Wednesday, July 10, 2024

A summer correlation, fireflies and the MDS

by Joel VanEaton

This time of year, I love to sit on my back porch and watch the fireflies dance in the twilight. Something from my childhood, I suppose. 

This year they seem particularly bright. Almost like fireworks in the trees every night. It’s spectacular. I’m thankful and nostalgic for these things. 

There are about 2,000 firefly species. Did you know that each species has its own unique flashing pattern for communication? They remind me of the MDS, with its multifaceted impact. 

The MDS is completed as part of what is known as the Resident Assessment Instrument (RAI) process. It’s essentially the Nursing process that we nurses learned in school, and it has five basic parts, as shown in the acronym ADPIE. 

ADPIE according to the RAI

1. Assess: “Taking stock of all observations, information and knowledge about a resident from all available sources (e.g. medical records, the resident, resident’s family, and/or guardian or other legally authorized representative).”

That’s the MDS. Along with other assessments, the MDS forms the foundation of the  RAI process

2. Decision Making/Diagnose: “Determining with the resident (resident’s family and/or guardian or other legally authorized representative), the resident’s physician and the interdisciplinary team, the severity, functional impact, and scope of a resident’s clinical issues and needs.”

That’s the Care Area Assessment or CAA process. Those who work the CAA process correctly are like artists painting a unique, colorfully dimensional picture of the resident.

3. Plan: “Establishing a course of action with input from the resident (resident’s family and/or guardian or other legally authorized representative), resident’s physician and interdisciplinary team that moves a resident toward resident-specific goals utilizing individual resident strengths and interdisciplinary expertise; crafting the “how” of resident care.”

That’s the care plan. The care plan is more than a surveyor placatory document. Rather, it is a unique and resident-centric roadmap. 

4. Implement: “Putting that course of action (specific interventions derived through interdisciplinary individualized care planning) into motion by staff knowledgeable about the resident’s care goals and approaches; carrying out the “how” and “when” of resident care.”

This is the care teams’ actualizing the RAI process for the well-being of the resident.

5. Evaluate: “Critically reviewing individualized care plan goals, interventions and implementation in terms of achieved resident outcomes as identified and assessing the need to modify the care plan (i.e. change interventions) to adjust to changes in the resident’s status, goals or improvement or decline.”

That’s the MDS schedule of assessments, along with monitoring the resident’s changing condition on a daily basis.

In these ways, the RAI process is a “richly practical means of helping nursing home staff gather and analyze information in order to improve a resident’s quality of care and quality of life.”

“The key to successfully using the RAI process is to understand that its structure is designed to enhance resident care, increase a resident’s active participation in care, and promote the quality of a resident’s life.”

In retrospect

While it didn’t seem to be at first, I remember as a new MDS coordinator discovering that the job I had been hired to do was what I went to school to learn. This discovery came as a result of reading the RAI Manual. 

Like the unique messaging that firefly species use to communicate, the RAI process identifies the individual characteristics of each resident that are further analyzed to create a resident-centric plan for care success to improve a resident’s quality of care, quality of life, and goal attainment.

Once I recognized the value of the RAI process, I remember having a greater sense that I was, in fact, practicing nursing as an MDS coordinator. 

That realization gave me great satisfaction, knowing that even in a less traditional nursing role I could still have a significant impact on the quality a resident could experience being cared for in my nursing facility.

We’re all in this together

While MDS coordinator often guides the RAI process, it is important to remember that this is a team project. It is an interdisciplinary problem-solving model that results in all team members being involved in a hands-on approach.

Each member of the IDT, with their distinct attributes and assessments of the resident, contributes to the “richly practical” RIA process.

When the RAI process is approached in these ways, there are significant positive outcomes for the resident and the caregiving team.

1. Residents respond to individualized care and “… have experienced goal achievement and either their level of functioning has improved or has deteriorated at a slower rate.”

2. Staff communication has become more effective resulting in an enhancement of the commitment to and the understanding of that care plan, challenging staff to hone the professional skills of their discipline as well as focus on the individuality of the resident.

3. Resident and family involvement in care has increased. “Staff members have a much better picture of the resident, and residents and families have a better understanding of the goals and processes of care.”

It’s good to remember

I often think about the road my career has taken. In one of my first clinical placements in nursing school I remember seeing the MDS for the first time and thinking to myself defiantly, “I’ll never do that!

I started out as an RN in an ICU step-down unit, planning to ride the adrenaline rush of advanced practice in the ER. That all changed when an MDS opportunity came my way unexpectedly and I took it, ostensibly as a temporary break from the grind of nights, weekends and holidays. 

Looking back, I recognize my skill set was more finely tuned to what I do now, and I’m thankful for the turn of events. I am still in love with the bedside and the clinical aspect of nursing; that’s why I went to school. But the MDS path rewarded me with an opportunity I was not anticipating.  

A correlation of thankfulness

Here on the backside of my 23rd year doing this, I can’t help but think about how things might have been had I not taken this nursing road less traveled, and I am hard-pressed to imagine a more satisfying development.

If fireflies are a metaphor for the RAI process, they also remind me of how grateful I am for being introduced to the MDS all those years ago.  The country hit “Flies on the Butter” captures it this way:

“Me and my best friend Jenny set up a backyard camp

Stole one of Mama’s mason jars

Poked holes in the lid and made a firefly lamp”

If you’re an MDS coordinator, you are exceptional. The lamp you create every day through the RAI process you participate in and oversee is key to your residents’ quality experience. Don’t forget that.  

Your residents are thankful for your firefly lamp, I hope you are too. 

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A summer correlation, fireflies and the MDS

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