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Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master’s degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs’ competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students’ achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs’ development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed.
This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students’ development of the required competence to become APNs in critical care.
This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data.
The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations.
Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs’ required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education.
Worldwide, health care institutions’ treatment of patients has become increasingly complex because of the rapidly aging population [
To become an APN in Norway, registered nurses must attend and complete a master’s program of 120 European Credit Transfer and Accumulation System points. The curriculum is designed to guide an advanced practice nursing student (APNS) to acquire the expected competence. To educate APNs in critical care, it is essential to offer learning activities that promote the development of professional competence needed to care for acutely or critically ill patients. The main competencies that APNSs must acquire in their education are biophysical knowledge, technical skills, communication skills, intra- and interprofessional teamwork skills, leadership skills, and guidance and coaching skills as well as knowledge of evidence-based practice [
The APN master’s program at Norway’s Lovisenberg Diaconal University College (LDUC) provides theoretical and clinical practice studies over a period of 2 years. The clinical practice studies are distributed over a period of 8 weeks in the first term, 12 weeks in the second term, and 9 weeks in the third term. In each term, APNSs study various theoretical subjects before and after their practical period. In the last term, they focus on their master’s thesis.
A crucial part of nursing education is helping students to develop a strong foundation of evidence-based practice skills and apply them in clinical practice [
RG meetings at LDUC have recently been held on campus, with APNSs participating in 3 group sessions of 3 hours in each practicum. During the meetings, which included up to 10 APNSs, each student presented a patient case from clinical practice and a related research paper, providing evidence as recommended by Straus et al [
To address these challenges, the FFRG meeting concept was redesigned according to the LDUC’s strategy of using active learning methods based on technology. The new design, called the virtual RG (VRG) meeting, was better structured and held remotely via the Zoom meeting platform rather than in person. The first course to use the VRG meeting design was the Management of Complex Patient Conditions, the main learning outcome of which was analyzing and managing complex clinical situations based on professional experience, research, and knowledge. APNSs must gradually develop situational awareness and action skills in complex patient situations. Specifically, they must collaborate with the preceptor to gradually act independently using evidence-based practice. The VRG meeting aimed to increase the students’ time in clinical practice placements, to better organize professional discussion and reflection, to optimize and facilitate the participation of the students’ preceptors in RG meetings, and to improve the APNSs’ achievement of expected learning outcomes [
Throughout the clinical practice period, the NE, NPs, and APNSs attended VRG meetings, which comprised three meetings of 45-minutes each that were executed over 3 days (see
Comparison of face-to-face and virtual reflection group meeting design.
|
FFRGa meeting design | Consequences of an FFRG meeting | VRGb meeting design | Consequences of a VRG meeting |
Attendees |
1NEc, 9 APNSsd |
Lack of expert opinions from NPse in the discussions |
1 NE, 1 NP, 9 APNSs |
Included expert opinions from NPs in the discussions |
Setup and location |
3 FFRG meetings of 3 hours each at the university college campus Led by the NE Time per APNS presentation and discussion in the meeting: 15 minutes |
The APNSs spent a total of 9 hours away from the clinical practice placement. Travel time was needed. NPs were not able to join the RGf, as travel and discussion would require too much time away from critically ill patients. |
3 VRG meeting sessions of 45 minutes, totaling of 2 hours and 15 minutes on each Zoom meeting Each session was led by 1 APNS. Time per APNS presentation and discussion in each session: 45 minutes |
The APNS spent a total of 6 hours and 45 minutes away from the clinical practice placement. No travel time was needed. The NPs were able to join the professional discussions, as they could join the meetings in a room close to critically ill patients. |
Content |
9 APNSs each presented a patient case from clinical practice placement and a research article related to the case. The presentation was followed by a group discussion. |
Various levels of APNSs’ preparation for the participation Short presentations by all APNSs, often leading to repetition in the professional discussions |
3 APNSs each presented a patient case from clinical practice placement and a research article related to the case. The patient case was sent to the participants before the meeting. The presentation was followed by a group discussion. |
The APNSs were prepared for participation. Long presentations by APNSs, allowing time for thorough professional discussions |
Tools |
None |
Unstructured discussion |
Zoom video conferencing platform |
Structured discussion and participation order based on raised hands. |
Participants’ roles |
The NE was responsible for the discussion section. The role of APNS respondent was not defined. APNSs had no defined responsibilities. |
Passive participation of APNSs |
An APNS was responsible for the organization of the discussion section. An APNS respondent critically assessed the chosen article in advance and presented the assessment to the group at the meeting. Constructive participation in the discussion section was expected from the APNSs. |
Active participation of APNSs |
aFFRG: face-to-face reflection group.
bVRG: virtual reflection group.
cNE: nurse educator.
dAPNS: advanced practice nursing student.
eNP: nurse preceptor.
fRG: reflection group.
This study aims to address the challenges experienced in FFRG meetings by implementing VRG meetings and to explore the experiences of APNSs, NPs, and NEs with VRG meetings as an active learning method to stimulate students’ development of the competencies needed to become APN in critical care.
The research questions are as follows:
How did VRG meetings address the challenges experienced in FFRG meetings?
In comparison with FFRG meetings, what were the experiences of APNSs, NPs, and NEs with VRG meetings as an active learning method to stimulate the students’ perceived development of the competencies needed to become an APN in critical care?
This study adopted a qualitative explorative design using focus group interviews. An exploratory design is useful for identifying views and experiences [
The participants recruited for this study were APNSs, NPs (from the CCUs where the students carried out their clinical practice), and NEs from the master’s program in APN in critical care. The APNSs were recruited from 2 cohorts (autumn 2018 and autumn 2019). To be eligible for the study, the participants (APNSs and NEs) had to have had experience with the previous FFRG meeting design before participating in the VRG meetings. The course coordinator and associate professor (MTS) and the assistant professor (Ørjan Flygt Landfald) were responsible for the concept and organization of the VRG meetings.
Information about the study and invitations to participate were disseminated to the APNSs and NEs via the Canvas (Instructure, Inc) learning platform. The NPs were contacted via email because they had no access to Canvas. Informational meetings were also arranged after the users’ participation in the VRG meetings to recruit informants for the focus group interview. Polit and Beck [
To inform the focus group interviews, the research team developed an interview guide with open-ended questions about participants’ (APNSs, NPs, and NEs) experiences with the VRG (
Main question
Can you talk about your experiences of participating in virtual reflection group (VRG) meetings as compared with the face-to-face reflection group meetings?
Supporting questions
What are the benefits and limitations of the VRG meetings?
What was your experience of following a guide for conducting VRG meetings?
What competencies did you develop from the VRG meetings regarding your role as an advanced practice nurse (APN)?
How did the professional discussion contribute to your development as an APN in critical care?
Different roles are included in the implementation of a VRG; what expectations did you have in advance regarding:
leading the professional discussion when conducting a VRG?
including the nurse preceptor in the discussion to share their experiences?
your role as a respondent?
Research shows that the manner in which an interview is conducted crucially determines the quality of the collected data and relies on the moderator’s proficiency [
The project was approved by the Norwegian Center for Research Data (reference number: 132520). After the participants (APNSs, NPs, and NEs) expressed interest in participating, the course coordinator and associate professor (MTS) again provided verbal and written information about the study, after which the participants provided written informed consent. Before signing the informed consent, they were made aware that participation in the study was voluntary, that they could withdraw their consent at any time without giving a reason, and that doing so would not affect their study conditions at LDUC. The NPs and NEs were assured that their participation in the study would not affect their work conditions. The collected data were treated confidentially and used as described for the purpose of the project. The data were anonymized, making it impossible to identify individuals.
All authors participated in the data analysis, first reading the transcripts several times to gain insight into the content. We used inductive content analysis as described by Graneheim and Lundman [
Examples of the analysis process from meaning unit to theme.
Raw data divided into meaning units | Condensed meaning unit description close to the text | Interpretation of the underlying meaning | Subtheme | Theme |
NPa 5: We had a difficult case that the student chose to take up, which involved several people in the unit, so we talked. Both I and the student and several others also talked about the case before she presented it [in the VRGb meeting]. And after the VRG, it also was talked about, because it was a case that many thought was a bit difficult, and it became a learning situation for the students, of course, but also for the colleagues in the unit. So, it was actually quite a useful method and there were more people who benefited by learning from it then. | The preceptor described that the student chose to discuss a difficult case in the VRG meeting that led to a great involvement of colleagues working in the CCUc. Both APNSsd and colleagues on the unit learned from the discussions. | The VRG meeting is organized in a way that led to a great deal of involvement and increased the competence of students, the preceptor, and employees in the CCU. | Improved focus on evidence-based practice in the clinical environment | Synergy in competence development |
Moderator: Several of you have said that it is scary. What is scary? APNS 5: It was probably what was supposed to happen, because you shall lead the meeting for an entire hour, which none of us has done before. You will welcome, then you will present a case, then you will present an article, then you have questions [the fellow students] what do you think...and what do you think? You have to “hold it all the time.” Then, it’s not as simple as someone has mentioned earlier here, that you just talk as you can in a normal discussion, but that you actually have to “name drop” the other students as I did. If no one is talking, then I “name drop” in a way [laughs] so that there will not be such silence. So, yes, there was a bit of that about being a leader, which was scary, but it was very educational. | The APNS thought it was both scary and educational to be responsible for leading the meeting for 45 minutes the first time. Their charge was to welcome the participants, present a case and an article, and include all the students and preceptor in the discussion so that they all actively contributed to the discussion instead of participating in silence. | The role of leading a meeting and presenting a case and research article while making sure that all the students participated was quite scary the first time but at same time very educational. | Increased leadership skills | Developed intrapersonal and professional skills |
aNP: nurse preceptor.
bVRG: virtual reflection group.
cCCU: critical care unit.
dAPNS: advanced practice nurse student.
Participants (APNSs, NPs, and NEs) were divided into 2 groups. Each group was interviewed by the moderator, who was an associate professor (AAGN) who led the group discussions according to the prepared guide. Moderator bias was minimized, as both the moderator and observer were not involved in teaching the APNSs and were completely unknown to the participants [
The NEs were responsible for delivering the intervention through VRG meetings but were not involved in student recruitment or data collection. The researchers responsible for data collection had no previous contact with the APNSs to avoid possible bias connected to students being afraid that positive or negative feedback in the interviews could influence their grades.
The eligible participants comprised approximately 35 APNSs, 10 NPs, and 3 NEs who participated in VRG meetings as a part of learning activities in advanced clinical practice (
To ensure anonymity, references to individual participants’ statements used nonidentifying numbers to represent the individuals (
Participants in the study.
|
Focus group 1 (in person), participated/invited | Focus group 2 (web-based), participated/invited | Total, participated/invited |
Students | 6/8 | 3/27 | 9/35 |
Preceptors | 4/5 | 2/5 | 6/10 |
Educators | 2/2 | 2/2a | 4/4 |
Total | 12/15 | 7/34 (−1)a | 19/49 (−1)a |
aOne educator guided the groups in 2 different clinical practice periods; therefore, this educator participated in both focus group interviews 1 and 2.
Overview of participants’ nonidentifying numbers.
|
Focus group 1 (in person), participant identifier | Focus group 2 (web-based), participant identifier |
Students | 1-6 | 7-9 |
Preceptors | 1-4 | 5 and 6 |
Educators | 1 and 2 | 3 and 4 |
An overall finding of this study is that technology-supported RG meetings led to a better-structured active learning method. The VRG design allowed APNSs to spend more time in clinical practice placements and promoted active and effective participation of APNSs and NPs in the meetings. Participating in the VRG meetings increased the perceived competence of APNSs and NPs. The APNSs also perceived an improved learning experience compared with their own expectations. The findings are presented according to overall themes, followed by subthemes.
The results of this study revealed 3 main themes. The first theme reflects the importance of a well-structured learning activity in creating learning opportunities, whereas the second and third themes reflect how APNSs perceived the achievement of the general required learning outcomes and their expected professional competence as APNs in critical care (
The findings categorized into overall themes and subthemes.
Themes | Subthemes |
Preparation process encouraging learning |
Importance of a defined teaching design Importance of clearly determined roles |
Developing intrapersonal and professional skills |
Increased learning focus Increased responsibility and commitment Increased leadership skills |
Synergy in competence development |
Increased collaboration between students and preceptors Improved focus on evidence-based practice in the clinical environment Improved professional interaction skills |
The VRG meetings were conducted based on a rigorous guide, which the students evaluated as “very good.” One of the NEs experienced that the design of the VRG meetings led to better focus, which she perceived as an advantage, especially for the students. Several APNSs thought that the VRG meetings were more structured and effective than the FFRG meetings they had previously experienced (
The NEs and APNSs from both focus group interviews experienced that the VRG stimulated learning, as patient cases were distributed to the participants before each meeting. This new RG meeting structure led to a perceived improvement in the participants’ focus when compared with the previous design. One student said as follows:
I felt that it led to more learning because it was a completely different way of having a reflection group meeting, and what was presented was more evidence based. We were supposed to present the case and the research in such a way that it was easier to discuss it instead of just sharing our own experiences and opinions.
Another student added the following:
So we come into [the meeting] and we have to just start. We have only 45 minutes, and we have a lot to get through during that time. It became much more academic [with virtual meetings] than when we met face to face; then, it was more like, “Hi, how are you doing?,” and then you maybe lose 10 to 15 minutes talking about what’s been going on and that we haven’t seen each other. We can log in and talk together before the meeting starts if we want to have a chat.
An NE pointed out that APNSs were supposed to be on a clinical practicum to learn and that it was important that APNSs, NPs, and NEs understood their roles. One student emphasized the importance of the design in clarifying roles:
Each week, I felt that my role as a student was emphasised; it was easier for me to say, “I’m here to learn new things and to find good learning situations.”
Another student added:
It is important for us that the NP knows what we’re up against, so I think that a good thing about the meetings is that the NPs who have taken part in the VRG meetings know a little bit more about it.
One of the NPs said:
I have understood that the student is the one who takes responsibility, and the preceptor gets involved when the article is found and gets involved with the discussion that takes place before the VRG meeting.
Overall, the NPs perceived that they helped as much as they could during the RG meetings. One of the preceptors experienced that everybody had a role to play and that she learned a lot by listening to the respondent giving feedback. One of the educators pointed out:
It is important to involve the clinical preceptor, because it benefits both the student and the preceptor.
The students expressed that they spent more time preparing for the VRG meetings than for FFRG meetings. Accordingly, they perceived that they had developed better skills in finding research articles and presenting patient cases. When preparing for the VRG meetings, the APNSs experienced increased learning, as they studied their fellow student’s patient case, demonstrating more committed to being prepared for VRG meetings than for FFRG meetings. They perceived that preparing for the VRG meetings and participating in the patient case discussions stimulated their critical thinking. One of the NPs expressed surprise at the APNSs’ skills:
They [the students] knew the literature well; I had also prepared in advance. The good thing about having these VRG meetings is that they require more preparation of participants when compared with FFRG meetings. Now you have the chance to go a bit more in depth, you can spend more time at the ward, discuss with the NE, discuss with others in your surroundings and other fellow students on the subject, and it means that you maybe develop more insights into the studied subject than before.
The VRG meeting was perceived to be evidence based, and the students experienced that each meeting they participated in gradually improved their skills in reading research articles and searching the database. One student said:
I felt that I learned much more than before, because it was a very structured design. I also felt that all the students were well prepared each time. We discussed only the articles that we presented, in addition to which there were different topics each time, not like earlier, where all the students presented the same subject [case], and there was a lot of repetition [before], I felt.
There was a general agreement among the participants in the focus group interviews that the students participated more in the discussions during the VRG meetings than in the FFRG meetings. The VRG meeting guide stated that all students had to participate actively during the meeting. One student felt that the discussion part of the VRG was uncomfortable, because all the students were to speak in turn, and no student was allowed not to participate in the discussion. However, many other focus group participants experienced the discussion section of the VRG as positive, leading to an increased perception of achieved learning outcomes. It had been easier for the APNSs not to participate in the discussion during FFRG meetings, which negatively affected their learning experience:
You didn’t have to say anything unless you were asked a question. In the virtual meeting, everyone was required to take part, everyone had to prepare, and I think it was good for us as students that you had to take more responsibility in that setting.
The NEs felt that they had a more passive role, as the responsible students and their peers were charged while continuing the discussion. In the VRG meeting, the NEs were able to sit and take notes, which they could then use to provide a summary at the end, which they could not do in the FFRG meetings.
Using a strict guide was also perceived as useful by students who did not like to speak up and therefore would become passive in the previous RG meeting design. One student pointed out:
In the meetings we had on campus, I have noticed that it’s often the same people who take part in the discussions; it’s the same people who speak up, the same who take part in the follow-up discussions, and there are always some who don’t take part. And I think it becomes even more obvious when you are sitting at a screen in a Zoom meeting.
Some students found it challenging to lead the VRG meetings, feeling that they were outside their comfort zone. The APNSs described diverse experiences related to leading meetings, but they all agreed that it was nerve racking:
The experience of leading a meeting was a bit scary to start with, but I think it would have been just as scary or exciting if I had been in a physical meeting; being on Zoom didn’t make it scarier. Physical meetings could have been scarier. It went very well altogether.
A few students felt it was difficult to encourage their fellow students to discuss the case:
It is scary being the meeting leader for a whole 45 minutes, which none of us have done before. You have to welcome everybody, present a case, then present your research article; then, when you are finished—then—what do you think, and what do you think? You have to carry on the whole time. So it’s not as simple as someone here said earlier, that you can just talk like you do in a normal discussion, but you have to “name drop” like I tend to do; if nobody talks, then I just sort of “name drop” [laughs] so it isn’t just silence. So, yes, it was a bit, being the leader, that was scary but also very educational.
Both APNSs and NEs felt that the VRG meetings were suitable preparations for the role of an APN. For APNSs, it was meaningful to choose a professional topic and discuss it. Some of the APNSs took part in several meetings before they assumed the role of a responsible student:
I managed to prepare myself and learn from the others before I had to do it myself in the end, so I think it [leading a meeting] went OK.
Several of the students experienced enhanced leadership skills by participating in the VRG meetings:
I think we were good at keeping the VRG meeting going. We learned from having to take turns to speak, to include everyone and to ensure that everyone got to say something about their own thoughts and experiences.
The APNSs felt supported by their NPs when performing the leader role:
The students managed to pass on the baton to the other students without it seeming embarrassing; it went quite well. And my role was really, I felt, to support my student through the meeting.
One student summarized the significance of developing competence in professional leadership:
I felt that the biggest advantage was that we learned to lead a meeting, how to steer it and how to argue. Yes, we are going to become intensive care nurses, but we are also going to become APNs, who will have a slightly different role, so it helped me to see that we will need to be able to lead that type of meeting in a work environment, to be able to take up problems out in the field, try to make changes or show something new; this was a good way of practicing that.
The NEs assumed that the VRG meeting was well structured and promoted APNSs’ development of leadership skills:
Each student practiced leading the professional discussions, and the discussions became very good, and everyone was well prepared.
The students experienced the NPs’ participation in the VRG meetings as positive. They pointed out that preceptors could not participate in the FFRG meetings because they were unable to leave the ward. The collaboration between NPs and APNSs in the VRG meetings was also seen as positive:
When it came to finding a research article, we had a lot of good conversations about what we wanted to discuss together; we went through several different subjects and found in the end a case that we both found interesting.
In the previous RG design, such cooperation was not possible. Another APNS said:
We discussed a case before the VRG meeting and discussed the results we had found in the article I had chosen. So it was more than what I previously experienced in clinical practicum, where I hadn’t even mentioned the choice of a research article to my preceptor.
The NPs experienced that collaborating with the APNSs in the VRG meetings led them to be updated with new knowledge from research publications. Usually, the NPs felt it was challenging to remain up to date on science in their research field because of their hectic, practically orientated daily work. Cooperation between NPs and APNSs stimulated their engagement in evidence-based knowledge:
There is something about the knock-on effects, which are also great when you go about your daily tasks and don’t have much time for additional work as well.
I think it is important. You get insights into what the students need to learn. You can update yourself, and, as [NP 1] says, there isn’t much time normally to find the newest research, so I think I learned a lot by being a preceptor.
The NPs also mentioned that the organizational structure of the VRG meetings led to a great deal of involvement, academic interest, and discussions on various topics:
Both I and the student, along with several others, also discussed a difficult case before the student presented it [at the VRG meeting]. We talked about the case afterwards, because there were many who thought that the case was difficult, and, in a way, it became a learning situation for the students but also for us on the ward. So, the VRG meeting was actually a useful method, and there were more people who got something useful out of it. First, the student wrote down the case. I got it as an email, so I could read it on my own time and think about it, and then we all spoke about it on the ward. I think it was a good way of doing it.
For the VRG meetings, the APNSs were instructed to share documents with one another before the meetings, which they perceived as useful. In each meeting, one of the APNSs assumed the role of respondent and had the task of giving the responsible student critical feedback on the chosen research article. The experience of receiving feedback from a fellow student was described as follows:
You get feedback [from the respondent] on how you have appraised the article, and, for me, it was informative and something I can take with me when I am finished. Because you know that you will also use this knowledge later in working life.
One of the NPs felt that the VRG meetings were perfect for cooperation with the APNSs, saying that even though it could be perceived as stressful to read a research article on a busy working day, the preparations for the VRG meetings energized them and helped them give more guidance to the APNSs. The preceptors experienced closer cooperation with the students, as they had a specific task:
You have it in the back of your mind all the time that you have to find a discussion topic together, so there are more professional discussions and learning situations that arise.
The primary findings of this study pertain to the perceived benefits of a structured, active learning approach supported by technology, namely, VRG meetings. When the teaching method is well structured, it generates positive consequences, as shown in our results. The VRG meeting design inspired well-prepared participants because of their well-defined roles and responsibilities, and the APNSs perceived increased competencies related to intrapersonal and professional skills. The VRG meetings also led to increased synergy and collaboration between APNS, NPs, and NEs and, consequently, to perceived enhanced APNS and NP competence.
To participate in the VRG meetings, the APNSs had to be prepared, which stimulated their responsibility and commitment to learning. Furthermore, they found that VRG meetings were more effective and focused more on evidence-based knowledge than FFRG meetings. Each week, some APNSs felt that their role as a student was recognized by the NPs, who perceived the APNSs to be more prepared for the meetings and took more initiative and responsibility for diverse learning activities in their clinical practice placement. Providing APNSs with structured, active learning has been found to enable their reflective process and improve their professional practice, and consequently, patient outcomes [
The VRG meeting Is a pedagogical method that, in line with Vaz de Carvalho and Bauters [
The APNSs and NPs who participated in the VRG meetings experienced stimulated critical reflection based on patient cases and available evidence in research articles. APNSs require critical reflection to turn their experiences into learning, for which a structured teaching approach, as implemented in this study is recommended [
Our results indicate that participating in VRG meetings was experienced as a good preparation for the role of an APN, primarily with regard to the development of intrapersonal and professional skills, which embrace a nurse’s capability to understand, deal with emotions, and practice self-discipline [
Another important finding of this study was students’ ability to develop their leadership skills, a core competency required in the APN role [
This innovative study used technology to improve the teaching approach (RG meetings) routinely used in clinical practice for nursing education. The data were collected from all parties (APNSs, NPs, and NEs) involved in clinical practice education, increasing the trustworthiness of the intervention evaluation. Data were collected from 2 different groups at different stages of the APN education program. Moreover, the developed VRG meeting can easily be adapted to several educational programs and to various levels of professional education.
As a limitation, we experienced a slight drop out of possible informants in the second focus group interview. One reason for this may be that we invited a larger number of students, as VRG meetings were implemented in a greater number of CCUs (
The participants perceived the VRG meeting—a structured, active learning approach supported by technology—as being more effective than FFRG meetings on campus in developing APNSs’ required competence in critical care. The VRG meeting was also perceived as an improved approach for solving several challenges previously experienced in FFRG meetings. On the basis of participants’ experiences, we conclude that VRG meetings contribute to increasing APNSs’ competence, specifically by preparing them to exercise complex decision-making with a higher level of analytical cognition in a clinical context. VRG meetings may also inspire professional discussions in the ward, increasing professional interaction.
advanced practice nurse
advanced practice nursing student
critical care unit
face-to-face reflection group
Lovisenberg Diaconal University College
nurse educator
nurse preceptor
reflection group
virtual reflection group
The authors wish to acknowledge Ørjan Flygt Landfald, who contributed to the conception and design of the study, was the observer in the second interview, and actively contributed to the completion of the study. The authors also acknowledge Irene Rød, who was the observer in the first interview.
The data sets generated and analyzed during this study are available from the corresponding author on reasonable request.
None declared.