Cultivating intellectual, behavioral, and attitudinal flexibility is central to a nurse's ability to work effectively across dimensions of difference. Alternately, thinking and acting based on a singular set of cultural norms is considered un-ethical in nursing practice because it does not provide accommodation for unique beliefs, values, and traditions. Furthermore, clients and communities seek out alternatives to health care providers who are not aligned with their wishes and do not understand them (Soulé, 2014). In preparing nursing students to work across diverse populations, experiential learning techniques can play a valuable role in effectively transforming classroom experiences into deep learning. The following activity was designed to help students imagine from multiple perspectives, reveal taken-for-granted assumptions, promote empathy toward alternate values, beliefs, and world views, and open areas for further reflection. Before beginning, faculty should review three guidelines with students. First, all ideas and perspectives are welcomed. Second, responses do not have to reflect the beliefs or values of the person stating them. Finally, responses do not have to be “practical” or “reasonable.”
The Rule of 16 classroom activity is presented in four steps and takes between 30 and 45 minutes to complete. Step one is students and faculty choose a shared experience or topic of interest. For example, choose an event that the students have experienced together—topics such as the positive aspects of obesity or smoking cigarettes have been used to stimulate thought. The faculty facilitator invites students to verbally share their initial responses to the event or topic in either a large group or pair-share format who then share their findings with the larger group. Please note that first responses are often automatic and based on personal values, beliefs, backgrounds, and world views (Soulé, 2014).
Step two is the faculty facilitator asks students to pause and think more broadly and deeply about the event or topic at hand. Intentionally pausing and slowing down the dialogue allows space to consider alternatives to the initial responses. Questions to consider are:
- What assumptions am I making?
- How else can I think about this?
- What might the other person (e.g., family, community) be thinking, feeling, or wanting?
- What else is possible in this situation or context?
Step three is the faculty facilitator asks students to generate a minimum of 16 alternate responses to the event or topic of choice. There is nothing distinctive about the number 16 other than it moves students beyond the easy first three to five alternatives. When time allows, many groups go well beyond 16 alternatives.
Step four is to develop awareness of the implication of our choices for either inclusion or exclusion of others (e.g., individuals, families, communities) and the consequences this has for nursing practice and health outcomes.
This experiential learning activity paired with skilled facilitated reflection has assisted faculty and students to consider mindful, inclusive responses to diverse views. This activity has been used in a classroom setting with nursing students, a faculty workshop on nurturing cultural competence in nursing, and preparing nursing students to work effectively with immigrant, refugee, and asylee populations. Students have reported many aha moments during this activity and report using this exercise again by themselves and with their own clients and nursing students after their original classroom experience. Recommendations to consider are (a) suspend certainty, (b) leave space for difference, (c) listen to understand, (d) slow down the inquiry, and (e) speak from self-awareness. This activity is applicable to both personal and professional dilemmas and can help generate creative, inclusive alternatives and solutions.
Isabelle Soulé, PhD, RN
University of Portland
- Soulé, I. (2014). Cultural competence in health care: An emerging theory. Advances in Nursing Science, 37, 48–60. doi:10.1097/ANS.0000000000000016 [CrossRef]24469088