Fostering Cultural Safety Through COIL: Evaluating an Indigenous Health Module for Nursing Students in Australia and Canada

Abstract

Background

Achieving culturally safe healthcare is a global priority, yet traditional immersion programs are often costly, inaccessible or short-term, limiting opportunities to examine positionality, power, and colonial accountability. Collaborative Online International Learning (COIL) offers a scalable alternative in nursing education. This study evaluated a COIL Indigenous Health module delivered through a virtual global classroom and immersive digital tools across two countries.

Methods

A mixed methods design included pre- and post-module surveys and focus group interviews. Of 165 enrolled nursing students, 162 consented to participate and 74 provided matched pre–post responses. Students engaged in synchronous virtual global classrooms, virtual reality (VR) simulations, and asynchronous Padlet discussions. Cultural capability was measured using a validated tool; paired-samples t-tests (α = 0.01; Cohen's dz) quantified pre-post change. Post-module surveys (students) and focus groups (students n = 12; faculty n = 10) assessed COIL perceptions.

Results

Advocacy for Indigenous health improved significantly (p < .001; dz ≈ 0.68), as did confidence in culturally safe communication (p = .001; dz ≈ 0.40). Students rated the Indigenous Health VR scenario highly (M = 4.50) reporting transformative learning. Faculty reported enhanced pedagogical skills, deepened research engagement and strengthened international partnerships.

Conclusions

The Indigenous Health COIL module improved cultural capability and facilitated deep reflection on equity and historical influences related to Indigenous health. Immersive VR and cross-national dialogue created emotionally resonant learning experiences. Faculty gained opportunities for professional growth and sustained collaboration. Embedding Indigenous-led COIL modules into core curricula offers a scalable, globally relevant approach to developing culturally safe health professionals.