Thứ Năm, 5 tháng 10, 2017

Waching daily Oct 5 2017

Ken Robinson: "I work a lot in in education I have done my entire life it's where I'm from

professionally and and spiritually really about my homeless education and

for as long as I can remember I've been worried about it I was worried about it

when I was in it so that's an early start as now I remember sitting there

thinking what's this we're doing this I can't remem I went to our chat about

this recently about how I got started actually I asked myself about it I was

nobody else asked me so I asked myself it's a good I often speak to myself it's

the only way of getting somebody to agree with me frankly but no but I uh I

went to a special school they used to be called I always think about this

recently I wrote a book about a girl called the element how finding your

passion changes everything and and Terry my wife we've been together for 35 years

she said you should tell your story in the book and I said why I don't think

it's not interesting really anyway she insisted and and it turned

out to be fascinating

if I say so myself I was riveted

no but I got until I was four I was all set to Wallace my family was convinced I

was going to be a soccer player my father was anyway because I was fit

and fast and deeply attractive toward the four-year-olds anyway

and so it remained actually seven city

anyway I got polio when I was four and so that put an end to my soccer career

ready with Everton it wouldn't do now by the way I think I think I have a good

chance of making the team these days the weather going on but

if you've been watching their performance recently but any I went to

this special school hand for a few years and and I was I supposed to discovered

there by a school inspector rather wonderful man called Charles Stratford

who saw something in me I don't know and encouraged the school to take more of an

interest but the reason I mention it is I suppose I've been struck from any age

by how different we are and how deeply hidden often our talents are nor

abilities that we all have tremendous natural talents and often people don't

know them they don't recognize them and they don't develop them they and to the

extent that they don't know what their talents are they don't really know what

they can do and to the extent they don't know that they don't really know who

they are I believe I think that's true of all of

us and I felt at the time that the kids I was in the class with as well probably

we were branded in a way by a single fact it's like people get branded by

their gender or they get branded by their ethnicity or they get branded by

their religion you know there's an old grammatical device called us I call it

is I used to call it cynic dogged score synecdoche isn't it where a single item

of something is taken to represent the whole of it like in Shakespeare let's

say a mast meaning a ship and I think we'd have this kind of cynical thinking

all the time about each other we take a single facet to somebody and extrapolate

from it and believe that's the whole of them somehow it's convenient to brand

them that way while I was in school with kids who had

cerebral palsy they had asthma and the guy who sat next to me had spasticity he

couldn't hold a pen in his hand he could only hold it in his feet but he did it

beautifully actually so he had and he didn't actually have much better

handwriting than I do was it handwriting we don't know

what was that what was he doing we don't know anyway whatever it was he

was great at it and there's a guy next to me about hydrocephalus and friend

Robert all kinds of people I was saying that our classroom was like the barroom

scene from Star Wars you know they were it was that people wandering around with

bits detached and falling off him

we had a monitor for had a body parts monitor you know other scores have

people turned away that chalk we'd say just collect whatever is dropped off

with you but the thing was you see that but that it wasn't what was of interest

to any of us in the class what interested us was whether people

interesting or funny or had something to say you know whether they entertained

your engages that stuff but I felt that for a long time

I mean afterwards that that's not quite how it was seen from the outside well in

a way special education I suppose ever since has struck me as a particular

example of a much more general principle which is that we do that to everybody an

education does it to everybody one way or another we have stereotypes in our

minds about what counts as ability what cancers success what counts as normal

and we apply them everywhere they're often just built into our mental

furniture we don't even know we're doing it half the time so a lot of what I've

been arguing for are supposed to Jerry my life is for a more thoroughgoing

principle of diversity in education that human life thrives on diversity and our

education systems are modeled ironically on the principle of conformity and it's

why so many people don't do terribly well at it people who could do a lot

better a lot of people go through education never discover what they're

good at at all or conclude that they're just not good I think of this as the

other climate crisis what I mean is that we've become used to see at least I hope

we have to the idea that there is a crisis in the world's natural resources

I mean there is I think if people doubt it just wait

you might think you know it's a waiting game this then but I think there's a and

by the way that that crisis in the natural climate has been caused by us we

know that let me ask you how many people do you think have ever lived on earth

how many human beings you think they're being I mean I've been trouble diets in

the under Thals I mean modern human beings Homo sapiens yeah groovy people

like ourselves you know with with cocktail shakers and and credit cards

you know seriously how many people do you think that it's right it's estimated

that human beings emerged on the planet in our modern form about fifty thousand

years ago so how many of us you think there are

have been all together thank you very much do I hear ten gone seven billion

eight billion oh don't you get in silly no no go on how many any advance on

eight billion fifteen buddy thank you thank you so all to the gentleman well

let me tell you first off nobody knows okay

well they're done I mean it how they gonna know

no nobody's been counting you know nobody's been I was going round with a

counter to go with four more over here hang on you two separate a second no six

eight six no but what would this being so smart as a species people have been

trying to figure it out and if you google the question how many

people have ever lived you'll find that estimates by serious people with poor

social lives have have resulted in a series of estimates and the estimates

range from 60 billion to 110 billion so it's a bit of a margin so let's split

the difference let's split the difference and say maybe 80 million

maybe 80 billion people have lived in the whole of history the last 50,000

years well they're two things to say about it the first is is that of those

almost 10% of the total is on earth right now wait we are the biggest single

generation I mean everybody living I don't mean people over 30 people under

12 right I all of us this collective cohort of humanity is there almost 7

billion dollars that's more people than have ever been on the planet at the same

time in the whole of human history and we're heading for 9 billion by the mid

of the century so around 10 percent of the total for most of history there was

hardly anybody around honestly if you go back to Shakespeare's day or go back to

the high Renaissance in Florence I mean Florence it was probably about

the size of Red Deer you know it was just warmer if Florence had been

in Alberta the Renaissance would not have happened it would be it wouldn't

because nobody would have ventured outdoors or they never there they'll be

home inventing electric blankets and things like that but we are now the

population has rocketed in the past 300 years pretty much that's 250 really and

growing exponentially well there was a study done a while after a great program

by David Attenborough done recently said if the question was how many people can

live on earth how many people can the planet sustain and it came to the

following conclusion which is that if everybody on earth consumed food water

fuel at the same rate as the average person in Rwanda the earth could sustain

the maximum population of 15 billion if everybody in Earth's consumed the same

rate as the average person in North America that tells the earth could

sustain a maximum population of 1.2 billion and we're at 15 billion that's

over 7 billion and Counting and honestly the only reason we're getting away with

it is because they're putting up with it or they're not really aware of it so

what it comes to for me is this that we are living in times of revolution and

over the next 50 years will face challenges which no previous generation

of humanity's ever had to deal with and to do that we have to think differently

about ourselves and about the way we run our communities and our schools and our

education systems and our our organizations I think we should always

have thought differently about it I think if we thought differently about it

in the first place we wouldn't have so many of these problems you see I think

of this is the the other climate crisis we're creating one but we're also the

DIMMs of another which is I think of as the crisis of human resources that most

people have no real idea of what they're capable of and it it plays out in pretty

disastrous ways sometimes frig's I mean there are lots of symptoms of this now

one of them is the high levels of dropout from education now I know it

varies I'm not speaking about British Columbia now I mean I live in America

where the dropout rate is 40 percent from public schools 40 percent in public

schools I'll tell you why in a minute but you see similar figures not just in

dropout rates but in disaffection in disengagement but people who can't be

bothered you know it's suicide rates especially

among people from 15 to 20 are at historically high levels and four times

as many young men commit suicide around the world as women it's it's the fourth

largest cause of death among young people suicide

there's people checking out for whatever and everyone has their own story of

course I mean there isn't you can look at generalities but among the things

that people believe are the lack of social cohesion the breakdown of the

family unemployment few prospects and a whole suite of depressive conditions

there are six hundred and thirty 1 million young people on earth at the

moment actually between 50 nothing at 25 and of those 81 million or about 13% are

unemployed so people at the inter labor organizing stocks matters about a lost

generation you know what I'm talking about and people who who don't know what

to do that would do it themselves in America one in 31 people is in jail one

in 31 in jail are on the way to jail or leaving jail well you see

this to me is a catastrophe and you know the price we pay you mopping it all up

and trying to deal with it and it's it's it to me it need not happen I mean

everyone has their own story you know they're 80 billion of us and we all have

our own biographies and that's my point well that we all chuck chart very

different courses of course through our lives but one of the biggest infants I'm

not saying education is responsible for these things but education could be the

solution and too often I don't mean individual schools or individual

teachers or anybody in particular but systemically taking it as a whole as a

system education doesn't contribute to the solution to these problems as

thorough as it could in fact in ways that it should not it contributes to the

problem it makes it worse and that's why I want to come and talk about this

business of educating the heart and the mind um I I was born in Liverpool I

mention this because it's very ten minutes since I mentioned myself and

now you get palpitations sent you did it no I can get you badly now I was born in

Liverpool in in 1950 and my brother John Etheridge is doing our family tree it's

not much of a tree Freddie it's a kind of small shrub ready with a curious

blight they wrap around the roots but John discovered to something very

interesting to me which was that our eight great-grandparents were all born

in Liverpool in the mid 19th century within two miles of each other that's

how they met they bumped into each other that's how people used to meet the

people they spent their lives with people until Corazon led very local

lives now you might say no no no this is nonsense this is not what happened

the this was the cosmos at work in its secret ways that these eight soulmates

it was contrived coincide at the same point in the space-time continuum that

they should further the process that has led to the miracle that is me you can

you should you can say that I don't think so myself I I just think people

had lower standards then thankfully I think I think people bumped into it and

thought you'll do you know this is yeah you are not to shoddy I can spend my

life with you with that without feeling embarrassed the rest of it the reason I

say this I mean think of all the people all the people of those 80 billion over

the past fifty thousand years in the most extraordinary circumstance how many

of those people had to meet each other and dip me to each other

and procreated down the centuries in a sequence that has finally led to you to

all the different relatives ancestors who on the top of which pyramid you

currently sit all the things have had to happen the chance meetings the places

the meals there and lastly the movies and the bottles of some say you know

what the expensive chocolates in it oh and all the things that may have stopped

people meeting you know the wars the catastrophe is then that was all the

stuff that had happened before you made it

it's extraordinary Danny Lama said he said that to be born at all is a miracle

so congratulations you know you made it we made it guys you know some and what

he also said is so what are you gonna do with this life now you have it what are

you going to do with it there are many people never got the chance and here you

are so what are gonna do we're gonna do something with it or frittered away and

education is meant to be the process by which we engage people in their fullness

to give them a sense of who they are on their capability so they can lead a life

that means something to them and to the rest of this and too often it simply

doesn't and we end up with lots of remedial programs or people being half

educated or willfully pulling away from it leading to what I say I think of as

this the other climate crisis I think certainly contributing to it there are

causes for this and I think that remedy lies in the type of work we're here to

talk about this evening that we'll talk about when the Linamar air and I get

together as well but let me just sketch up what I think the problem is the

problem as I see it is in the ideology of Education what I mean is the values

and assumptions that are taken for granted the things that we don't think

about so much but which kind of calibrate our actions there are two in

particular one of them and I've talked about about it is this idea of

standardization and conformity I don't want to go on about it now but but let

me just ask you a question um well I'll make a point buddy the first sister

existed I believe that what we've developed in our education systems is

analogous to what's happening in the catering industry you know in the

catering industry there are two modes of business and two methods of quality

assurance there's the fast food business and there's like the Michelin Guide with

fast food if you've got a favorite outlet you know whichever one you go to

you know exactly what you're going to get no matter where it is you can get

the same food the same bear the same fries the same bun the same Cola or the

same chicken nuggets what are chicken nuggets my dinner what

what what are they Terran I used to live in the countryside

and we had chickens they did not have nuggets it did they didn't know if they

had them they weren't showing them I mean they were they were keeping them

out of sight I can tell you I don't do not eat chicken nose

the result is that whichever fast without let you go - you know exactly

what you're gonna get it's all horrible and bad for your health but it's

guaranteed the Vic and its tribulus the worst outbreak of diabetes and obesity

in the history of the planet but hey the the other form of quality assurance in

catering is like the Michelin Guide and that's very different they set up

criteria of excellence and they say if you meet these criteria you're in the

guide it doesn't matter what food you serve you can be an Italian French Asian

fusion doesn't matter you can all be in the guide they don't tell you what time

to open they don't tell you what uniform swear or to have uniforms were there to

serve wine or not you meet these criteria in your own way and the

consequence is under that system you get very high level restaurants with great

great stuff to eat in every type of genre and culture and they're all

different now I think what's been happening over time and education is is

becoming more and more standardized it's becoming more like the fast-food model

when it ought to be much more like the Michelin model every school should be

different and great every classroom should be different and great it should

be built on diversity and not conformity and one of the symptoms I think is

becoming more and more worrying can ask you how many of you here would consider

yourself to be baby boomers go on thank you

me too well you know how many of you if you don't mind me asking I have had your

tonsils removed there we go that's a lot isn't it how many of you here are under

the age of 30 you're amazing how many of you have had your tonsils removed

like oh no it's interesting scent as a proportion

you see our generation the Boomers routinely had our tonsils removed

didn't we when you're a kid the first sign of a sore throat so I'm going to

pants on you and take you tonsils oh they did when I was a teenager you

couldn't afford to clear your throat in public or someone would be on you and

whip your tonsils out and your adenoids and and your appendix any loose bit of

flesh they couldn't account for it's not true anything that was lying around out

it would come and it'd be stacked in the corner of the surgery for collection

later on what happened to all the tonsils

what are chicken nuggets I mean come on what are they

witness we should be told we should be told it's

a conspiracy no the thing is that then it was a false identity medical

profession people still get sore throats they still get inflamed tonsils but they

don't whip them out anymore as witness the fact people under 30 of mostly got

them they let them heal they give them but there are other ways of treating

them it was a fad just a fad know what tonsillitis

take the tonsils are people to stop up their entire sets of teeth removed

because they needed a filling that's what people did it's a it's a medical

contagion that runs through the profession our kids don't suffer from

that the kids in your classrooms they do suffer from a new false epidemic I

believe which is the plague of ADHD now I don't mean to say and I've said it

elsewhere that there is no such thing people agree they were qualified to

pronounce these things that there is a suite of conditions called ADHD what I

contest is its status as a as an epidemic and there are studies around

which support that view there's one published reason you can read about on

CNN they reckon in the United States last year maybe 900,000 children were

falsely diagnosed with ADHD often apparently if if the kids who are

youngest in the class will be diagnosed with ADHD if they're in there because

they stand out more they may have more restless energy but you know III speak

to lots of people about our speaking so many recently had a son was being

diagnosed with ADHD and then I said what does he like to do said oh he loves to

play the guitar and write songs and I said does he lose interest when he's

doing that I don't know we all sit there for hours doing that

so part of it is this obsession of conformity we now have a suite of

narcotics or drugs available which can help people stay within the barriers so

standardization is a big issue I think we should be personalizing education or

standardizing it on the basis that we're all different but there's something else

which is the heart of our academic culture our education systems have

evolved really based on many of the the intellectual principles of the European

enlightenment and that way of thinking which has many benefits and of course

has produced spectacular success in science and technology and the rest it's

nonetheless predicated on the division between intellect and feeling if you

read a lot of the architects of the Enlightenment the whole burden of it the

whole drive of the Enlightenment was to push out intuition and superstition only

reason and objective facts would do human others right about keeping

feelings away from our attempts to understand the world and that view and

we could talk a bit more about that later on has contributed to I think a

schismatic view of of human beings we have developed a view of the mind which

is based on a particular view of rationality and we've come to mistake

the mind that entity that consciously thinks with consciousness which is the

broader character of our being we can engage with the world in many other ways

than are made available through our normal systems of Education in fact the

meditation is the tradition in which the Dalai Lama Center sits and others

I'll dedicate to the proposition that there is in the sense more to us than

the conventional sense of a thinking mind a carte tolay who lived

in the city is and as a friend of ours I'm not you doing a program with them on

Saturday if you've read his book a new earth or the power of now is also

dedicates that proposition that that we can apprehend ourselves and the world

more effectively if we don't depend upon or collide our association of conscious

with this rather narrow view of the rational mind the other thing that comes

from this is a division between thinking and feeling and I've been a longtime

advocate of the Arts in education and the arts are always at the bottom of the

pecking order in schools so when cuts begin to be talked of in

education or when standardization becomes the order of the day the

hierarchy of scores becomes apparent you know maths and science the top and

languages and then the commands of the Arts get pushed further and further down

and then in the arts there's now the hierarchy music and after normally given

a better place in theatre and dance and it's partly because we've also become to

associate those other disciplines with those particular science of mathematics

with hard knowledge and the arts with a softer form of knowledge the arts for

some people are seen as being less rigorous not really knowing at all some

form of self-expression some form of recreation some form of leisure and it's

a terrible caricature of how the arts actually work and we've also in a way

disembodied our children we've become to focus on them as minds in a head rather

than as people embodied by very good example is we have two kids so far as I

know how would I know I mean listen no and

our son James is great our daughter Kate is also great our two

children who are equally great our firm one is call James when he was 16 James

asked as if he was taking some exams is skilled in England and he said he wanted

to get a Playstation a Sony Playstation and he said if I do well in the exam was

gonna get a Playstation and Terry and I said no you cannot he said but all my

friends get anything this you know for doing well in the exams we said well

great he said well you know so what's gonna be my motivation I said we'll be

thrilled we we both said Terry is much more astute on these things than I was

but pushed for this anyway we didn't bribe him but after he got his exams he

and he did well he said to us you know could I could I have a Playstation

that's like three weeks later and I said Terry I think I think we should get

anyone you know because I wanted one

I thought we should have a Playstation hey I'm starving basically the house is

not completely any so we got we got this PlayStation and I I spent an Arab says

in James's room fixing the thing up I mean this was 10 years ago

so it's fixing up this PlayStation and

and I got the thing working it I mean you would have done it without leave

probably a lot faster but I'm a dad you know sit down my boy grasshopper you

know and I what is I know so I went downstairs and Kate was in the kitchen

we lived in the countryside of time he said would you make me a swing she was

12 and so I said okay I make perhaps they were 14 and 10 so I went out and

she found this 50-foot piece of rope in the shed where we did have this apple

tree outside the door so I rigged up a swing you put a piece of wood across the

bottom and she was on the spring playing and our two later James came down to get

a drink glass of water then again and he saw

Kate outside he said what's that I said that made her a swing so he dashed out

and he spent the whole of the rest of the afternoon on the swing with Kate in

fact they spent the whole week and went on to spend most of the summer on the

swing in the garden swinging back forwards so they kind of created this

ditch underneath them destroyed the grass most apples fell off but they were

doing Star Wars set to sell a you know Paris the Caribbean 10 years before the

movie came out I think we're still no royalties for it

Harry you know they were doing they were just lost in this fantasy world and they

were exhibited by the whole thing and of course the reason was it was a physical

embodied activity which was firing up their imagination it wasn't just all

here it was a full physical embodied experience and I just find it

fascinating turn I was saying it's interesting is because I think I think

if we'd said to James in the June you know James if you do really well in your

exams you can have that piece of old rope in the shed you know I'm not sure

it would it be the incentive he was looking for frankly but there is

something about the physicality of that type of play well there is a there are

legion reports now from every quarter about emotional dysfunction daniel

goleman you know wrote famously the book

emotional intelligence there was a book written actually 1974 by a guy called

Robert Witkin which had a title with the same meaning but it was expressed

differently he called his book the intelligence of feeling and he begins it

by saying in a de cartes thing that I think therefore I am

which is a contestable argument right there but wicken said perhaps we would

be better saying I feel therefore I am that we are above all feeling organisms

we are organic but he makes a very interesting point at the beginning of

the book which is an obvious another point but he says that and he speaks in

a long tradition in saying is that we all live in in two worlds there is a

world that exists that existed before you existed and we're all being well it

would exist after you have ceased to be because in the end we're not here for

long you know in terms of the history of the planet the planet is four-and-a-half

billion years old and we've been here for fifty thousand years apparently if

you were to liken the whole history of the planet the lifespan of the planet

to a single year human beings appeared on the planet at one second to midnight

on the 31st of December there's a great piece on the onion recently about save

the planet you know commenting on everyone saying

we should save the planet they said don't worry about it the planet will be

fine we may go as a species the planet may decide to shrug it off and say we

tried humanity not so good

the next planetary conference don't recommend it

we gave it 50,000 years it ended in tears so the planet will continue but

his point was Robert Witkin is that there is a well that exists whether or

not we exist it's the outer world of objects and events and physicality and

of other people but he said there is also a world that exists only because

you exist it's the world that came into being when you did and will end or

change according to your beliefs when your physical being ceases to be it's

the world of your private consciousness of your own being and whereas we all

make attempts to know the outside world nobody can truthfully know the detail of

your inner world it's the world that RD Laing once said in which there's only

really one set of footprints it's your own inner world of consciousness well

what we constitute try to is to bridge these two we try to relate the one to

the other we try to often to understand ourselves in terms the other I think the

problems that have arisen in education because of our obsession with a certain

type of rationalism is that we spend a great deal of time in education now

getting children focused on the external world giving them data and information

about it and increase in that world is becoming more and more distracting and

kaleidoscopic and insistent I'm sure that is one of

the contributions to people's lack of attention now the constant flickering of

data but our education systems are remorse C turned outwards to the outer

world when what kids and all of us des we need to is time to look inward and to

dwell in that inner space where in the end we find the only things that

truthfully make sense for us and education is increasingly poor at giving

people techniques to look inward and to understand the relationship between the

two you see science if I can caricature it seems to me the primary purpose

science and I'm a great advocate for science education but the primary and

I've written a lot about the creativity of science but broadly speaking Sciences

broadly speaking the physical sciences are directed to understanding the

external world in its own terms seems to me that the enterprise of

science is explanation we're trying to figure things out and to be as objective

as we can I don't think objective means true and we might talk about that you

can be objective and wrong and the history of Sciences of people being

perfectly directive but wrong but trying to be right but people have often

believed things to be factually correct which turned out to be nonsense the role

of the Arts I think is to be self-consciously to manage this

relationship between the inner and outer world it's to and the aim of an artist

is not so much to explain their experience but to describe it to give an

account of it in objects or somehow convey that sense of perception well I

think we pay a high price for the Exile of feeling in education this remorse is

turning out and the failure to help people engage with what's within them I

believe that what identifies us as human beings above all are the powers that

flow from our deep resource of imagination to our right searched a lot

about creativity if you ask you know for the foot

most of the past fifty thousand years we have lived harmoniously with the rest of

life on earth our ancestors did in the last 300 years which is a blink of an

eye we've taken off like a rocket and are about to bring the house down around

our ears and what accounts are it or what is it that makes us so different

because here most respects were like the rest of life on earth were mortal

organic no different from them lives are short but what makes us different why

are we sitting in the building that we've made you know rather than sitting

outside while all the dogs are sitting in here you know all the lemurs and the

squirrels sitting out in meetings are we're outside in the trees trying to

figure out what to eat you know there is a difference and the difference is that

we have evolved this powerful sense of imagination the ability to bring to mind

things that aren't here and from it flow all kinds of powers like creativity and

uniquely and distinctively the power of empathy the ability to put yourself in

somebody else's position and to imagine what that might be like what happens in

all times of conflict and cruel tears we shut empathy off so that we can do

things that are unimaginable and the way we avoid that is by killing our

imaginations and making those things unimaginable in turn empathy essentially

in imagination are the things that make us human and the powers that flow from

it creativity and intuition so it seems to be we have two big challenges in

education one of them is to have a more unified conception of what it is to be a

person one that recognized that feeling and knowing are parts of the same

complex of a whole being that our feelings are forms of perception and

they're affected by what we think by our frameworks of ideas they're affected by

how well we can express ourselves and the languages we have available to do

that so part of the task graduation is to connect ourselves with ourselves and

I think that the reason suddenly people get depressed and last as they have lost

the connection with themselves they have no sense of purpose Carl Jung said this

he said in his 30 years of professional practice he said there wasn't a single

person who came to see him whose malaise he said couldn't in the

end be attributed to a loss of faith in religion now I don't think he meant and

I said he don't mean in quoting him organized religion I think the word I

would use and perhaps he would have except it would be spirituality a sense

of your spirit but he said in the end nobody either nobody either got well

without regaining a sense of spiritual connection so part of the task education

is connect ourselves with ourselves but the other great task is connected with

each other through the power of empathy through the power of intuition and

mutuality and all those things get lost in an industrialized homogenized

atomized system of Education and the price couldn't be higher and we're

paying it every day in disaffection disengagement and emotional turmoil now

I don't see education as the whole of it but we contribute to it it's the old

Marxist principle isn't it you know that part of the problem or you're part of

the solution and we have to be careful not to be part of the problem so what do

we do about it so let me cure the conversation I hope we're going to have

I think any rate there are a number of practical strategies which think about

the first is that we have to recognize that education is personal if you make

education impersonal people pull away from it or pull out of it or just

disengaged interests me that all the remedial programs in education are based

on personalized curriculum I was in a meeting in LA the week about alternative

education to get kids back into school alternative education is based on all

that was the same thing always the same thing on personalized curriculum on

close working relationships between teachers and students negotiated

programs and collaboration group work and mutual support and now member states

this meeting it's interesting that's called alternative education

because that's really education it's the alternative that's causing the problem

you know we should call all the mainstream stuff alternative education

and get on to the good stuff I feel us by there in all of what I do i

I feel I stand in a very long tradition of people who've been arguing for

something like this for a very long time you can there are precursors and

ancestor for every argument I ever think I put you know whether it's Bruner or

prj or Montessori or or Pestalozzi or freeball all in their different ways

people have been arguing for holistic approaches to education since we had

education it's just the mainstream has rocketed away

into this on these rails of conformity and I think it's time to make the

alternative into the mainstream so personalizing it is a big piece of it

and we might talk a bit about that the second is I believe we have to put the

arts back into education the arts are not only but among the prime ways in

which we negotiate our own understanding of ourselves in the world around us it's

through music and art and theatre and dance all the things that are

marginalized that we express our own unique individual humanity not just

doing them but learning about them learning about other cultures through

them and creating our own unique forms of expression in the process the arts

should be at the center of this not instead of but Foursquare alongside the

humanities and the sciences and physical education I think a school that

marginalizes the arts is not doing education they might be doing something

else some version of it but if you leave out of account one of these major areas

of human growth and development then you're not doing the job it's and I

think it's as simple as that and the final thing is that we can we are

learning more and more through studies of the brain through the fusions of

ancient method of processes about what's increasing being called mindfulness

there are practical things techniques that we can use in classrooms to get

children to focus in on themselves to create some common allies some points of

meditation some points of practice which if they became routine I think would

start to show themselves in the change

in the overall culture of Education and

we're going to be hearing some more about those in the conversation we're

about to have but those particular things seem to me

at the heart of what they're all versions of personalizing education but

the root of it to me is that they all point to a different metaphor for

education you see most of our sisters vegetation are mechanistic I think

they're kind of data-driven and and impersonal

the trouble is that human beings are not mechanisms we are organisms and schools

are like organisms too and if you create certain cultures people flourish and in

other cultures they tend to feel demeaned and to pull away so to me it's

about looking again at the nature of the culture of the school the vibrancy of

the school recognize that we're all unique individuals but that together we

create unique patterns and forms of behavior which we can change I've seen

terrible scores improve in the space of six month when a new T head teacher came

in and saw the potential to make people work differently I've seen great schools

go down for the opposite reason schools have much more freedom I think than we

often believe we do there's nothing I think in the legislation we all operate

within that says that you have to have 40-minute periods in high schools they

have to have separate subject departments how the school is wrong is

really about the leadership of the school and the collective what are the

people who work within it but there's we pay a high price of a current system but

there's a great prize in the new one there's a wonderful quote remember Anais

Nin approach she wants in the interests use an organic metaphor she said of

herself that there came a point in our own our own life in a way where she had

to be true to herself she said they came a point when the pain of remaining tight

in a bud was greater than the pain it took to blossom I thought that was

lovely but I think it's true in for all of us that very often the pain of

containing our consciousness or our failure to understand us

it's greater than the paint it would take to go on the journey to make it

happen and I think that's true in scores the pain of containing people who are

being disengaged is more than the effort it would take to reconnect with them if

we changed our metaphors and I think if we do I think as we sit here at this

point in humanity's growth and development we may be feeling that shift

I know Eckhart Tolle writes about that it but he calls he subtitles his book a

new earth the flowering of human consciousness it's again it's an organic

metaphor but I think it's true I feel a shift as I go around the world and I

think you can sense it in lots of ways the people who it's often a long

revolution but I think it's begun in front fold but if we go with it if we

understand that these things are all making and that we can remake them that

education and human life is organic and it's out of culture if we get the

culture right and I think will witness a harvest of human flourishing that will

amaze us

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Jisoo may be the BLACKPINK member popular for her small waist - AMAZING NEWS - Duration: 1:38.

Jisoo may be the BLACKPINK member popular for her small waist but it seems like Jennie is gaining a similar amount of attention! .

Recent photos of the singer revealed that she's starting to develop quite an "ant waist.

A small waistline on top of her already slender and fit figure.

…and quite muscular too! .

Many believe it may have been the results of her recent fitness regime including flying yoga.

A sensible figure for quite a charismatic lady! .

Jennies got a waist thats small and bod thats kickin.

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Patient-Centered Fall Prevention Care Planning: AHRQ Toolkit for Preventing Falls in Hospitals - Duration: 1:01:27.

Let's get started.

So, thanks everyone for joining today.

This is the sixth webinar, learning network webinar, and today just as a

reminder, to let you know, we are recording this webinar for the purposes of

preparing a summary, and also for your sharing this webinar amongst other

members of your team.

All right.

So, today's topics, first thing we'll do is just a real brief overview of some

of the housekeeping items related to using the webinar features.

I'll briefly update you on where we are with some of the upcoming webinar

topics.

And then the bulk of our presentation today is going to be presented by Patty

Dykes, and she is going to be talking about fall prevention care planning and

patient engagement.

And then we'll end with open questions and discussion, and we hope you guys, you

know, will feel free and comfortable to ask questions or use the chat feature,

raise your hand, et cetera.

So, in terms of the housekeeping, just as a reminder, and we've sent out a tip

sheet for you all, just to kind of -- you know, that you can have on hand to

refamiliarize yourself with some of the tools.

If you have a question, a burning question that you would like to ask, we ask

that you use the hand feature that is in the right-hand panel of the WebEx

window sort of towards the bottom of the list of names.

If you click on that, it will indicate that you are interested in asking a

question.

And then we can call on you, unmute you, or you can unmute yourself, et cetera.

The other way that you can ask questions is to use the chat feature.

You know, we welcome you to send questions via the chat.

The one key thing you want to make sure is that you send that to "All

Participants" I believe it is, "All Participants." So, you're going to need to

scroll down that list and find all participants, unless there's a specific

person that you want to send it to.

So that's one other way that you can, you know, communicate a question to us.

The other thing I want to ask is that you please minimize background noise.

And if you have your computer speakers on and you've also dialed in, try to make

sure that you turn down the volume on your speakers, otherwise there will be

some background noise.

But you can also use the mute option on your phone.

Just remember if you ask a question, that you need to unmute it before you ask

that question.

All right.

So, with that, let me just give you a couple of updates on our webinars coming

up in the future.

So next February, in our next webinar in February, we're going to be doing a

special webinar on the topic of creating and using control charts to monitor

fall metrics.

I know that this is some of our fall cohort hospitals have been doing, and but

not everyone does it, and that's fine.

But what we'd like to do is just sort of a tutorial on that.

So this is going to be led by our QI specialists, who are going to talk about

how to use control charts as a way to monitor what your fall metrics are and how

they're changing and whether or not it's within the range of, you know, normal

variability from month to month.

And then beginning in March and going through May, our plan is to have the

hospitals -- and I'm sure you've heard about this from your QI specialist, but

the plan is to have hospitals, several hospitals each month, provide updates on

their implementation efforts, just a brief update on, you know, one or two of

the interventions that are part of your implementation action plan, talking

about what you did, why you did it, and how it's gone, any barriers, and sort of

preliminary results at this point in time.

So those will be coming up March through May, and you will be working with your

QI specialists to determine which hospitals are going to go first.

So we'll only do, at most, around three each month.

So we'll be working to generate a schedule for you guys in terms of when your

presentations will be.

All right. So, with that, I would like to introduce Patricia Dykes.

Patricia Dykes is, as you all know, one of our standing expert faculty on this

project, and she was also involved in the expert panel that reviewed the AHRQ

toolkit.

So we've been really lucky to have her among the group of experts that we have

at our disposal to ask questions and engage in these kinds of webinars.

She serves as a senior nurse scientist and a research program director in the

Center of Nursing Excellence and in the Center for Patient Safety, Research,

Practice at Brigham and Women's Hospital in Boston.

And she's done a lot of research on the link between fall risk assessment with

individualized and tailored interventions to prevent patient falls in the acute

hospital setting.

And so today she's going to be talking about that, as well as strategies for

engaging patients in that process.

So, with that, I'm going to now turn it over to you, Patty.

I'm going to just move the ball down to you and let you take it over.

Okay. Thank you, Michelle.

Good afternoon everyone and thank you all for the opportunity to be part of this

important network and for the opportunity to present some of the work that our

team is doing on patient-centered fall prevention care planning.

So, as Mitchell mentioned, I am a nurse scientist at Brigham and Women's

Hospital here in Boston.

I have a joint appointment in the Center for Nursing Excellence and our Center

for Patient Safety Research and Practice.

I spend most of my time working with nurses and interdisciplinary teams to

develop and then test innovations to improve patient safety and to engage

patients and families in improving the quality and the safety of care that they

receive in our healthcare system.

And we'll be talking about some of those projects today.

So here's an overview of our program today, so we're going to talk very briefly

about the evidence related to fall prevention care planning.

I'll talk about the advantages of using an electronic health record for fall

prevention care planning, and then I'll talk about the rationale for engaging

patients in the three-step fall prevention process, and how, through our

research, we really came to a place where we really believe, if we are going to

stop all preventable falls, we do need to engage with the patients and families.

And then I'll review some tools for engaging patients and families in the

three-step fall prevention process.

So, you know, I know most of you at this point are really fall prevention

experts, so you know that most falls are preventable, and preventable falls can

be divided up into, according to Dr.

Dana Morse's work, accidental falls and anticipated physiological falls.

So, accidental falls are those falls that are caused by environmental hazards or

lapses in judgment.

We know that we can prevent these through universal precautions.

And then we have anticipated physiological falls that account for about 78

percent of preventable falls.

And these are falls that are caused by the patient's known physiological

condition.

And these are the falls that we assess for when we do a fall risk assessment.

They can be predicted using a valid and reliable fall risk assessment tool like

the Morse Fall Scale, like the stratified that identifies modifiable risk

factors, and then also to prevent falls, though, we need to -- based on those

modifiable risk factors, we need to implement interventions, and they should be

tailored to patient-specific areas of risk.

We also know that some falls are not preventable, but luckily this is a very

small percentage, about 8%.

And these falls are, you know, according to Dr.

Morse's work, called unanticipated physiological falls.

So these are caused by an unknown or an emergent medical condition.

So, for example, you're walking down the hall with a patient who has no history

of seizure disorder, they all of a sudden have a seizure and they fall.

And so you could argue that that fall was not preventable.

If you review the evidence-based literature on fall prevention you'll see that

fall prevention is really a three-step process that involves fall risk

assessment or screening, creating tailored or personalized care plan and then

consistently implementing preventative interventions, and we'll go through each

of these very quickly.

So, fall risk assessment, you know, we've gone over this again, and I've

attended several of these programs.

I presented a program on evidence-based care planning early on.

And, really, the fall risk assessment is really the foundation of our care

planning.

We have to use a reliable prospectively validated scale.

This helps us to identify patients who are at risk for anticipated physiological

falls, and then it provides the basis for our tailored

or our personalized care planning.

So, any of the assessments that we do, we can use that assessment information

to identify our plan.

And then the second step is tailored personalized care planning.

So, once we finish our assessment, we review the areas of risk that are

identified.

We select interventions to address each area of risk, and then we need to

communicate the tailored fall prevention plan to all the staff who interact with

the patient.

We also need to share the plan with the patient and his or her family members.

And so it's not enough to just develop a plan, but we want to make sure that

it's communicated.

And then the third step is that we need to consistently implement the

preventative intervention.

So, to do this, all staff should practice universal precautions for every

patient every day, and all care team members -- and we're including the patient

and the family in the care team, they need to be aware of patient-specific areas

of risk and what interventions are going to prevent that patient from falling.

So, any tool that can help nurses, patients, family, and other professionals and

care professional providers to get on the same page about the fall prevention

plan can help us to consistently carry out the three-step fall prevention

process and to prevent falls.

So we know that electronic health records can be particularly useful, because

they can reuse information that we document related to the patient assessment or

the fall risk assessment, and then the electronic system can provide clinical

decision support that can directly link each area of risk that's present in any

given patient to evidence-based interventions.

And so this can improve our efficiency, but it can also ensure that every

patient gets an evidence-based plan to mitigate their personal risk factor.

So we found, in our research on using the EHR for care planning, that usually

the EHR did improve the fall plan of care documentation.

So, for the patients where the nurses were using the electronic planning care,

we found that the fall risk status was more likely to be documented according to

the protocol.

We also found that the plans of care were much more likely to address

patient-specific areas of risk.

So they were tailored.

Unfortunately we didn't find that there were any differences related to the

documentation of completed interventions when we compared what was documented as

done on the intervention versus the control unit, and, you know, we found this

in other studies too, and I think that the take-home message is that we need to

remind nurses to document not only what they're planning but also interventions

that they also carry out, because this allows us to collect data from each phase

of the nursing process in the EHR so that we can continue to build evidence from

our practice and better understand the impact of nursing care of patient

outcomes, and in the case of fall prevention, we can understand specifically

which interventions are most effective based on individual risk profile.

So over the next few minutes I'm going to review a couple of project that our

team has done or we're currently doing to improve the likelihood that all

patients receive an evidence-based plan of care.

So, the first project, some of you might have heard about it.

I've talked about it in other venues is the Fall TIPS Project.

So that's Tailoring Intervention for Patient Safety, and this was a two-year

mixed method study that was funded by the Robert Wood Johnson foundation.

And we first conducted qualitative work because, up to this point, there wasn't

an evidence-based intervention plan that had showed us statistically significant

reduction in falls and acute care hospitals.

And so we wanted to go back to nurses, to patients who had fallen in the

hospital, to other professional and paraprofessional providers to ask, from

their perception, why they think, you know, despite all the work that we've done

in fall prevention, that hospitalized patients still fall, and then, you know,

based on their experience, what interventions do they think are not only

effective but feasible in acute care hospital settings.

And so, from the results of that work, we built a fall prevention toolkit that

we call Fall TIPS, and then we conducted a cluster randomized control trial to

test this EHR-based fall prevention toolkit to address issues that were

identified during the qualitative phase, and, ultimately, to prevent falls.

So, based on our qualitative works in the first phase, we found that

communication related to fall risk status and the plan to prevent falls is

highly variable.

So what this meant to us is that patient falls are a communication problem.

We found that nurses are consistently conducting fall risk assessment.

They're consistently developing fall prevention plans.

But the degree to which they are communicating the results of their assessments

and the tailored plans that are needed to prevent a fall to other team members,

including patients and families, was highly variable.

And this inconsistent communication was a barrier

to collaboration and teamwork.

To prevent a fall in hospitals we really need to all work together.

We also found that non-nursing team members did not always know -- they weren't

always aware that nurses were even doing fall risk assessment and that they

documented them in the medical record.

We heard physicians asking when nurses were describing their process of fall

risk assessment and care planning, physicians, physical therapists asked, "You

really document fall risk assessment every shift," or, "you really do this every

day?

Where do you document?

Can we access this information too?" So really, you know, just documenting it in

the medical record isn't enough.

We have to make sure that all team members have access to that.

And then the other issue is one of the limitations of the electronic record is

we can't rely soley on the electronic record for our documentation related to

fall risk assessment in the plan because some of the very important members of

our team, including the paraprofessionals and the patients and the families,

they don't always have access to the electronic record.

So we have to think about not only how do we document and use the advantages of

the EHR for tailoring, for making sure we get good evidence-based plans, but

then how do we communicate that information at the bedside so it's really going

to be useful?

What we found was very popular when we were doing our observation work was that

very often hospitals use these high-risk-for-falls signs.

On medical units, most patients have a high-risk-for-falls signs, and what the

nurses and the nursing assistants told us was that they weren't really very

helpful because it just became noise in the environment; that high risk for

falls doesn't tell you why the patient's at risk.

It doesn't give you any information about what you need to do for that patient

to really safely care for a patient with a high risk for falls, they very often

had to leave the room and find out what specifically they needed to do for that

patient.

So, the bottom line is that all stakeholders, that means all of our members, our

professionals, the paraprofessional members of our care team, the patients and

the families, they needed to have the right information so that they could work

together to prevent falls.

And so, based on this qualitative work, we developed the Fall TIPS toolkit.

And so, you know, I summarized on this slide the categories for our Fall TIPS

toolkit requirement.

And these are the things that we learned from the nurses, from the other

professional, paraprofessional providers about what their toolkit had to be in

order to be useful to them.

So, one of the main requirements was that we had to leverage existing workflow,

so all of the nurses and the other team members told us, "We're already working

very hard to try to prevent falls.

You need to not give us additional work but look at what we're doing and help

us learn to do it smarter." We also heard about team work and how

important that was, and that we had to help with this communication problem.

So nurses were already doing the assessment.

And in some cases, they were creating tailored plans, so we needed to be able to

make sure that every patient could get a tailored plan, and that this could be

available across team members, and then communication.

So how do we communicate the tailored plan not only to our professional

providers but also the paraprofessionals and the patient and the family at the

bedside?

How do they get that information there so that everybody knows how to safely

help the patient, and the patient knows what their role is in fall prevention?

And then tailoring, that these high-risk-for-falls signs were not useful because

they don't provide any information about what can be done for each specific

patient to prevent falls.

At the bedside, you really want to know, for this patient, you know, what do I

need to do, so there was a tailoring problem.

And then surveillance, you know, we needed to also, again, provide information,

the context of the workflow so that any staff member who is walking by a room,

if they see a patient starting to get out of bed, they need to know at a glance,

is it okay for the patient to get up, because if it is, we don't want to

restrict movement.

We want patients to be able to move around.

But if it's not safe, they need to know that too.

And so this is a screenshot of the Fall TIPS toolkit that was integrated into

the EHR, and on the left-hand side is the fall risk assessment, and on the

right, so that's the Morse Fall Scale.

And as the nurse clicks off the areas of risk on the left-hand side, the

interventions that we had learned through our focus groups to be both effective

and feasible in busy care or hospital environments automatically check off.

So, when the nurse completes a fall risk assessment, then the tailored plan

that's most likely, according to our research, to prevent a fall based on that

individual risk profile is documented.

Now we do know that, you know, we always want to apply evidence based on, you

know, what we've learned in research.

But we always want to be able to tailor based on what the nurses know about the

patient.

And so once this tailored plan is completed, the nurse can go in and further

tailor or make changes based on what that nurse knows individually about the

patient.

But once the plan is filed it generated three different tools.

So one was a fall prevention bed poster or actually it's a fall prevention

patient education tool.

And so the workflow was that when the nurse filed the assessment, instead of

going to pick up a high-risk-for-falls sign, they went to the printer, they

picked up this fall prevention plan of care that had some information about why

the patient was at risk, and which interventions needed to be done to prevent

the patient from falling.

Oh, so for some reason all my slides are not showing here.

So there were three tools.

So this is the plan of care results.

There was also a bed poster and a patient education sheet.

And so the workflow was the nurse would take the patient education sheet and the

bed poster, the nurse would explain to the patient about why they were at risk,

what the plan was, and then ask the patient if it was okay if I hang this sign

above your bed that had specific information about how to prevent the fall so

that my other colleagues will be able to help you.

So, while we can't see the sign here, it would have these same four icons.

And so anyone who walked into that would know, okay, so this person has a

history of falls.

We know these are patients that are most likely to fall again.

If the patient says to me, you know, I to go to the bathroom, you know, I don't

need to leave the room to go ask the nurse, you know, how do I help this patient

to the bathroom, can I leave them in the bathroom.

I can see that this patient needs one-person assistance; that they need their

walker to walk safely.

And I see that the patient has a bed or chair alarm icon, which means that

either the patient does not reliably call for help or they're confused.

So I know that if I walk them to the bathroom I can't leave them there.

I need to stay with them until they're finished, and then bring them back.

And so we implemented this -- or we tested this intervention on over 10,000

patients, and we found that it was very effective in reducing falls.

We saw 22% reduction in falls.

There were fewer falls in intervention units than the control units.

Patients over 65 or older benefitted most from the Fall TIPS toolkit.

We did not see any significant effect with injuries, but we weren't powered to

see that.

We had powered our study on falls, and we needed 10,000 patients to see that.

We had a little over 10,000 patients.

We needed over 80,000 patients in order to note an effect on injury.

And we did public our results in JAMA.

So what were our lessons learned from the Fall TIPS study?

So we know that, overall, the intervention was successful.

We saw a statistically significant reduction in falls.

But, you know, we started this presentation by looking at Dr.

Morse's work, which says that over 90% of falls are preventable.

And so our question was, you know, why is it that we only prevented 22%, you

know, we saw a reduction of 22%, when we know that 90% of falls are preventable.

We wondered, you know, why is it that some patients with access to the Fall TIPS

toolkit still fell.

And so we did a case controlled study, looking at the factors for patients who

were on the unit, on the intervention units, they had access to the toolkit and

they still fell, and we looked at case control, you know, control patients who

had access to the toolkit and did not fall.

And what we were wondering is, you know, did we miss interventions?

Were there interventions we should have had as part of this intervention that we

had met that we need to maybe revise the toolkit?

And so we looked very carefully at the cases and the controls, and what we

found, the main difference between patients who had fallen and patients who had

not fallen was that in patients who had fallen, the planned interventions were

not followed consistently, either by the patient or the nurse.

And most frequently it was the patient.

So, for example, the patient was supposed to only get out of bed with assistance

but maybe they got themselves up.

They, you know, didn't wait for help, or maybe they were supposed to have a

two-person assist, and there was only one person that walked into the bathroom,

and on the way, they fell, and the one person was unable to, you know, help them

in that case.

And so our question, after doing the case control study was, you know, how do we

get patients to consistently follow our fall prevention plan?

And it really convinced us, you know, the difference between that 22% and the

92%, at least some of that difference is probably related to patient engagement

and getting patients to really understand why they're at risk for falls, what

the plan is to prevent a fall, and then what their role is.

And so our next steps coming out of the Fall TIPS study was to try to develop

tools to engage patients and families more in the three-step fall prevention

process.

This slide acknowledges our team who worked on the Fall TIPS study.

And so now, over the next couple of minutes, I'm going to talk about another

study that we're doing now.

This is our Patient Safety Learning Lab, and one of the projects within it is

patient-centered fall prevention.

And in this project, we are trying to engage patients and family caregivers, as

well as acute care providers designed to implement the test of a fall prevention

toolkit.

And so with this project we're using a participatory design approach, so we are

using mixed methods.

We're using surveys and observations, semi-structured interviews, very similar

to what we did with the Fall TIPS study, we did include patients and families in

that work.

But our focus has really been on, you know, looking more carefully at, you know,

what is our current state in terms of engaging patients and families in each of

the phases of the -- or each of the steps of three steps of the fall prevention

process, so how often are patients and families actually involved in the

assessment?

Are nurses just doing it by -- in their computers, or doing it at the desk,

but not really doing an assessment and talking with the patient and reviewing

those risk factors with them before developing a plan?

So we've done a lot of observations.

We have conducted some interviews with nurses, patients, and families, and we've

also done an analysis of all the recordings that we've done of these interviews,

and through this we have identified some -- and user requirements for patient

participation in the three-step fall prevention process.

And, you know, based on the feedback that we got from this early phase, we

developed two prototypes.

One is an electronic prototype that patients could use at their bedside with

their nurse and the other is a paper, and we'll look at both of those.

So this is the electronic prototype that we started with for fall risk

assessment.

And so we had integrated this into a portal that we're using already in our

acute care environment.

And so you can see that we included, on the left-hand side here, the Morse Fall

Scale is sort of implied what these risk factors are, and then on the right side

are the icons or the interventions.

And so this is really based on, you know, the Morse Fall Scale and the Fall TIPS

work that we had done, and idea being that, you know, could we do the first fall

risk assessment with the patient and really talk about the plan and what their

role would be in that plan so that the patient would have that with them at the

bedside within the portal that they're reviewing anyway to look at their test

results, to look at their medications, et cetera.

We also developed a paper version of Fall TIPS, the idea being that not all

units have access to portals for patients.

And so we wanted to have a way of disseminating the evidence that we had to all

units in all hospitals, not just, you know, hospitals that could implement

electronic systems with patients at this point in time.

And so here, again, you can see this is really sort of the patient version of

the Morse Fall Scale, and then on the right-hand side are the interventions that

correspond with the interventions that we use in the Fall TIPS study.

And so we took these prototypes to patients, to family members.

We have a lot of patient family advisory committees here at Brigham Memorial

Women's Hospital.

We met with nurses and practice committees.

We got a lot of feedback on the tool.

And, you know, so based on the feedback from the nurses and from the faiths and

families, and also from our workflow observations, we came up -- we sort of

summarized, you know, what we learned from this process, and one is nurses lack

the awareness of evidence-based fall prevention practices and the potential

benefits of patient engagement in the three-step fall prevention process.

So, you know, we had come to the conclusion that nurses really needed education

about, you know, the benefits of engaging patients, that this was not something

that they routinely did.

We also found that patients lacked awareness about their personal fall risk

factors and interventions.

So a lot of patients would tell us, yes, my nurse told me I'm at risk for falls,

I need to call for help, or, you know, that was really the most common response.

I know I'm at risk for fall, I have to call for help.

But when they were pressed and asked, you know, what specifically, you know, put

them at risk, most patients could not tell you what their risk factors were.

We also found that nurses perceived some barriers to completing fall risk

assessment and planning at the patient bedside; that, you know, nurses have a

lot to do in the context of a shift, and completing the fall risk assessment

with the patient at the bedside takes longer.

Now you will get more accurate information but it's a change in workflow, it's a

change in practice.

And, you know, we spend a lot of time with them exploring these barriers and try

to figure out, you know, some ways to overcome the barriers.

We also found that, you know, the electronic version of the Fall TIPS that was

in -- you know, that we had originally developed, where we saw the 22% reduction

in falls, didn't adequately engage the patient and the family in the process.

So the nurse was doing the assessment but independently, and they were

developing and following the plan and then, you know, printing plan and placing

that at the patient's bedside.

But what we wanted to do with this project, and what we think we need to do, is

to push that a little bit further and say, okay, you know, the nurse, to do the

risk assessment with the patient, the patient should be involved in all three

steps.

They need to be involved in the assessment so that they really understand their

risk factors.

They need to be involved in developing this tailored plan so that they can help

us to consistently implement the plan.

Also, in this particular project, we're partnering can Montefiore Medical Center

in the Bronx, and some of the units there, as well as some of the units for the

Brigham don't have the resources for the electronic Fall TIPS solutions, and so

we wanted to make sure that we had a range of tools that could be used so that

all patients had access to this evidence and it wasn't just patients who were

fortunate enough to be in a hospital that could have an electronic system that

could provide these tailored solutions.

So, you know, based on our interviews with patients and with nurses and

families, one of the comments that we got about our original tools, our

prototypes, or the electronic prototypes that I showed, and the paper prototype,

you know, the patients didn't really like the icons.

We had developed those icons originally with nurses and paraprofessionals

because we wanted to make sure that they were understood across wide literacy

levels and had not ever validated them with patients.

And so we learned from doing our work with the nurses and the patients and the

families that we should validate the icons with patients.

We also found that the nurses perceived, you know, providing electronic tool for

patients at the bedside that this was going to be double work; that they really

didn't want to document their fall risk assessment in the electronic system and

then do it again at the bedside.

They also found the user interface unappealing.

They thought it was difficult to use.

They encouraged us to simplify it.

They encouraged us to link the Morse Falls Scale documentation that they were

already doing in their EHR to the interventions that were in the patient tools.

And then with the paper tool they felt that the visual display was too busy, it

wasn't optimized for the patient and family.

They encouraged us to simplify.

The other big issue for nurses was that, you know, with the paper tools,

remember it was completely yellow, and so while it did have the Morse Fall Scale

on the left and all of the interventions that we had used in Fall TIPS that we

knew are effective on the right, there was no way for the nurses to know

automatically which interventions went with which area of risk.

And so they told us that that was, you know, a main downfall of that tool,

because there was no guarantee that a patient was going to get an evidence-based

plan, that we needed to make it easier for them to see which interventions they

should consider for each area of risk.

And then we were also told we should develop a Spanish version, that, you know,

a good percentage of patients, and many of the patients at Montefiore Medical

Center are Spanish speakers, and that we should make sure that whatever patient

education tools we developed can be used with that population.

And so this is an example of the forms that we use.

We did validate the icons with patients.

We went through this iterative process where we, you know, we went over each

icon with patients, with family members.

They gave us feedback about what they liked, what they didn't like.

They gave us suggestions.

Some of them drew pictures for us.

And we went through a series of iterations before we ended up with the icons

that are on the right side of this page.

And so now we can look at some of the newer electronic health record designs.

So one of the requirements was, as I mentioned the nurses, wanted us to link the

Morse Fall Scale in their EHR to the patient tool, and so we are in the process

of doing that right now.

Montefiore Medical Center is also in the process of doing that in their EHR.

And so this is the later version of the patient's version of Fall TIPS, and so

when the nurse completes their fall risk assessment in the EHR it will

automatically populates the areas of risk in the plan in the patient version.

So this is based on this, it looks like this patient has all six risk factors

present and this is their plan.

So the patient can see they need to communicate recent falls.

If they click on these buttons, it gives them very specific information about

what that means.

This patient needs assistance with their IV when they walk.

This person must be on -- you know, it uses a bedpan, they have a cane for

walking.

Now the patient must be confused because they have their bed alarm on, their bed

alarm icon.

We also have a mobile app version of the patient -- the electronic Fall TIPS

tool for the patients, so, again, this one, too, will be populated with the

Morse Fall Scale.

It's done in the electronic health record, and the patient can easily review

their plan with their nurse and update it.

And the way we're trying to set this up is if they update their plan and they

have suggestions for the nurse, that that will send a message to the patient

in the EHR so that they can make changes.

And then for the paper tool, as you remember, this was the yellow one that we

started with.

And so this one, the requirements were to simplify to add clinical decision

supports so that they knew which areas of risk were matched with which

interventions and to add a Spanish version.

And so here patient has the history of falls, so we use color to communicate

which interventions went with which areas of risk so that they would know what

to consider.

We got some feedback that while this was better, it was still -- they wanted us

to use more color.

They thought that this was still a little bit confusing and hard to follow.

This is the Spanish version, which is also, though, like our English version,

you can see this has the most recent updated version of how we use the color to

communicate the clinical decision support.

So we did use full color in the boxes to make it easier for them to see which

interventions they should be considering for each area of risk, and, again, the

Morse Fall Scale on the left, all the interventions we had used on the Fall TIPS

study on the right.

So we did some usability testing with these tools with nurses.

We found that 60% more nurses told us they'd rather use the redesigned Fall TIPS

tool over the existing version, which was the yellow version.

90% of the nurses believed that the redesign Fall TIPS toolkit was easy to use

and 50% more nurses were satisfied with using the redesigned toolkit to support

fall prevention over the original version.

This is a picture of one of our nurses who is using our paper fall TIPS on one

of the clinical care units at the Brigham Women's Hospital.

So this is up on one of the medical units.

And this is me with one of the nurses and one of the RA's, Emily, who is working

on this project as well.

So these are some of the tools that we're working on right now.

In our future work, it's really, we would like to continue to apply this

user-centered sign cycle to continue to refine the suite of tools that we've

developed so far.

I've showed you electronic tools but also paper tools, and we're really trying

to look at ways that we can continue to engage patients in using these tools

through piloting.

We are hoping to expand the redesign paper Fall TIPS toolkit to partnering

institutions.

So right now, I mention we are partnering with Montefiore.

There are other hospitals that have reached out to us, and we are hoping to

continue this partnership.

We think that this is a good way to integrate evidence into practice because

it's a very simple but user-friendly tool, and we think it can really make a

difference in fall prevention if it's used widely.

And then, of course, we'll continue to evaluate our fall and fall-related injury

rates and other outcomes.

This is just a screenshot of a lot if the tools that we're working on here right

now.

The picture that's on top is a screensaver that we're working on that's going in

the patient rooms that, based on the clinical documentation of the nurse, it

shows icons that are specific to that patient, so we're hoping, you know,

instead of printing out signs we can automatically present the icons to the

nurses based on their documentation related to each individual patient.

So that's really kind of next steps for our work.

And before we stop and have a discussion, I just wanted to acknowledge our team.

So, again, this is part of the Brigham and Women's Hospital Northeastern

University Patient and Safety Learning Lab.

The fall prevention team is myself, Emily Leung, and, you know, the whole group

that I have here on the slide.

And I thank all of you for your attention and your time, and we have plenty of

time now for discussion and questions.

Thank you so much, Patty.

The research guides you guys are doing there is very interesting, so I wanted to

open this up.

I know one of the things that we had asked the hospitals to think about sort of

in, you know, the lead up to this webinar was just, you know, what are some of

the strategies that is you are using to engage patients in your fall prevention

activities.

So I just wanted to see if there were a few hospitals who -- well, before we

kind of go to that question, I'd like to see if there's anybody who has specific

questions about anything that Patty has presented, any of the tools and

resources or approaches that they're using.

So, remember, you'll need to unmute yourself if you have a question.

And, again, remember, you can type it in or you can raise your hand and let us

know.

So, any questions at this time for Patty regarding her presentation?

This is Lynn from UMAS.

I have no question at this time.

Okay.

It looks like Donna -- I cannot pronounce your last name, Donna.

Donna -- It's Guillaume.

Guillaume.

Okay.

Hi, Patty.

Thank you for this research.

This is really exciting, and I've been following your literature and I've seen

you at conferences, so I'm really excited to hear you at the webinar.

I have one question.

What we find in the organization is the engagement of the patients themselves.

Have set up a message how you begin that engagement?

Is there like a standard way of telling patients that they're at risk before you

even begin to go through the tools?

Hi, Donna.

Thank you so much for your question.

Thanks so much for participating in the webinar.

So, you know, I think part of the -- Hold on one, second, Patty.

Folks, if you could please mute your line if there's any background noise.

We have taken the mute off, but we'd like to keep the background noise to a

minimum.

Thank you.

So go ahead, Patty.

Okay.

So, I think one of the issues that we have is that I don't think we have

traditionally been engaging patients enough.

And so, you know, patients aren't used to it and nurses aren't used to it;

right, so we have to sort of bring both along and provide tools that help with

the process.

So I think, like the paper tool that we developed that I showed you, the idea

there is to, when you're admitting the patient to pull that out, it's 11 by 17,

to sit with the patient and say, you know, for every patient that comes in we do

a fall risk assessment.

I'd like to do that with you now, because we've learned that if patients

understand why they're at risk and they help us develop a plan, that it's

implemented more consistently and they're less likely to fall.

So, really, just educating the patient up front.

It's a patient education tool.

But there's no pre-engagement to getting them to use the tool.

It's really sort of jumping right in and telling them why it's important.

Now that strategy, that process, we've developed based on, you know, years of

talking to patients, talking to patient and family advisory committees about,

you know, what is the best way to do that.

How do we make sure that patients understand this is important?

How can we engage them?

And so, you know, I showed two versions of the tool.

This work has been going on for several years, and, you know, we've had many

iterations and have talked to a lot of patients and families about how to do

this, and this is the process we've arrived at.

Thank you.

So, for Donna, was part of your question, too, whether or not it's helpful in

terms of training staff and nurses on doing this engagement, having, like

scripting available, that sort of helps them introduce the engagement process?

Yes.

Okay.

All right.

I'm sorry I misunderstood your question.

It's extremely importance to provide training to the nurses.

And what we've found is that there's a couple things that they need.

So there's the engagement piece.

But they also need education about how to do the fall risk assessment.

So even though, for example, at our organization nurses are doing the fall risk

assessment every shift, we found that there was some inconsistent understanding

about how important it was to actually do the risk assessment with the patient,

because, you know, the Morse Falls Scale for example, you can't do that

accurately unless you have a conversation with the patient, and unless you

observe them for many of the areas of risk; for example, history of falls, you

need to ask the patient and the family if they've fallen, you know, within the

last three months, and based on what they tell you, you need to, you know, put

that into your plan.

So, if the patient tells you, "Oh, yes, you know, I fell last week because I got

up quickly and I started walking, and all of a sudden I collapsed," you know.

So maybe based on that that you might decide with the patient, you know, at

least in the beginning while you're here, how about if we put down one-person

assist for you to get out of bed, and you put on your light, we'll help you, and

if things change we can change the plan.

For when you're doing a gait assessment, you need to be able to

distinguish between a weak gait and an impaired gait, and you can't do that

unless you actually watch the patient walk.

And they need to be able to do that with their walking aid.

So, you know, you can't just look at what has been done previously or look up

the answers in the chart and be able to see a Morse Fall Scale.

The other one, you know, mental status, for the Morse Fall Scale, it's not just

is the patient confused, it's will they reliably call for help; right?

So you want to make sure that even patients who aren't confused, if they don't

reliably call for help and they're going to get up, you want to know.

So those are the only patients we would ever use a bed alarm on, because we need

to know when they're going to get up because they don't reliably call for help.

So that's part of the assessment.

It's very important for nurses that we have good reliability, interrelated

reliability, with nurses doing the scale, and then we want to educate nurses

about the three-step fall prevention process.

What we've found in the research about, you know, having an evidence-based

intervention like this, reducing only 22% of falls and really believing that if

we engage the patients more, if they really understand why they're at risk, if

they really understand the interventions, they can help us implement the plan.

So that does take education for the staff.

It takes modelling.

So what we have, we have a training program, so when we implement even the paper

tools, we have a training program.

It's the e-Program that we do, where we review the fall risk assessment and then

we give them case studies, and they actually complete the plan based on the case

studies, and we talk through how this would be done with the patient.

But that's an excellent question, and it does take modelling.

It's going to take time before I think we consistently incorporate this type of

patient engagement in our practice.

But it's something I think we have to do.

Thank you.

One other question.

Do you do an assessment every shift?

And if you do an assessment, do you do the same level of assessment every shift?

So, in our hospital, the policy is they do fall risk assessment every shift.

We ask that they do -- the policy for the patient tool is that they do it on

admission, that they remind -- that they check it over day with the patient,

remind the patient about it, and then only if it changes do they actually go in

-- like at the intervention change they would update.

But, otherwise, they would point to it and say, oh, remember, you know, this is

your fall risk.

So this is placed on the wall in the patient's room.

There's Velcro on the back, and so they, you know, point out what the plan is

and point out their risk factors each day so that patients are reminded.

And then when the family comes in, they use it as a teaching tool with the

family, so, yeah, we really want your mom to call for help before getting up, or

we have the bed alarm on because, you know, your mom hasn't consistently been

calling for help, and we really think she needs help to get up basically.

And if I can ask one final question, please.

For patients who are alert and oriented and not your confused patients, do you

do any contracting with those patients?

Those are the ones that you tell, you know, please call for assistance and you

walk outside the bathroom for privacy and they refuse to use the call light and

then fall?

So, you know, we don't use that here.

But I think that a tool like this is a kind of a contract.

You know, I think we had talked about contracting, actually, when we were

developing the Fall TIPS intervention, because a lot of nurses thought that that

would make a difference, and I think it would make a difference in some

patients.

But the problem is, you know, some nurses were really opposed to it.

They thought that, you know, it was, like, two heavy-handed.

And so, you know, I think if you have a process where you really are engaging

the patient with doing the risk assessment and you really are engaging them with

identifying interventions and you get agreement with them, that they'll help you

carry that out.

It's a form of contract.

You're not making them sign anything.

Right.

You are completing it with them.

It's hanging in their room.

You're reinforcing it.

It's sort of not as heavy-handed as a contract they sign, but it's the same sort

of process.

Right.

Thank you very much.

So, are there any hospitals who are on right now who actually employ other

strategies or something similar to this in engaging patients that you would be

willing to share?

I see -- This is Kate.

I have a question.

Yeah.

Yeah, this is Kate.

So we do have a fall promise.

People do not sign it, but I could actually send it to you if you want to share

it.

Sure.

And it kind of goes over some principles.

I just want to say to, Patty, loved your lecture.

Thank you.

Also, with teach back we're doing a lot of teach back, so it's not just

educating the patient and families, but actually asking them to present that

material back so they understand how it pertains to them.

What we're finding is, is you can educate.

But a lot of times they forget, so then you have to think of other ways that

you're going to deal with the situation, you know.

And then also, you can see how well they are and being able to incorporate it or

understand what it means to them.

So that's something that we're definitely doing on many things, not just fall

prevention, but medication, all of that on the teach-back method.

Right.

That's a great point.

A great way to ensure that patients actually are able to understand what you've

shared with them, is to have them tell you back in their own words what you just

went over with them.

Now one question I guess sort of along those lines, Patty, or anyone else who is

on the line, how do you deal -- I know you have a Spanish translation of your

tool for interacting with patients.

But what about patients who have limited literacy or, you know, just don't even

really understand, may have -- and, you know, obviously they're in the hospital,

they're compromised already, you know, how do you deal with different type of

patients at different places, have different levels of understanding or even

ability to communicate?

And I know you engage the patients -- I mean, the patient families.

I think for all tools you would definitely have to have it at -- I can't

remember what the term is, but, you know, a language, I think it's fourth grade

or something like that.

Level.

Yeah, there's a level that has to be for education, and I think that's what most

hospitals do.

They don't put anything out higher than that level.

Yeah, with our tool, we actually do health literacy testing with patients.

So, for example, with our paper tool, we actually tested the icons, and then

also the simple text that we put with them to make sure that patients actually

understood what they meant.

Now you encounter -- what do you do in situations where a patient doesn't speak

English or Spanish?

Do you have to bring in a translator to engage in those conversations?

Yes.

And we have that available for, really, any language.

So if there isn't a person, there's a phone number that nurses can use, and

hospitals to use it.

Right.

But we do, for translation for patients who can't understand English or Spanish.

So, again, just going back to the question about how hospitals, other hospitals

that are in this program are -- you know, what are some strategies, if anyone

would be willing to share, that you are using to work with patients?

And do the majority of the hospitals, is it sort of standard protocol that the

Morse Scale is completed with the patient, just curious from the hospitals that

are on the line.

Anyone?

No takers?

Any other questions from anyone?

Okay.

Well I think, then, we have come to the top of the hour, so I know we've gone

over in the past, so, Patty, would you mind just scrolling through to the next

slide.

I just want to, first of all, thank Patty again for her presentation.

I think the research that you are doing there is really outstanding, and if

there are any related tools that you're able to share -- I know, Patty, in your

presentation there were a couple of slides where you had animation and several

of the shots didn't come through.

I guess, if it's okay with you, I'd like to be able to share those missing

slides with the other -- with the hospitals so that they can get a visual of

those things that you were describing.

Yeah, I agree.

I missed them myself.

Right.

Well it was the animation that didn't come through in the presentation.

But, so, we can share that, you know, with the hospitals so they have an

opportunity to see it.

And then certainly if there's any additional information you want to share about

the Fall TIPS that we circulate to the hospitals, that would be great.

But thank you so much for taking time today to do this webinar.

And I just want to remind everyone that next month we're going to be doing a

webinar on "Creating and Using Control Charts to Monitor Your Fall Metrics" over

periods of time, and also, just one last reminder, please complete the webinar

evaluation form that is available as you exit the webinar today.

And thank you all again for coming, and I hope that you found the information

valuable.

So, thank you so much, Patty.

Thank you, Michelle.

Thank you everyone.

Bye.

Bye.

Bye everyone.

Bye.

Thank you so much.

Falls Prevention Hospital Learning Network Webinar 6 - Patient-Centered Fall

Prevention Care Planning 1

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For the brave - Honor - Duration: 1:55.

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A few months after experiencing

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I did my regular tests every year and

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crystal images to plot her treatment plot, allowing radiation

to be safely given in that space and eliminating her discomfort

during the procedure. This approach targets the cancer more accurately,

spares healthy surrounding tissue from radiation exposure

and cuts and 8 hour procedure down to just 2.5.

Doctor Ananth Ravi and Dr. Eric Leung led her brachytherapy team.

So that's just paradigm shifting now that we can see

what we're doing. We know can then say for this particular patient

we're going to design just for her the perfect dose distribution.

Patients have better outcomes with this technique and lower side effects so

it's very exciting for us.

Kasia says the experience of having the procedure done in the traditional and now

new way, was like night and day. When I went into the operating room

I was obviously put under and then I woke up and everything was

done, so there was none of that waiting around and the discomfort.

I could just get back to my son and I was definitely more alert

and it was a much more pleasant experience, that's for sure.

The hope is to now

treat more women, up to several dozen cases of gynecological cancer

here, every year. With Sunnyview, I'm Monica Matys.

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