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The 21-Headed Nurse and Other Perspective-Shifting Activities

Using exercises that evoke strong emotions, Sharon Bigger, MA, helps break down personal biases, raise transcultural awareness, and increase collaboration.


Sharon Bigger, MA, BSN, RN-BC, CHPN

Visiting Assistant Professor of Nursing, Judge-McRae School of Nursing at Mars Hill University in Mars Hill, NC

PhD candidate in Nursing, MA in Philosophy and Religion/Women’s Spirituality, BS in Nursing, BA in Sociology, RN-BC in Nursing Professional Development, Certified Hospice and Palliative Nurse (CHPN)

Even in nursing school, Sharon Bigger gravitated toward teaching with engaging and interactive activities. She was usually the one who stood up to explain things in her study group—while doing movements to help everyone remember. “I was referred to as the ‘interpretive dancer’ of the group,” Bigger says. But it worked. They consistently remembered what was discussed.

Her methods worked so well that she brought them back when she became a hospice educator and was tasked with training volunteers about infection control. To liven things up, Bigger invented a dance—the Gown-Mask-Glove Shuffle—to help them remember how to put on and take off protective equipment. “Gown mask gloves, gloves mask gown. I got them into a rhythm,” she says, grooving to a tune in her head.

Later, she turned to song to ensure that volunteers washed their hands long enough to remove germs. For this, she would ask the group who was born that month, then have everyone sing “Happy Birthday” to them while washing their hands for the duration. (That is about 15–20 seconds, or the amount of time recommended by the Centers for Disease Control and Prevention.)

“After my successes teaching these subjects, I felt like I could teach anything and make any subject more emotive,” Bigger says with a laugh.

Now a visiting associate professor at the Judge-McRae School of Nursing at Mars Hill University in North Carolina, Bigger has added to her repertoire of teaching techniques, and she applies them to all of her nursing classes. In addition to being as engaging as her former song-and-dance routine, her latest inventions serve another purpose: They help nursing students look at the world from a perspective other than their own. This helps them connect with material—and future patients—on an emotional level, which will serve them well throughout their careers.

She shares some of her favorite exercises below.


“The literature supports that transcultural awareness is a safety issue, because lacking cultural awareness endangers patients.”

— Sharon Bigger, MA, BSN, RN-BC, CHPN

Courses: NUR 257 Transcultural and Global Health; NUR 420 Promoting Healthy Aging and Quality of Life; NUR 421 Promoting Community Health; NUR 409 Informatics, Communications, and Telehealth

Course descriptions: See sidebar.

See resources shared by Sharon Bigger, MA, BSN, RN-BC, CHPN

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11 interactive activities to shift students’ perspectives

Here are 11 activities Bigger uses to help students learn more deeply as they expand their point of view and rethink their stance on certain issues.

Sharon Bigger, MA, BSN, RN-BC, CHPN, uses interactive learning activities in all of her classes. These currently include the following courses:

Mars Hill University. (2018). 2018–2019 Mars Hill University catalog:

NUR 257 Transcultural and Global Health offers a worldview on health. The student is exposed to beliefs and values of other cultures in order to develop a sensitivity and respect for impacts on health promotion. Service learning is an expected component of this course and will be included in the Reflective Learning Journal. The importance of service learning, character development, responsibility, citizenship, and health promotion with cultural sensitivity is stressed and threaded throughout the curriculum.

NUR 420 Promoting Healthy Aging and Quality of Life: This course examines the components of healthy aging in the older adult and explores quality of life approaches inclusive of Palliative and Hospice Care. Cultural sensitivity, caring, respect, independence, and ethical/legal aspects are researched and applied. The pre-licensure BSN student is expected to utilize appropriate assessment, communication, and therapeutic skills with this population. Basics of ELNEC (End of Life Nursing Education Curriculum) will be incorporated.

NUR 421 Promoting Community Health: This course is focused on the promotion of health in the community as a whole. The “upstream” philosophy is explained and the Health Promotion Model applied with a holistic lens to the various cultural groups within the community.

NUR 409 Informatics, Communications, and Telehealth: This course focuses on principles and concepts related to the use of informatics in the practice of nursing. The roles of the nurse in promoting health and safety in a culturally sensitive manner will be emphasized. The legalities, socio-economic issues, and ethics will be examined in relation to communications through information systems, electronic health records, Telehealth, regulatory oversight, continuity planning in disasters, and relationship with patient outcomes.

A sociometry continuum

On the first day of class, Bigger uses a strategy called sociometry to see where students stand on a variety of issues. First, she creates a continuum by placing signs on the floor, with one end being “strongly agree” and the other “strongly disagree.” Then she reads a series of statements and asks the participants to physically move to the spot that corresponds to how much they agree or disagree with the statement.

This not only allows Bigger to see how her students are feeling about the subject matter before studying it but also lets them relate to one another. “Sociometry allows students to see, quite literally, where they stand in relation to one another in terms of beliefs or opinions,” says Bigger. “It is a snapshot in the moment, and we may find that feelings and attitudes change as a result of their learning from one another in the classroom or from their patients in clinical experiences.”

Intergenerational interviews

Students interview an older family member about their beliefs and values regarding birth, death, family roles, and other domains. They also provide their personal responses to the same prompts, then write a paper comparing responses across the generations. Bigger says this activity was designed by the nursing school’s dean, Dr. Cathy Franklin-Griffin.

Transcultural service learning

In another activity designed by Dr. Franklin-Griffin, students engage in 12 hours of service learning for an organization dedicated to a cultural group (other than their own) that interests them. Meanwhile, students also partner to conduct a literature review of a relevant topic. Ultimately the student partners compose a final paper based on both the literature review and their service learning experiences.

An age progression exercise

Bigger guides students in an in-class imagery activity, prompting them to project themselves into what their lives will be like at 90. She asks them questions such as, “At age 90, where are you living? Who is around you? What brings you joy? What wisdom do you have to share with your 20-year-old self?” This helps the students develop insights into goals for healthy aging and quality of life, in preparation for their future work with older populations.

Culture-based similes

Bigger provides prompts, such as “Appalachian culture is like _____ because _____,” and students offer responses, coming to their own conclusions about the accuracy and adequacy of what they hear. Bigger says she tries not to judge or interpret but aims to be neutral and reflective (repeating their answers back to them), so as not to inhibit their creative thinking.

Have them examine issues from a new angle

Bigger also has her students work through how they feel about a subject in front of a class so that they can explain why they think a certain way. Here are some specific activities she uses:

Subject-matter similes

Bigger sets up a scenario like this one: “The cardiovascular system is like _____ because _____________.” She often gets evocative answers, such as: “The cardiovascular system is like a water pump and garden hose, because you have to look at the whole system to make sure water is getting to where it needs to go.” These vivid answers can help students gain clarity about a concept or find another way to “file” it in their brain.

Student debates

Often, Bigger has the class split in half to debate a topic, usually on technology and society. Students do research in one class, then debate during the next. She does not always tell them what side they will be defending, so they have to research both sides equally well. This has worked particularly well when she chooses thorny topics, such as those in her informatics classes. Some topics she has used in the past include: Do children benefit from using smartphones? Is AI a threat to humanity? Should Google be able to use your location? Should electromagnetic fields be regulated by law? Should controlled substances be prescribed remotely via telehealth?

The 21-headed nurse

For this role-playing activity, students take on the role of a 21-headed nurse who has to interview a single patient, played by Bigger. To succeed, students must consider the thoughts and feelings of everyone involved.

Put students in the role of teacher

Collaboration plays a huge role in Bigger’s philosophy. She wants students, particularly those nearing graduation, to take a leadership role in their learning, so she increasingly puts them in the driver’s seat during class. She points out that, as nurses in direct care, they will need to educate their clients. “We teach them to complement their experience (trust what they know) with evidence from the literature,” she says.

A Google Slides learning guide

Bigger breaks the class into small groups, each of which creates a slide on an assigned topic and then explains it to the class. “They all get a chance to be the presenter,” she says. And they all get to keep a copy of the collective slideshow as a study tool.

A fill-in-the-blank concept map

Here, Bigger asks students to fill in “bubbles” on a concept map. For example, when talking about the cardiovascular system in older adults, she uses a premade concept map that has some bubbles filled in and others left blank (for the students to fill in). “Students appreciate the visual and interactive nature of this,” Bigger says.

Sharon Bigger

A collaborative exam

Bigger sometimes asks students to tell her what they think the most important concepts are in a particular chapter or unit. She then uses their responses to help craft the actual exam.

“This really freaks out the nursing students, because they already have so much anxiety about their upcoming standardized exam [the NCLEX] that they look toward the faculty to coach them about what is important to remember,” says Bigger. “However, once I got started, the students really seemed empowered and engaged.”


When Bigger thinks back to her first years as an educator, she wishes she had been less intimidated by students’ initial reluctance to do things that are unorthodox. She let this get to her at first, but she has since learned that balance is key. Her new approach: Some lecture is OK, and some activities are OK, so long as they all balance out.

She seems to have mastered the balancing act at this point, several years into her career as an educator. One of her students summed it up in a recent course evaluation: “If everyone taught like her, we would all learn our information very well.”

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