Most American hospitals apparently do not offer formal programs of diabetes-related patient education. In many in stitutions, patient educa tion consists only of the provision of written materials or is assumed to be an informal respon sibility of the primary care nurse. Both of these instructional arrangements are inadequate: many written materials are too difficult for patients to read, and most floor nurses lack the training to carry out diabetes patient education. As a result, substantial gaps exist in patient knowledge and performance of essential aspects of self-care. These gaps appear unrecognized in many institutions.
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