1. Hawkins, Janice MSN, RN
  2. Campbell, Ann MSN, RN, CPNP

Article Content

Nursing programs are challenged to prepare students to provide culturally sensitive care to increasingly diverse populations and "to practice in a variety of healthcare settings."1(p8) Nurse graduates must be equipped to deliver holistic, patient-centered care whether practicing at home or around the world. For our students, the world has become a much smaller place. The availability of instant and continuous worldwide news and information has increased exposure to global issues. As well-traveled nursing faculty with extensive global nursing experience, we believe that increasing global health awareness is the first step to better equip nursing students to practice in our own communities and abroad. Students express interest in this content but are limited in their ability to participate in costly study-abroad experiences. Global health content has been identified as an essential component of baccalaureate education,1 but only 21% of nursing programs define global health content in their curricula.2

Janice Hawkins... - Click to enlarge in new windowJanice Hawkins
Ann Campbell... - Click to enlarge in new windowAnn Campbell

To address this need, we developed a Web-based course to increase global health awareness in undergraduate nursing students. This course uses innovative wikitechnology as a teaching/learning tool allowing students to "travel" to other countries without leaving the comfort of their computer chairs.


Why Wiki?

Wiki, a Hawaiian term meaning "to hurry or swift," is a collaborative Web site whose content can be edited by anyone.3 Wikipedia is the most commonly recognized example. When used as a discovery learning tool, wiki has the potential to "deepen levels of learners' engagement and collaboration within digital learning environments[horizontal ellipsis] [by] actively involv[ing] learners in their own construction of knowledge."4(pp1-3) Wiki is widely available through Internet sources as well as housed in university learning management systems such as Blackboard. Advantages of this format include low cost, ease of use, and the ability for virtual exchange of ideas. According to Kardong-Edgren et al,5 "wiki creates a learning community among students and actively engages them in the learning process."5(p1)


What Is a Wikicountry?

Using the wikitool as a vehicle to present key elements that impact health, each student develops an individual wikicountry on a country of interest. A wikicountry is a student analysis and compilation of current data and statistics examining complex relationships between environmental and cultural factors and health outcomes. Taken together, individual wikicountries result in an international global health encyclopedia (see Document, Supplemental Digital Content 1, for a sample wikicountry,


A Modular Approach to the Wikicountry Assignment

The overall purpose of our course is to introduce students to determinants that impact the health of populations worldwide. In designing this course, we determined the essential content for wiki development, selected a textbook, and translated key themes and critical issues related to global health into modules that allowed students to progressively construct their wikipage. These modular themes (Table 1) serve as the building blocks of the wikicountry and facilitate understanding of the connection between key health indicators and health outcomes. Using the wikitool, students introduce their country of interest and describe general information such as location, size, population demographics, natural resources, and political climate. Inclusion of visual aids such as pictures, maps, tables, and videos enhances reader interest and understanding. Progressing through each module, students add current statistics related to health indicators such as the leading cause of death, infant mortality, life expectancy, and maternal morbidity specific to their chosen countries. From the statistics and data posted on each wikipage, students are able to connect and compare the relationship between global health concepts and the impact on health. For example, students linked life expectancy and infant mortality to statistics related to the literacy rate and potable water supply. This approach fosters discovery learning, as they construct their wikicountry, module by module, into a final wikicountry product.

Table 1 - Click to enlarge in new windowTable 1. Modular Themes

Wiki Tips for Educators

Nurse educators are compelled to integrate global health content into existing nursing curricula.1 Using the wiki as an instructional tool to teach these concepts not only fills a curricular need but also "encourages students' interaction with the content, their peers, the faculty, and the technology."6(p209) The following tips may be helpful for educators interested in adapting the wikicountry assignment into their courses and curricula.


Do Not Assume Competence With Wikitechnology

We discovered that just because students are "digital natives" and grew up with technology does not mean that they are comfortable using all technology.7 Despite the fact that our students are adept at social networking and texting, we found ourselves answering questions such as "how do I post a picture?" and "how do I open my page?" To address this challenge, we post clear directions at the beginning of the course answering the most common technical questions. We post an example on the course site for students to refer to as a template.


Provide Formatting Guidelines

In addition to determining the content to complete each module, we found that providing guidelines on the format of a "country" resulted in a more engaging final product. These guidelines include headings that match each modular theme; supplemental graphics, such as of pictures, maps, tables, and videos for visual appeal and reader interest; and text citations along with a cumulative reference at the bottom of each wikipage. Such guidelines allow for student creativity while ensuring consistency of format for the overall wikicountry collection.


Require Peer Review

Our culminating assignment directs students to visit other wikicountries to compare similarities or differences in overall health factors to their own. The wikitool allows students to post comments at the bottom of each wikicountry page. They are directed to provide complimentary and constructive feedback related to visual appeal and inclusion of required components. A noted advantage of the wiki is that it allows students to critique each other's work.5 In addition to facilitating peer review, this assignment helps students gain awareness of health issues in other countries of the global community.


Integrate Wikitool Technology to Other Nursing Content

The wikicountry concept is not only contagious, but it is also easily adaptable. We have found that faculty colleagues wanting to connect didactic concepts to real-world application have adapted the wikitool to their own course content. A colleague in the nurse educator program uses the wikitool in her graduate-level course for sharing teaching plans and strategies. Students contribute their personal ideas and experiences related to nursing education, resulting in a collection of teaching strategies and examples.


Expand Global Health Beyond Nursing

This modular, elective course can easily be adapted to incorporate perspectives of other professions. This results in multidisciplinary approach to examine healthcare outcomes. Our global health course is now part of the biomedical engineering minor at our university.



As faculty and course developers, it has been extremely rewarding to observe how increased knowledge has transformed students' global health perspectives.8 The wikicountry has proven to be an exciting learning modality that enables geographically bound, undergraduate students to examine health concepts across the globe. Ultimately, the desired outcome is for students to increase their awareness of global health concepts and connect these to health outcomes. Student comments on the course have been positive and confirm that we have met the objectives of our course (Table 2). We believe that whether students come to the course dragging their feet or skipping with enthusiasm, they leave with a deeper appreciation for global health that they can incorporate into their future practice.

Table 2 - Click to enlarge in new windowTable 2. Student Comments



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7. Orlando J. Save time and teach better with screencasting. Faculty Focus. Available at Updated August 18, 2010. Accessed July 26, 2011. [Context Link]


8. Hawkins J, Campbell A. Wiki travels: using technology to teach global health concepts. Reflect Nurs Leadersh. 2010; 36 (3). [Context Link]