A nurse has a very great role in patient education. Teaching a patient requires effective communication and use of information competency skills to improve the delivery of vital information to patients, therefore, contributing to effective patient care (Herdman, 2011) . In the clinical area, I observed a nurse give teaching to a diabetic patient on nutrition that is optimal to the body's requirement. For this particular patient, the nursing diagnosis was imbalanced nutrition: less than body requirements related to poor appetite, nutrition knowledge deficit and increased metabolic needs caused by diabetes as evidenced by a loss of weight, decreased serum albumin, documented suboptimal caloric intake, loss of subcutaneous tissue, and recurrent hospital admissions.
The behavior change that was required of the patient was mostly dietary as research has shown that dietary behavior has an intricate link in patients with diabetes. It was, therefore, vital that the nurse teaching the patient on adequate nutrition understand the patient’s requirements as well as his knowledge basis on the topic (Peter et al., 2015) . The patient knew that he should have a balanced diet and that he should avoid any form of calories. Greater intake of legumes, fruits, nuts, whole grains has shown to reduce the risk of morbidity due to diabetes and therefore the patient out to change his nutritional behavior to more of those (Herdman, 2011) . Due to his reduced caloric intake, he also ought to have optimal rations of calories as well as other food groups preferably prepared by a nutritionist.
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In communication and especially teaching a patient, there are often cultural barriers that impede effective communication. They include language, prejudices and stereotypes, beliefs and behaviors, ethnocentrism, religion, among others (Riley, 2015) . The patient spoke and understood English, is an American, was elderly, a Muslim, and a Caucasian. The nurse offering the teaching also understood and spoke English, and was Caucasian and was impartial and objective. There were few cultural barriers to communication since the patient displayed subtly some ethnocentrism where on issues that involved diets and behavior changes not aligned to his religion, he made statements such as "those are for them" and completely shut down on discussing any further on the subject.
During the teaching, the nurse took an individualized approach. He first sought to understand what were the patient's specific needs and deficiencies both in diet and knowledge of nutrition as well as his medical condition and on that he taught as per the patient's particular needs (Riley, 2015) . He also sought to know the readiness of the patient to take up the information given. This has shown to be quite an effective method in effective patient education. He kept the whole teaching session as patient-centered as he could and gave intentional support for the patient to own his health (Herdman, 2011) . The nurse was patient enough to listen to the patient's thoughts, ideas, and opinions on the subject and clarify any points that were not clear to him. He relayed all the information in a way that was clearly understood and was able to make the patient take responsibility for his health and diet.
After the end of the teaching, the patient was content with the information he had acquired and was so eager to change his dietary behavior immediately that he asked to see a nutritionist immediately who would help in the daily rations. Before the teaching, it was established that one of the main reasons that he had imbalanced nutrition was insufficient knowledge which after the teaching was somewhat solved. Clinically, a week later, the patient's serum albumin was close to normal; he had an added weight of 2kgs and looked healthier. In communication, there are many dos and don'ts (Peter et al., 2015) . Most of the dos were elicited by the nurse doing the teaching; however, it was not entirely perfect on his side since, at the beginning of the teaching, the caregiver assumed that the elderly patient shared the same sentiments as to how he was deteriorating due to improper nutrition. That is one of the don’ts in communication. The first approach to a patient ought to be on how to make the patient care about what one is prepared to teach on (Peter et al., 2015) . From this patient teaching experience, it was interesting to learn that patient teaching ought to be specific for the patient and not a blanket teaching. The knowledge of effective communication from this basic principle, I believe, will greatly influence my goal of being an excellent caregiver.
References
Herdman, T. H. (Ed.). (2011). Nursing diagnoses 2012-14: definitions and classification . John Wiley & Sons.
Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015). Reducing readmissions using teach-back: enhancing patient and family education. Journal of Nursing Administration , 45 (1), 35-42.
Riley, J. B., (2015). Communication in nursing . Elsevier Health Sciences.
