Author: Stacy Lutter, D. Ed, RN
Title: Assistant Professor, The Stabler Department of Nursing
Institution: York College of Pennsylvania
Patient-Centered Care Skill:
Incorporate reflective practices into own repertoire
Patient-Centered Care Attitudes:
Honor learning opportunities with patients who represent all aspects of human diversity
Seek to understand one’s personally held attitudes about working with patients from different ethnic, cultural and social backgrounds
The Circle of Objects is a teaching strategy that can be used as a way to acknowledge cultural differences and facilitate reflection of one’s own heritage, which is an essential component of establishing patient-centered relationships in nursing practice. This exercise was originally developed by the Fetzer Institute in San Francisco and is discussed in Brookfield and Preskill (2005).
For this activity, students are asked to bring an object to class that reflects their cultural heritage. Students are sometimes initially concerned with this request because they do not believe they have a unique history or traditions. While it is tempting to give examples of objects students could bring, it is best to let the prompt open to interpretation and allow students to reflect on an aspect of their cultural heritage they are willing to share.
• Because this is a vulnerable activity, the course instructor should begin the sharing process.
• Each student is given 2-3 minutes to share their cultural artifact.
• Students must stand to present their artifact and there should be no interruptions during this process.
• There should be no specified order in presenting and each student should speak when they feel ready to share.
• Silence should be maintained between students.
• After each student presents his/her object, it should be placed on a centralized table.
• Time for discussion and interaction with the objects should be allowed after everyone has had an opportunity to participate.
• The instructor should express gratitude for the participation in this process and state the importance of reflecting on our own identity and attitudes in order to provide high-quality patient centered care.
Ideally, the activity should take place towards the end of class, because it can be overwhelming and deeply personal. The course instructor does need to be prepared for the potential for students to become emotional in respect to their own background or the cultural heritage of others.
This activity honors the backgrounds of different ethnicities and social classes. It brings awareness to the notion that we are more than our outward appearance, which is a critical step in developing the attitude required to provide high level patient-centered care. Self-reflection is an important step towards developing competence in patient-centered care.
During this activity, students have brought in favorite family recipes or foods, traditional cultural garments, religious objects, immigration paperwork, and symbols of favorite family activities or traditions. After this experience, students who perceived their family life as “normal” are often surprised to find that they do have unique traditions. Additionally, using this activity in an introductory graduate course can provide an opportunity for students to know each other better and connect on a deeper level.
Students have reported this is as a valuable learning activity on course evaluations. I would not recommend soliciting feedback immediately, because many students will continue to reflect on the experience. Soliciting a written reflection after a period of time may enhance the reflective process. The reflection should focus on how this activity facilitated their thinking about:
1. one’s personally held attitudes about working with patients from different ethnic, cultural, and social backgrounds
2. patients who represent all aspects of human diversity
3. strategies they could infuse into their own practice to promote patient-centered care
While this activity could be adapted for use in the on-line environment using video or photography, the opportunity to kinesthetically connect to the cultural heritage of others is a powerful learning tool.
Brookfield, S., & Preskill, S. (2005). Discussion as a way of teaching: Tools and techniques for democratic classrooms (2nd Ed.). San Francisco, CA: Jossey-Bass.