Facilitating Client Centred Learning

For a full set of references refer to the BPG

The recommendations within this guideline are based on the following key assumptions:

1. A client is defined as a person, persons, group, aggregate or community with whom the nurse is engaged in a professional, therapeutic partnership relationship in any setting

2. Clients have the right to assume responsibility for their own learning or to delegate this responsibility to others

3. Collaborative partnership relationships with clients are critical to the success of client centred learning

4. Nurses must know their learner

5. Communication is central to client centred learning. It is the responsibility of nurses to actively listen to their clients and align their conversations accordingly

6. Information, resources and support for clients should promote care that is evidence informed and respects clients’ preferences

7. Client understanding of the information is needed for effective learning

8. Nurses are reflective practitioners, and continue to grow and learn in their role as facilitators of learning

9. Given the complexities of health care, strong health literacy skills of nurses and clients can have overall benefits for the health-care system.

• Health literacy is more than just being able to read health information and complete medical forms
• Health literacy involves the integration of a wide variety of individual skills, health-care professional communication skills, health-care practices and system processes 
• Data from the International Adult Literacy and Life Skills Survey estimated that limited health literacy skills affect 55% of Canadian adults over 16 years of age and 88% of seniors 
• Segments of the population that are more vulnerable to the risks associated with low health literacy include seniors, immigrants and the unemployed
• There are higher average health literacy scores among adults who reported excellent health, compared to those who reported poor or fair health status 

• This best practice guideline is based upon a specific learning theory – social constructivism.
• This theory argues that people create their own understandings by integrating their previous experience/knowledge with new learning, within specific contexts, including crucial social contexts. 
• This is consistent with the principles of client centred care.
• Social constructivism promotes effective assessment.
• In health-care settings, this assessment is about how well the client understands the knowledge, the implications for safety/health, how supported they are to adopt healthy behaviours, and the availability of resources to follow-up and continue to engage actively in learning to care for themselves and maintain their health.
• Nurses assess client learning regularly, taking into account the challenges of health literacy, incorporating holistic analysis of client learning and building on client strengths.

• Promoting health is a key competency of all nurses.
• Nurses promote health by advocating for healthy public policy and use their knowledge and expertise to promote health literacy with individual clients, families, groups and communities
• Nurses engaged in promoting health and facilitating client centred learning have a key teaching/educational role that is based upon sound educational theory.

• There are five key changes to explore in the practice of a nurse with a constructivist approach:

1) power relations; 2) content; 3) role of the facilitator; 4) responsibility for learning; and 5) assessment of learning.

Power Relations

• Power relations between the client and the nurse need to be balanced. The nurse is not the expert in the client’s life – the client is the expert.
• The focus is on the learner.
• The nurse as teacher is a facilitator, one who seeks to promote a positive learning environment, beginning by listening carefully to the client’s story of their life including power relations.

Content

• Constructivism seeks to move beyond surface learning to a deeper learning, one where the learner constructs meaning; “the focus shifts from covering content to using the content to develop unique ways of understanding the content and creating meaning.” 
• Facilitators need to encourage questions, and encourage learners to use many strategies to locate the content knowledge that is important to them including using the Internet, literature, cultural knowledge and peer informed knowledge.

Role of the Facilitator

• The authority of the nurse/facilitator is challenged by a constructivist approach. The facilitator’s expertise is not negated but rather recedes into the background
• The more active/interactive role is that of the client who is trying to learn about health

The nurse/facilitator encourages the client to be an active learner, and promotes client engagement in an interactive way with the learning materials, media, Internet, and seeking their own knowledge sources.

Responsibility for Learning

• Ideally, nurses are facilitating learning with autonomous, self-directed learners who “assume responsibility for their own learning” 
• Nurses must assess the learning needs of the learner and work collaboratively to negotiate an approach to learning that promotes learner responsibility but still guides and facilitates that independence.

Assessment of Learning

• In a constructivist approach the approaches to assessment must be clear. 
• For the most part, this assessment is about how well the client understands the knowledge, the implications for safety/health, how supported they are to adopt healthy behaviours, and the resources to follow-up and continue to engage actively in learning to care for themselves and maintain their health.
• Nurses should plan to assess client learning regularly, taking into account the challenges of health literacy, incorporating a holistic analysis of client learning and building on client strengths

Comparison of Educational Theories

• The following is an example of a communication tool that can be used by various health-care professionals
• This example is focused on asthma care and illustrates how education can be delivered across initial client visits and follow-up visits, promoting self-management education in asthma care
• To view the sample communication tool click here

To view the Check for Understanding model click here.

• Facilitating client centred learning is based on the foundation of four pillars which include 1. Client Centred Care 2. Promoting Health Literacy 3. Building Knowledge and Skills 4. Supporting Self Management Strategies
• These four pillars support client centred learning and encourage self-efficacy and decision-making
• L.E.A.R.N.S. (Listen, Establish, Adopt, Reinforce, Name and Strengthen) is the acronym for the interactions that take place between the client and nurse
• The L.E.A.R.N.S. Model also signifies the nursing process
• By listening to the client’s needs, the nurse is able to understand the client’s perspective, see the client as a whole and begin to build a partnership relationship that is therapeutic and respectful of autonomy, voice and self-determination
• Facilitation of client learning is an intentional intervention which recognizes that learning requires information, opportunity to practice new skills, ability to translate new knowledge and skills into the client’s context, assessment of the learning, and the opportunity to enhance comprehension or mastery of the skill which promotes self-efficacy and self-management
• To view the L.E.A.R.N.S Model Developed by the expert panel click here.