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Academic and Community–Engaged Approach to Integrating Open Educational Resources in Population Health Course

Nguyen-Truong, Connie Kim Yen PhD, RN; Graves, Janessa M. PhD, MPH; Enslow, Electra MA, AHIP; Williams-Gilbert, Wendy PhD, RN

doi: 10.1097/NNE.0000000000000653
Feature Articles

Background Open educational resources (OERs) increase access to high-quality academic learning materials and promote affordable education in nursing.

Problem Integrating OERs into existing nursing courses can be arduous for faculty.

Approach An academic and community–engaged approach involved faculty, university librarians, and community stakeholders. Community leaders and population health experts helped identify OERs for a population health theory course.

Outcomes Community stakeholders identified potential OERs, and university librarians assisted faculty in evaluating the OERs for quality.

Conclusions Findings illustrate the value of faculty engaging with community stakeholders to help identify OERs and with university librarians to evaluate the OERs to ensure that the information presented is relevant and applicable to course objectives.

Authors Affiliations: Assistant Professor (Dr Nguyen-Truong), College of Nursing in Vancouver, Washington State University; and Assistant Professor (Dr Graves) and Clinical Associate Professor and RN-BSN and Professional Development Director (Dr Williams-Gilbert), College of Nursing in Spokane; and Head of Library Research and Instruction, Spokane Academic Library (Ms Enslow), Washington State University.

Funding from Washington State University Vancouver Open Educational Resource Planning Grant was awarded to Dr Nguyen-Truong, and Drs Graves and Nguyen-Truong also received the Washington State University Vancouver New Faculty Research Start-up Grant.

The authors declare no conflicts of interest.

Correspondence: Dr Nguyen-Truong, Washington State University College of Nursing, 14204 NE Salmon Creek Ave, Vancouver, WA 98686 (

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Accepted for publication: December 15, 2018

Published ahead of print: February 11, 2019

Online date: February 14, 2019

In the last 3 decades, the growth of internet-based education led to the development of online courses and degree programs.1 Classes and learning objectives have evolved to adopt new modes of information delivery, including online readings, internet-based assignments, and digital books. However, poor-quality materials, including some low- or no-cost online resources, warrant concerns about reuse.2 In 2002, the Hewlett Foundation funded an effort to use information technology to help distribute high-quality knowledge and educational opportunities throughout the United States and world to address those challenges.2(p2) From this effort, the concept of open educational resources (OERs) was coined and defined as “teaching, learning, and research materials in any medium—digital or otherwise—that reside in the public domain or have been released under an open license that permits no-cost access, use, adaptation, and redistribution by others with no or limited restriction.”3(para7) Currently, a wide selection of OERs is available for research and teaching (see Examples of Open Education Resources, see Table 1, Supplemental Digital Content 1,

Integrating OERs into nursing curricula can provide students with access and exposure to affordable, high-quality learning resources beyond the traditional textbook. However, faculty planning to integrate OERs into existing courses face a steep learning curve. The authors introduce an academic and community-engaged approach (CEA) that involves faculty, university librarians, and community stakeholders in integrating OERs. Although community stakeholders are not actually integrating OERs into the course, they can help to identify potential OERs. In this article, the authors describe (1) the OER initiative at their large public university, (2) the value of faculty collaboration with university librarians, (3) the types of licensing for OERs, and (4) an evaluation process on how to use an OER assessment rubric using key criteria. We also provide an example of engagement of community stakeholders (ie, community leaders and population health experts) to help identify potential OERs and working with university librarians to evaluate those identified OERs for a population health theory course within an RN-BSN program.

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OER Initiative at a Local University

In higher education, OERs have been welcomed as a means to address the rising costs of textbooks and proprietary software. At a large public university in the Pacific Northwest, an OER initiative was borne of these concerns, brought forth by the associated student body and supported by the university administration in 2017. The OER initiative identified the need to reduce education costs through adoption of high-quality academic materials available at no cost to students. To encourage OER use, the university provides grants to faculty to modify courses, encourages student-led OER content, provides an institutional repository for generated learning resources, and assists with instructional design.4 As a result, faculty can be more flexible in adapting learning resources into their courses and can produce culturally appropriate, inclusive, and interdisciplinary content for students.

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Value of Faculty Collaboration With Librarians

When developing an OER plan for an existing course, nursing faculty can benefit from consulting one-on-one with a university librarian. Librarian assistance can include identifying supplemental material, developing an OER from scratch, or repurposing an existing one.5 When faculty develop courses, it is an opportune time to identify and evaluate key OERs relevant to course content. Multiple OERs are available; however, faculty may have limited knowledge on how to adequately evaluate the most appropriate OER for their course content. University librarians can facilitate this process, break down barriers, and address misconceptions about OERs. For example, librarians can assist with copyright issues, provide online guides as a starting point for faculty, locate and assess OER materials, and partner with institutional repositories for sustainability and longevity of resources.6

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Licensing and Evaluation Considerations

The first consideration for librarians working with nursing faculty to address prior to integrating OERs into courses is licensing. Creative Commons ( has several types of licenses available from least restrictive (no restrictions for use) to most restrictive (prohibiting remixing or creating derivatives of the work or copying, distributing, displaying, performing, or remixing the work for commercial purposes). Within this range, however, many other licenses exist, with varying levels of restriction.7 A librarian can work with faculty in identifying and confirming copyright restrictions.

After licensing consideration, a librarian can work with faculty in evaluating OERs for quality as the next important step prior to use in nursing courses. Much like evaluating quality journals, articles, and publishers, there are key criteria in an OER assessment rubric to consider prior to integrating into courses. BCcampus Open Ed: BC Open Textbooks Review Criteria can be used as an OER assessment rubric.8 These key criteria include comprehensiveness, content accuracy, relevance/longevity, clarity, consistency, modularity, organization, interface, grammar, and cultural relevance. The following is a description on how to use an OER assessment rubric with these key criteria for evaluation.

First, a librarian and faculty review whether the resource is sufficiently comprehensive (covers areas and subjects appropriately) to ensure that the information presented is relevant and applicable to course objectives. Then, content is reviewed for accuracy (error-free and unbiased). There should be a path for continuous updating OERs to ensure content is accurate regarding relevance/longevity. Next, the resource is reviewed for writing, which should be clear and free of grammatical errors, and to confirm the content is at the appropriate level of learning for the audience and text is internally consistent (terminology and framework). OERs should be reviewed for cultural relevancy including text that is culturally insensitive or offensive in any way, and examples such as a standardized patient scenario should reflect a variety of races, ethnicities, and backgrounds. Modularity, or the organization of OER information, is reviewed whether it is presented in a sequential format, which is important so that, if needed, faculty can selectively use specific modules for a class. The interface is reviewed to determine if the OER is simple to navigate and free of issues of distortion of images/charts or other display features. A number of OER assessment rubrics are available (Examples of Rubrics for Assessing Open Educational Resources, see Table 2, Supplemental Digital Content,

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Engagement of Community Stakeholders to Help Identify Potential OERs

In addition to collaboration with university librarians, the authors engaged with community stakeholders to help identify potential OERs for a population health theory course. Interdisciplinary courses such as population health are well suited to OERs, because the content inherently incorporates information from multiple sectors. The content that OERs present can address the critical need for multiple voices and expertise from diverse environments. The richness of this diversity of practice and thought by engaging community stakeholders is valuable to inform students' educational experiences.

A CEA was used to garner community and population health experts' input in helping to identify potential OERs.9 There was a diverse group of community stakeholders. Eight community stakeholders represented public, not-for-profit (eg, hospital or clinic), and nonprofit organizations (eg, community-based organization) and had varied backgrounds, including recent nursing graduates and experts in public health, gerontology, law, social justice, and advocacy.

CEA uses an empowering participatory approach to engage community stakeholders.9 In their engagement with community stakeholders, faculty used the climate setting and generating steps of group-level assessment to solicit perceptions and recommendations in the identification of OERs.10 Community stakeholders engaged in decision making through an interactive, participatory process using an online learning management system (LMS). The community stakeholders engaged in this process for 3 weeks, during which the average time commitment was about 2 hours per participant (total). Participation allowed for time flexibility (ie, did not need to complete in a single sitting).

In the climate setting step, community stakeholders were asked to review the course learning outcomes for a population health course to gain an understanding about the course. In the generating step, faculty provided 3 topical areas of discussion: 13 weekly topics covered in the course (Supplemental Digital Content, Table 3,, learning objectives aligned with each weekly topic, and course concept maps for the first 2 foundational weeks on the topics of public/population/community health and epidemiology. Faculty provided semistructured, open-ended topical prompts to promote discussion in the LMS. In one of the discussions, prompts included solicited perceptions and recommendations on free educational resources and products to support nursing students' learning. The course faculty generated a list of major and minor concepts and terms existing in the course, which were then connected as a visual depiction that linked concepts. Faculty highlighted course information to help community stakeholders understand what students were learning in the course, which informed their assistance to faculty to identify OERs.

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Community stakeholders provided helpful recommendations for potential OERs to integrate into the course. These resources includes resources at other universities, nonprofit and nongovernmental organizations (eg, Public Health Foundation, World Health Organization [WHO]), and governmental agencies (eg, Agency for Healthcare Research and Quality, Health Resources and Services Administration). Resources housed by the National Library of Medicine, such as Native Voices (, and by the Indigenous Food Systems Network (Working Group on Indigenous Food Sovereignty, were suggested. These resources were consistent with, although not as extensive as, resources recommended by the health sciences librarian collaborating on this project.

BCcampus Open Ed: BC Open Textbooks Review Criteria were used as an OER assessment rubric to evaluate for quality prior to selecting.8 We provide 2 exemplar descriptions of high-quality OERs: the first is an evaluation of a resource that was not familiar to faculty, Indigenous Food Systems Network, and the second is a resource that was familiar to faculty, the WHO. In the first exemplar, faculty worked with a librarian and examined the copyright to determine if the content was available for use as an OER. In this case, there was not an obvious creative commons logo, but under terms of use, the website clearly stated the user needed to be respectful of the content and not use it for monetary gain. Importantly, it cited the Canadian Copyright Act, “Fair dealing for the purpose of research or private study does not infringe copyright” (section 29), “…Further, [n]o action… may be carried out with motive of gain” (section 29.3). Next, after copyright had been established, we evaluated the material using the OER assessment rubric. In summary, the website has been adding quality information about indigenous foods since 2006, making the site comprehensive; the content is well organized and easily accessible for reuse in a course. Next, we evaluated the content for accuracy, grammar, reading level, and culturally relevant knowledge.

In the second exemplar, faculty worked with a librarian to evaluate the WHO Health Impact Assessment (HIA) ( First, we checked for permissions to use the HIA section. While there was not an obvious copyright permission available, such as Creative Commons licensing, in the opening text it states, “Many HIA guidance documents have been produced from all regions of the world, and we encourage you to use these for detailed work.” Additionally, WHO has a Permissions and Licensing page that states, “Extracts of WHO information can be used for private study or for educational purposes without permission.” Next, we evaluated the information using the OER assessment rubric. In summary, the material pertaining to HIAs is comprehensive, accurate, and relevant. The information is clearly presented and free of grammatical errors. The interface is simple to navigate, and the information can be easily parsed to aid in a course. The information is not offensive in anyway.

Through the engaged dialogue among community stakeholders, 2 themes arose (beyond community stakeholders' recommendations for OERs). First, several community stakeholders endorsed the value of using “human resources” to learn in addition to or instead of online resources. One community stakeholder noted, “Students [should] get off the internet to talk with real people… and visit real people for perspective.” Community stakeholders noted that the value of traveling to learn about cultures and populations, resulting in “opportunities to change [students'] beliefs and understanding through direct learning, is much greater than in the classroom and online.” Faculty incorporated the suggestion about having students talk to people into the course (in this case, students had the option to talk to a key informant or an expert in the form of a personal communication related to the population health topics in their writing assignments).

The second theme that arose was to rely on students as resources to identify OERs. One community stakeholder wrote that “some students are often better able to identify these types of resources than we are.” Several community stakeholders offered suggestions for student activities in identifying OERs, including using a case-based, small group format with specific task areas to motivate students to explore this issue on their own (after providing examples). Faculty discussed this suggestion but did not incorporate a specific expectation in the course to have students identify OERs as faculty were still learning to integrate OERs into the course.

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Because faculty need to learn how to integrate OERs into their courses, there is value to collaborating with community stakeholders to help identify potential OERs and with university librarians to evaluate resources using an assessment rubric. In this project, faculty selected OERs after evaluating them using BCcampus Open Ed: BC Open Textbooks Review Criteria as an assessment rubric. Two culturally specific high-quality OERs were adopted and used in the population health theory course. This learning process was initially intensive but became more comfortable and will serve as a basis for faculty integrating OERs in future courses. These methods can be employed across a broad range of nursing courses to enhance student learning and address concerns about affordability of academic resources. Integrating OERs into nursing curricula may improve students' access and exposure to affordable, high-quality learning resources beyond the traditional textbook.

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The authors thank Sue F. Phelps, Health Sciences and Outreach Services Librarian, at Washington State University Vancouver Academic Library, for her expertise in this project.

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community engagement; nursing education; open educational resources; population health

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