The invisible patients was eye opening and sobering. This documentary mentioned that there are approximately five million home bound adults in the US. Most of these adults are facing poverty, chronic illnesses, and some kind of hardship that impedes them from accessing the health care system. Fewer than five of them receive primary care in their homes (O’ Connor, 2016). Jessica, has been a nurse practitioner for two decades. She sees about 8 patients a day and for some of her patients she is the sole member of the healthcare system following up with them. An ethical dilemma that Jessica faced was discussing end of life with her patient Roger who was 30 years old and suffered from Duchenne muscular dystrophy. DMD is a “genetic condition that affects the muscle leading to muscle wasting that gets worse over time” (2020).
Throughout the documentary Jessica shared with Roger and his mother Shirley about the progression of this disease and the deterioration his body was experiencing, but this was not without struggle. Jessica found herself troubled at times to share with them because of his young age but also because of Roger’s eagerness to live. Roger really wanted to keep on living and at first he was not interesting in signing a DNR or in receiving palliative care. Jessica had to explain to him a few times about the risk of him receiving resuscitative measures and the damage it would cause to his already weak heart. Jessica was very upfront yet gentle with Roger and his family about where things were headed with the progression of his DMD. I would of handled the situation similarly to Jessica. Having conversations about end-of-life, palliative care, and death are not easy conversations to have, yet she had them with Roger and his family.
According to Hamric and Hanson’s type name of book here, Disruptive innovators “are described as those less expensive, that provide more convenient products and services” (Tracy et al., 2019). Jessica is a disruptive innovator because she worked for a company that offered affordable home-healthcare. This is very convenient for her patients. Most of them dealt with poverty, limited resources, and inability to travel to see a primary care physician or specialist. Most of her patients had chronic illnesses and complex medical issues, Jessica was able to aid them with most of their medical issues at a much lower rate than a physician would have. Without the help of Jessica, some of those patients would of not had medical care.
Jessica was the perfect advocate for Roger and his family. She made sure they were informed, safe, and receiving the proper resources at each stage of DMD Roger was facing. My personal beliefs and values are consistent with Jessica’s. She informed them about palliative care in order to make the end-of-life process more tolerable for Roger and his mother regardless of how uncomfortable it might have been for all three of them. A mechanism she used to overcome this barrier was knowledge and open communication. “Some ethical disputes reflect inadequate communication rather than a difference in values” (Tracy et al., 2019). Jessica could of easily chose the easier route and not informed Roger about the damage resuscitative measures could do to a person with a deteriorating body like him. She also could of stopped trying to talk to him and his mother about palliative care and the benefits of it. Knowing the needs of her patient, she suggested palliative care which provided expert assessing, planning for the needs of that specific patient, and comfort measures (Tracy et al., 2019).
Once end-of-life care is identified as a need, an adult gerontology NP can serve at a lower cost and as a first line resource in order to evaluate the individual needs of this patient, the interventions needed, and comfort knowing the client’s condition and need for palliative care, the NP can contact social services in order for services to be prepared early on and for the patient to start. One benefit of having palliative care sooner is allowing the patient to process and become more familiar with the process. Palliative care is not readily accepted by some patients because of the awareness of death this process brings. Becoming familiar with palliative care allows patients to be informed and to practice autonomy in their interventions and comfort measures.