if it makes you uncomfortable,” Kennedy counseled. Always use a nonjudgmental approach to residents’ interview responses.

“Allowing emotional expression … recognizes its validity and provides support to residents,” Saliba said. “However, it is important to remain calm and reassure the person that you are there to help them.”

Also, don’t try to steer residents into certain answers or talk them out of a particular answer, Kennedy cautioned. “Don’t be afraid of what they might say; you’re there to hear it.”

8. Record the responses. “Do not try to interpret what the resident means; clarify it to make sure you’re recording their responses, not just what you think it should be,” Kennedy said. “Follow the rules in each section for when to consider an item not completed and when to use secondary data sources.”

“Even in long-stay residents in excellent facilities, we can miss important needs if we rely solely on our impressions,” Saliba noted. “Interviewing takes time, but it takes less time than reviewing pages of medical records and querying staff observers across all shifts.”

Follow the 5 Keys to Active Listening

Yet another essential part of conducting successful resident interviews is being an “active listener.” According to Kennedy, there are five key elements of active listening:

1.  Pay attention.

2.  Show that you’re listening.

3.  Provide feedback.

4.  Defer judgment.

5.  Respond appropriately.