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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

• Refer to the “Population-Focused Nurse Practitioner Competencies” found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
• Refer to your Clinical Skills Self-Assessment Form you submitted in Week 1, and consider your strengths and opportunities for improvement.
• Refer to your Patient Log in Meditrek, and consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.

• Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
• Reflect on the three (3) most challenging patients you encountered during the practicum experience. What was most challenging about each?
• What did you learn from this experience?
• What resources were available?
• What evidence-based practice did you use for the patients?
• What would you do differently?
• How are you managing patient flow and volume?
• How can you apply your growing skillset to be a social change agent within your community?

Communicating and Feedback

• Reflect on how you might improve your skills and knowledge, and communicate those efforts to your Preceptor.
• Answer the questions: How am I doing? What is missing?
• Reflect on the formal and informal feedback you received from your Preceptor.

Watch three videos:

– Measure of Center ‘Mean’: https://lc.gcumedia.com/hlt362v/the-visual-learner/measure-of-center-mean.html

– Measure of Center ‘Median’: https://lc.gcumedia.com/hlt362v/the-visual-learner/measure-of-center-median.html

– Measure of Center ‘Mode’: https://lc.gcumedia.com/hlt362v/the-visual-learner/measure-of-center-mode.html

Go to the (https://www.random.org/integer-sets/) website, to generate a set of random numbers. Click on the “Get Sets’ link at the bottom left of the page to generate some data. (Note: If you are not able to access the link, you can randomly generate 10 numbers yourself for this calculation.)

Imagine these numbers are the care satisfaction scores from a recent sample of discharged patients. Randomly select one row of numbers to use for the following calculations:

• What was the mean?
• What was the median?
• What was/were the mode/s?
• Given that the range of data was between 1 and 20, what do these numbers tell you about the overall satisfaction of the patients?
• If you were reporting these scores back to your supervisor, how would you explain or interpret these satisfaction scores?

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.

Review the terms Stratified Sampling from “The Visual Learner: Statistics,” (https://lc.gcumedia.com/hlt362v/the-visual-learner/the-visual-learner-v2.1.html).

Use the Stratified Sampling method to answer the following question:

Imagine that you are conducting a patient satisfaction survey at your health care facility. How would the assigned sampling method be applied in this case? What are the strengths and weakness of the assigned sampling method in this scenario?

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.

Established in 1987, ABC Community Hospital not-for-profit is an acute care hospital located in an east coast Metropolitan area. With a staff of nearly 200 physicians and specialists, 800 employees and 100 volunteers, they offer a full range of healthcare services. They are accredited by the Joint Commission on Accreditation of Healthcare Organizations. The hospital has been profitable for the last 5 years with a profit margin of 3-4%. The mission of ABC Community Hospital is to provide accessible and comprehensive healthcare services in a convenient and cost-effective manner to the people who live in our community.

At the last Board meeting, hospital administration and the Board of Directors began to discuss a proposal to build a new wing devoted to a Cancer Center and ancillary services devoted to the treatment of cancer.  The new wing would have 30 acute care beds, four surgical operating rooms, intensive care unit and extensive support services, including physical therapy and hospice care. All patient rooms would be private. There is no Cancer Centers within a 200 mile radius of the hospital service area.

Now, the Board of Directors has come back with more questions that they want you to add to the original plan with new content:

• Compare and contrast the kinds of decisions that are made in the Cancer Center capital investment decision analysis for ABC Community Hospital.
• What information is needed by the CFO to evaluate the Cancer Center capital investment project? Use the classification of capital expenditures and justification of capital expenditures for this project, and include working capital management. 
• Who, internally from the healthcare system and externally, should be involved in the capital investment decision process to determine the feasibility of the Cancer Center?

The case study based on CAD involves a 65-year-old male with a history of smoking and high cholesterol.

Patient Demographics

• Gender: Male
• Age: 65 years old
• Family History: Father had a heart attack at a young age
• Occupation: Retired in nursing home

Symptoms

• Chest pain
• Shortness of breath
• Nausea

Medical History

• Smoker (pack-a-day)
• High cholesterol levels
• Sedentary lifestyle

Physical examination

• Slightly elevated blood pressure

Diagnostic test

• Stress test: positive for ischemia
• Electrocardiogram (ECG): shows ST-segment depression with exercise

Treatment plan

• Lifestyle changes: smoking cessation, regular exercise, healthy diet
• Medications: statins to reduce cholesterol levels, beta-blockers to slow heartbeat and reduce blood pressure

References

Bauersachs, R., Zeymer, U., Brière, J., Marre, C., Bowrin, K., & Huelsebeck, M. (2019). Burden of coronary artery disease and peripheral artery disease: A literature review. Cardiovascular Therapeutics, 2019, 1-9. https://doi.org/10.1155/2019/8295054Links to an external site.

Cassar, A., Holmes, D. R., Rihal, C. S., & Gersh, B. J. (2009). Chronic coronary artery disease: Diagnosis and management. Mayo Clinic Proceedings, 84(12), 1130-1146. https://doi.org/10.4065/mcp.2009.0391Links to an external site.

Wilson, P. W., & O’Donnell, C. J. (2018). Epidemiology of chronic coronary artery disease. Chronic Coronary Artery Disease, 1-15. https://doi.org/10.1016/b978-0-323-42880-4.00001-7

My Topic is on HIV

General question: Which diagnostic tools—labs, imaging, or physical assessments—are most critical in confirming the diagnosis? Why? 

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