Best Practices in Healthcare Management Begin With Self

Miki Goodwin, PhD, RN, PHN, NEA-BC; Kim Richards, RN, NC-BC


Nurs Econ. 2017;35(3):152-155. 

In This Article

Literature Review

There is an overabundance of literature about men's cardiovascular health and a growing but less significant amount of information on the topic regarding women, suggesting cardiovascular disease is predominantly a male problem (Westerman & Wenger, 2016). Such thinking provides a false sense of security in women; especially those who may not know their risk factors and who consider themselves in good health. Cardiovascular disease (CVD) is the main cause of death in men and women; however, the prevalence is higher in women (Appleman, van Rijn, ten Haaf, Boersma, & Peters, 2015). Appleman and colleagues discuss emerging evidence regarding potentially independent risk factors for CVD exclusive to women, noting that CVD is more common in women than in men due to risk factors which vary in both sexes, especially as women have differing hormonal changes in reproductive years and early menopause, which can accelerate the development of CVD.

Winham, Andrade, and Miller (2015) add that other biological differences include smaller carotid arteries in women, which may have less plaque but a greater likelihood of stenosis. They also suggest sex differences may interfere with decisions regarding diagnosis, treatment, and outcomes. Similar findings in a study in Serbia (Jankovic et al., 2015) suggest significant differences in the prevalence of metrics for risk factors between men and women. Spence and Pilote (2015) included living environment as a risk factor, citing reports that women with a spouse and children have a higher incidence of coronary heart disease than women living with a spouse but no children.

The addition of other risk factors such as autoimmune disease in females exponentially increases the risk for CVD (Gianturco et al., 2015). Inflammation, a hallmark of autoimmune disease, contributes to plaque formation and instability. The authors describe the resulting atherosclerosis as "auto-inflammatory" injury, suggesting increasing collaboration among specialists is vital when investigating CVD in women with concurrent autoimmune disease.

Richards, Sheen, and Mazzer (2014) described self-care as "choosing behaviors that balance the effects of emotional and physical stressors" (p. 3). They discussed the importance of listening to one's body and using corrective measures even though we cannot control our genes. Simple but effective "rescue remedies" such as mindfulness, nutrition, exercise, and adequate sleep can be powerful remedies. Having an accountability buddy is particularly important for nurses who may find it easier to give their patients advice than follow it themselves.

Compassion fatigue and burnout are consequences for empathetic caregivers who do not make replenishment of self a priority within their professional roles. The cost of compassion fatigue and burnout extends to nurse, patient, and organizational outcomes. Nurse outcomes include forgetfulness, losing things, anger, edginess, insomnia, depression, apathy, poor job morale and performance, increased sick calls, and leaving the profession (Absolon & Krueger, 2009). As Hevezi (2016) so eloquently stated, "Recurrent generation of the energy that enables nurses to provide compassionate care is essential" (p. 346).

Figley (2002), a pioneer in the concept of compassion fatigue, described compassion fatigue as a state experienced by individuals helping people in distress; it is an extreme state of tension and preoccupation with suffering. The helper, in contrast to the person( s) being helped, is traumatized or suffers due to the helper's own efforts to empathize and be compassionate. Often, this leads to poor self-care and extreme self-sacrifice. Figley believes this combination can lead to compassion fatigue and symptoms similar to posttraumatic stress disorder (Gould, 2005).

In 2012, Johnson conducted a study of 65 staff nurses, which showed a moderately strong negative relationship with both compassion fatigue (r=0.60, p<0.001) and burnout (r=0.60, p<0.001).