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.
Full Article & Source:
A summer correlation, fireflies and the MDS
