Introduction
It is important to note that understanding the prevalence of specific diseases and their categories involves assessing their manifestations demographically. In addition, it is critical to be aware of practical implications in healthcare practice when it comes to nursing, such as leadership and challenges faced within the field. The given analysis will primarily focus on three subjects: women and cardiovascular health, nursing leadership, and nursing shortage. Cardiovascular illnesses among women involve both conventional patterns manifestations as well as sex-specific risk factors, which complicate the preventative measures.
Women and Cardiovascular Diseases
General Statistics
Cardiovascular diseases (CVDs) are among the most prominent healthcare problems of the current century. In the United States, heart disease is considered the number one cause of death for all Americans, regardless of race, gender, or ethnicity. It is reported that “about 697,000 people in the United States died from heart disease in 2020—that’s 1 in every five deaths” (CDC, 2022, para. 2). In other words, an individual dies from a cardiovascular disease every 34 seconds (CDC, 2022). Among a vast range of manifestations of the given health issue, coronary artery disease is the most prevalent one, which is responsible for half of the total deaths caused by cardiovascular problems (CDC, 2022). It should be noted that females die from heart problems at a rate of 19.5% of all total deaths compared to males, 21.6% (CDC, 2022). Thus, on average, men are more likely to suffer deadly consequences than women. The common risk factors include excessive alcohol consumption, physical inactivity, unhealthy diet, obesity, and diabetes (CDC, 2022). The provided information is applicable to all human beings, which indicates alarming statistics and the impact of CVDs on the population.
CVDs among Women: Sex-Specific Factors
However, when it comes to CVDs among women, there are a number of intricacies that require thorough consideration. It is stated that “in addition to traditional cardiovascular risk factors, understanding nontraditional risk factors specific to women, like … and menopause are central to designing personalized interventions aimed to curb the epidemic of CVD” (Manrique-Acevedo et al., 2020, p. 1210). In other words, there is a wider range of health specificities that affect women differentially in terms of the development and risk of death. A study found that “women are at higher risk of CVD when obese and insulin resistant, in particular at higher risk of developing heart failure with preserved ejection fraction and ischemic heart disease” (Manrique-Acevedo et al., 2020, p. 1210). Therefore, death rates are not the sole consequence of CVD since it additionally impairs one’s ability to live a high quality of life as well as increases the chance of dying from other causes.
On the basis of the information provided above, it is evident that women are faced with a larger number of sex-specific risk factors on top of the traditional ones. One of the most critical ones includes the reproductive physiology of the female body, such as pregnancy, which can lead to longitudinal ramifications. Research suggests that “key stages of a woman’s reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories” (O’Kelly et al., 2022, p. 652). There is a strong association between the development of CVDs later in life when women experience the absence of breastfeeding, adverse pregnancy outcomes, infertility, polycystic ovary syndrome, and late or early forms of menarche (O’Kelly et al., 2022). Many manifestations of CVDs cannot be fully explained through the lens of conventional risk factors linked to reproductive history, which means that in-depth analysis and awareness of the sex-specific risk factors are required.
Gestational Diabetes
Gestational diabetes is a form of diabetes that develops during pregnancy. A systematic review of 5,390,591 women revealed that “compared with those who did not have GDM, women with GDM had a twofold higher risk of future cardiovascular events” (Kramer et al., 2019, p. 905). In addition, the higher risk of death and development of CVDs among women with gestational diabetes is independent of the sex-nonspecific type 2 diabetes (Kramer et al., 2019). The primary reason is the fact the former impacts a woman even after a decade. She did not have any indications of the latter. In other words, while the male population is primarily faced with a set of traditional risk factors, the female population needs to deal not only with these elements but the sex-specific characteristics, such as gestational diabetes, as well.
Gestational diabetes mellitus, or GDM is a major risk factor when it comes to cardiovascular diseases and type 2 diabetes mellitus. A study found that “women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD” (Daly et al., 2018, p. e1002488). Thus, there is a cascade of health issues initiated by GDM, which results in an increased risk effect as well as chronic consequences. The implications of such observations are that “identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes” (Daly et al., 2018, p. e1002488). GDM needs to be recognized as a significant sex-specific risk element for CVD, which necessitates close monitoring of the mother’s health during the gestational period and long after it.
Menopause
Moreover, menopause is another key sex-specific risk factor for CVDs, which significantly increases the chances of developing and suffering from heart issues. It is stated that “cardiovascular disease is very common in women. It is still under-diagnosed and under-treated. Many women are not having their risk factors for cardiovascular disease properly addressed” (Newson, 2018, p. 44). Although medical science is not fully aware of how hormonal changes impact a woman’s health and vulnerability to CVDs, the data is evident about the role of estrogen in these dynamics. Another study states that “the increasing evidence supporting age at menopause onset as a marker of overall health calls for worldwide efforts to implement a standardized approach to define the age at menopause” (El Khoudary, 2020, p. 33). Despite the great importance of menopause in women’s health and CVD vulnerabilities, the issue is not properly addressed, understood, or researched.
There is a lack of data on the question of whether menopause is a cause or effect of CVD development risks. It is suggested that “there is a growing body of evidence demonstrating that VMS may be a biomarker for chronic disease … the association between VMS and a range of chronic postmenopausal conditions including CVD” (Biglia et al., 2017, p. 306). In other words, vasomotor symptoms (VMS), such as night sweats and hot flashes, can be used as indicators for the onset of a period with a greater risk for the development of CVDs. The implications of the findings are that menopausal women need to be considered as an at-risk group for more careful treatment. There is a growing need to introduce CVD preventative measures as well as treatment procedures as early as possible for menopausal women. In addition, women need to be educated about the risk associations of menopause and cardiovascular diseases in order for them to be proactive about their health and well-being.
Anemia
Among the most common extragenital pathologies in pregnant women are carbohydrate metabolism disorders and anemic syndrome. According to the World Health Organization (2021), in most cases, anemia in pregnant women is iron deficiency, and its frequency in developed countries reaches 25-30%. However, during pregnancy, a woman is aggravated by a violation of carbohydrate metabolism due to the implementation of the mechanisms of glucose-glucotoxicity and the formation of subclinical inflammation. Therefore, there is a high probability of developing anemia or chronic diseases resistant to treatment with iron preparations. The high prevalence of anemic syndrome and its heterogeneity is observed in the presence of concomitant pathology in pregnant women and possible complications. The latter includes increased perinatal mortality, fetal growth retardation, intrauterine hypoxia, neonatal asphyxia, weakness of labor, and poor blood loss tolerance (Paolillo et al., 2020). These trends make this problem relevant for studying the pathogenesis of anemia and improving the methods of its laboratory diagnosis.
Gestational diabetes mellitus is accompanied by the development of subclinical inflammation, which is more pronounced in anemia of chronic diseases than in iron deficiency anemia. It has been shown that the mechanism of the development of anemia in chronic diseases with the participation of the hepcidin protein is also realized in GDM, characterized by subclinical inflammation (Paolillo et al., 2020). It has been found that GDM aggravates the heterogeneity of the anemic syndrome during pregnancy. For example, less than half of the patients had true iron deficiency anemia, while in most women, anemia was associated with intracellular iron blockade (Paolillo et al., 2020). The obtained results indicate the importance of establishing the type of anemic syndrome in pregnant women with GDM for the purpose of effective therapeutic support for patients.
Treatment
One should be aware that there are no clear-cut solutions to gestational diabetes, but the existing treatments are effective and evidence-based. It is stated that “treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes” (American Diabetes Association, 2022, para. 2). In addition, “the treatment always includes special meal plans and scheduled physical activity, and it may also include daily blood glucose testing and insulin injections” (American Diabetes Association, 2022, para. 2). Therefore, the actions need to be taken as early as possible since the potential damage of gestational diabetes can not only hurt the mother but the baby as well. Mothers should aim to have a blood glucose level at or lower than 95 mg/dl before a meal and 140 mg/dl an hour after a meal is consumed (American Diabetes Association, 2022). Since pregnancy itself is already a complex and intricate process, there is no general treatment for the issue, which necessitates consulting with a medical professional in order to devise an individual treatment plan.
Nursing Leadership
Any major challenge requires some form of countermeasures to either curb its effects or completely prevent the manifestations of the problem. However, such actions need a coordinated and consolidated approach, which is why the role of leadership cannot be overstated. Nurses are among the few professionals who are aware of the intricacies of the healthcare processes as well as diseases, including CVDs. Nursing additionally originated and still continues to be a female-dominated field. Therefore, it is only natural that nurses are in a position of competence, relatability, and insightfulness to provide the necessary leadership when it comes to advocating, raising awareness, and fighting CVDs among women. It is important to note that healthcare quality and patient safety are highly reliant on evidence-based practice or EBP. The latter requires from a healthcare organization a capability to both sustain and implement it. Therefore, nursing professionals in leadership positions need to be able to ensure that there are specific strategic plans put in place. Nursing leaders are the ones who promote and support interprofessional teamwork. When it comes to interprofessional teams, they can be considered instrumental in improving outcomes.
Transformational Nursing Leadership
When it comes to advocacy and promotion of healthy practices to fight CVDs and other diseases affecting women, nursing leaders have several options in regard to the framework of leadership. One of the most effective and well-known leadership approaches is the transformational leadership style, which has a high degree of applicability in nursing in terms of advocacy and patient outcome improvement. A nursing leader’s ability to drive change is directly and profoundly affected by the organizational culture, which translates into how diseases are recognized, identified, treated, and prevented. Transformational leadership attempts to change the root causes of ineffective systems by inspiring and developing new methods of transformative change.
Since the nursing environment is heavily reliant on leader support and constant professional growth, transformational change is among the most suitable styles in nursing. However, the most important aspect of the transformational leadership style is the fact that it is about change at its core (Prochazka et al., 2018). In other words, the sole purpose of TL is to cause positive change leading to performance improvements, which is why it is potent and powerful at overcoming problems related to organizational culture. Therefore, the core competencies include leadership knowledge, emotional intelligence, empowerment, interpersonal relationships, and problem-solving. A study found that “organizational climate was positively related to knowledge-sharing behavior … knowledge-sharing behavior was found to affect organizational learning and to be a mediator in linking transformational leadership and organizational learning” (Kim & Park, 2017, p. 761). In other words, leadership knowledge under the transformational framework improves knowledge-sharing, which betters the organization’s climate and learning. Emotional intelligence is positively correlated with transformational leadership effectiveness (Kim & Kim, 2017). Problem-solving is an essential skill which is both improved by and necessary for the transformational leadership theory.
Interpersonal Relationships
The skill of being able to build and harness interpersonal relationships is greatly influenced by the transformational leadership theory. It is reported that “transformational leadership and interpersonal trust significantly affect innovation capability. In addition, interpersonal trust mediates the relationship between transformational leadership and innovation capability” (Hui et al., 2018, p. 1). Therefore, an effective transformational leader needs to practice his or her leadership by maximizing the use of the skill of fostering follower trust by building a meaningful relationship. A major benefit of such a dynamic between a leader and follower is an enhanced capability for innovation, which creates better competitiveness among organizations, especially businesses. In an environment of high professional demands, multitasking, and stressful work environments, the transformational leadership model focuses on meeting the needs and problems at the individual level of each member of the group, thereby emphasizing the creation and development of emotional bonds. A high share of responsibility of the leader in the process of cooperation and assistance to group members.
Empowerment
In order for nursing leaders to encourage collaboration, communication, and positive changes, it is critical to use the strategy of empowerment. In the context of CVDs affecting women and sex-specific risk factors, it is critical to utilize empowerment in order to address the sensitive and less known ramifications of cardiovascular diseases among women. The transformational leadership theory also positively influences the leadership strategy of empowerment. A study suggests that there is “the linkage between transformational leadership and work engagement is partially mediated by structural empowerment … by enabling access to information, opportunities, support, and adequate resources” (Amor et al., 2019, p. 169). In other words, being an effective transformational nursing leader is impossible without the approach of empowerment, which is a necessary ingredient in improving engagement among the followers. The given strategy is tightly tied to leadership knowledge and knowledge-sharing, where increased access to information as well as support creates positive changes in a group or organization.
Motivation
Thus, it is necessary for a nursing leader to be skillful at empowering the followers both individually and structurally to increase their involvement, motivation, and engagement within the process or task of achieving the common goal. The first and most important tool of managerial influence on human resources is motivation, or the formation of a motivational spirit in the team. Motivation helps the nursing leader to explain, convince and prove to nurses the need for changes in the organization. The motivational model is closely related to the development of nursing professionals in the organization and their self-esteem, which will be effective in cooperation with each other. A high degree of charisma in a transformational leader directly impacts nurses since, at this stage of organizational transformation, their organizational behavior changes.
Policy
Currently, nurses can actively participate in policy review by defining the most appropriate standards of practice in healthcare for CVDs. They can engage in utilizing their knowledge to shift the government’s attention to the most effective solutions within the evaluation process. In the first or former case, the most critical challenge is the need for a “commitment to developing skills and acquiring knowledge about activities that lead to change” (Weiss et al., 2019, p. 132). In other words, nurses are not directly trained to be proficient at proposing policy standards, which is why they might be faced with communication or conceptual barriers when defining the most appropriate standards of practice.
However, the given opportunity is essential for nursing professionals because it can be addressed by improving the quality of CVD care delivered to female patients and illuminating the problematic areas that are not well-known among policymakers or doctors. In the case of the second option, the challenge is that “you may find that you’re not even aware of an issue until it’s in a state of legislation, regulation, design, and implementation, or evaluation” (Weiss et al., 2019, p. 157). However, they can be overcome by focusing on the matters which have to be voiced and addressed with subsequent evaluation of whether or not these suggestions can be integrated at the current stage. The first strategy to better advocate for or communicate the existence of these opportunities is to directly contact the key managers and policymakers. For example, the Department of Health and Human Services can be contacted to find the key figures. The second strategy is to a healthcare institution’s resources, such as chief managers’ contacts and connections.
The Impact of Nursing Shortage
Shortage of Nurses
It should be noted that the nursing shortage is among the most prominent problems in the healthcare system of the United States. Nursing professionals carry out highly critical tasks, and they are primary and direct providers of healthcare services to the people. In other words, their interactions with patients are points of contact where healthcare meets the needs of the population. The issue was massively impacted by the COVID-19 pandemic in a negative manner since hospitals became overcrowded and overwhelmed by infected individuals. When it comes to an understanding the implications of nursing shortage on the issues of health, including cardiovascular diseases among women, the consequences are multifaceted. Sex-specific factors contributing to the prevalence of CVDs among the female members of the population are already under-addressed, and a shortage of specialists to integrate the solutions can further worsen the issues.
Firstly, it is critical to consider the fact that the nursing shortage problem is not uniformly distributed across the United States. It is reported that the severity of the issue is more serious in primary care settings as well as rural areas (Haryanto, 2019). The latter is especially vital to comprehend since people living in more remote and isolated regions tend to be more vulnerable. The core reason behind such a trend is the locational distribution of nursing schools, which tend to be more concentrated in metropolitan areas. Since nursing graduates are more likely to work at larger hospitals and urban regions, rural locations are facing the short end of the shortage.
Secondly, the demographic shift in the American population cannot be overlooked. The findings suggest that the population segment of the baby boomers is aging, which is sharply increasing the need for larger output of healthcare services provided across the nation (Haryanto, 2019). In addition, the longer life expectancy of the existing older adults means that healthcare services are needed for a more prolonged duration in a continuous manner. These dynamics shift the demographic patterns towards a population having a larger percentage of the elderly groups.
The role of the nursing leaders is central for both areas of knowledge since nursing care is vital in determining both healthcare policies as well as population-wide interventions. For public health, the DNP’s input can be critical in ensuring that healthcare organizations are adequately staffed in order to avoid nursing shortages, medical errors, and nursing burnouts. In the case of population health, the DNP can substantially direct the data analysis and interpretation to the delivery aspects of healthcare services. DNP nurses are able to lead various healthcare programs aimed at improving overall health at a larger scale by advocating for specific initiatives and strategic healthcare plans. These implementations can take place on both state and federal levels indicating the importance of leadership in such efforts and endeavors.
The key factor is the nursing shortage and the healthcare’s approach to addressing this issue. The best strategic actions recommended for the healthcare and nursing leaders to complete revolve around various revisions of its retention and recruitment approaches. The solutions need to be implemented at an industry level to evaluate and develop better objectives, human resource management, and innovative technology. The nursing shortage is an external threat to healthcare organizations, which is why it needs to properly adjust and adapt to the difficult labor market situation by focusing on their internal resources. The emphasis is primarily put on managing its workers due to labor shortage, where the focus areas are nursing talent attraction and employee management. The latter element focuses on superior human resource management through retention, efficient use of its existing workforce, and ensuring that no nurse is leaving the organization. Healthcare organizations should focus on more effective use of their human resources and talent to drive retention, education, and training.
It is important to note that there are many reasons for the shortage of labor. Some of them arise at the level of the organization, such as the rapid and largely unexpected forced expansion of the organization’s scope of its activities. In addition, there are factors such as the retirement of nurses who, for some time, there is no one to replace and the lack of proper staff motivation. The latter, in turn, is due to uninteresting work, difficult working conditions, combined with relatively low wages, and the lack of prospects for qualification and job growth.
As a result, nurses leave the organization or even the field, whereas replacements are difficult to find. Among the macroeconomic reasons for the emergence of a shortage of nursing labor in healthcare should be attributed to the health policy of the state and federal governments. Nursing shortages in certain sectors of healthcare, such as elderly care, may arise from the expansion of employment opportunities in areas of activity with more attractive working conditions in the field of health service provision. Healthcare organizations should pay attention to the time during which the vacancy can be closed. Within a short period, the vacancy of the head can be filled if the organization has an appropriate candidate from the labor reserve. It will take some period of time to fill the vacancies of skilled workers and representatives of specialized professions. It may take a relatively long time to close the shortage of subspecialized professionals.
Implications and Solutions
One of the most critical implications of nursing shortages is the reduction in the quality of patient care. The latter is a result of medical errors and poorer healthcare service quality. The ratio of patients to nurses must be lowered if one seeks to reduce mortality rates, morbidity prevalence, as well as negative patient outcomes. The key areas of focus include nursing job dissatisfaction, nursing burnout, and nurses leaving the field altogether. The core drivers of the nursing shortage problem are the fact that more nurses are leaving the field than new nurses are being trained and educated to replace them.
The issue is made even more complicated and challenging by the fact that the most valuable and experienced nursing professionals tend to leave, which is impossible to replace solely by educating and training more nursing students. In other words, the implication of the nursing shortage is not only the reduced number of nurses available to deliver healthcare services but additionally the decrease in experience among the existing pool of specialists. A report suggests that experienced nurses are less likely to make medical mistakes or errors compared to new nurses, which is the result of having more experience (Lockhart, 2020). Therefore, the impact is massive in terms of both the quality and quantity of care provided.
Therefore, the solution to the nursing shortage needs to address an underlying issue of nursing retention before focusing on nursing education and training. One of the most notable factors in making nurses leave the field is shift length. Long-duration shifts tend to be more stressful for nursing professionals, which causes a higher likelihood of nursing burnout (Lockhart, 2020). The latter translates into lower nursing retention, which leads to a nursing shortage. The most effective recommendation is to decrease the shift length to eight hours and increase the nurse rotation frequency if a medical organization is unable to hire more nurses (Lockhart, 2020). In other words, each complete day cycle needs to be accompanied by three nursing professionals instead of two. These solutions are easy to implement and greatly reduce the stress and burnout levels experienced by nurses.
Conclusion
In conclusion, the prevalence of CVDs among women is as prevalent as among men. However, the disease in females not only follows the conventional patterns of manifestations but additionally includes sex-specific risk factors. Processes such as pregnancy or menopause severely increase the likelihood of developing a CVD. Nursing leaders can become the best advocates for addressing CVD among women. The nursing shortage is a highly important issue that requires complex solutions at the education, training, and retention levels.
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