Research Articles

Implementation of COIL in mental health education: Outcomes of a collaboration between Spain and the United States nursing students




COIL, intercultural learning, health behaviors, mental health, nursing students


Collaborative International Online Learning (COIL) provides students meaningful and valuable engagement with students in another country to reach the goals of academic programs at the participating institutions. The strategy has demonstrated benefits for nursing students, including the acquisition of self-awareness, empathy, cultural humility, and leadership skills. The aim of this study was to share the results of the partnership in a COIL project using digital technology between a university in the United States and a university in Spain. The goals of this collaboration were twofold: to expose students in the U.S. and Spain to an international experience on mental health and to provide a comparative view of their respective health care systems. The chosen technique focuses on perceptions of mental health and how mental health care is delivered in clinical settings. A total of 166 students took part in this experience. The virtual exchange allowed students and faculty to share best practices in caring for people with mental illness. Nursing students providing care to COVID-19 patients reflected on lessons learned during the pandemic and its impact on community mental health. Small group activities such as icebreakers, homework assignments, and reflections were used to share and compare experiences. Students completed COIL surveys, which demonstrated that students from both countries perceived learning gains using evidence-based best practices related to key nursing concepts in a mutually respectful virtual exchange. The results show a perceived increase in the comprehension of mental health-related content and enhancement of clinical practice. Therefore, the COIL methodology is a feasible option as it allows for an intercultural exchange with an in-depth examination of content from the learners and teaching perspectives. In addition, it prepares students to work in international teams virtually.

Author Biographies

Hoa Bui Appel, University of Washington Bothell

Hoa Bui Appel is a Lecturer and the Behavioral Health Chair at the University of Washington Bothell School of Nursing and Health Studies. She teaches undergraduate public health and nursing students. Her areas of expertise and research focus on mental health, behavioral health, underserved populations, health disparities, co-occurring disorders, and interventions.

María Cristina Martínez-Fernández, University of León

María Cristina Martínez-Fernández is an Assistant Professor. She currently teaches mental health and adult nursing in the degree in nursing. She is a researcher in the SALBIS research group at the University of León. Her lines of research focus on health, mental health, and social network analysis.

Elena Fernández-Martínez, University of León

Elena Fernández-Martínez is a Full Professor at the University of León (Spain) and a member of the SALBIS research group. She teaches nursing students and health science professionals at master's and doctoral level. Her areas of expertise and research are mental health, well-being, vulnerable groups and health behaviors.





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