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 complaint of knee pain x 3 days after a basketball  

 be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources. 

 with epigastric pain x 6 days 

What is the most likely diagnosis for a patient with the following CBC findings? WBC: 8.8 × 103/µl; RBC: 3.01 × 103/µl; Hgb: 10.3 g/dL; Hct: 32.2%; MCV: 74 fL; MCHC: 28.3 g/dL; Plt: 400 × 103/µl; RDW: 18.4%; Reticulocytes: 2.1%.

Identify which anemia is the patient experiencing, which tests should be ordered and what type of treatment should be followed.

For all the SOAP note assignments, you will write a SOAP note about one of your patients and use the following acronym:

S =Subjective data: Patient’s Chief Complaint (CC).O =Objective data: Including client behavior, physical assessment, vital signs, and meds.A =Assessment: Diagnosis of the patient’s condition. Include differential diagnosis.P =Plan: Treatment, diagnostic testing, and follow up

The theory of cultural marginality explores the lived experiences of individuals who exist between two or more cultural systems without fully identifying with either. This often leads to feelings of isolation, identity conflict, and social displacement. In the healthcare setting, cultural marginality significantly influences patient care, as individuals living on the margins frequently experience disparities in access, communication barriers, and mistrust toward the healthcare system. Nurses play a pivotal role in mitigating these challenges by adopting culturally competent and compassionate care strategies. Caring, as defined by Watson’s Theory of Human Caring, emphasizes the importance of authentic presence, respect, and individualized attention in fostering trust and healing. Applying this principle to culturally marginalized patients involves recognizing their unique backgrounds, listening to their concerns, and advocating for equitable healthcare.

     An example from practice involves a young immigrant mother from Central America living in a shelter. She spoke limited English, lacked insurance, and hesitated to seek medical care due to fear of deportation. As her nurse, I employed a culturally sensitive approach by using an interpreter, validating her concerns, and providing education about community resources for undocumented individuals. By creating a safe and nonjudgmental space, I was able to establish trust, ensuring she received prenatal care and support. This encounter underscored the importance of integrating cultural competence and humanistic caring to address the vulnerabilities faced by marginalized populations. Culturally marginal individuals require more than clinical interventions; they need holistic care that acknowledges their struggles and affirms their dignity. Nursing, at its core, is about advocacy, understanding, and the promotion of inclusive healthcare.

References

Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13(3), 189-192.

Watson, J. (2008). Nursing: The philosophy and science of caring. University Press of Colorado.

Sagar, P. L. (2012). Transcultural nursing theory and models: Application in nursing education, practice, and administration. Springer Publishing Company.

The theory of cultural marginality corresponds with caring in the human health experience by encouraging nurses to critically examine their own cultural biases and privileges, and by understanding the marginalizing experiences of cultural minority groups (Kwame & Petrucka, 2021).The lack of mutual understanding between health care providers and immigrants has increased as more people start to migrate to the United States, an article from 1996 stated that almost 1 in 10 people living in the United States was a foreign-born immigrant and the number of foreign-born in the population exceeded 25 million (H;, 2001), now imagine how that number double or maybe tripled by 2024. Cultural marginality is defined as “situations and feelings of passive betweenness when people exist between two different cultures and do not yet perceive themselves as centrally belonging to either one” (H; 2001).

Cultural marginality can be seen in cities and in a state with a great migration rate such as Florida, working as a nurse in Miami and now in North Florida I can understand and relate to the patients and their needs to find and identify themselves with a culture. Often migrants tend to embrace the American culture but also keep close their own heritage and culture, thus creating a new mixed culture of both nationalities. Since 1960, Florida’s population has increased 248% to 19,057,542 in 2011, making it the fourth largest state in the nation (Hill, 2014) although this vital statistic is from past years one can see the increase in migration to the state of Florida.

Years ago, I worked in a dialysis unit that was the closest unit to the Everglades, and I had a many Native Americans although they are the first Americans their culture is very different from the American culture we see now. He was Miccosukee and I had to learn how to interact with them and learn their culture and costumes. At first it was challenging because they see the white man as a threat, I can say I blame them nevertheless I got to know him and his family during the hours he was on treatment, once I showed interest to learn his culture new doors opened, his friends and family were now wanting to treat at our clinic. Their culture is so fascinating and interesting that once I asked to learn more the better, he felt with me caring for him, his wife was Seminole, and both explained to me that although the same tribe they have different names because Miccosukee separated and reminded in the Everglades where he lived in the reservation. I learned about his culture through his stories, and he taught me beliefs as well as I educated myself through research. My patient was very misunderstood by many of the staff there because of his culture, beliefs and traditions. By educating myself and by showing respect to his culture I was able to provide positive care and achieve trust and provide a safe place to treat three times a week. As nurses we must look beyond our beliefs and our culture and immerse our self to live a different culture in order to help our patients succeed in order to provide positive outcomes for everyone.

References

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing, 20(1), 1–10.

H; C. (2001, July 24). Cultural marginality: A concept analysis with implications for immigrant adolescents. Issues in comprehensive pediatric nursing. https://pubmed.ncbi.nlm.nih.gov/12141837/

Smith, Mary J., & Liehr, P. R. (2013a). Middle range theory for nursing Mary J. Smith; Patricia R. Liehr (ed.). Springer Publ.

Hill, J. R. (2014). Cultural indicators report – Florida family policy council. STATE OF FLORIDA Cultural Indicators. https://flfamily.org/wp-content/uploads/2014/03/FFPC-Cultural-Indicators-Report.pdf