Abstract
Technological advancements and digital accessibility have increased expectations for flexible learning in higher education, requiring pedagogical approaches that support self-regulation and self-directed learning, which are core principles of self-determination theory. The present study aimed to explore how students experienced courses with flexible learning design within a master's nursing programme. Four focus group interviews were conducted with master`s students in advanced clinical neonatal nursing in spring 2023, and the data were analysed using reflexive thematic analysis. The study adhered to COREQ. Four main themes were identified: “Reflections on Professional Growth”; “Experiences with Flexible Learning Strategies”; “Perceptions of the Learning and Social Environment” and “Balancing Flexibility with Everyday Life”. Flexible learning design supported both autonomy and professional growth. Despite limited face-to-face interaction, students reported a strong sense of relatedness. To meet core psychological needs, a well-structured flexible environment must offer clear communication of structure, expectations and learning opportunities.
Keywords
Introduction
Technological advancements and digital accessibility have increased expectations for flexible learning options within the framework of existing higher education programmes.1,2 This is particularly relevant in professional education programs such as master's degrees, where students often balance academic studies with clinical practice and caregiving responsibilities. 3 According to Dziuban et al., 4 tailoring education to students’ individual needs and life stages can enhance its appeal to a broader population. Here, “needs” refer not only to special educational needs, but also to diverse personal circumstances such as age, work commitments and learning preferences.
Flexible learning formats are increasingly recognised as essential for enabling master's nursing students to complete their studies. 5 Moreover, they also serve as a means to broaden access to higher education and promoting lifelong learning. 1 Flexible learning design (FLD) refers to when, where, and how learning occurs and incorporates digital tools, varied learning formats and opportunities for individual progression. 6 Its primary objective is to enhance accessibility, learner motivation and educational outcomes. Nevertheless, such formats may present challenges, particularly regarding structure, social integration and access to academic support.7,8
Understanding how students perceive and engage with flexible learning formats is therefore critical for informing pedagogical strategies and programme development. 9 To explore these perceptions, this study draws on three complementary theoretical perspectives: Self-Determination Theory (SDT), Self-Regulated Learning (SRL) and Self-Directed Learning (SDL).10–12 SDT emphasises the role of intrinsic motivation and identifies three core psychological needs, namely autonomy, competence and relatedness, as being essential for effective learning. When these needs are met, students are more likely to experience motivation, engagement, and academic success.13,14 SRL focuses on students’ ability to plan, monitor, and evaluate their own learning, while SDL highlights the initiative and responsibility learners take in managing their educational experiences, often independently of external guidance. Both SRL and SDL require a high degree of motivation and personal commitment, as emphasised by SDT.13,15,16
Study aim
The aim was to explore how students experienced courses with flexible learning design within a master's nursing programme.
Methods
A qualitative, exploratory approach was adopted, utilising focus group interviews as the primary method of data collection. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting standards. 17
Context
The master's programme in advanced clinical neonatal nursing is a part-time, nationally accredited initiative. The curriculum is aligned with the Norwegian Qualifications Framework for Lifelong Learning. 18 It recruits registered nurses from all 20 Norwegian neonatal intensive care units (NICU), as well as from NICUs located in other Nordic countries. Admission to the programme requires a bachelor's degree in nursing and a minimum of 2 years of full-time clinical experience, including 1 year in neonatal intensive care. The Norwegian students typically work part-time (approximately 34%) during their studies and receive financial support through their employment.
The implementation of a flexible learning design
In response to a growing demand for educational programmes incorporating FLD, a Norwegian University College (UC) collaborated with a Regional Health Authority (RHA) to implement FLD within the specific master's programme. The initiative was grounded in the principles of constructive alignment and blended learning. According to Biggs, 19 constructive alignment involves ensuring coherence between intended learning outcomes, teaching methods and assessment strategies. Blended learning integrates digital and face-to-face modalities to enhance educational outcomes.20–23 Course development was informed by the eight dimensions of FLD outlined by Korseberg et al., 24 of which seven were adopted (Table 1). The ‘requirements’ dimension was excluded, as the formal admission process fell outside the scope of course design.
Dimensions of an education implementing a flexible learning design.
Modified and translated from Korseberg et al. 24 by Rød, I. & Korseberg, L..
Up to 50% of classroom time in six courses was replaced by asynchronous activities (e.g., recorded lectures) and synchronous sessions (e.g., simulation-based training), consistent with blended learning principles. 25 The UC's learning management system (LMS), Canvas© (Instructure, Salt Lake City, USA) provided unlimited access to syllabi, activity descriptions and collaboration tools, as well as digital pathways, podcasts and videos. Workplace-based learning in NICUs included training in advanced equipment and pharmacological guidelines. Clinical placements were to be carried out either at a national or Nordic NICU, which, for some students, involved travel and extended stays. Formative assessments were conducted digitally or in person, while summative assessments followed formal UC procedures. Student feedback was collected each semester to support ongoing development of the FLD.
Recruitment process and participants
Nineteen eligible master's students, who had completed four semesters of FLD-integrated courses (90 ECTS (i.e. European Credit Transfer and Accumulation System)) by spring 2023 were invited to participate. Thirteen consented, but two withdrew before interviews for unspecified reasons, resulting in a final sample of 11 female participants. None reported their age or held qualifications beyond a bachelor's degree in nursing. Prior to admission, participants had 2–25 years of NICU experience (median: 4 years), caring for sick term and preterm infants born
Data collection
Data were collected between April and May 2023 through four semi-structured focus group interviews involving between two and four participants per group. Focus groups were selected for their interactive nature, which enables the generation of rich data through collective discussion and reflection. 26 The interviews were moderated by an experienced nursing researcher and a university lecturer from another master's programme at UC, neither of whom were involved in developing the FLD. To support moderators, stay focused and manage time effectively, an interview guide with open-ended questions was developed. This approach supports structured yet flexible discussions, allowing participants to build on each other's responses and generate rich data within a limited timeframe. Using the same guide across all groups also ensured that key topics were consistently addressed, enhancing comparability and supporting systematic data collection. 27 Topics included students’ motivations, perceptions of the FLD in relation to seven dimensions from Korseberg et al., 24 and suggestions for improvement. Example questions included :“How did you experience the programme's facilitation of flexibility in terms of time, place and pace?” and “Which learning activities did you perceive as flexible or not flexible?”. The interviews were conducted via the Zoom platform (https://www.zoom.com). Each session lasted approximately 1 h and was audio-recorded with consent. Transcription was carried out by Totaltekst AS (Oslo, Norway) and verified by the first investigator. Participants were not invited to validate the transcripts.
Data analysis
Reflexive Thematic Analysis (RTA), developed by Braun and Clarke, 28 was selected for its suitability in identifying and interpreting patterns across informants and focus groups (Figure 1). As a flexible, interpretative method, RTA supports researcher reflexivity and aligns with paradigms valuing subjectivity and context. Byrne 29 demonstrates how RTA can be adapted to various theoretical frameworks, including constructivism and critical realism, and emphasises that themes are developed through interpretation rather than discovered as objective facts. Pearson et al. 30 illustrate the relevance of RTA within health research where researcher subjectivity is regarded as an analytic strength in line with non-positivist approaches. Meetings between the investigators supported the coding process. Semantic coding was applied using NVivo, version 1.7.1., 31 with keywords identified to maintain analytical proximity. Shared patterns across informants informed theme development progressing from text excerpts through coding to themes (Table 2).
Overview of the analytical process.
The process of analysis.
Ethical considerations
The Norwegian Agency for Shared Services in Education and Research (SIKT) (2023/358218) confirmed that the processing of personal data complies with The General Data Protection Regulation in research (GDPR). 32 The data protection officer at UC and the students’ RHA were informed, with no concerns raised.
The informants received both oral and written information about the study, including that they could withdraw from the study at any time without having to give a reason. Before the interviews started they were informed that the interviews would be audio recorded. Recorded files were stored separately from transcripts, and were accessible only to the first investigator. Transcripts were anonymised before being shared with co-investigators to ensure confidentiality. The data will be retained only as long as necessary and deleted in accordance with institutional guidelines. Because students were still enrolled during the interviews, ethical awareness was essential. Researchers held multiple roles, requiring caution to avoid role conflicts. 33 The researchers ensured that none of the interviewees could be identified in the reporting of the study.
Preconceptions and reflexivity
The research team had extensive experience as researchers and as educators at the master's level, as well as clinical backgrounds in neonatal intensive care. This dual expertise may have shaped both the design and interpretation of the study. To address potential preconceptions, the team engaged in continuous reflexive discussions throughout the research process, aiming to remain aware of own assumptions and ensure a balanced and transparent analysis.
Results
A comprehensive analysis identified four main themes: 1) reflections on professional growth, 2) experiences with flexible learning strategies, 3) perception of learning and social environment and 4) balancing flexibility with everyday life (Figure 2)
The thematic map.
Reflections on professional growth
The prospect of professional development and enhanced competence was a motivating factor in the decision to pursue a master's degree. Informants reported that the FLD of the programme facilitated the acquisition of both theoretical and practical knowledge. Upon completing four semesters, they felt they had achieved the intended learning outcomes, which aligned with their expectations and supported their professional growth: I can sense that I’m much more confident in providing care and mentoring newly employed nurses. It's genuinely rewarding to be one of those colleagues who gets asked for advice – it means you’re recognised as someone with a high level of competence. (FG4-10) I completely agree … this is a high-quality education that provides strong competence. I feel more prepared, especially when dealing with complex patient situations. Although there were challenges along the way, the learning activities and lecturers were of very high quality. This education is highly respected. (FG4-11)
Several informants highlighted that alternating between the roles of student and part-time employee enabled them to apply new knowledge directly in patient care. This contributed to a deeper understanding of professional practice.
Experiences with flexible learning strategies
The blend of online activities benefitted students that lived far from campus, but also those who lived nearby. Digital activities, such as group discussions and quizzes engaged students. While the digital lectures were highly informative and covered a wide range of important topics, informants preferred real-time lectures over those streamed or uploaded to the LMS. Digital resources like films and podcasts offered flexibility in terms of time and location, along with unlimited opportunities for repetition and in-depth learning: It was surprising how much you learned about a topic after preparing for lectures by watching these videos. (FG2-5) We had several videos where they [educators] explained the topics. I think it was great when studying for (an) exam, and I could just watch it again or listen to it in the car. It's extremely flexible. (FG1-1)
Campus-based activities, such as simulation training, were found to fill knowledge gaps, promote collaborative learning and provide opportunities to practice on communication relevant to acute settings. When simulation training was implemented as a self-directed learning activity, it facilitated both autonomous learning and collaborative engagement with peers. Opportunities to complete their assignments and submissions in a variety of ways using the LMS, with unlimited access to content, were highlighted, but this flexibility placed a greater demand on the students’ self-discipline and responsibility for learning and academic progression. This was described as challenging and stressful, but valuable: It was helpful to receive information about all submissions and assignments early, but it also led to increased stress. The upcoming deadlines created constant pressure, especially when several tasks had to be carried out around the same time. (FG3-8) I agree … Maybe it would be better to have a shorter timeframe, so you could really focus on just one task? But then again, having more time lets things mature in the back of your mind, even if you're not actively working on it. (FG3-9)
Informants valued the ability to choose their clinical placement location, whether at their workplace NICU or at an alternative site. Both models had perceived pros and cons, but all placements enhanced their skills in advanced neonatal care. Those placed in different NICUs noted variations in clinical practice and patient populations. Some informants suggested a more flexible placement arrangement, involving rotation between different NICUs within the same period. This would provide more options and enhance learning outcomes.
Perceptions of learning and social environment
Informants noted that, despite infrequent face-to-face interactions, they got to know each other through the digital format: At first, I found it a bit intimidating to get to know people over Zoom. But we actually got to know each other really well, and it turned out to be a great group …. there was also a bit of social interaction. Overall, it was a really positive experience (FG3-7). Well, it's like always – people are different. Some take up space, while others stay quiet, that's natural. I’ve felt safe, though. (FG3-9)
Educators’ efforts, such as holding informal digital morning coffee sessions, were experienced as positive for social environment. Digital activities and online group work fostered group cohesion and a sense of relatedness enhancing the in-person campus experience. Older students often did not feel the need to socialise, while those studying with colleagues preferred to socialise with them. Relatedness with educators were enhanced through various digital activities, positively impacting on-campus activities: When we did meet, it was very nice. I felt that we knew each other …. In relation to educators, I felt the same; you felt that you knew them even if it was digital. (FG2-5)
Student–educator interactions were experienced as more ‘natural’ on campus, whereas the digital format posed some challenges for these interactions. When academic supervision with the educators was provided digitally, some informants experienced a lack of flexibility and strict adherence to templates and deadlines. Others felt that the digital format made less impact on their interactions. The introduction of an open chat function in the LMS enabled students to receive quick academic support from educators and peers, while others preferred contacting educators via email.
Balancing flexibility with everyday life
The FLD influenced the informants’ everyday lives. Those with caregiving responsibilities particularly appreciated the programme's adaptability, which enabled them to tailor learning activities to their personal and professional circumstances. The ability to manage academic demands alongside family obligations and part-time employment was seen as essential for sustained engagement. In addition to supporting work–life balance, the FLD also reduced the burden of travel. Informants living far from campus highlighted the value of digital access to lectures and resources, which allowed them to participate without the need for extended stays away from home: I really appreciated having that kind of freedom – being able to follow lectures no matter where you are. (FG 2-5) I’ve also found it really positive, especially since I live far away. It's made it much easier to attend lectures without having to spend weeks at campus. (FG2- 6)
Despite the benefits of a FLD, most informants reported spending considerable time balancing their studies with everyday responsibilities. Uncertainty regarding the structure of learning activities often led to frustration, particularly due to their commitments as part-time employees. Several participants emphasised the importance of clear and consistent frameworks within the FLD to support individual adaptation. Above all, predictability was highlighted as essential: I think it is important that the UC has a clear framework in advance. It must be communicated clearly when we meet digitally and on campus, preferably as early as possible. (FG1-3)
Structure and clarity were consistently described as critical components of an FLD-based programme. Student experiences underscored the need for a well-defined and coherent framework to support learning and enable effective management of competing responsibilities.
Discussion
The overall result of the present study was that FLD in an advanced master's nursing programme supported autonomy and peer connection, reflecting key aspects of SRL, and SDL. While reduced classroom time posed challenges, the design facilitated competence development and advanced neonatal care skills. Some students experienced stress due to increased responsibility, and a need for clearer structure, which is essential for supporting core psychological needs in SDT, was identified.
Students perceived the programmès quality and relevance as central to developing professional competence in advanced clinical neonatal nursing. By building on prior clinical experience, they deepened their understanding of professional practice and highlighted the importance of clinical relevance in education. These reflections suggest that the programme, with FLD as its pedagogical approach, not only met the formal learning outcomes, but also supported students’ development as reflective and competent professionals. This finding aligns with the principles of SDT, which suggests that, when students perceive themselves as competent, their intrinsic motivation increases as they experience a sense of mastery and success in learning.13,14,34 In relation to the FLD, the combination of online activities, on-campus sessions and clinical placements in NICUs was regarded as both effective and adaptable to students’ personal and professional goals. These findings support the core intentions of FLD, 35 and broader recommendations for blended learning in higher education.36–38 When aligned with pedagogical theory, FLD appears to promote sustained motivation, competence development and professional growth.
A key example of how the FLD supported the students’ sense of autonomy, was the flexibility in clinical placement locations. Exposure to diverse institutional cultures enabled students to integrate theoretical knowledge with practical experience in real patient settings, thereby further enriching their learning. Some students suggested that rotating between NICUs could further enhance this experience even more, and, for some, reduce the time spent away from home. To support students’ sense of autonomy, as outlined in SDT, 13 in seems like the FLD dimensions of “time”, “place” and “progression” enabled students to make meaningful choices and exercise control over their learning. 24 Such an approach often enhances both intrinsic motivation and engagement.13,14,34 To continue developing this flexible approach, offering students more choices and acknowledging their feelings could strengthen their intrinsic motivation. 39
The ability to access course materials remotely and progress at an individual “pace” was especially valuable for students balancing academic responsibilities with caregiving or part-time work. This aligns with the “progression”, “content” and “context” dimensions of FLD, and supports findings on accessibility and inclusivity in higher education. 9 By recognising and building upon students’ existing knowledge and professional experience, they were able to tailor their learning pathways, which is an approach supported by the “scope” dimension of FLD, as well as principles of SRL and SDL.15,16 However, this flexibility also introduced challenges. While digital platforms promoted student responsibility and aligned with SDL principles, some students experienced stress and uncertainty due to overlapping deadlines, unclear expectations, or information overload. These findings are consistent with research showing that such pressures can lead to procrastination and reduced academic performance, particularly for students juggling multiple responsibilities.40–42 Still, the students emphasised the value of early access to information about learning activities. Flexible submission deadlines and varied assessment formats enabled them to better manage competing demands, in line with the “progression” dimension of FLD. At the same time, they expressed a need for clear and structured guidance to support SDL. Others have also noted that this could prevent cognitive overload.43,44 Although personalised assessments may increase the burden of decision-making, they can also strengthen students’ ownership of their learning process. 45 Involving students in the design of assessments may further enhance their motivation and sense of SDT.46,47
Students appreciated the ability to ask questions via online chat, while preferring email for more personal or sensitive matters. Direct communication with educators was seen as crucial for both academic success and overall satisfaction, comprising points that also have been highlighted by others.9,48 Nevertheless, certain students perceived digital collaboration with educators as comparatively inflexible with regard to scheduling and responsiveness, despite the provision of diverse forms of guidance and feedback via online meetings and optional face-to-face sessions, aligned with the “content” dimension. 24 Given that this was a project, educators may have faced limitations in how much flexibility they could offer. In a previous study, educators have highlighted concerns about FLD's potential impact on educational quality and learning outcomes, emphasising the need for a balance between flexibility and structure. 8 Nevertheless, students consistently valued flexibility as a sign of being acknowledged and supported. 49 To ensure that FLD continues to meet diverse student needs, its further development should involve active collaboration between students and educators, with the goal of co-creating learning environments that are both adaptable and relationally supportive. 9
Although face-to-face interaction was limited, many students still reported a strong sense of relatedness to both peers and educators. Relatedness is emphasised in both SRL and SDT as a key component of a supportive learning environment, as well as a core psychological need.11,14 The sense of connection was fostered through collaborative group work, informal digital communication and on-campus activities. These learning experiences actively encouraged participation and critical thinking, aligning with the “interaction” dimension of FLD1,24 and contributed to a deeper understanding of neonatal care.
However, students’ need for social interaction varied, as also previous research has indicated by noting that students with part-time jobs or family responsibilities often deprioritise the social aspects of learning. 50 This variation highlights the importance of recognising the diverse ways in which students experience and seek relatedness in flexible learning environments. To address this diversity, educators play a crucial role. By encouraging participation and fostering open dialogue, educators can support relatedness and enhance both engagement and motivation.13,14 A flexible learning environment that accommodates different preferences for social interaction can help ensure that all students perceive acknowledged, connected and supported.
Methodological considerations
The strength of the present study lies in its relevance to a master's programme, offering insights into a specialised educational context. Nationwide student participation enriched perspectives and enhanced credibility. The moderator's neutrality – being uninvolved in the FLD – fostered a safe space for open dialogue in the focus groups. Collaborative data analysis and contributions from experienced researchers further strengthened the credibility and reflexivity of the results. However, shift work limited broader participation, affecting sample representativeness and focus group sizes. The fact that the informants were students during the COVID-19 pandemic may have influenced responses, thereby reducing transferability. As the findings are specific to a national master's program in neonatal nursing, and due to the small sample size, the generalisability of the results may be limited. Despite these limitations, the study contributes valuable insights into the potential of FLD to enhance accessibility in master's level courses. Future research is encouraged to replicate this study in broader educational contexts to further validate and extend these findings.
Conclusions and implications
In response to growing expectations for flexible learning in higher education, a pedagogical shift was made by implementing a FLD in a master's programme in advanced clinical neonatal nursing. This study indicates that such an approach can promote professional growth, particularly when grounded in the principles of SDT, SDL and SRL. While students appreciated the autonomy afforded by the FLD, they also emphasised the importance of clear structure and guidance. Despite reduced face-to-face interaction, many students reported a strong sense of relatedness with peers and educators. These findings underscore the need to balance flexibility with supportive frameworks and transparent communication to ensure effective learning outcomes. For nurses, FLD enables professional development while accommodating work and family responsibilities, potentially strengthening motivation and professional identity. For healthcare organisations, such models may support recruitment and retention in specialised clinical settings, while reducing the need for extended leave. In higher education, the results highlight the importance of prioritise clear structure, adequate support, and continuous student feedback to foster autonomy, engagement and adaptability, particularly within the context of nursing education.
Footnotes
Acknowledgements
The authors would like to thank the students who participated in this study. We also would like to thank our colleague Lena Rengård Kolstad, who contributed with focus group interviews. We would also like to acknowledge Lene Korsberg, researcher at the Nordic Institute for Studies of Innovation, Research and Education, Norway for her permission and collaboration on the translation of the eight Dimensions of an education implementing a flexible learning design.
Declaration of conflicting interests
Declaration of generative AI and AI-assisted technologies in the writing process During preparation for this work, the author(s) used Microsoft CoPilot (Microsoft Redmond Campus, USA) to improve the paper’s language. After using this tool/service, the author(s) reviewed and edited the content and take(s) full responsibility for it.
Author contributions
IR, as first author, conceived the study, developed the design, prepared for data collection, led the coding process, conducted the thematic analysis and drafted the manuscript. HG contributed to the study design and preparation, participated in coding and analysis, and supported manuscript development through to submission. KB, ALS and BST contributed to the study design, provided feedback during analysis, critically reviewed the manuscript, and approved the final version submitted for publication. HA assisted in study design and preparation, guided coding and analysis, contributed to the manuscript's content and structure, and approved the final version.
Funding
This project was supported by the Norwegian Directorate for Higher Education and Skills, Lovisenberg Diaconal University College (LDUC), and the Regional Health Authority (RHA). The authors received no financial support for the research, authorship and/or publication of this article.