Nursing Practice 6: Consolidation of Contemporary Nursing Practice in Diverse Settings 

Introduction to Cardiovascular Health in Older Adults in Rural Australia

According to Peng et al. (2018), the cardiovascular health status of older adults in rural areas in Australia is facing serious complications due to the prevalence of diabetes, heart attack, heart stroke, and a few others. This is due to various factors like social determinants and health inequities which include their remoteness from the health care centers. As a result, they have to travel a long distance from their region to get health services and this often results in delayed care delivery. The men of the older age groups in rural areas above 65 years of age face more cardiovascular health problems than females. It is found that every 1 out of 4 in the rural older adult population is suffering from cardiovascular issues whereas, that every 1 out of 5 in the metropolitan older adult population is suffering from cardiovascular issues. Moreover, the risk factors like smoking, alcohol intake, obesity, poor communication system, poor response time, and few others are also contributing to poor cardiovascular health in older adults in rural areas of Australia. The males of 65 – 74 years of age are more affected whereas the females above 75 years are found to be more affected than men (Bishop et al., 2018).


According to the Australian Institute of Health and Welfare (2015), above 70 years of age among the rural older adults, the rates of coronary heart disease (CHD) is 13 %; chronic obstructive pulmonary disease (COPD) is 6.8 %; rates of strokes are 8 %; between 65-74 years the prevalence of high blood pressure in males is 41 % and 38 % in females; between 75-84 years the prevalence of high blood pressure in males is 40 % and 45 % in females; in 2017-2018, the prevalence of stroke, heart, and vascular disease is more in males 6.5 % and less in females with 4.8 %. Moreover, the rural areas older adults had a poor education, poor income, less control over healthy lifestyles, limited access to sporting clubs, healthy food, a healthy environment, reduced health infrastructure, poor transport facilities, and many more factors that lead to their poor cardiovascular health. It is found that most of the Australian population is getting old and 29 % of the population lives in rural areas. Due to poor lifestyle and habits of smoking, alcohol intake, and others, the older adult is more likely to have poor cardiovascular health with major health issues of congenital heart disease, heart failure, heart stroke, coronary heart disease, rheumatic heart disease, and few others. Due to high cholesterol and high blood pressure in the diet of older adults they are at high risk of mortality as well (van Gaans et al., 2018).

The Social Determinant of Health and Its Impact

According to Northwood et al. (2018), social determinants include various factors like income, employment status, education, social, and power support. The older adults of rural areas are found to lack in these social determinant factors and also have poor immunization rates and poor physical activity as well. It is also found that only 10 % of the older population in rural areas is working resulting in a high proportion of the population who have poor economic status and many have homes without a mortgage (76 %). 80 % of the aged population rely on pension only. This shows that the economic status remained low due to poor education and unemployment or low income. All these acts as barriers as well in limiting the good cardiovascular health of the rural aged population, thereby, making the population less happy, more divided due to cardiovascular disease and poor well-being.

Health Inequalities

According to Beer et al. (2016), 35 % of the target population experience discrimination due to their age. The common types of discrimination are being treated rudely, being ignored, having disparaging jokes made about their age, and many others. The older population living in regional areas is getting chances of getting targeted for the health care services comparatively at a high rate. Therefore, it was found that health inequalities occur on the basis of geography. Moreover, it was found that old populations with non-English backgrounds had poor health literacy and were less aware of the health offers and services as well in comparison to the population who can speak English. Therefore, the socio-economic and cultural differences led to health inequalities in the target older age (above 65 years) in rural areas in Australia. 22 % are found to smoke daily, 72 % do no physical exercise, 24 % do lifetime risky drinking, 22 % have high blood pressure, and more than 50 % are obese, therefore multimorbidity and these factors together contribute to poor well-being of the target population. The target populations with more such disadvantageous conditions are found to have long-term effects on their health for cardiovascular health diseases. The old age and age-related stigma often act as a barrier to getting effective health services. Moreover, the mortality rates are also high because of the poor affordability of health care services due to low economic status. The target population is found to live another 20 years after the age of 65 in the case of men and another 20 years in the case of women (van Gaans et al., 2018).

Health Inequities

According to van Gaans et al. (2018), the old adults either have no jobs or working at very low income, as a result, their capability to move to major cities for their health treatment or health centers becomes a difficult factor to afford; whereas, those residing in major cities can easily get the access for their health care services. The rural populations also have higher levels of diseases, short lives, and limited access to health services in comparison to metropolitan older adults. Due to health inequities, there are 20 % more chances of poor health in rural areas than in metropolitan areas. There are also fewer general practitioners in rural areas, hospitals, lack of access to tertiary and vocational education opportunities and ultimately lead to poor older health. This is so because poor education led to poor lifestyle with unhealthy control over health. There are approximately 100 general practitioners per 100,000 populations in Australia for rural areas with only 102 hospitals in rural areas (Beer et al., 2016). 

Health Outcomes

Due to poor cardiovascular health issues, social determinants, and other factors the target population faces many other health outcomes. According to Mariño et al. (2016), governmental and non-governmental organizations are putting efforts into better health in older adults in rural regions in Australia. With the concept of healthy aging, campaigns, and programs to support healthy aging. With increased interaction of health professionals with the aged care system, the chances of good health in rural old adults are increased. There is an increased decline in the rural target population due to heart attack, stroke, hypertension, and other health complications. Other major health issues are mental health (every one in 5) and 40 % face injury issues due to muscular stress.

Nursing Care and Nursing Standards

The care to the targeted population can be delivered with the help of 3 nursing practice standards, these are as follows: standard 1 – analysis and critical thinking during practice; standard 2 – engagement in therapeutic and professional relationships; and standard 4 – conducting the assessments comprehensively (Nursing and Midwifery Board of Australia, 2016). Older adults should be provided with evidence-based nursing practices. This includes maintaining their health status by monitoring their blood pressure, infection control, and others. The patient should be asked for his/her cultural backgrounds to provide the patient with culturally safe and respectful care services. As the patient is of old age so proper time should be given for clearly explain the patient about his/her doubts, confusion, consent should be taken for treatment planning, and the patient should be involved in decision-making with family members. The family members or close peers should be asked to ensure effective and strong support to the patient during his/her old age or treatments. They should be encouraged for volunteering work, this result in meeting with new people, happy life, physical activity, better mental and emotional health as well. According to Alston et al. (2020), older patients should be delivered with consistent cardiac care. For example, the patient should be assessed for cardiac risk factors like insulin resistance, cholesterol, tobacco, hypertension, infection, renal issues, and others. With age, various co-morbidities become common like hearing or vision deficits, dementia, depression, and anemia. The patient should be educated about his/her health condition, self-management, signs, and symptoms of poor and good cardiovascular health, and should be encouraged for physical activity and proper lifestyle with a healthy diet. Moreover, the patient should be asked to get a regular health check-up and conduction of follow-ups as well. The nurses should ensure that they are young their best for coping with the health of the old patients. The coping strategies help in improving the health of the old patient and impacting their health. Moreover, the plan should be prepared in such a way that the patient does not have to make several visits to different doctors. There should be a combined care service delivery for rural patients with respect to their income status.

According to Carrington et al. (2017), if there is effective communication then the older patient does not feel depressed or alone. There should be the proper and effective acknowledgment of the patient’s statement with either effective oral or written communication. As the patient is a very old age group so there should be at least one care provider near them for surveillance and delegation of the care delivery functions. This avoids unexpected results and the information should be kept private and confidential. As the patient is old he/she might not remember about his/her medications or plans, so these should be written in simple language so that the patient can understand it. He/she should be provided with alert systems or e-health systems so that they can access their health status from their rural areas without long traveling for care centers in cities. The nurse should sit directly opposite the old patients, this result in effective communication without distraction and generates complete focus. There should be proper eye-contact so that the facial expressions can be deciphered. According to Orr et al. (2016), during the treatment of the old care, it is found that that dignity and autonomy are often compromised when there is a lack of privacy of the patient and no maintenance of the desires and needs of the patient.

According to Lee et al. (2020), patience is also helpful in conducting a comprehensive assessment while delivering care to old adults. There can be moments when the care provider has to repeat several points several times. This can resolves by using a slow rate of speech and clear and simple language so that the old adults understand the message and assessments can be conducted easily. The care providers or nurses should make sure that the sentiments of the old patients are not hurt. As they might have differing opinions for their treatment, so they should be respected to ensure holistic and culturally safe care is delivered. There should be a complete and effective acknowledgment of the different experiences shared by old patients. If there is a development of strong rapport then the patient will feel the sense of familiarity that will help in developing improved planning for the care of the patient. It is often found that old patient suffers from sensory challenges like hearing issues, vision problems, cognitive impairments, difficulty in communication, and many others. Each factor should be monitored and assessed comprehensively and it should also be ensured that the ailments are impacting the patient in the desired and expected manner. This is so because it is found that the ailments or treatments impact different old patients differently. With the help of comprehensive conduction of assessments, the unexpected issues can be easily resolved. According to Thabet et al. (2019), physical discomfort can lead to distractions, therefore, these factors should be the focus on the patient and his/her family members as well. The patient should be provided with blankets, sweaters, pillows, and others to maintain their comfort level. These factors ensure that the well-being of the patient is maintained during his/her treatments. The patient should be informed about family nurse practitioners; they ensure care delivery as a part of the family practice. These family nurse practitioners work in close collaboration with health care experts, doctors, advanced practice nurse practitioners, and many other care providers. If the patient is suffering from various serious cardiovascular issues that might result in the death of the patient soon, then, the patient should be provided with end-of-life care planning. Moreover, there should be advanced care planning for such patients to ensure their effective holistic and culturally safe care. They should be informed about the various referrals as well like nutritionists for their healthy diet, psychologist, physiotherapist, orthodontists, dentists, and many others. This information should be transferred in writing to the family members as well to ensure that there is a complete transfer of the information. The social, economic, biological, and other factors should be checked for the patient that might impact the health of the patient and his/her treatment or other management plans as well (Orr et al., 2016). There should be involvement of the family members or close peers for decision-making because it is often found that the old patients find it difficult in decision-making procedures.

Conclusion on Cardiovascular Health in Older Adults in Rural Australia

The cardiovascular health complications in old adults of rural areas in Australia are facing many complications. The risk factors include their socio-economic status. The poor education, poor transportation to reach the health centers in major cities, poor employment rates, and many others have resulted in negatively impacting the health of the population. Many older adults of rural areas are found to have health issues like hypertension, hypotension, heart attacks, heart strokes, alcohol and smoking problems, respiratory complications, and many others. Many are found to have low income or dependency on pensions; their inability to understand the prescription in English language or access to offers and services also resulted in their poor cardiovascular health. However, with the help of effective nursing care with nursing standards ensured the health of the target population can be improved with the delivery of quality care. The use of effective communication, evidence-based nursing practices, and comprehensive assessments can help in ensuring the good health of the target population. The nurses should also ensure that the care is not impacting the economic level of the patient, access to the care services is practically possible, holistic, and culturally safe care delivery.

References for Cardiovascular Health in Older Adults in Rural Australia

Alston, L., Bourke, L., Nichols, M., & Allender, S. (2020). Responsibility for evidence-based policy in cardiovascular disease in rural communities: implications for persistent rural health inequalities. Australian Health Review, 44(4), 527-534.

Australian Institute of Health and Welfare. (2015). Australia’s health 2014. Retrieved from:,%25)%20and%20blindness%20(2%25).

Beer, A., Faulkner, D., Law, J., Lewin, G., Tinker, A., Buys, L., & Chessman, S. (2016). Regional variation in social isolation amongst older Australians. Regional Studies, Regional Science3(1), 170-184.

Bishop, L., Ransom, A., & Laverty, M. (2018). Cardiovascular health in remote and rural communities. Canberra: Royal Flying Doctor Service of Australia.

Carrington, M. J., & Zimmet, P. (2017). Nurse health and lifestyle modification versus standard care in 40 to 70 year old regional adults: Study protocol of the management to optimise diabetes and metabolic syndrome risk reduction via nurse-led intervention (MODERN) randomized controlled trial. BMC Health Services Research17(1), 1-10.

Lee, J., Kang, M. J., Garcia, J. P., & Dykes, P. C. (2020). Developing hierarchical standardized home care nursing statements using nursing standard terminologies. International Journal of Medical Informatics141, 104227.

Mansour, H. E. (2019). Developing Nursing Standards for Maintaining Fluid and Electrolyte Balance for Critically Ill Patients in Intensive Care Units. Journal of Intensive and Critical Care5(1), 4.

Mariño, R., Hopcraft, M., Ghanim, A., Tham, R., Khew, C. W., & Stevenson, C. (2016). Oral health‐related knowledge, attitudes and self‐efficacy of Australian rural older adults. Gerodontology33(4), 530-538.

Northwood, M., Ploeg, J., Markle‐Reid, M., & Sherifali, D. (2018). Integrative review of the social determinants of health in older adults with multimorbidity. Journal of Advanced Nursing74(1), 45-60.

Orr, N. M., Boxer, R. S., Dolansky, M. A., Allen, L. A., & Forman, D. E. (2016). Skilled nursing facility care for patients with heart failure: Can we make it “heart failure ready?”. Journal of Cardiac Failure22(12), 1004-1014.

Peng, Y., & Wang, Z. (2018). Cardiovascular health status among Australian adults. Clinical Epidemiology10, 167.

Thabet, O. F., Ghanem, H. M., Ahmed, A. A., & Abd-ElMouhsen, S. A. (2019). Effect of developing and implementing nursing care standards on outcome of patients undergoing cardiac catheterization. IOSR Journal of Nursing and Health Science (IOSR-JNHS)8(01), 42-54.

van Gaans, D., & Dent, E. (2018). Issues of accessibility to health services by older Australians: A review. Public Health Reviews39(1), 20.

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