Holistic and Culturally Humble Care:
An Evidence-Based Reverse Case Study
NUR 302: Nursing Research and Evidence-Based Practice
Project Two: Reverse Case Study
Southern New Hampshire University
Instructor: [Instructor Name]
Date: June 10, 2026
, NUR 302 Project Two: Reverse Case Study
Abstract
This reverse case study analyzes the care of Sequoia, a 54-year-old widowed Native
American female presenting with a non-healing diabetic foot ulcer, poorly controlled
type 2 diabetes mellitus (HbA1c 9.4%), hypertension, and signs of depressive grief
following the death of her spouse. The analysis applies the NCSBN Clinical Judgment
Measurement Model (NCJMM) to work backward from the clinical presentation,
identifying the interplay of chronic hyperglycemia-induced peripheral neuropathy and
impaired wound healing with grief-related depression, social isolation, and rural health
disparities. Evidence-based interventions for diabetic foot ulcer management—including
off-loading, sharp debridement, and moisture-balanced dressings—are integrated with
depression screening using validated tools and glycemic optimization. Social
Determinants of Health, including transportation barriers, food insecurity, and social
isolation, are identified as primary drivers of the clinical deterioration. Cultural humility
principles guide the respectful incorporation of traditional healing practices and the
mitigation of implicit bias that may otherwise label the patient as non-compliant. An
interprofessional care plan addresses the biological, psychological, and social
dimensions of Sequoia's health.
Keywords: reverse case study, diabetic foot ulcer, cultural humility, social determinants
of health, clinical judgment, NCJMM, Native American health, type 2 diabetes
1. Introduction
The delivery of high-quality, equitable nursing care requires the seamless integration of clinical
judgment, evidence-based practice (EBP), and a deep understanding of the psychosocial and
cultural factors that influence a patient's health trajectory. This paper presents a reverse case study
analysis of Sequoia, a 54-year-old widowed Native American female presenting with a non-healing
diabetic foot ulcer and signs of depressive grief. A reverse case study methodology begins with the
patient's current clinical presentation and works backward through the underlying pathophysiology,
contextual barriers, and systemic factors that produced the presenting condition. The purpose of this
analysis is to apply the NCSBN Clinical Judgment Measurement Model (NCJMM) to prioritize
Sequoia's care, integrate current 2026 EBP guidelines for diabetic wound management and
glycemic control, and critically address the Social Determinants of Health (SDOH) and implicit
biases that impact her health outcomes and discharge readiness.
2. Patient Profile and Pathophysiology
Sequoia is a 54-year-old Native American female with a 12-year history of type 2 diabetes
mellitus (T2DM) and hypertension. She presents with a non-healing plantar foot ulcer, an elevated
HbA1c of 9.4%, a fasting blood glucose of 185 mg/dL, blood pressure of 148/92 mmHg, and
expressed feelings of hopelessness following the death of her spouse eight months ago. She lives
alone in a rural area and relies on intermittent public transportation or rides from a distant
community member to attend clinic appointments.
The pathophysiology of Sequoia's presentation centers on the long-term consequences of
chronic hyperglycemia. Advanced glycation end-products (AGEs) accumulate in blood vessel
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An Evidence-Based Reverse Case Study
NUR 302: Nursing Research and Evidence-Based Practice
Project Two: Reverse Case Study
Southern New Hampshire University
Instructor: [Instructor Name]
Date: June 10, 2026
, NUR 302 Project Two: Reverse Case Study
Abstract
This reverse case study analyzes the care of Sequoia, a 54-year-old widowed Native
American female presenting with a non-healing diabetic foot ulcer, poorly controlled
type 2 diabetes mellitus (HbA1c 9.4%), hypertension, and signs of depressive grief
following the death of her spouse. The analysis applies the NCSBN Clinical Judgment
Measurement Model (NCJMM) to work backward from the clinical presentation,
identifying the interplay of chronic hyperglycemia-induced peripheral neuropathy and
impaired wound healing with grief-related depression, social isolation, and rural health
disparities. Evidence-based interventions for diabetic foot ulcer management—including
off-loading, sharp debridement, and moisture-balanced dressings—are integrated with
depression screening using validated tools and glycemic optimization. Social
Determinants of Health, including transportation barriers, food insecurity, and social
isolation, are identified as primary drivers of the clinical deterioration. Cultural humility
principles guide the respectful incorporation of traditional healing practices and the
mitigation of implicit bias that may otherwise label the patient as non-compliant. An
interprofessional care plan addresses the biological, psychological, and social
dimensions of Sequoia's health.
Keywords: reverse case study, diabetic foot ulcer, cultural humility, social determinants
of health, clinical judgment, NCJMM, Native American health, type 2 diabetes
1. Introduction
The delivery of high-quality, equitable nursing care requires the seamless integration of clinical
judgment, evidence-based practice (EBP), and a deep understanding of the psychosocial and
cultural factors that influence a patient's health trajectory. This paper presents a reverse case study
analysis of Sequoia, a 54-year-old widowed Native American female presenting with a non-healing
diabetic foot ulcer and signs of depressive grief. A reverse case study methodology begins with the
patient's current clinical presentation and works backward through the underlying pathophysiology,
contextual barriers, and systemic factors that produced the presenting condition. The purpose of this
analysis is to apply the NCSBN Clinical Judgment Measurement Model (NCJMM) to prioritize
Sequoia's care, integrate current 2026 EBP guidelines for diabetic wound management and
glycemic control, and critically address the Social Determinants of Health (SDOH) and implicit
biases that impact her health outcomes and discharge readiness.
2. Patient Profile and Pathophysiology
Sequoia is a 54-year-old Native American female with a 12-year history of type 2 diabetes
mellitus (T2DM) and hypertension. She presents with a non-healing plantar foot ulcer, an elevated
HbA1c of 9.4%, a fasting blood glucose of 185 mg/dL, blood pressure of 148/92 mmHg, and
expressed feelings of hopelessness following the death of her spouse eight months ago. She lives
alone in a rural area and relies on intermittent public transportation or rides from a distant
community member to attend clinic appointments.
The pathophysiology of Sequoia's presentation centers on the long-term consequences of
chronic hyperglycemia. Advanced glycation end-products (AGEs) accumulate in blood vessel
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