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

Emphysema, a hallmark of chronic obstructive pulmonary disease, is primarily caused by prolonged exposure to cigarette smoke, which leads to irreversible alveolar damage. Smoking initiates an inflammatory response characterized by increased neutrophils and macrophages, which release proteolytic enzymes such as elastase and matrix metalloproteinases (Barnes et al., 2020). These enzymes degrade elastin, an essential component of alveolar walls, resulting in the destruction of alveolar septa and the formation of enlarged air spaces. This structural damage reduces alveolar surface area, impairing gas exchange and leading to ventilation-perfusion mismatch. Additionally, smoking-induced oxidative stress further exacerbates lung injury by depleting protective antioxidants like glutathione, amplifying inflammation, and inducing apoptosis in epithelial and endothelial cells (Aghapour et al., 2021). Over time, emphysema results in progressive airflow limitation, hyperinflation, and reduced lung compliance, contributing to dyspnea and decreased exercise tolerance.

     β-Agonists are central to managing diseases with increased airway resistance, such as asthma and COPD. These drugs, primarily short-acting such as, albuterol and long-acting such as, salmeterol and formoterol, stimulate β2-adrenergic receptors on airway smooth muscle cells, leading to cyclic adenosine monophosphate activation and smooth muscle relaxation (Rabe & Celli, 2022). By reducing bronchoconstriction, β-agonists improve airflow and alleviate symptoms of wheezing and dyspnea. In addition to bronchodilation, these agents may modulate airway inflammation by inhibiting the release of pro-inflammatory mediators from mast cells and cytokines from immune cells. Their therapeutic role is particularly crucial in COPD, where chronic inflammation and mucus hypersecretion contribute to airway obstruction. Long-acting β-agonists, often combined with inhaled corticosteroids, enhance symptom control, reduce exacerbations, and improve quality of life for patients with obstructive lung diseases.

References

Aghapour, M., Raee, P., Moghaddam, S. J., Hiemstra, P. S., & Smit, J. J. (2021). Airway epithelial barrier dysfunction in chronic obstructive pulmonary disease: Role of cigarette smoke exposure. American Journal of Respiratory Cell and Molecular Biology, 64(2), 163-174. https://doi.org/10.1165/rcmb.2020-0244TR

Barnes, P. J., Baker, J., & Donnelly, L. E. (2020). Cellular senescence as a mechanism and target in chronic lung diseases. Nature Reviews Immunology, 20(12), 707-721. https://doi.org/10.1038/s41577-020-0370-1

Rabe, K. F., & Celli, B. R. (2022). Pharmacological treatment of chronic obstructive pulmonary disease: The ABCD revised. European Respiratory Journal, 59(2), 2100939. https://doi.org/10.1183/13993003.00939-2021

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?

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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