Cultural competence training for clinical staff: measuring the effect of a one-hour class on cultural competence.

In an environment of changing demographics and health care disparities, it is essential that nurses continue to develop competence in providing care across cultures. This article presents the findings of a pilot project to measure and compare self-reported cultural competence scores before and after participation in one of the core classes of a cultural competence curriculum. Cultural competence of the staff of a patient care unit (N = 98) was assessed prior to the class, at 3 months, and at 6 months posteducation using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised. The results demonstrated that following an educational intervention the participants self-reported a statistically significant increase (p = .03) in cultural competence within the category range of cultural awareness. Providing cultural competence education may better equip nurses to care for patients from diverse cultures.

Prolonged severe hypotension following combined amlodipine and valsartan ingestion.

INTRODUCTION: Compared to other calcium channel blockers (CCBs), overdose with dihydropyridine CCBs are considered relatively benign due to their vascular selectivity. Although not a sustained-release preparation, amlodipine's prolonged duration of effect is concerning following overdose. In addition, angiotensin II receptor blocker blunting of vasoconstrictive and sympathetic compensatory responses could exacerbate calcium channel blocker toxicity. We describe severe toxicity associated with an overdose of amlodipine and valsartan. CASE REPORT: A 75-year-old woman presented to the ED 45 minutes after a witnessed suicidal ingestion of a "handful" of amlodipine and valsartan tablets. Hypotension, which appeared two hours after ingestion, was refractory to crystalloids and colloids, calcium gluconate, epinephrine, norepinephrine, phenylephrine, and vasopressin infusions. High-dose insulin euglycemia (HIE) therapy, and treatment with glucagon and naloxone were successful in improving her hemodynamic status. In this combined overdose, right heart catheterization demonstrated both negative inotropic effects and decreased systemic vascular resistance. CONCLUSION: Co-ingestion of amlodipine with valsartan produced profound toxicity. Early institution of HIE therapy may be beneficial to reverse these effects.