Communication breakdown among healthcare providers is a major contributing factor in healthcare errors that could lead to serious patient harm. The ability to convey patient information accurately and promptly is pivotal in order for healthcare providers to make informed care decisions. However, pre-licensure nursing students rarely have opportunities to practice reporting patient information to non-nurse healthcare providers. The use of deliberate practice (DP), a conceptual model for skills acquisition, is widely used to develop psychomotor clinical skills and demonstrate effectiveness. The purpose of this dissertation is to explore the feasibility of using DP to develop communication skills for pre-licensure nursing students. This project examines the impacts of using an online DP intervention that is guided by mastery learning theory on learners' skill performance and confidence in reporting a patient critical incident using the standardized communication tool, SBAR (situation, background, assessment, recommendation).

This dissertation is composed of three papers. The first paper is a systematized review of the current literature on the use of DP in developing clinical communication skills. The second paper describes the design and evaluation of story-guided online DP sessions to provide learners with an avenue to practice reporting a patient critical incident. Based on a 10-week pilot experimental study, the third paper examines the impact of engaging in regular online DP, at least five sessions for the intervention group (n = 22) versus two for the control group (n = 21), on learners' ability to achieve a preset mastery standard and on any changes in their SBAR performance and confidence.

The results of the systematized review support the continued study of DP for developing clinical communication skills to produce further evidence of its effectiveness. Feasibility testing of the online DP sessions shows that this cost-effective teaching/learning approach could provide highly satisfactory learning experiences and be adopted into nursing curricula. The results of the pilot experimental study indicate that the intervention group learners showed significantly (p < .05) greater improvement in their performance and confidence levels than the control group after controlling for covariates. Two intervention group learners (versus none in the control group) met the mastery standard. Future study is needed to examine the number of practice sessions needed to attain mastery, retain skills, and determine the effects on patient outcomes.