In this DB, after watching the video Tuesdays with Morrie (1999) by Mitch Albom, answer the following questions. Refer to the video located under INSTRUCTIONAL MATERIALS. Discuss the following prompts related to normal aging and acute and chronic co-morbid physical conditions as they relate to Morrie.• Discuss the modalities of reminiscence and life review and the significance of the life story of an elder.• What inference can you make to improve effective communication strategies for older adults with speech, language, hearing, vision, and cognitive impairment.• Identify the impact of culture and family values in providing quality care for older persons.Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.References: Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references. Words Limits Initial Post: Minimum 200 words excluding references (approximately one (1) page)

Collaboration for Change The only constant in the world of health care is change. When changes happen at health care facilities, the process can go roughly or smoothly, depending on how well the collaboration among staff is with the process. Last year at Clarion Court Skilled Nursing Facility, which is in Shakopee, MN, and part of the Vila Health network, the implementation of Healthix, a new electronic health record (EHR) system, was very bumpy for all involved, leading to serious risks to patient safety. Vila Health’s central QA office has asked you to travel to Clarion Court and talk to several staffers on both the management and patient care sides to get some perspectives on what went wrong (or right!) and what lessons can be learned for the future. First, talk to management. (3 people) Stephen Silva Administrator, Clarion Court OK. I understand why you’re here, and I don’t want to be uncooperative. But I want you to keep something in mind as you talk to everyone here: this situation happened because of problems upstream in the Vila Health network. If we were allowed more autonomy at the facility level, this wouldn’t have gone so roughly. What do I mean? Well, the pressure from Vila Health Corporate to keep costs low and run a steady profit is intense. And I mean, I understand that this is a business. Of course! But we need to balance short-term thinking with long-term perspective. Anyway. Just day to day, it was getting clear that our old record system was being held together with duct tape and bailing wire, and we needed to upgrade. But rather than let us run our own search for the right system for our situation, we get a mandate from Corporate that if we were going to upgrade, we would need to buy Healthix, because Vila Health has an ongoing relationship with them and we’d get a deal. And: I mean, I like a deal! I need to keep costs down, so that’s great. But it’s not great to wind up with the wrong tool just because we got a deal. Healthix’s designed for hospitals and we’re a skilled nursing facility. And those are related things, but they’re not exactly the same thing. If you need to screw something together, you don’t go and buy a hammer just because they’re cheaper. But nobody at corporate would listen to me when I tried to make that point. After running roughshod on us there, corporate stomped down on us again by insisting we use an “implementation coach” that they had an existing relationship with. So we get some guy flying in from Baltimore who doesn’t know us, our staff, our needs, or anything other than how to make Healthix work in the big hospitals he usually works at. I think that was 90% of our trouble right there, this guy from the outside coming in and just refusing to listen to everybody here when we told him over and over that this or that detail just wasn’t quite right for us. People talk about staff buy-in as an important thing, and ours pretty much evaporated after the second day of that clown stomping around in here ignoring everyone’s suggestions. I’m sure you’ll hear more about this, but that’s the main thing. Excuse me, I’ve got to go on to a meeting. But remember: sometimes things go smoother if you let the people on the ground make their own decisions. ---------- Elise Wang Director of Operations I guess I’m glad someone’s asking about the EHR implementation. God, that was a nightmare. I think that ended up chewing up an entire year of my life, with different phases of rampup, and then implementation, and then, I don’t know, fallout. There were long stretches where I’d just wake up in the morning and have to force myself to get out of bed because I didn’t want to go in and deal with the day’s mess. I know Stephen’s upset with a bunch of the process stuff, how we ended up using Healthix instead of a system more suited for our facility, and so on. And he’s got a big point! But to be honest, I think the trouble was a lot more localized. We were always going to pick *some* system, and every system has its quirks. I think the whole thing was a massive, massive failure of change management. A place like this only works when there’s teamwork and collaboration. And that stuff doesn’t just happen, you have to make it work. And I was trying to lay the groundwork- I know the staff here, I know who responds to what, and I was trying to get things rolling with the kind of slow, collaborative process that we value here. But we had this abrupt, crash timeline with the corporate implementation coach coming, I think his name was Josh, and he just keeps bulldozing ahead and ignoring what people said to him, and that’s just a recipe for disaster. He irritated our IT guys when they had some concerns, and then they stopped cooperating. You know, absolute do-the-bare-minimum-required-and-nothing-further type thing, just short of a strike. And if I could kind of understand that on the human level, WOW was that unhelpful and disruptive. And pretty childish. It took Stephen calling them into his office and chewing them out for them to participate even grudgingly. But I don’t know. I could have told him that if our IT people felt shut out of a thing they’d eventually be responsible for, they’d react badly. I *did* tell him that. But he didn’t listen. We had kind of the same sort of situation with the nurses, too. But less childish in their case. They felt like the training process was leaving them unprepared and left behind, and they had to start making choices about using Healthix the right way or just taking care of patients. And they chose patients, of course, but that wasn’t good in the long run. I’m sure you’ll hear more about that from them when you start talking to them. ------------------------- Chad Cook IT Manager Hey, there. I’m happy to talk to anybody and everybody about that stinking EHR. I came so close to quitting so many times with that thing. I gotta tell you, running IT in this place isn’t a picnic in the best of times. I like my coworkers and respect the other managers, but since this is a skilled nursing facility everyone acts like IT is an afterthought. And I kind of get that- for a long time, it was! But c’mon, we’re a couple of decades into the 21st century now, and technology is core to everything! It’s like trying to have a car without brakes or something. So we’re underfunded and understaffed and overstretched to begin with. That means it takes most of our capacity to keep things running, not leaving us a ton of bandwidth for planning and for special projects. Which sucks, and is no way to run a railroad, but when I try to tell Stephen that he just sighs and says the budget is what it is. So you shrug and move on and wait for the whole thing to blow up. My gut tightened up when Stephen decreed that we were doing a new EHR, then. I could see the need, for sure. But I could also see that we didn’t have the staff to really do it right, and probably weren’t going to take the time to even try. It was just rush rush rush, boom, here’s this new system that’s getting rammed down our throats by corporate, sprinting the whole way. And then this joker from corporate swoops in to tell us what to do and how to do it, never taking a moment to listen to me or my guys if we had something to say. By the sixth round of that, yeah, we got pretty irritated, and yeah, I might have taken my guys aside and told them it’d be fine by me if they did what was specifically asked of them and not a thing more. I mean, Corporate Josh is going to ignore our knowledge from making this place work? Fine, we’ll keep that knowledge to ourselves. But you know what? Corporate Josh got to fly back to Baltimore and I had to sit here with my team and help the medical staff fight their way through the worst user interface I’ve ever seen. Had to be calm and patient when they got mad at the clunkiness and took it out on us because we were the only ones handy, even though we didn’t have any say in picking the stupid thing. Or then be the guy having Stephen yell at me that patient care is sliding because the care staff are having so much trouble with Healthix that they’re falling behind and crucial stuff isn’t getting entered and people’s medication schedules got blown. That was fun! I still get to be the guy who has to sweat through patch installations every two weeks and then go around apologizing for the bugs that pop up every. Single. Time. I guess we’ve gotten through the worst of it, and nobody died because of it, but wow was that bad. And it would have been a whole lot easier if I could have at least felt like I was defending my own decision instead of something forced on me. Next part is Care staff Shonda McCrae RN Ohhhhhhh, Healthix. I hate Healthix. I got into this line of work because I wanted to help people, not because I wanted to fight with computers. I can barely work my phone! I mean, I don’t think I’m a dumb person by any means, but we’ve all got our strengths and being good with computers isn’t one of mine. But OK, I know it’s a tool of the trade these days. I understand that. I liked the paper chart system, but I knew that we were way, way behind the times with it, and I was excited when Administrator Silva said we were getting with the times. But it just hit us like a tidal wave! No time to talk about what we needed, no time to figure out what was best for us! Just this burst of workers showing up to install computers in all the rooms—and boy did that cause a mess, playing some kind of shell game with our patients from room to room—and then a couple hours of really half-assed training and then here we go, on our own. That “coach” they brought in, Josh Whatshisname, I tried to tell him that it takes me a while to learn how to do things on computers. He just kept pushing me away and telling me that the IT folks here would always be able to help me. As if. Those guys sit around and watch YouTube videos all day and won’t get off their butts unless Administrator Silva is on the phone personally telling them to go help out. I remember the first week we were using Healthix, I kept having all kinds of trouble just logging in to the system to enter vital signs. You know, something that just takes a second with a paper chart. And should just take a second with a computerized system! But you try to log in and just get this error message saying “invalid security domain” or something like that. You re-enter your stuff, over and over, just getting more and more panicked and falling behind on your rounds! Then you get one of the IT guys to leave their YouTube to come and help you and they just shrug and have you try again for the tenth time, and then they tell you that it’s a known problem that Healthix has “trouble with authentication” sometimes. A known problem! Well that’s sure helpful! I ended up just writing vitals down on paper again and then trying to catch up and reenter it all later in the shift when there was quiet time and I could try logging in again. But that didn’t work so well, because sometimes there’s not a quiet time, and sometimes you lose the sheets of paper, and it’s just a mess. And that’s not counting the times you couldn’t see some important note about a patient that’d been left in Healthix because you couldn’t log in! We’re lucky we got through that. ----------------- Lisa Cotrone LPN I am so tired of talking about Healthix. I go home and complain about it to my husband every night. He’s sick of hearing about it. I’m sick of talking about it. But I hate it so much I can’t stop. I’m a real practical person. If there’s something I need to get done, I want to get it done by the straightest route possible. I don’t want to have to monkey around with logins and go to this screen and then that screen and go through this pull-down list and try to remember what all the new abbreivations mean that are just a little bit different from the old abbreviations. I’m not dumb. I can see why people want to use a system like Healthix. But holy cats did we do a bad job of setting it up here. After you log in, you have to click through three pages to get to the page we nurses need the most often to enter vitals and check for status notes. Why can’t we just make it so that that page is the first thing that comes up? I don’t know if that’s possible or not, because every time I suggest it, the IT guys just get huffy. I just don’t like being told that all of this is the way it is, this or the highway. Take the time to explain it to me and I’ll be a lot more on board. Especially if you sit and listen to what I have to say. You might not even agree, just make me feel like I’m part of the process, not some little kid just being told what’s what. Also: you better not tell her I said this, but I got really sick of Shonda’s cutesy oh-I-can’t-help-myself routine as we were trying to make it work. Sure, we were all frustrated, and sure that system was a stubborn mess. But suck it up and figure it out! Don’t just get all woe-is-me. I got so tired of getting yanked off of my own rounds so that I could come to her rescue. Especially when she knew that I wouldn’t be able to help her! It was tough not to feel like she just needed an audience for her little show. I guess it’s better now, but there are still a lot of little pockets of hurt feelings here and there. Of course, there always are. -------------------------- Nora Church RN Wow do I hate Healthix, and I especially hate the way we brought it in here. I was really excited when it was announced that we were installing it. It sounded great, and the list of stuff it was supposed to help us with sounded so awesome. But then once it got installed, the reality didn’t match the sales job at all! We got told this story about how our lives were going to be so easy, just entering information and having easy access to whatever we needed to see. But then we just get thrown to the wolves, barely any training. A lot of our patients have been in the system for a while, and their info is all garbled and messed up in there. And that’s if you can get to it! Once it lets you log in—which might take a while, depending on what kind of mood the system’s in—you open the system and see 20 tabs you have to pick through, and maybe three of them are actually useful to you. And then as you’re poking through, every now and then the whole thing freezes up and just gives you a spinning circle for half a minute. When you’re in with a patient, you always want to be paying attention to them! But since we’ve installed Healthix, you’re always distracted by fighting with the computer. Am I mad that management and IT here just left us hanging to figure it out on our own? You bet I am, but I’m not surprised. I’m used to that. Here’s the thing that really burns my butt: some of the nurses on staff who won’t help anyone else out. I hate to name names, but take Lisa Cotrone. She got her head above water faster than anyone else with this thing. It was still clunky for her, but she could get by. But you ask her for help and she gets all snippy at you really fast. “I figured it out, why can’t you?” is her whole approach to the world. That's not helpful, and it doesn’t really leave me full of warm feelings for the long term. I bet you heard this a lot, but I’m one more person who spent a couple of weeks carrying a little notebook with me on rounds, writing stuff down to enter later. I know a couple of patients missed meds because of that. It was a disgrace, and we’re lucky it wasn’t a full-on disaster to get us in the newspapers. ---------------------------------- Conclusion After talking to the staff at Clarion Court, take a second to think about what you’ve learned. PLEASE ANSWER THE FOLLOWING QUESTIONS BASED ON YOUR OBSERVATIONS. What are some of the ways in which staff collaboration failed in the implementation of the EHR? What could have been done differently on the management side to facilitate better collaboration? How about on the care staff side?

You will enter Sentinel City® via the link to begin your virtual experience by taking a bus tour of Sentinel City®.Sentinel City® is a city just like your neighborhood. People live there from culturally diverse backgrounds. They vary in age, gender, and income level. Nurse researchers are unable to study the entire world so they choose “groups” or populations to study that actually mirror the population of interest. Your role is to experience the city and identify the “neighborhood” or sample that would provide the best place to study-GeriatricsOnce you have identified the neighborhoods, complete an analysis of any evidence-based practice intervention that applies to one population of your choice and describe how you would implement this in the Sentinel City® neighborhood. Remember, use resources that are interprofessional, evidence-based and focus on improving health outcomes.