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Gender Gap in Women's Cardiac Care Services

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on 7 November 2014

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Transcript of Gender Gap in Women's Cardiac Care Services

The Gender Gap in
Women's Cardiac Care Services

Group 1
Charelle Belle
Manvit Johal
Maria Elisa Maltese
Kathryn Molendyk
Jasinthira Shanmugeswaran

November 3, 2014

The Heart and Stroke Foundation released a report indicating the
major differences in the signs and symptoms of hearts attacks in men and women
, and the subsequent
treatment and management
of women's cardiac problems.
Linda Lewis-Daly suffered a heart attack on a hike, but
did not recognize the symptoms
or understand the need for treatment. She only visited her doctor at the urging of her coworkers, two days later.
Hospital physicians also did not recognize the symptoms, and it took a further
two days before a correct diagnosis

was reached
She eventually received treatment and began
in a class dominated by men.
There are crucial differences differences in symptoms of heart attacks between men and women. The fact that these differences have historically gone unrecognized has resulted in a stark gender disparities in the treatment of cardiac events.

Effective treatment and care must be characterized by gender-sensitive approaches. Nurses must advocate for greater equity in health research, and educate themselves about the unique needs of their clients in order to ensure the best health outcomes for both men and women.
Explore the differences in symptoms and treatment of cardiac events between men and women
Explore gender inequality issues present in the role play and media scan in reference to:
- Canada Health Act principles
- Determinants of Health
- Primary Health Care
- Nursing scope of practice statement
- RNAO (2002) BPG:
Client Centred Care
- Feminist political economy approach
- the International Council of Nurses
- Recent media articles
RNAO Best Practice Guideline
Client Centred Care Value : TIMELINESS
Client Centred Care
= the client is viewed as a whole person. This involves advocacy, empowerment, and respect for the client's autonomy, voice, self-determination and participation in decision making.
The Canada Health Act (1984):
"Universality requires all residents of a province or territory be entitled,
on uniform terms and conditions
, to the publically funded health services by provincial/territorial plans. It ensures everyone

equal access
, and that no one is
against based on various factors (ie. age, income, gender, health status, etc.)"
Primary Health Care:
Focused on recognizing and treating clients existing health problems

Primary care
Secondary care
Tertiary care
Nursing Scope of Practice Statement
Feminist Political Economy
Feminist political economy is concerned with how the needs of the population are gendered, and how being male or female intersects with the conditions under which they live.

Women and men are equally affected by cardiovascular disease but a gender gap exists that prevents women from getting the care they require
Heart disease presents differently in women and research in women has lagged behind men
Additional Articles
Lear, M.W. (2014, September 28). The woman's heart attack.
New York Times
, p. L5.
Determinant of Health:
What is Gender?
"Array of society-determined roles, personality traits, attitudes, behaviours, values, relative power, and influence that society ascribes to the two sexes on a differential basis" (PHAC, 2004)
Gender can influence health status, behaviours, and care
Gender can influence men's and women's experience of sex-specific health issues, exposure to potential risk conditions, and interactions with health care professionals
Heart attack presented differently in Linda
Doctor did not consider the possibility of a heart attack
(Potter, P. & Perry, A., 2010)

International Council of Nurses (ICN) Position Statement: Women's Health
Underline basics of women's rights in health care
They endorse a gender mainstreaming approach in all aspects of health
Gender mainstreaming: gender equality is not just a woman's issue. It acknowledges that different health experiences and health care needs of women and men need to be translated into health policy and planning. It means that HCPs must have knowledge and awareness of the ways gender affects health so that they may address gender issues effectively
ICN strongly supports the establishment of services that are accessible, sensitive to women's needs at all stages in the life cycle, and that provide a full range of integrated health care and health education

(ICN, 1996)
Points of Focus in Role Play
There exists a gender gap in prevention, treatment, care and rehabilitation for cardiac patients.
The symptoms of heart attack in women are different than in men, and often go unrecognized
Women's cardiac issues have not been given the same priority in research as men's, and primary care may be suffering as a result.
Women may downplay their symptoms, or fail to recognize the need for treatment
Martha Weinman Lear had a heart attack two years ago; her symptoms included feeling unwell, a “fluttery sensation” in the chest, mild chest pressure, chills, sudden nausea, vomiting and diarrhea
The symptoms did not point to a clear problem; it could have been flu or indigestion
Lear was concerned by the chest pain, so reported her symptoms to her doctor. He thought it was unlikely to be her heart, since diarrhea was an atypical symptom. He advised her to come in the next day to confirm
Overnight the chest pressure resolved and she awoke feeling much better, but went to her doctor for an EKG and echocardiogram, which revealed she had had a substantial heart attack
Lear had a stent implanted in an occluded artery
A nurse practitioner advised Lear that anything below the nose and above the pelvis could be a symptom of heart attack, including the jaw, neck, throat, back, shoulders, chest, arms, diaphragm, or abdomen
In 1978 Martha Weinman Lear’s first husband, Hal, died of a heart attack. His had been a “Hollywood Heart Attack” which followed the then-expected pattern: acute chest pain, sudden collapse, and grimaces of agony
(Ruben, A., 2014)
Alamy. (2013). Heart attack victims

[Image]. Retrieved October 24, 2014 from http://www.telegraph.co.uk/journalists/laura-donnelly/10153699/Chilled-nose-spray-to-help-heart-attack-victims.html

Brampton Civic Hospital. (2014). Brampton Civic Hospital [Image]. Retrieved November 1, 2014 from http://www.oslerfoundation.org/Why_Give/Build_Osler/Brampton_Civic_Hospital.aspx

Bryant, T., Raphael,D., & Rioux, M. (2010)
Staying alive: Critical perspectives on health, illness, and health care.
Toronto, ON: Canadian Scholars' Press.

Canadian Nurses Association (CNA). (2000). Fact sheet: The Canadian health act. Retrieved November 1, 2014 from http://www.sna-aiic/~/media/cna/page-content/pdf=fr/fs01_canada_health_act_june_2000_e.pdf

Denton, D., (2014). Mohinder Doman [Image]. Retrieved October 24, 2014 from http://www.vicnews.com/news/246075981.html

Hankivisky, O. (1999). Social justice and women’s health: A Canadian perspective. Maritime Centre of Excellence for Women’s Health: Dalhousie University. Retrieved from http://www.dal.ca/content/dam/dalhousie/pdf/ace-women-health/ACEWH_social_justice_womens_health_canada.pdf

Health Canada. (2003). Exploring concepts of gender and health. Women’s Health Bureau: Health Canada. Retrieved October 30, 2014 from http://www.hc-sc.gc.ca/hl-vs/alt_formats/hpb-dgps/pdf/exploring_concepts.pdf

Heart & Stroke Foundation. (2011a). Antiplatelets. Retrieved October 28, 2014 from http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484139/k.C87F/Heart_disease__Antiplatelets.htm

Heart & Stroke Foundation. (2012). Cardiac catheterization. Retrieved October 28, 2014 from http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484089/k.361/Heart_disease__Cardiac_catheterization.htm

Heart & Stroke Foundation. (2011b). Cardiac rehabilitation (Cardiac rehab)
Retrieved October 28, 2014 from http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3975487/k.BE16/Heart_disease__Cardiac_rehabilitation_cardiac_rehab.htm

Heart & Stroke Foundation (2007).
Time to bridge the gender gap
. Retrieved October 14, 2014 from

Kingston, A. (2012). Medicine's deadly gender gap.
(17). Retrieved October 26, 2014 from http://www.macleans.ca/society/health/medicines-deadly-gender-gap-2/

Lear, M.W. (2014, September 28). The woman's heart attack.
New York Times
, p. L5.

Neville, A. (2012). Cardiac gender gap; Doctors, survivors, and even Rosie O’Donnell spread the
word about women’s often ignored heart attack systems.
Buffalo News
, p. C1.

Picard, A. (2007, February 1). Heart-care gap harms women, report finds.
The Globe and Mail
, p. A13.

Potter, P., & Perry, A. (2014).
Canadian fundamentals of nursing
(5th ed.). Toronto: Elsevier

Registered Nurses Association of Ontario. (2002).
Best practice guideline: Client centred care.
Retrieved October 23, 2014 from http://rnao.ca/sites/rnao-ca/files/client_centred_care_0.pdf

Registered Nurses’ Association of Ontario (RNAO). (2009).
Nursing best practice guideline:
Nursing management of hypertension.
Toronto: Author. Retrieved from http://rnao.ca/sites/rnaoca/files/storage/related/608_BPG_Hypertension_summary.pdf

Ruben, A. (2014). Martha Weinman Lear [Image]. Retrieved October 24, 2014 from http://danspapers.com/2014/09/martha-weinman-lear-pens-new-memoir-echoes-of-heartsounds/

St. Michael’s Hospital (2009, December 10). Gender gap persists in cardiac care, study finds.
Retrieved October 14, 2014 from www.sciencedaily.com/releases/2009/12/091209114152.htm

Vlassoff, C. (2007, March). Gender Differences in Determinants and Consequences of Health
and Illness.
Journal of Health, Population, and Nutrition, 25
(1), 47-61.

WebMD, LLC. (2014. Symptoms in women [Image]. Retrieved October 30, 2014 from http://www.webmd.com/heart-disease/ss/slideshow-heart-attack
(Lear, M.W., 2014)
Additional Articles
Sun, C. (2014, February 18). Heart talk focuses on women’s health.
Victoria News
, p.1
Mahinder Doman's symptoms began in 1999 with indigestion that lingered and bouts of a cold.
She visited numerous doctors who told her she was getting just getting older; she was then in her 50s.
She continued to feel tightness in her chest, joint pains in the shoulders and swollen feet, but was only prescribed pain medication and told to rest
Eventually she had difficulty standing and breathing in the shower, she gained weight and was unable to participate in social gatherings
She was visited by a friend who was a nurse, who was shocked by her physical condition and took her to see a doctor who was able to diagnose her with congestive heart failure.
Mahinder Doman’s health was in decline for four years before she received a diagnosis of congestive heart failure with multiple heart attacks.
(Denton, D., 2014)
(Sun, C., 2014)
Facts about Heart Attacks in Men and Women
Symptoms are often subtle, unusual, and may begin before the heart attack itself
More likely to experience unaccustomed fatigue, shortness of breath, indigestion, anxiety, weakness, cold sweat, dizziness, and discomfort (mainly in the back and high in the chest, but may also be experienced in the jaw, neck, shoulders or arms)
More likely to downplay or deny their symptoms, and may fail to seek treatment
Two to three times more likely to suffer from high blood pressure
Diabetes poses a greater risk factor than for men
Low levels of HDL ("good" cholesterol) is a risk factor
(Bryant, Raphael & Rioux, 2010; Heart & Stroke Foundation, 2007; Neville, A, 2012; St. Michael's Hospital, 2009)
More likely to experience the "Hollywood" heart attack:
sudden crushing or squeezing chest pain
pain in one or both arms
shortness of breath
High levels of LDL ("bad" cholesterol) is a risk factor

Nurses Role in Women's Cardiac Care
The practice of nursing is the promotion of health and the assessment of, the provision of, care for and the treatment of health conditions by supportive, preventative, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function.
Universality and the Female Heart Attack
: women are under-served in terms of receiving cardiac care compared to men (unequal and inequitable treatment)
Standardization of Health Care
Recent health care reforms in Ontario intended to streamline health care services for improved cost-effectiveness, increased standardization of treatments for improved equality.
Discrimination in Receiving Cardiac Care for Women
Pervasive gender stereotypes influencing responsiveness to health care needs. Health care providers may treat women differently, not take their concerns as seriously.
What can be done to improve Universality...
Health care practitioners:
Recognize gender differences exist in manifestations of cardiac diseases, increase awareness of differential treatment based on gender, increased understanding of the contexts of individual's lives, use of better-informed evidence-based practice
What does this principle tell us about health care in Canada?
Canadians are entitled to the same level of treatment regardless of age, gender, income, or ethnicity.
= the needs of clients and communities deserve a
prompt response

What does the research tell us?
Women tend to seek treatment for cardiac issues when they are
and older.
Women are less likely to be screened for high cholesterol and other indicators of heart disease than men.
Women tend to have
onger periods of hospitalization

for CVD-related illnesses (average length of stay 13.1 days compared to 11.4 days for men).
Timeliness within the healthcare system
Timeliness measured in terms of time it took to take action to address a specific health concern.
Media scan and role-play:
timeliness in the managing health care providers to respond to Linda's needs.
The attending physician did not initially consider a heart attack based on presenting symptoms and her gender.
There a delay in diagnosis because the health care providers were not initially looking for a heart attack.
As a result, Linda's prognosis and quality of care could have been impacted.
Systemic Delay in Timeliness of Screening, Diagnosis and Treatment
Gender differences exist in screening for cardiac issues where women are not screened as often as men.
Symptoms often dismissed or not taken as seriously by physicians, affecting
timing of diagnosis
and getting life saving treatment.
What can be done to address timeliness...
Nurses can focus on modifiable factors that can affect a woman's risk of developing CVD or suffering a heart attack. They can collaborate with other health care professionals to educate and help patients make changes in areas of
diet, exercise, weight, alcohol consumption, and smoking.
At the level of Primary Health Care,
stress the importance of screenings for heart disease indicators (disease and injury prevention), which can improve promptness of diagnosis and subsequent treatment.
Nurses Role: Health Promotion
- Assess activity level and encourage 30-60 minutes of moderate exercise 4-7 times per week

- Assess diet and factors that may increase risks. Encourage a healthy, balanced diet.

Healthy Weight
- Assess body weight, BMI and waist circumference. *
Women who have a BMI of 25 or greater and a waist circumference of 88cm are at an increased risk *

Alcohol Consumption
- Assess alcohol use including frequency and quantity. *
Women should consume a max. of 1 drink per day and 9 drinks per week

- Assess tobacco use and encourage smoking cessation

Universality is concerned with promoting equality. From this approach, women and men should be treated equally in response to their health needs. However, this fails to take into account differences between genders and amongst different groups of individuals influenced by social, environmental, biologic and economic factors.
(Bryant, T., Raphael,D., & Rioux, M., 2010)
Gender-related factors affecting when women and men seek treatment = context of individual lives
The statement guides nurses to engage in health promotion. One way that this can be done in women's cardiac care is through primary prevention strategies. Nurses can work to enable individuals to improve their health and increase their control over their health in an effort to prevent them from developing disease.
(RNAO, 2002)
(RNAO, 2009)
Advocate for equal access to lifesaving treatments
Educate women on the benefits of cardiac rehabilitation and advocate for them to be enrolled in these programs
At the individual/public health level:
Increase awareness of heart health risks for women, work to address societal structures and attitudes that impact women's health
Start a program to conduct ongoing population surveillance of women's health indicators
In terms of research:
increase funding and research focus to include women's heart health issues with the intent to increase understanding of gender differences to improve evidence-based practice and treatment and provide more equitable care.
Nurses can play a significant role in women's cardiac care and bridging the gaps between genders. The scope of practice statement can guide nurses as to what their roles should be.
(College of Nurses of Ontario [CNO], 2014)
Facts about Heart Attacks in Men and Women
More likely to have another heart attack within six months
More likely to die within one year of a heart attack
Less likely than men to be hospitalized after a heart attack, but stay longer when they do
Report higher disability rates and worse functional status when living with heart disease
(Bryant, Raphael & Rioux, 2010; Heart & Stroke Foundation, 2007; Neville, A, 2012; St. Michael's Hospital, 2009)
Respond better to Aspirin therapy
More likely to be referred to a cardiologist
More likely to be offered invasive procedures such as cardiac catheterization, revascularization, or pacemakers
More likely to be prescribed statins (cholesterol-lowering drugs) or clot-busting medications
More likely to be referred to cardiac rehabilition
More likely to be carefully monitored after a heart attack
80-90% of heart transplants are performed on men
Aspirin therapy
: Aspirin (or ASA) is an antiplatelet used prophylactically in the prevention of heart attack or stroke. Daily administration of ASA can reduce the likelihood of clot formation in arteries, a major cause of heart attack or stroke. (Heart & Stroke Foundation, 2011a)

Cardiac catherization
: a technique used to evaluate heart valves, heart function and blood supply. May also be used therapeutically to correct heart defects and open valves or arteries. (Heart & Stroke Foundation, 2012)

Cardiac rehabilitation
: a personalized program of exercise, education and counseling. Designed to aid recovery and prevent complications after a heart attack. (Heart & Stroke Foundation, 2011b)

: the process of restoring blood flow to the heart, often accomplished with bypass surgery. (University of Rochester Medical Center, 2014)
Symptoms and Risk Factors
(Alamy, 2013)
(WebMD, 2014)
Female heart attacks may be misdiagnosed, delaying treatment
Women are less likely to monitored for cardiac risk factors
Women are less likely to receive adequate rehabilitative care after a heart attack
Differences in power relations:
Women are the primary users of health care and make up the majority of health care workers, yet they are in the minority in positions of power, within organizations, or in leading research.
From a feminist economic perspective..
Gender Sensitive Approach to Health Care
Adopting a gender-sensitive approach means recognizing how gender shapes and is shaped by conditions, practices, and relations between power and inequity. It helps to understand how differences in gender exist in health care use and treatment.
One of the main reasons gender disparities remain in health care is that the existing health care system does not adequately recognize the impact of sex and gender on women's health.
Existing Literature on Gender Inequalities..
Existing policies, practices, and structures contribute to put the burden of care onto women while not responding to their needs equally.
Medicine has historically perpetuated aspects of women's oppression.
Structural inequalities
= differential access to education, income, benefits, personal security, reliable full-time work, access to public day care, limited access to public transit
In assessing equality of access at and within healthcare, it is necessary to examine the differences in the contexts of individual's lives (differing values, attitudes, access. etc)
Within the health care system
Inequalities in research
: majority of research on women's health issues are gender-specific
Lack of
in the
between genders in relation to symptoms, diagnosis, treatment, and rehabilitation.
Contexts of individual's lives influences health-seeking behaviours and equal access to health care. This can then affect the care available.
Media Scan
: Linda did not immediately seek care because of a lack of understanding on her symptoms, importance placed on other issues in her life, "put everybody else's needs ahead of my own", her own issues not as important.
(Hankivisky, O., 1999)
Research recap:
Gender sensitive approach
= what works for men doesn't necessarily work for women
This can then effect
in health care for the same health issues.
Research into cardiac health:
The majority of research specific for heart health has been done on male subjects. As as result, the majority of heart disease treatments and medications are more effective on men.
These examples demonstrate
from participation in research studies, in which the purpose is to improve knowledge to better inform evidence-based practice and development of more equally effective treatments.
Fewer women participate in cardiac rehabilitation programs
Women less likely to be monitored for cardiovascular risk factors.
Context of women's lives can impact the level of care they receive
Women more likely to die following a heart attack, are sicker and older when they do seek out care (onset of of heart diseases generally presents 10 years later than in men.
Women less likely to be referred to a specialist, undergo bypass surgery/angioplasty, receive assistive devices.
Differences in treatment between men and women:
This can stem from lack of gender-specific research (as women, until recently, have largely been excluded from cardiovascular research).
Due to a lack of research, this can cause a lack of understanding and failure to recognize issues when they occur.
Women experience poorer outcomes following a heart attack, more likely to die in hospital.
Media Scan/role play:
It took two days for Linda's doctors to diagnose her heart attack, as they were not looking for it/assumed her symptoms were due to something else.
Women are not diagnosed and treated as aggressively as men for heart disease, in-hospital treatment for longer periods of time, more likely to be readmitted =
poorer prognosis
Media scan and role-play:
the attending physician had a paternalistic attitude and immediately attributed Linda's symptoms to other causes, demonstrating bias.
Using male norms and standards for treatment can result in errors, potentially harmful side-effects, overall inequitable care and
increased health care costs
resulting from poor diagnosis, eventually impacting quality of life.
Systemic barriers =
factors creating inequitable access to screening programs and seeking care (Primary health care levels)
Health Promotion
(RNAO, 2009; Potter, P. & Perry, A., 2014)
Nurses can continue to promote health while assessing, providing care for and treating health conditions.
They should:
Assess patients personal and family history for risk factors
Screen patients for risk factors such as hypertension, high levels of cholesterol and diabetes
health care
professionals and
on the prevalence, signs and symptoms of heart attacks in women so that a timely diagnosis and appropriate treatment can be given
Engage in research to further increase the information available on women's cardiac issues and focus on understanding the differences between genders
Continued Roles of Nurses
* through health teaching, workshops, seminars and/or changes in policy
Primary Care
First contact client makes with health care system, including early detection and routine care.

Both men and women are equally affected by cardiovascular disease yet it is considered to be a "man's disease"
Women are less likely to be monitored for cardiovascular risk factors
high blood pressure
high cholesterol
low HDL
In the skit...

The patient has a family history of cardiovascular risk factors
Father has hypertension
The patient's doctor did not screen blood pressure or cholesterol
Doctor did not have discussion regarding salt intake or maintaining healthy lifestyle
Secondary Care
When client develops recognizable signs and symptoms that are diagnosed

Men and women have different symptoms
Symptoms for women are more subtle, atypical
In the skit...

The doctor did not recognize the patient's symptoms as a heart attack, instead provided alternative suggestions
When the nurse advocated for the cardiovascular diagnosis, doctor was reluctant to confirm until the tests came back
Tertiary Care
Highly technical and specialized care for diagnosis and treating problems

Women do not receive as much care as men after a heart attack
Compared to men, women are less likely to:
Undergo bypass surgery, angioplasty, implantable cardiac defibrillators
Be prescribed medication to lower
cholesterol (statins)
Be recommended for rehab classes
Be referred to a cardiologists
In the skit...

There was only 6 women in a rehab class of 70 men
Women have
cardiac health outcomes compared to men.
Cardiac risk screening programs are not used as often for women despite growing incidence of cardiac health problems.
Delay in diagnosis could have also been because lack of results concerning cholesterol levels, angiograms (which are more common in men), screening and monitoring information for heart health
What the research tells us:
Feminist political economic approach:
Pervasive gender biases in treatment of clients by health care professionals (persistent beliefs of heart disease being mainly a male disease) limit women's access to screening, causing a
delay in diagnosis/treatment
appropriate care
(the right service,
at the right time
, delivered by the right person in the right place)
majority of research has been related to ovarian, cervical, breast cancers, MS, osteoporosis, rheumatoid arthritis, etc.
demonstrates how seriously gender is taken into account in the health care system
Media Scan and Role Play:
At the individual/community level
, address barriers that can impact health-seeking behaviours and knowledge on gender-specific differences in symptoms of cardiac health problems.
At the health care systems level
, improve research on diseases to better understand differences in presenting symptoms, disease course and treatment effectiveness. Incorporate this knowledge into education.
Incorporate gender sensitivity into practice to improve health outcomes.
(Brampton Civic Hospital, 2014)
(WebMD, 2014)
Female enrollment in clinical trials is much lower than males
When studies do recruit women, many do not report sex-specific results
Differences between men and women are not recognized
In animal studies, males are easier, faster, and cheaper to work with
Males cost less, do not have an estrus cycle, do not get pregnant, provide both
chromosomes, and keep variables constant
In human studies, hesitancy to recruit women exists due to risk of pregnancy and breastfeeding effects
Under-representation of females puts women's health at risk and limits scientific knowledge
Need to put more effort into working with females in animal studies and recruiting women into human clinical trials
Research specific to females is necessary to make progress in women's health
Lack of Research
Challenges in
Studying Females
Need for Change
(Canadian Nurses Association [CNA], 2000)
(Health Canada, 2003; St. Michael’s Hospital, 2009)
Bryant, T., Raphael,D., & Rioux, M., 2010; Health Canada, 2003)
(Heart & Stroke Foundation, 2007)
(Health Canada, 2003)
Health Canada, 2003; Heart & Stroke Foundation, 2007)
(Heart & Stroke Foundation, 2007)
(Heart & Stroke Foundation, 2007)
(Heart & Stroke Foundation, 2007)
Media scan/role play:
Existing attitudes towards heart health and a lack in general knowledge - may not be aware of the importance of seeking care; end up
waiting too long to seek treatment
(Health Canada, 2003)
: update the existing RNAO (2002) BPG for
Treatment Hypertension
to include sex and gender-specific considerations in terms of diagnosis, treatment
Certain systemic factors can influence rates of heart disease (eg: increased incidence in Aboriginal women, women from poorer SES)
Be aware of the gender biases that exist, and work to decrease these biases by seeing women's cardiac issues as equally significant to men's
(Kingston, 2012)
(Kingston, 2012)
(Kingston, 2012)
(Kingston, 2012; Picard, 2007)
(Neville, 2012; Picard, 2007)
(Neville, 2012)
Nurses should also:

(Bryant, T., Raphael,D., & Rioux, M., 2010)
(Bryant, T., Raphael,D., & Rioux, M., 2010; St. Michael's Hospital, 2009)
Unequal Treatment Based on Gender
(Bryant, T., Raphael,D., & Rioux, M., 2010)
(Bryant, T., Raphael,D., & Rioux, M., 2010; Health Canada, 2003)
Timeliness in Seeking Treatment
(RNAO, 2009)
(RNAO, 2009)
Doman was shocked that she could have had multiple heart attacks, since she had always thought that heart attacks kill people
Carolyn Thomas hosts the Cardiac Café at the University of Victoria (Victoria, BC), and urges women to listen to their bodies. Women should know when something is not right.
Hal’s heart attack and hers illustrated the gender differences in heart attack presentations. Men’s are characterized by crushing pain, women’s by nausea.
In a 1996 survey two-thirds of doctors were unaware of gender differences in signs and symptoms of heart attacks
"Heart-Care Gap Harms Women, Report Finds"
by Andre Picard (The Globe and Mail)
(Picard, A., 2007)
Differences in how the health system responds to male and female clients
The doctor did not suspect it was a heart attack, and as a result, Linda received treatment 2 days later
Differences in the way an illness affects men and women
Linda's friend compared her husband's heart
attack symptoms to Linda's symptoms
Differences in health-seeking behaviours
Linda was reluctant to get help

(Vlassoff, 2007)
Gender as a Determinant of Health
Gender and Research
Clinical research used a primarily male model; findings were generalized to women
Protocols for the diagnosis and treatment of heart disease were based upon findings from middle-aged white male patients
Women who did have heart disease were diagnosed later with a more advanced disease
Consequence = harder to treat
(Vlassoff, 2007)
ICN: Women's Health:
Gender Mainstreaming
Use gender mainstreaming in epidemiology studies, research, decision-making, service planning, and care delivery
If gender mainstreaming is successful, health care providers will be aware that gender affects health; they will recognize that female and male heart attacks present differently
Care will be tailored accordingly
That did not happen in Linda's situation
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