Cardiovascular Disease in Australian Women: A Case Study of Jan

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INTRODUCTION
The given case study is about Jan, 42 years old women living in remote and rural areas of
Queensland in Australia. Jan is a divorced single mother of two teenage children and is
currently unemployed. Her basic necessities are addressed through unemployment financial
benefits and she is lately been suffering from severe stress due to her social, financial and
physical state. She has high BP and a positive family history of Cardiovascular disease
(CVD). So, the doctor has referred her to the community nurse for further support and risk
management for the disease. This essay is aimed at discussing the impact of the development
of CVD on Australian women. Further, the social and behavioural determinants of health that
enhances the risk of Jan to develop CVD would be discussed along with depicting the
appropriate motivational interviewing strategies for supporting her.
IMPACT OF CARDIOVASCULAR DISEASE IN AUSTRALIAN WOMEN
Cardiovascular disease is the disease caused due to insufficient blood flow to heart vessels
that in turn damages the heart muscles (Worrall‐Carter et al., 2011). It is a collective term for
heart diseases such as stroke and myocardial infarction and is characterized by severe chest
pain, radiating arm and jaw pain, tightness in the chest, sweating, angina, stroke, cardiac
attack and other disorders (Franklin, Brinks & Friedman., 2013). CVD is considered to be the
topmost cause of deaths in Australia and exert a major impact on women (AIHW, 2019).
Among Australian women, coronary heart disease, stroke and other cardiac diseases are the
leading causes of death. Data suggests that nearly two million women filled 36.5 million
prescriptions for CVD medicine in 2008 and out of these two million, nearly 226000 women
have had CHD, 170,000 had suffered from stroke and nearly 180,000 women had heart
failure (AIHW, 2019). The numbers are quite significant indicating the severity of CVD
prevalence in Australia. Moreover, AIHW (2019) suggests that 5% of all hospitalizations of
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women in Australia are due to CVD as reported in 2006-07. But the major issue is this
condition is less researched and less recognized. Currently, heart diseases have become so
prevalent that it is taking lives of almost 22 women a day which is thrice than that due to
breast cancer (Heart Foundation, 2018).
Poor diet, lack of physical activity, increased prevalence of type 2 diabetes and hypertension,
alcoholism and smoking etc. are found to be major risk factors of CVD (Heart Foundation.
2018). Genetically also the disease is inherited and prevalent in many individuals. Jan is
having a family history of CVD, is reported to have high BP, consume a high salt diet, drinks
high sugar containing cold drinks and is suffering from major stress. All these factors along
with her age make her highly vulnerable for CVD and thus, immediate actions are required to
modify these factors and prevent the disease.
SOCIAL DETERMINANTS OF HEALTH
The social determinants of health are defined as the social conditions in which people are
born, live, grow and age and that influence their health and wellbeing (WHO, 2019). Factors
such as employment status, education level, financial and social status, social environments
and physical environment are certain essential social determinants of health (Allen, Balfour,
Bell and Marmot, 2014). Development of CVD is also affected by several social determinants
such as high-income people with better financial status are reported to have more incidences
of CVD and people with a busy schedule who rely more on take away foods also develop
CVD readily (Dorner et al. 2013). Further, educated people with increased awareness and
knowledge suffer less from CVD. Jan's social determinants are that she is an unemployed
single mother who is recently divorced and lives in a rural remote area. Additionally, she has
a family history of heart disease and major stress in her life.
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The geographic area where Jan lives is one of the essential factors influencing her health as
rural areas have limited access to health services and thus, exerts a negative impact on overall
health (Allen et al. 2014). People have less awareness and less motivation towards healthy
lifestyle habits that make them prone to develop heart diseases (Kreatsoulas & Anand, 2010).
In addition, she is recently divorced with two teenage children and is not having any job
which exerts a negative impact on her mental health and gives her high stress. Psychological
stress is found to be one of the essential risk factors for CVD and is closely related to rising
disease incidences (Thornton et al., 2016). Jan is already having a genetic predisposition,
over that presence of these social factors would increase her chances to develop CVD
manifold. Thus, these factors need immediate attention and action and must be modified.
BEHAVIOURAL DETERMINANTS OF HEALTH
Behavioural determinants of health are defined as the individual’s perception and actions
related to their own health and wellbeing (WHO, 2019). These are the modifiable risk factors
such as nutrition, alcohol consumption, physical exercise, tobacco smoking and drug usage.
The behavioural determinants of Jan are high dietary salt intake, consumption of high sugar
drinks and lack of physical activity. (Allen et al., 2013). Jan consumes high salt diet and of 3
to 4 colas per day. O'donnell et al (2012) have depicted that high salt is considered as a
major risk factor for high blood pressure and consumption of sugary aerated drinks further
increase the risk of metabolic disorders. Several studies have proved the direct link of high
sugar and salt in the diet to the development of cardiac disorders. Further, WHO recommends
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reducing or controlling the dietary intake of salt for the people at risk of CVD. As per the
Australian Dietary Guidelines, Jan should plan her diet and reduce her daily dietary intake of
salt. Lack of physical activity is another aspect that increases the risk of CVD. Reduced
physical activity decreases the body's metabolism and causes accumulation of fat. Lack of
exercise also causes blood vessels and arteries to narrow due to fat accumulation. Thus, the
chances of heart diseases increase manifold. Jan is fond of walking but is not well motivated
towards it. Further, her stressful mental state does not motivate her to be physically active.
Myers et al (2015), stated that physical activity is associated with reduced risk of CVD and
better heart health for the individual. According to this evidence, Jan should be educated and
motivated to improve her lifestyle by including physical activity in her routine and improve
her diet to prevent the development of fatal CVD.
MOTIVATIONAL INTERVIEWING
Supporting the patient while providing better care is the aim of nursing individual and this is
done through motivational interviewing in Jan’s case. Motivational interviewing is referred to
a set of techniques and styles for interacting with people that motivated them to adopt better
lifestyle choices (Arkowitz et al., 2015). It is considered a highly beneficial technique to
reduce the risk of the development of diseases and maintain a healthy lifestyle. The four
principles of motivational interviewing include "engage", “focus”, “evoke” and “plan”
(Arkowitz et al., 2015)Engaging is about establishing a rapport with the client; here a nurse
needs to be compassionate and understanding. Focusing is the second step where the client
and the nurse focus on specific health issues where the current health condition of client
requires changes. Here the communication skills of the client and nurse have to be developed
using verbal and nonverbal techniques. The foundation skills for motivational interviewing
come into action at this point where OARS (Open-ended questions, Affirmation, Reflection
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and Summarization) is used to communicate with the patient (Resnicow & McMaster., 2012).
These skills help the nurse to ask open-ended questions to the client, use affirmative positive
statements, reflect back on the person’s response and summarize the whole conversation to
plan accordingly.
Other than these skills “PACE” is applied, explaining the core values of health and nursing
care are incorporated while interviewing the patient. PACE stands for Partnership,
Acceptance, Compassion and Evocation (Resnicow & McMaster., 2012). Motivational
interviewing is not the technique to teach the patient what to be done but it is a process of
communicating with the patient including compassion and empathy to modify their behaviour
for our health. These fundamental skills of PACE and OARS applied with the core principles
of MI will be applied while counselling or interviewing Jan (Resnicow & McMaster., 2012).
Her current health condition determines her risk towards developing CVD and her lifestyle
habits needs some modifications including behavioural changes towards health. Motivational
interviewing will not only help Jan understand what is right for her but will also help her to
cope with the current condition and adopt better living habits to enhance her health and
reduce the risks towards developing a disease such as CVD.MI will also help in reducing her
stress levels that are up due to her current condition and employment status.
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CONCLUSION
Health determinants are the factors that influence an individual's health and in a given case,
the social and behavioural determinants are affecting the health and wellbeing of the Jan.
Australian women are at high risk of CVD and this condition has become the leading killer of
women in Australia. thus, The overall evaluation concluded some lifestyle modifications will
help Jan to reduce her risks towards developing cardiovascular disease and the health care
professional will help her to manage her lifestyle.
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REFERENCES
 Allen, J., Balfour, R., Bell, R. and Marmot, M., (2014). Social determinants of mental
health. International review of psychiatry, 26(4), pp.392-407.
 Arkowitz, H., Miller, W. R., & Rollnick, S. (Eds.). (2015). Motivational interviewing
in the treatment of psychological problems. Guilford Publications.
 Australian Institute of Health and Welfare (AIHW) (2010). Women and heart
disease: cardiovascular profile of women in Australia. Retrieved from
(https://www.aihw.gov.au/reports/men-women/women-heart-disease-cardiovascular-
profile/contents/table-of-contents)
 Australian Institute of Health and Welfare (AIHW) (2019). Death from cardiovascular
disease. Retrieved from (https://www.aihw.gov.au/reports/heart-stroke-vascular-
disease/cardiovascular-health-compendium/contents/deaths-from-cardiovascular-
disease)
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 Dorner, T. E., Stronegger, W. J., Hoffmann, K., Stein, K. V., & Niederkrotenthaler, T.
(2013). Socio-economic determinants of health behaviours across age groups: results
of a cross-sectional survey. Wiener klinische Wochenschrift, 125(9-10), 261-269.
 Franklin, B. A., Brinks, J., & Friedman, H. (2013). Foundational Factors for
Cardiovascular Disease: Behavior change as a first-line preventive
strategy. Circulation, 128, 2169-2176.
 Heart Foundation (2018). Heart Disease in Australia. Retrieved from
(https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia)
 Kreatsoulas, C., & Anand, S. S. (2010). The impact of social determinants on
cardiovascular disease. Canadian Journal of Cardiology, 26, 8C-13C.
 Myers, J., McAuley, P., Lavie, C. J., Despres, J. P., Arena, R., & Kokkinos, P. (2015).
Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk:
their independent and interwoven importance to health status. Progress in
cardiovascular diseases, 57(4), 306-314.
 O'donnell, M. J., Mente, A., Smyth, A., & Yusuf, S. (2012). Salt intake and
cardiovascular disease: why are the data inconsistent?. European heart
journal, 34(14), 1034-1040.
 Resnicow, K., & McMaster, F. (2012). Motivational Interviewing: moving from why
to how with autonomy support. International Journal of Behavioral Nutrition and
Physical Activity, 9(1), 19.
 Thornton, R. L., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., &
Williams, D. R. (2016). Evaluating strategies for reducing health disparities by
addressing the social determinants of health. Health Affairs, 35(8), 1416-1423.
 WHO. (2019). Social Determinants of Health. Retrieved from
https://www.who.int/social_determinants/en/
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 World Health Organization (WHO) (2018). Health promotion, The Ottawa Charter
for Health Promotion, Retrieved from
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
 Worrall‐Carter, L., Ski, C., Scruth, E., Campbell, M., & Page, K. (2011). Systematic
review of cardiovascular disease in women: assessing the risk. Nursing & health
sciences, 13(4), 529-535.
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