Deliberate Practice In Nursing.

Abstract

Purpose: Demands being placed on nursing to maintain competence and strive for expertise attainment are great. Expertise development has been linked to deliberate practice (activities engaged in to improve performance) in many domains but little is known about its impact on skill acquisition of registered nurses (RN). The purpose of this dissertation study was to: (a) examine a conceptual framework for evaluating the effects of individual nurse characteristics and deliberate practice on expertise, (b) develop and test an instrument to objectify the deliberate practice activities of nurses, (c) evaluate the relationships between experience, education deliberate practice, and expertise (d) identify which of these variables makes the highest contribution to expertise. Methods: An instrument, the Deliberate Practice in Nursing Questionnaire (DPNQ) was developed to measure deliberate practice in RNs. Reliability and content validation was conducted via expert panel review and survey testing. A cross-sectional study using a descriptive, correlational design assessed the relationships among deliberate practice, experience, education and nurse competence of 92 RNs from one large, Midwestern teaching hospital. Results: Content validation of the DPNQ revealed an inter-rater agreement (100% reliability) of .54-.75 and (80% reliability) of .92-.96 and a content validity index of 0.94. Cronbach’s alpha coefficient was .660 (standardized, .703). Deliberate practice was found to have a significant correlation with nurse competence (rs = .366, p = .001). No significant correlation was found between experience and nurse competence (rs = .131, p=.245). Education had a significant negative association with nurse competence (beta = -.241, p < .05). Most notably, it was found that deliberate practice (beta = .326, p < .01) made the highest contribution to nurse competence after controlling for gender, experience and education. Conclusions: This study found that higher competence (expertise) was most significantly impacted by those who engaged in more deliberate practice activities, not necessarily with a longer length of experience or more education. Future studies should examine the effects of deliberate practice on actual performance in addition to self-report competence to better clarify the relationship. Additional research with larger, varied samples in different settings is warranted to further test DPNQ reliability and validity.