Interview skills. PROGRAM Prep. Tips and tools for CNA training. Collective improvement. Questionnaire answer key. Program time. Learning objectives

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1 February 2010 Vol. 8, No. 2 The interviewing skills of long-term care staff members, including CNAs, are becoming increasingly important. CNAs must be able to comfortably serve as both an interviewer and an interviewee. The MDS 3.0 emphasizes the value of information obtained from residents through the interview process. In addition, CNAs are subject to unannounced interviews conducted by surveyors for the Quality Indicator Survey (QIS). As a result, CNAs must understand how to appropriately ask certain questions and answer a variety of others. This issue includes techniques new CNAs can use to establish core skills, including methods to improve listening and strengthen relationships with residents. In addition, it offers information that can help experienced CNAs build on their interviewing skills by taking attitude, body language, interview preparation, and communication style into consideration. Have a good day of training, and stay tuned for next month s issue of CNA Training Advisor, which will cover activities for short-stay residents. Program time Approximately 30 minutes Learning objectives PROGRAM Prep Participants in this activity will learn how to: Develop interview confidence Become a better listener Recognize body language and attitude Improve critical relationship skills Preparation Review the material on pp. 2 4 Duplicate the CNA Professor insert for participants Gather equipment for participants (e.g., an attendance sheet, pencils, etc.) Method 1. Place a copy of CNA Professor and a pencil at each participant s seat 2. Conduct the questionnaire as a pretest or, if participants reading skills are limited, as an oral posttest 3. Present the program material 4. Review the questionnaire 5. Discuss the answers Collective improvement The best way for CNAs to improve their interview skills is by practicing. Ask your CNAs to pair off and conduct interview rehearsals, taking turns acting as the interviewer. This is a great opportunity for your CNAs to focus on exemplifying appropriate body language during the interview while improving their listening skills and molding their communication style. Questionnaire answer key 1. c 3. b 5. a 7. d 9. c 2. a 4. d 6. a 8. b 10. b Tips and tools for CNA training Looking for more information about CNA training? Sign up to receive the LTC Nursing Assistant Trainer, a free biweekly e-newsletter that addresses all of your training needs. The LTC Nursing Assistant Trainer provides training tips on nursing measures, best practices, and other crucial aspects of job training for CNAs. This free e-newsletter gives you valuable information and tools to help you conduct efficient, innovative training for every CNA in your facility. To sign up for your free subscription, visit com/prod-1983.html. If you experience difficulty subscribing online, please call 800/

2 Page 2 CNA Training Advisor February 2010 One of the major advances of the MDS 3.0 is the use of direct interview items to capture the resident s voice. Research and analysis related to the MDS 3.0 concludes that resident interviews can be accurate and feasible. Even residents with cognitive impairment can reliably answer questions about how they feel and what they want. In fact, the assessments for cognition, mood, preferences for customary routine and activities, and pain will all use a simple interview with standardized language and can serve as the sole information source. Only a small percentage of residents who cannot participate or communicate will use an alternative assessment method. According to the Centers for Medicare & Medicaid Services research team, these new interview sets Brief Interview for Mental Status, Confusion Assessment Method, PHQ-9 or mood assessment, and pain items were easy for staff members to use in the demonstration facilities and revealed improved sensitivity and correlation to clinical standards. The QIS also uses interviews to gather information, which can be intimidating for staff members, residents, and families. Residents and families might share information with a surveyor that is surprising to staff members and not usually positive for the facility. For example, if you have not addressed a request or criticism from a customer, it s likely to surface during an interview with an external source, such as a surveyor. The possibility of unfavorable comments from residents and families should compel facilities to conduct a mock survey, utilizing the QIS interview tools, and to reevaluate their grievance program. When the survey team shows up on your doorstep, there is always a physiological response on the part of staff members and administration. It feels like a final exam. The more staff members practice being interviewed under pressure, the easier it will become. Building necessary skills Interviewing is the art of questioning and listening. It s a skill you use every day. If you observe two people in a conversation, you ll notice that there is generally a give and take. Although some people are naturally skilled at interviewing, most have to work at it. A good interviewer understands his or her own style of communication, both verbal and nonverbal. Sometimes, actions do speak louder than words, and this is especially true during an interview. In addition to understanding what he or she communicates nonverbally, a good interviewer must also perceive the nonverbal communication of the person he or she is interviewing. Once an interviewer can do this, he or she can begin to build a relationship with the interviewee, helping that person become comfortable and allowing the conversation to come to life. There are times when an interview can go off track, and it takes a skillful interviewer to bring the conversation back to its main purpose while also letting it flow naturally. It s best to find a comfortable pause in the conversation and use that time to refocus the interviewee on the original question or purpose of the interview. It s okay if you re not proficient in the interviewing process right away; it s a skill that improves with time and practice. Keep in mind that every interview needs an end. Knowing how to end the interview but keep the line of communication open is important to developing an ongoing relationship with the resident you are interviewing. As you begin to practice your interviews, your relationships with residents, families, and staff members will begin to grow as well. The relationships will increase satisfaction on all levels and move your facility toward cultural change. Attitude and body language Your interview technique is important, but your attitude and body language are key factors in interviewing success. For example, look at the relationship between CNAs and the nursing staff. A CNA might believe that a nurse doesn t value his or her input. Although the nurse may deny this, the CNA likely came to this conclusion by interpreting the nurse s body language. Attitude and body language are everything. How you act or react will be perceived by others in certain ways. Body language is a public reflection of your attitude and will either confirm your interest or convey insincerity to the interviewee. As an interviewer, it helps to maintain an open body position to avoid demonstrating negative nonverbal behavior. In addition, the following are a few characteristics to watch for when conducting a resident interview or being interviewed by a surveyor during the QIS: Posture. If a person is telling the truth, he or she will be in an upright position, leaning forward with the shoulders squared and the body aligned with the interviewer. The person will have an open facial expression, and his or her foot or leg positions will be natural. Someone who may not be comfortable during the interview process will assume a defensive position with his or her arms and/or legs crossed. To create some distance, he or she will lean back, look tense or restless, and face away from the interviewer. Head and face. To demonstrate cooperation, a person may tilt his or her head to the side, whereas tilting forward is a sign of aggression. Truthful communication is demonstrated with relaxed eyes and eyebrows, but a wide-eyed look or raised eyebrows could indicate deception. To show aversion to talking, a person might bite or tense his or her lips. A person who is trying to ease anxiety may continuously touch his or her face. Arms and hands. To redirect the interviewer, a person may move his or her arms away from the body. Keeping the hands and arms at the side or on the lap demonstrates that the individual is content. Legs and feet. Relaxed legs indicate a person who is comfortable with the situation. If the individual s legs are suddenly pulled under the chair or take on a position of flight, it shows this person has changed from relaxed to defensive.

3 February 2010 CNA Training Advisor Page 3 Conducting the interview Any staff member can conduct resident interviews, including CNAs. It s helpful if you have built a positive relationship with the resident, as this will often make him or her feel at ease during the interview session. Interviewing is a give-and-take process. During the MDS 3.0, you are the interviewer, so be ready for the answers. During the QIS, you are the interviewee, so get ready to answer the questions. In both situations, you need to listen. Don t let your attention wander. Maintain eye Attitude is everything Although technique is critical, the most resonant aspect of any interview is attitude. Take a step back and think about your attitude, which you display to residents and coworkers through your body language. How do you interact with other staff members and residents? What about your body language? Think about how you act during an interview and ask yourself the following questions: Do you smile? Do you cross your arms? Do you acknowledge others with a warm greeting? Do you roll your eyes? Do you sigh or make undecipherable comments? These actions are noticed, and during an interview, it s these unconscious actions or reactions that must be controlled. Keeping your nonverbal cues in check is important, but also watch for the resident s nonverbal cues when you conduct the interview. Be aware of the resident s response to you, which may give you an idea of how you are being perceived and how the resident really feels. contact and be on alert for hidden clues. To show the resident you are listening, repeat back what he or she just told you. This helps the interviewer ensure that he or she understands the resident, and it lets the resident know that the interviewer is paying attention. Another way to show you are listening is to use the same words the resident used to describe a situation or a feeling that was just discussed. This leaves little room for misunderstanding of the question and increases chances the answer will be understood. Preparation is essential to a successful interview. First, estimate how long the interview might take. Take into account the resident s capacity for an interview and the best time of day to conduct the interview. You can develop your own interviewing style, but stay flexible. Situations change, and you ll adapt better if you aren t married to your script. For first-time interviewers and interviewees, or those who still get butterflies at the thought of asking or answering questions, it helps to practice or role-play with a friend or coworker. When practicing with another person, keep the following interview tips in mind: Determine the time involved. The time it takes to rehearse will most likely be different than the time it takes to conduct the actual interview. Do you need to break up the interviewing session into manageable components for a specific resident? Each resident is different, and it might take longer than you planned for an elderly person to respond to a question or get to the point he or she wants to make. Familiarize yourself with the interview questions. Review the questions beforehand and determine how to make them conversational. Check facts and paraphrase. To be successful at interviewing, know how to ask the same question in more than one way. Use a mix of open and closed questions. If you ask a resident to describe his or her average day, you are asking an open question. This type of question elicits a descriptive response. The person answering the question will have to say more than yes or CTA Subscriber Services Coupon q Start my subscription to CTA immediately. Options No. of issues Cost Shipping Total q Electronic 12 issues $149 (CTAE) N/A q Print & Electronic 12 issues of each $149 (CTAPE) $24.00 Sales tax Order online at (see tax information below)* Be sure to enter source code Grand total N0001 at checkout! For discount bulk rates, call toll-free at 888/ *Tax Information Please include applicable sales tax. Electronic subscriptions are exempt. States that tax products and shipping and handling: CA, CO, CT, FL, GA, IL, IN, KY, LA, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NV, NY, OH, OK, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV. State that taxes products only: AZ. Please include $27.00 for shipping to AK, HI, or PR. Your source code: N0001 Name Title Organization Address City State ZIP Phone Fax address (Required for electronic subscriptions) q Payment enclosed. q Please bill me. q Please bill my organization using PO # q Charge my: q AmEx q MasterCard q VISA q Discover Signature (Required for authorization) Card # Expires (Your credit card bill will reflect a charge to HCPro, the publisher of CTA.) Mail to: HCPro, P.O. Box 1168, Marblehead, MA Tel: 800/ Fax: 800/ customerservice@hcpro.com Web:

4 Page 4 CNA Training Advisor February 2010 no. If you ask whether the resident had a good day yesterday, you are asking a closed question. The resident can easily respond to this with a simple yes or no. Use nonleading questions. A leading question ( Was your staff person the one who was rude to you? ) versus a nonleading question ( Did anyone treat you disrespectfully? ) might elicit different responses. If you want to elicit an honest response, ask a nonleading question. Providing less information in a question will force the interviewee to think about his or her answer before responding. For example, asking the resident whether he or she thought breakfast was unappetizing that morning is leading the resident. But if you ask the resident what he or she thought of breakfast, you will receive an honest response. Focus and stay on topic. It s easy for the interviewee to get sidetracked. The resident might reminisce about a past experience or change the subject altogether. It s best to develop techniques or key phrases to bring the conversation back to the topic at hand. Empathize. Be sure to balance listening with talking. Be real. For example, if a resident has trouble walking, don t say that you understand how he or she feels. Instead, give a more honest response, such as commenting, It looks like you might be having a more difficult time moving around, but you re still working at it! Prepare to hear the unusual. Never think you ve heard it all. React slowly. Slower responses will help you hide the shock you might feel after hearing a resident s answer. Learn to summarize for confirmation. The ability to repeat back what you just heard is an essential communication and interviewing skill. The environment Take control of the interview environment. Whether you are the interviewer or the interviewee, establishing an environment that is conducive to interviewing is essential for success. When assessing environmental factors, consider the following: Eliminate distractions. Arrange for a suitable environment with the fewest possible interruptions and the least amount of people. Location. A quiet room that is free from distractions or a space where the resident feels comfortable will start the interview off right. Privacy. Ensure privacy and confidentiality to receive the most honest responses. This includes a location where the conversation cannot be overheard by others. Lighting and sounds. Make sure the light is adequate for the resident to see your face and body. Turn off televisions and radios to prevent distractions and provide any necessary communication devices. Proximity. It s important to sit near the resident but not to invade the resident s space. There are four zones to be aware of: intimate distance (actual physical contact to 18 inches), personal distance (16 inches 4 ft.), social distance (4 12 ft.), and public distance (greater than 12 ft.). Interviews should be conducted within the limits of the personal distance zone. Closer zones may make the interviewee feel uncomfortable, and farther distances may cause the interviewee to feel disconnected. n Know your communication style There are multiple styles of communication, and it s important to know which style best describes you as well as when a particular style may best suit a situation, including interviews. Three wellknown styles of communication are as follows: Aggressive. This style of communication is helpful if you need to find an answer right away. For example, an aggressive style can be helpful during an emergency involving a resident, a fire in your facility, or when you know you re right about a situation and it s essential that others believe you. Passive. This style of communication is acceptable when an issue is minor or you are in a situation that may escalate and cause greater problems or conflict. It s also best to keep a passive style of communication in situations involving your superiors. A passive communicator will avoid conflict at all costs. Assertive. This form of communication is what everyone should strive for. An assertive communicator takes responsibility for his or her actions, which typically leads to an effective and positive outcome. This person tries to resolve conflict by finding a solution that keeps everyone happy. Editorial Board Group Publisher: Emily Sheahan Associate Group Publisher: Jamie Carmichael Associate Editor: Justin Veiga jveiga@hcpro.com CNA Training Advisor (ISSN: [print]; [online]) is published monthly by HCPro, Inc., 200 Hoods Lane, Marblehead, MA Subscription rate: $149/year; back issues are available at $15 each. Copyright 2010 HCPro, Inc. All rights reserved. Printed in the USA. 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5 February 2010 Vol. 8, No. 2 Interview Skills Mark the correct response. Name: Date: 1. is a public reflection of your attitude and will either confirm your interest or convey insincerity. a. Clothing b. Voice volume c. Body language d. Hair style 2. If a person is telling the truth, he or she will have an upright posture (leaning forward, shoulders squared, and body aligned with the interviewer). 3. An individual demonstrates truthful and cooperative communication with all of the following behaviors except. a. maintaining eye contact b. biting or tensing his or her lips c. relaxing his or her eyebrows d. tilting his or her head to the side 4. Repeating what a resident says during an interview. a. shows you are paying attention b. helps to ensure that you understood the resident c. is a sign of good listening d. all of the above 5. Successful interviewers know how to ask the same question in more than one way. 6. An open-ended question elicits a descriptive response because the resident has to say more than yes or no. 7. Prior to conducting an interview, you should. a. prepare to hear the unusual b. familiarize yourself with the questions c. select an appropriate interview setting d. all of the above 8. It s best to immediately respond to shocking statements made by a resident. Slower reactions may show doubt and a lack of concern or interest. 9. When assessing environments that could be used for an interview, you should consider all of the following except. a. privacy b. lighting and sounds c. distance to restrooms d. potential for distractions 10. Interviews should be conducted in which of the four proximity zones? a. Intimate distance (actual physical contact to 18 inches) b. Personal distance (16 inches 4 ft.) c. Social distance (4 12 ft.) d. Public distance (greater than 12 ft.) A supplement to CNA Training Advisor