Initially, discuss the barriers/issues with the patient/family and collaborate with the health care team to determine the best course of action. Depending on the issue, the time of day, and your location, it may be necessary to call the AOD, Patient Services, or the Nursing Supervisor for assistance.

Consideration Approach

Language issues

• At the Columbia Presbyterian Center, contact the Volunteer Interpreter Corps. At the Allen Pavilion, call Patient Relations.
• At the New York Weill Cornell Center, refer to the list of translators, call Patient Services, or call the Department of Volunteer Services
• At the Westchester Division, staff can request an interpreter by calling Human Resources.
• Use staff or volunteer translators rather than family members or friends to maintain objectivity, privacy, and confidentiality.
• Use demonstrations, pictures, and diagrams.
• Use the AT&T Language Line A-4
  
  Cultural and religious considerations
• Identify cultural or religious practices that can affect the teaching plan.
• These may include diet, activity restrictions, grieving practices, etc.
• Work with the patient and the health care team to obtain a suitable solution.
• Keep an open mind about others', cultural and religious beliefs, attitudes, and practices.
• Call Pastoral Care/Chaplaincy for assistance.
  
  Literacy
  
• Use diagrams, pictures, discussion and video as availability permits.
  
• Choose reading material that is prepared for those with limited reading proficiency. (4th to 6th grade).
  
  Cognitive barriers
  
• Use simple terms, demonstrations and pictures, frequently restate, reinforce and reassess learning.
  
  Emotional barriers

• Try to determine the source of anxiety, provide support, and referrals as needed, explain benefits of learning.
• Enlist family's assistance while ensuring patient confidentiality
  

  Financial implications

• MD, Social Work and other members of the health care team collaborate as needed to discuss the financial implications of proposed care.