Discuss about the Cardiovascular Diseases in Australian Women for CVD.
Cardiovascular disease also referred to as heart disease is among the leading causes of mortality in Australia. The National Heart Foundation indicates that heart disease leads to more deaths in women as compared to their male counterparts. There are different risk factors that are more particular for women in regard to heart disease. These include lack of physical exercise, being post-menopausal, family stress for single mothers, excess intake of fatty food, and high salt intake among others (Cho 2016). Social determinants that influence the risk of acquiring heart disease include; coming from disadvantage areas and being indigenous Australian, having a family history of the disease, and minimal social amenities within one’s residential areas for exercising and finding immediate medical attention (Zeigler, 2016). Registered Nurses need to use tailor-made motivational interviewing principles in order to help women take up personalized approaches to reduce the risk of heart disease. The following discussion outline the impacts of CVD on Australian women, the social and behavioral risk factors, and the principles of motivational interviewing for Jan, a client who is at risk of acquiring heart disease.
CVD impacts negatively on Australian women. The first impact of CVD in Australian women is that it leads as a cause of premature death. According to National Heart Foundation about 45,392 deaths in Australia in the year 2015 was caused by heart disease (Kay et al, 2017). This means that in each 12 minute, Australia records one death as a result of CVD. Therefore, the year 2015 experienced 30% of deaths resulting from CVD in Australia. More specifically, 27% of male deaths and 30% of female deaths in the same year resulted from CVD (Kay et al, 2017). It is thus clear that Australian women are more likely to die from CVD than their male counterparts. While Australian males suffer twice the number of heart attacks, their female counterparts are a higher chance of dying from them. More women also die from stroke as compared to men.
Secondly, CVD being a major cause of death in Australia, it is costly in terms of treatment. The National Health Foundation indicates that CVD accounts for about 18% of Australia’s total burden of disease. Recent research also indicates that the condition is the most expensive group of diseases to treat in Australia. Between 2008 and 2009, the CVD cost an approximate $7.47 billion to treat where more than half of this went to paying for patients who were admitted in hospital (Kay et al, 2017). It is thus expensive especially for poor indigenous communities in rural Australia.
CVD as an illness has social implications including long hospital stays and hospital separations. Between 2014 and 2015, CVD contributed to 490,000 hospitalizations in Australia. More than half of these included women (Kay et al, 2017). The long stays in hospitals and the separations from families for hospitalization negatively impact on families both emotionally and psychologically. The National Heart Foundation indicates that there was an increase of hospital separations from 2004 to 2015 by 8% (Kay et al, 2017). Understanding the role of women in homes especially among indigenous Australians who live in families, it is clear that their families suffer emotionally while bearing the burden of responsibilities.
Different social determinants influence the risk of CVD among women in Australia. One of these include gender as indicated above that women are at a higher risk of developing and even dying from CVD as compared to men in Australia. This is because there are higher chances of a woman at post-menopausal age to develop CVD due to deteriorated levels of estrogen production (Kay et al, 2017). Further, women like Jan, are more likely to be obese due to inadequate physical exercise as compared to men and this increases their risk to CVD. This is the reason why while twice the number of men gets heart attacks; more women actually die from it than men.
Secondly according to Vaccarino & Bremner (2017), having a family history of CVD as is the case for Jan puts one at risk of developing CVD. Studies indicate that parents who have heart disease are most likely to have children with the condition. Even so, the older one gets, the higher the risk of the condition (Zeigler, 2016). Therefore Jan having had a mother with CVD, she is most likely going to develop the disease if she does not reduce the risk factors.
Another social risk factor is poverty and a lack of access to proper health care. According to the National Heart Foundation, women who come from the most disadvantaged regions of Australia have 29% death rates due to CVD, above other women who come from least disadvantaged regions (Vissers et al, 2016). Women from rural areas are exposed to more risk factors as they have no facilities to exercise, carry out regular health check-ups and participate in their own healthcare. This is the case for Jan, who is in rural Queensland with limited access to counseling and/or facilities for exercise as could be the case for those in urban areas (Vissers et al, 2016). Further, women who are Aboriginal and/or Torres Strait Islanders are at a higher risk of CVD than their non-indigenous counterparts. They are also more likely to have higher diabetes and obesity rates. Jan is thus at a higher risk of acquiring CVD, as she comes from the rural areas where healthcare services are poorer as compared to those in urban areas.
There are several behavioral risk factors that Jan in the case study faces, which can make her develop cardiovascular diseases. Unhealthy diet is one of the major behavioral factors contributing to development of cardiovascular diseases (Alley et al, 2017). Diets which are highly saturated with cholesterol, fats and trans-facts bring about heart disease including related conditions like atherosclerosis. Studies also indicate that foods with too much salt lead to hypertension. From the case study, it is clear that Jan is likely to develop cardiovascular diseases due to her consumption of food with excess salt. High sugar intake is risky as it leads to obesity and high insulin levels. This leads to insulin resistance, a precedence of diabetes and eventually CVD (Chockalingam et al, 2016). Jan drinks 4 to 5 full-sugar Cola drink daily and this puts her at risk of CVD in the long-term.
Lack of physical exercise also puts one at the risk of CVD. This is because it increases the likelihood of obesity, hypertension and diabetes, which are major contributors to CVD causation (Wise, 2014). From the case study, Jan has opted to avoid walking exercises and considering that she likes cooking and eating, she is likely to be obese in the short-run. Inadequate exercise means that excess fats and cholesterol are not broken down and can end up blocking arteries including coronary arteries to cause heart attacks.
Stress as a behavioral aspect also contributes to the development of heart disease. From the case study, Jan is stressed as she is currently unemployed single mother who separated with her husband recently. She is apparently worried about how she will manage to care for her 13 and 15-year old children single-handedly. Stress puts one at a higher risk of getting strokes and/or heart attacks (Bartrop, 2017). Anxiety and depression that comes with stressful events are major behavioral risk factors as well.
The first principle I will use, is expressing empathy while avoiding arguments with the client (Miller, 2015). In order to discuss about exercising for instance, I will tell Jan “I honestly understand that it must been hard for you being a mother to exercise so as to maintain a healthy in the recent past. A lot of my patients have also reported of this difficulty. Even so, I think it remains imperative for us to attempt to find how you can work on this. Jan, what do you think can make you eat less but exercise more?” From this discussion, the patient will understand that as the nurse I am empathetic but at the same time she will give out direct answers without arguments.
Secondly, development of discrepancies where nurse and/or physician helps a patient to understand the variation between their behavior and their goals is paramount (Schumacher, 2013). This will enable the patient to strive to take part in their own care. In this case for instance, I would tell Jan “You just informed me that you want to feel better, reduce the risk of CVD having a family history of the same, and reduce the potential amount you might use for CVD medication. I believe you understand that exercising, avoiding depression, maintaining proper diet and losing weight would be of good help in preventing CVD. Jan, what are the reasons you think make it hard to find sufficient time for yourself to exercise and practice these healthy behavior?” The patient can then compare her health goals and the direction she wants to take in preventing CVD in future.
Further, there is need for a nurse and/or physician to approach the patient with resistance and then provide a feedback that is personalized (Schumacher, 2013). When the patient expresses the reasons as to why they cannot achieve their goals, it is important a nurse and/or physician to assist them find successful ways. For instance I will tell Jan “I am aware that you are tired from taking your routine walking exercise, is it possible for you to create time to resume this?” This will help the patient consider revisiting and working on her health goals.
Summary and Conclusion
CVD stands as the major cause of mortality in most industrialized countries including Australia. Even so, it contributes to more deaths in women than in men in Australia. The above discussion outlines the impacts of CVD on Australian women including death, high cost of the disease burden, hospitalization and emotional problems to families. The discussion also highlights the social and behavioral determinants of CVD including gender, family history of disease, social amenities, physical exercise, and dieting, high stress levels among others. Further, the discussion provides different motivational interviewing principles that are appropriate for handling Jan the patient in the case study. These principles include the need to; be empathetic but minimize arguments with the patient, create discrepancies between the patients’ health goals and their current behavior and further; approaching the patient with resistance yet providing them with feedback that is tailor-made for them.
References
Alley, S., Duncan, M., Schoeppe, S., Rebar, A., & Vandelanotte, C. (2017). 8-year trends in physical activity, nutrition, TV viewing time, smoking, alcohol and BMI: A comparison of younger and older Queensland adults. PLOS ONE, 12(3), e0172510. https://dx.doi.org/10.1371/journal.pone.0172510
Bartrop, R. (2017). Cardiovascular risk following widowhood. Coronary Artery Disease, 28(2), 93-94. https://dx.doi.org/10.1097/mca.0000000000000446
Cho, K. (2016). Women, Stress and Heart Health: Mindfulness-Based Stress Reduction and Cardiovascular Disease. Kosin Medical Journal, 31(2), 103. https://dx.doi.org/10.7180/kmj.2016.31.2.103
Chockalingam, P., Vinayagam, N., Vani, N., & Chockalingam, V. (2016). PM084 Modifying Behavioral Risk Factors: A Key Component in Coronary Heart Disease Prevention. Global Heart, 11(2), e84. https://dx.doi.org/10.1016/j.gheart.2016.03.290
Kay, S., Scalia, G., Seco, M., Vallely, M., Celermajer, D., & on behalf of the Board of Structural Heart Disease Australia. (2017). Structural Heart Disease Australia (SHDA). Heart, Lung And Circulation. https://dx.doi.org/10.1016/j.hlc.2017.04.003
Miller, W. (2015). Celebrating Carl Rogers: Motivational Interviewing and the Person-Centered Approach. Motivational Interviewing: Training, Research, Implementation, Practice, 1(3), 4-6. https://dx.doi.org/10.5195/mitrip.2014.54
Mitchell, J., Donovan, R., & Straveski, B. (2014). PM350 New directions to address heart disease in Australian women. Global Heart, 9(1), e133. https://dx.doi.org/10.1016/j.gheart.2014.03.1701
Schumacher, J. (2013). Motivational Interviewing Step By Step. Motivational Interviewing: Training, Research, Implementation, Practice, 1(2), 24-25. https://dx.doi.org/10.5195/mitrip.2013.37
Vaccarino, V., & Bremner, J. (2017). Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neuroscience & Biobehavioral Reviews, 74, 297-309. https://dx.doi.org/10.1016/j.neubiorev.2016.04.023
Vissers, L., Waller, M., van der Schouw, Y., Hebert, J., Shivappa, N., Schoenaker, D., & Mishra, G. (2016). The relationship between the dietary inflammatory index and risk of total cardiovascular disease, ischemic heart disease and cerebrovascular disease: Findings from an Australian population-based prospective cohort study of women. Atherosclerosis, 253, 164-170. https://dx.doi.org/10.1016/j.atherosclerosis.2016.07.929
Wise, J. (2014). Lack of exercise outweighs obesity among heart disease risk factors, says Australian study. BMJ, 348(may08 7), g3182-g3182. https://dx.doi.org/10.1136/bmj.g3182
Zeigler, V. (2016). Women’s Heart Health: Differences in Heart Disease in Women Compared to Heart Disease in Men. International Journal Of Women’s Health And Reproduction Sciences, 4(3), 87-88. https://dx.doi.org/10.15296/ijwhr.2016.22
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