Disruptive Innovation Transforms an Existing Market
Disruptive Innovation Transforms an Existing Market
Jessica has been a nurse practitioner for nearly two decades. She has been providing primary care services to home-bound and home-limited patients since 2013 with an organization known as MD2U in Evansville, Indiana. In viewing the documentary, The Invisible Patient, Jessica presented herself as a disruptive innovator.
According to Hamric, Hanson, Tracy, & O’Grady, “disruptive innovation transforms an existing market or creates a new market by making processes simpler and improving access” (2014). Jessica took pride in caring for individuals in the community facing challenges. In viewing the documentary, I saw many of them live in difficult situations. For many reasons, some cannot travel to see a clinician at a doctor’s office. They all had multiple chronic conditions, and all faced some form of poverty.
Jessica mentioned several times that only a handful of people are currently reviving primary health care in their homes. Jessica’s background was in renal and telemetry medicine at Yale New Haven Hospital. Before joining MD2U, she cared for the adult and geriatric population with dementia. She also spent a decade in traditional family practice before branching out.
If Jessica did not provide her services, many patients would have frequent hospital admissions or require long-term or skilled rehab services. During the documentary, Jessica displayed respect and empathy for her patients while delivering high-quality patient-centered care. Per Jessica, her services are also more cost-efficient for the patients, especially since they are on a fixed income.
The ethical dilemma that stuck with me most while watching the documentary was Jessica’s care for the 34-year male Roger Brown. He was diagnosed with muscular dystrophy at four years old. “Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscular mass” (“Muscular dystrophy,” 2018). According to “Muscular Dystrophy,” the genes are abnormal and mutate, interfering with the production of proteins needed to form healthy muscle (2018).
This disease is very common in young males. There is no cure, but medications and therapy can help manage symptoms and slow the course of the disease. The normal life expectancy is approximately twenty years; Roger exceeded this. Symptoms may include “frequent falls, waddling gait, walking on the toes, large calf muscles, muscle pain/stiffness and respiratory complications” (“Muscular dystrophy,” 2018).
The ethical dilemma faced here was informed consent, “Concerns that patients and their families have not been fully informed about there treatment or clinical prognosis is a common ethical concern for nurses” (“Muscular dystrophy,” 2018).
Patients often feel more comfortable asking a nurse to decipher what their doctor says because of comprehension, especially with end-of-life decision-making. In one part of the documentary, Jessica is faced with discussing end-of-life care with Roger and his mom due to the progression of his disease especially impacting his respiratory status.
Jessica’s conflict was Rogers’s age. Normally treating a person of his age, you would take aggressive measures. But regarding Rogers’s health, his EF is 20%, and he has fluid buildup, heart failure, kidney stones, and generalized pain.
He had multiple co-morbidities, and Jessica knew if his heart stopped beating, performing CPR to prolong his life would cause more harm to him. At first, Roger wanted to continue aggressive measures to continue his life if he could.
Jessica had to find another approach to assist Roger and his mother in understanding the progression of his disease. She helped him understand that he wasn’t getting better regardless of his treatment.
Aggressive measures and hospice/palliative care services are two different treatments. Jessica had difficulty discussing this because she knew Rogers’s time was near. She did a great job explaining to Roger and his mother what would happen once he transitioned.
Many people face difficult decisions regarding code status, hospice, and palliative care services in their lifetime. The end of life should be a smooth transition, but it is often difficult because people find it hard to accept.
One important factor that affects ethical decision-making is your belief system (Hamric, Hanson, Tracy, & O’Grady, 2014). Your life experiences may change your values Hamric, Hanson, Tracy, & O’Grady, 2014). My personal beliefs are in line with Jessica with this ethical dilemma. I feel that end-of-life patients should have pain and symptoms management.
I would also assist the patient and family through the dying and death process, so the anxiety and fear can be decreased, as Jessica did. Advocacy for the patient is key to me. Effective communication should occur for a person to give great end-of-life care appropriately.
Becoming an adult gerontology nurse practitioner, I will be the spokesperson for my patient and honor their rights and give them dignity. I will ensure my patients are informed on what advance directives and living wills are in case they ever cannot make a sound decision, and I wouldn’t want to put that burden on their loved ones.
Everyone should honor a patient’s wishes as it is not causing any harm. The tales will be eliminated through education on end-of-life, DNR, palliative care services, hospice services, and advance directives, and anxiety/fear will be decreased (Hamric, Hanson, Tracy, & O’Grady, 2014).
One mechanism to overcome barriers is recognizing patients’ needs and making
patients and families aware of additional services such as palliative care. It is for patients with life-threatening illnesses. “Patient have better quality of life and live longer and cost the health system less” with palliative care services (Perrin & Kazonowski, 2015). Barriers to palliative care consultation for patients in critical care include misunderstanding.
Some feel that palliative care undermines the focus on saving the patient’s life. Providers often have difficulty determining when critically ill patients are approaching the end of life, causing patients to die in pain.
According to Perrin & Kazonowski, palliative care is an approach that improves the quality of life of patients and their families facing problems associated with wildlife-threatening illnesses (2015). APNs can emphasize to families that symptom management care to the patient can improve a patient’s outcome.
When the dying process is detected earlier, comfort-focused treatment goals are initiated sooner. When appropriate, patients are moved to lower-intensity care sites (Perrin & Kazonowski, 2015). The length of stay in the intensive care unit decreases (Perrin & Kazonowski, 2015). The cost of care is reduced because realistic goals are established. Staff would receive support for patients and families.
The need for repeat admission could be reduced because treatment goals have been clarified. And lastly, with palliative care, the patient and families would have continuity of care with familiar faces because they would be followed from the hospital to skilled/long-term care or home.