Care of women and marginalized populations in the critical care setting.

Cardiovascular disease (CVD), the leading cause of death, disability, and lost productivity in adults, drains our society physically and economically. Once considered a male domain, hospital mortality attributed to CVD has become more prevalent among women. As a result of this trend, critical care nurses can expect to care for more women with CVD. The psychobiological model of CVD suggests that psychological factors, such as anxiety and depression, contribute to the development and progression of CVD. Anxiety and depression occur more often in women than in men and possibly could be explained by the fact that women report experiencing physical and sexual abuse at a much higher rate than do men. Women with a history of physical and sexual abuse report more anxiety and depression than do women without such a history. A possible means by which abuse may begin and continue within the lives of women is marginality. Marginality serves as a perspective for viewing women's health in terms of physical and psychological health outcomes. By understanding marginality and its impact on health outcomes, critical care nurses may recognize patients at risk for adverse CVD health outcomes while in their care. These patients present unique health care challenges in critical care.