Abstract
Background:
Nursing students are often noncompliant with foundational patient safety procedures during medication administration.
Purpose:
Determine the effectiveness of deliberate practice on hand hygiene and patient identification compliance among prelicensure nursing students during simulated medication administration.
Methods:
A repeated-measures quasi-experimental study was conducted at 4 schools of nursing. Participants independently completed 8 simulated scenarios across 2 semesters. Deliberate practice occurred after each simulation. Data were collected using the Observational Medication Administration Tool. Changes in compliance were analyzed using the Generalized Estimating Equations model.
Results:
Sixty students participated. Hand hygiene compliance improved from 17% at baseline (T0) to 59% at final assessment (T7). Patient identification compliance improved from 47% at T0 to 90% at T7. Statistically significant (P < .001) improvements occurred across assessment times.
Conclusions:
Findings provide support for deliberate practice in improving compliance with hand hygiene and patient identification. Continued focus and reinforcement of foundational patient safety procedures with nursing students is recommended.
Keywords: clinical competence, clinical skills, competency-based education, patient safety, skill decay, simulation training
Health care-associated infections (HAIs) and patient identification errors are critical patient safety issues that can lead to serious harm or death. An estimated 7% to 15% of patients will acquire an HAI during a hospital stay, and 10% of those patients will die from their HAI.1 Medical errors, such as medication or blood products administered to the wrong patient, result in over 200 000 deaths each year,2 and are frequently because of noncompliance with patient identification procedures.3,4 Given the severity of harm that can occur, reducing HAIs and improving patient identification are consistently included among the yearly Joint Commission National Patient Safety Goals.5
Background
It is well-known that hand hygiene (HH), defined as rubbing hands with soap and water or alcohol-based hand rub,6 is the best method for preventing HAIs. Yet, HH compliance among health care workers is poor, with rates reported between 40% and 60%.7 Among nursing students, HH compliance rates range between 19% and 43%.8,9 The US Centers for Disease Prevention and Control6 and World Health Organization10 indicate that HH should be performed before a clean/aseptic procedure (eg, preparing medication), before touching the patient, after bodily fluid exposure risk, and after touching the patient/patient surroundings.
According to The Joint Commission,5 a minimum of 2 approved identifiers should be used to verify a patient’s identity before providing care, treatment, and services. Active patient identification is recommended through direct interaction with the patient (when possible), such as requesting the patient to verbally state their full name and date of birth, while the health care provider confirms the information with the patient’s medical record.11 Physical confirmation of information, even when using technology such as barcode scanning of patient identification bands, must always be performed.12 Senior nursing students are often noncompliant with patient identification procedures, with studies reporting that less than half (43%-44%) properly identified patients during simulated medication administration.9,13
The importance of HH and patient identification is taught early in nursing programs, and nurses and nursing students seldom have difficulty demonstrating knowledge of when and how to perform these procedures.11,14 However, there are distinct differences between demonstrating knowledge, such as describing steps of a skill or recognizing correct answers on a quiz, and demonstrating competence, such as through simulated or real-world performance.
On graduation, nursing students are expected to demonstrate competence in core nursing skills, including safe medication administration.15 Yet, a review of 32 original studies found that senior undergraduate students often make errors and are noncompliant with HH and patient identification during medication administration.16 Students voice that limited “hands-on” and “start-to-finish” practice with medication administration are primary contributors to their errors and omissions.17 Foundational clinical skills, like medication administration, HH, and patient identification, must remain a focus and continue to be reinforced as students progress through their educational programs.
Deliberate practice is a specific teaching method that has a goal of improving a learner’s skills through expert feedback and repetitive practice,18,19 and is ideal for developing and reinforcing nursing students’ clinical skills. Recent studies found significant improvements (P < .001) in CPR skills,20 medication administration,21 and handoff accuracy22 after students were taught with the deliberate practice method.
Purpose
This study aimed to determine the effectiveness of deliberate practice on: (1) HH and (2) patient identification procedural compliance among prelicensure nursing students during simulated medication administration. Based on prior research findings20,23 it was hypothesized that the deliberate practice intervention would lead to increased procedural compliance. This study was part of a larger study that investigated the effectiveness of deliberate practice on medication administration errors,21 handoff accuracy,22 and use of the Stay SAFE interruption management strategy.24
Theoretical Framework
Ericsson et al’s18 deliberate practice theoretical framework was used to guide the educational intervention in this study. According to the framework, an expert: (1) provides explicit skill instructions to the learner, (2) supervises the learner’s skill performance to identify areas for improvement, (3) provides the learner with immediate actionable feedback, and (4) instructs the learner to repeat the same or similar skill, using the feedback to work toward improved performance.18,19
Methods
Research Design
A 1-group quasi-experimental repeated measures study was conducted at 4 study sites. The Transparent Reporting of Evaluations with Nonrandomized Designs guidelines were followed.25
Sample and Settings
An a priori power analysis determined that 66 participants were needed to detect an effect size (f) of 0.20, with an α level of .05 and power set at 0.80. Each study site aimed to recruit 20 participants, for a total sample of 80, to account for expected attrition. Convenience sampling was used. The study took place in each institution’s simulation center.
A total of 464 eligible prelicensure nursing students from 4 US schools of nursing—3 schools in the Midwest and 1 in the Eastern region—were invited to participate via email and posted flyers. Recruitment began in November 2023 and ended in January 2024. Invited students were enrolled in either a 4-year bachelor of science in nursing, a 16-month accelerated bachelor of science in nursing, or a 2-year associate degree in nursing program. To be eligible to participate, students must have earned a passing grade in a foundational nursing skills course that included HH and patient identification psychomotor skill demonstration during simulated medication administration. In addition, students were required to be enrolled in a first clinical course(s) or have limited (5 or fewer) medication administration experiences in a clinical course when the study began. This criterion provided some control for medication administration experience as a potential confounding factor on performance.
Operational Definitions
HH was defined in this study as the application of and rubbing hands with alcohol-based hand rub. HH was not assessed through the use of soap and water as these were not available in the simulated environments. HH compliance data were collected at the following indications: (1) before touching the medication packaging, (2) before touching the patient, (3) upon exit from the patient room. The duration of rubbing hands was not assessed.
Verification of patient identification was defined as completion of 3 steps before administration of medication: (1) verbally asked the patient to state their full name and date of birth; (2) looked at the patient’s identification wristband; (3) looked at the patient’s medical record. The steps could be performed in any order, but all had to be completed consecutively to be considered correct. Electronic barcode scanners were not used in this study.
Implementation Fidelity
All research team members were nurse educators with simulation experience. The principal investigator trained all team members on the operational definitions and study procedures using written materials and demonstration videos. An operations manual was accessible to all members via a secure online site. Videos were produced to demonstrate how to (1) set up the study environments, (2) implement the deliberate practice intervention, and (3) collect data. Videos were also produced to establish interrater reliability among data collectors before study implementation.21,26
Procedures
Participants independently completed 8 different simulated medication administration scenarios across 2 consecutive semesters. Four simulations were completed in 1 semester, and 4 in the following semester. All participants completed the scenarios in the same order. A trained team member observed participants’ actions from an unobtrusive area (eg, control room) during the simulations. The first study visit involved a baseline assessment (T0), deliberate practice intervention, and the first postintervention assessment (T1).
The deliberate practice intervention included an educational bundle of didactic content and simulated practice. Critical safety procedures required during medication administration, including how and when to perform HH and patient identification, were presented via prerecorded PowerPoint slides and a demonstration video. After the presentation and video, students individually practiced simulated medication administration while experts (the trained research team members) supervised and provided feedback. The students then repeated simulated medication administration focusing on correcting errors.
After the deliberate practice intervention, students completed the T1 assessment. Four to six weeks later, participants returned to complete the T2 assessment. Four to six weeks after the T2 assessment, the T3 assessment was completed. This was followed by a 20-week summer semester break, during which students were not in clinical courses nor taking part in the study. After the break, 2 simulated scenarios—T4 and T5 assessments—occurred on the same visit to allow for additional practice and feedback. Approximately 4 weeks later, participants returned to complete the T6 assessment, and approximately 4 weeks after the T6 assessment, the final assessment (T7) was completed. Immediate feedback, a key feature of deliberate practice, was provided to study participants after each assessment. When feedback was provided, students were reminded on when and how to perform HH and verify patient identification.
Simulated Scenarios
The Healthcare Simulation Standards of Best Practice27 were applied during the development and facilitation of the simulations. All scenarios were assessed for content validity by a minimum of 3 Certified Healthcare Simulation Educators before study implementation.21 Item-content validity indexes (CVIs) ranged from 0.86 to 1. The scale-CVI value of each simulation scenario ranged from 0.98 to 1.
Study team members followed scripts when providing the prebriefing, patient responses, and debriefing. Each prebriefing session included orienting participants to the simulated environments (patient room and medication room), including where to locate supplies such as the alcohol-based hand rub pumps. At all study sites, alcohol-based hand rub pumps were placed in the same locations during each simulation, ensuring that the pumps were visible and easily accessible. Alcohol-based hand rub pumps were conveniently located in the medication room near the medication dispensing unit and at the entrance and exit of the patient room. All patients were portrayed by adult manikins that had clearly visible patient identification bands applied around 1 wrist. The identification wrist bands correctly matched the patient information on the patient's medical record. When a study participant asked a patient to state their name and date of birth, a trained research team member responded with correct information that matched the patient’s identification wrist band and medical record.
Data Collection
Data collection took place from January 2024 to November 2024. Data were collected in real-time; however, the simulated environments were also audio-visually recorded for data collectors to refer to as needed to confirm a participant’s action. On the first study visit, participants self-reported their demographic data. At each subsequent study visit, participants self-reported the number of medications they had administered in a clinical (including simulated) setting since the prior study visit. These data were collected to investigate experiences outside of the study as a potential confounder on skill performance.
Data on HH and patient identification compliance were collected independently by 5 trained research team members using the Observational Medication Administration Tool (OMAT).26 The OMAT is a 17-item checklist with yes/no options of essential safety behaviors required to complete during medication administration. The tool does not require that all 17 behaviors be assessed, thus reporting data only on HH and patient identification was permitted. OMAT items regarding HH were guided by the US Centers for Disease Prevention and Control6 and World Health Organization10 guidelines, and the patient identification item was guided by The Joint Commission5 recommendations. The OMAT has reported I-CVIs of 0.89 to 1, and scale-CVI/average of 0.98.26 Inter-rater reliability testing was completed among all data collectors before study initiation and ranged 0.89 to 0.98.
Data Analysis
The Generalized Estimating Equations with a binomial distribution and logit link function was used to examine the change in HH and patient identification compliance pre- and post-deliberate practice intervention. This approach was selected to account for the repeated measures design and potential correlation within participants across time points. A set of covariates were considered, including age, gender, grade point average, highest degree attained, study site, program type, previous health care work experience (yes/no), and number of medication administration experiences between assessments. The study site was the only covariate that significantly contributed to the model and improved overall model fit.
Ethical Considerations
Each study site received Institutional Review Board approval. All participants provided written informed consent and received a $100 Amazon gift card upon completion of the study requirements.
Results
Sample
Sixty students enrolled and completed T0 and T1 assessments. Nine participants were lost to attrition before T4. Most self-identified as female (n = 50; 83%). The mean age was 24 years. Self-reported race/ethnicity was Asian (n = 16; 27%), African American/Black (n = 8; 13%), Hispanic (n = 8; 13%), and White (n = 28; 47%). Supplemental Digital Content, Table 1, https://links.lww.com/NE/C286 provides additional demographic data.
Hand Hygiene Compliance Rates
Overall HH compliance (HH performed at all 3 indications) was lowest preintervention (T0) at 17%, and highest at T5 at 78%. At the final assessment (T7), overall HH compliance was 59%. Among the 3 indications, compliance rates were often highest before touching a patient and lowest upon exit from the patient room (Table 1 and Supplemental Digital Content, Table 2, https://links.lww.com/NE/C287). The odds of HH compliance significantly increased at all postintervention time points compared with baseline (Supplemental Digital Content, Table 3, https://links.lww.com/NE/C288). The predicted probability of compliance increased from 0.216 at baseline (T0) to 0.683 at the final post-intervention assessment (T7).
Table 1.
All Sites Hand Hygiene Compliance During Medication Administration
| T0 n (%) |
T1 n (%) |
T2 n (%) |
T3 n (%) |
T4 n (%) |
T5 n (%) |
T6 n (%) |
T7 n (%) |
|
|---|---|---|---|---|---|---|---|---|
| Indication 1 | 25 (42) | 46 (77) | 46 (79) | 47 (82) | 43 (84) | 44 (86) | 42 (82) | 43 (84) |
| Indication 2 | 47 (78) | 57 (95) | 45 (78) | 52 (91) | 43 (84) | 47 (92) | 46 (90) | 43 (84) |
| Indication 3 | 24 (40) | 44 (73) | 43 (74) | 51 (89) | 45 (88) | 48 (94) | 41 (80) | 42 (82) |
| Overall | 10 (17) | 36 (60) | 27 (47) | 40 (70) | 31 (61) | 40 (78) | 31 (61) | 30 (59) |
Abbreviations: Indication 1, before touching the medication packaging; Indication 2, before touching the patient; Indication 3, upon exit from the patient room; Overall, hand hygiene performed at all 3 indications; T, assessment time; T0, baseline assessment.
Patient Identification Compliance Rates
Patient identification compliance was lowest at baseline (T0) at 47%. Highest rates were 92% at T1 and T5, and 90% at the final T7 assessment (Table 2). With the exception of T2, after the deliberate practice intervention, the odds of compliance significantly increased as shown in Supplemental Digital Content, Table 4, https://links.lww.com/NE/C289. The predicted probability of compliance increased from 0.345 at baseline (T0) to 0.86 at the final post-intervention assessment (T7).
Table 2.
Patient Identification Compliance During Medication Administration
| T0 n (%) |
T1 n (%) |
T2 n (%) |
T3 n (%) |
T4 n (%) |
T5 n (%) |
T6 n (%) |
T7 n (%) |
|
|---|---|---|---|---|---|---|---|---|
| Site 1 | 4 (22) | 16 (89) | 9 (50) | 14 (82) | 9 (60) | 13 (87) | 12 (80) | 14 (93) |
| Site 2 | 11 (55) | 19 (95) | 16 (89) | 13 (72) | 16 (100) | 16 (100) | 15 (94) | 12 (75) |
| Site 3 | 4 (36) | 9 (82) | 8 (73) | 7 (64) | 9 (82) | 9 (82) | 7 (64) | 11 (100) |
| Site 4 | 9 (82) | 11 (100) | 3 (27) | 7 (64) | 9 (100) | 9 (100) | 8 (89) | 9 (100) |
| All sites | 28 (47) | 55 (92) | 36 (62) | 41 (72) | 43 (84) | 47 (92) | 42 (82) | 46 (90) |
Abbreviations: T, assessment time; T0, baseline assessment.
Discussion
Patient identification and HH, 2 foundational patient safety procedures, are seldom a focus of investigation among nursing students. The few studies that have examined these procedures among nursing students during medication administration report low (less than 50%) compliance.9,13 In this study, baseline compliance rates were also low, but significantly improved after deliberate practice. Both patient identification and HH compliance increased by over 40% from baseline to final assessment.
Eight assessments took place over a 10-month time period during this study. The spacing of assessments (each including deliberate practice) was an important consideration in the study design, given that procedural skill decay can occur within weeks to months, and the degree of skill decline increases with longer intervals of nonuse.28 Many of the assessments in this study were spaced by 4 to 6 weeks to better assess and address skill decay. However, some assessments occurred on the same day, and T3 and T4 were spaced by 20 weeks due to the summer break between semesters.
Large improvements in patient identification and HH compliance occurred from T0 and T1, and the highest rates were seen at T5. These findings were not surprising given that T0 and T1 assessments occurred on the same day, as did T4 and T5. Somewhat unexpected was the increase in patient identification compliance between T3 and T4, as these assessments were spaced by 20 weeks. Students were not participating in simulations nor in clinical courses during the 20-week break between semesters, yet they retained and even had improvements in their patient identification skills. Furthermore, students’ compliance with patient identification remained high (above 80%) from T4 to T7. HH rates, on the other hand, did not follow the same pattern.
Overall, HH compliance fluctuated, with postintervention rates frequently around 60%. However, post-intervention compliance at each HH indication ranged between 70% to above 90%. It appears that students did not have substantial difficulty with a specific HH indication, but completing HH at all 3 indications proved challenging. Educators are encouraged to emphasize the importance of performing HH at every indication to protect both the patient and provider.
Recommendations
The findings from this study contribute evidence to support the deliberate practice method with core nursing skills. Deliberate practice provides a structured framework for developing skills, supports a learner-centered approach, and aligns with competency-based education. Nursing programs are recommended to incorporate deliberate practice into their curricula, particularly with frequently performed nursing skills that have can have serious patient safety implications if omitted or performed incorrectly.
Many nursing programs teach a large number of psychomotor skills at the beginning of a program, and rely on sporadic and often limited opportunities in clinical rotations and simulations for students to perform skills again.29,30 Instead, teaching fewer skills (core skills) at the beginning of a program using deliberate practice, and allowing opportunities for students to develop competency in those skills, is recommended. Core nursing skills, like HH and patient identification, are often key steps in other nursing skills (eg, physical assessments, specimen collections), thus can continue to be assessed and emphasized across nursing courses.
Recommendations are also offered for future research. Qualitative studies that explore factors that contribute to noncompliance with procedures among nursing students can guide educators on where to tailor educational approaches. In addition, future work on deliberate practice is needed. Studies that examine the transfer of skills taught using the deliberate practice method via simulated settings into clinical settings (eg, clinical courses), deliberate practice with various skills, and how best to implement deliberate practice into nursing programs are recommended.
Limitations
The investigators aimed to enroll 80 students to meet the a priori determined sample size of 66 and account for expected attrition. Enrollment resulted in a sample of 60, with a loss of 9 students. While the sample size was less than desired, this did not undermine statistical power as shown by the large improvements in compliance across the assessments. Patient identification compliance was determined as correct or incorrect if a student was observed performing 3 required actions. Actions were not documented separately (eg, asked the patient to state their name and date of birth). Documentation of specific patient identification actions would have provided better guidance for educators on where specific reinforcement may be needed. Lastly, even though students were instructed to treat the simulated experience as a real-word patient encounter, some students may have perceived risks to the patient (portrayed by a manikin) and themselves as low, resulting in lower compliance rates with HH and patient identification.
Conclusion
The findings from this study contribute important knowledge to underexplored areas in nursing education. Prelicensure nursing students from 4 different schools and 3 program types had statistically significant improvements in their HH and patient identification compliance rates after engaging in deliberate practice. HH and patient identification are seldom the focus of studies with nursing students, and while studies on deliberate practice with nursing students is growing, they are still limited. This study also contributes to a further understanding of skill decay and the spacing of skill practice sessions. Educators and researchers are encouraged to use the findings and recommendations to continue work in these areas.
Supplementary Material
Footnotes
Early Access: March 31, 2026
This study was funded by the National League for Nursing and the Illinois Nurses Foundation.
The authors declare no conflicts of interest.
Cite this article as: Schroers G, Pfieffer J, Vanderzwan K, et al. Deliberate practice of hand hygiene and patient identification during simulated medication administration: a multisite study. Nurse Educ. 2026;51(4):175–180. doi: 10.1097/NNE.0000000000002158
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 website (www.nurseeducatoronline.com).
Contributor Information
Jill Pfieffer, Email: jpfieffer@luc.edu.
Kathryn Vanderzwan, Email: kszige1@uic.edu.
Laura Klenke-Borgmann, Email: lklenke-borgmann@kumc.edu.
Susan Kilroy, Email: susan.l.kilroy@villanova.edu.
Dina Tell, Email: Dtell@luc.edu.
Jenny O’Rourke, Email: jorourke1@luc.edu.
References
- 1.World Health Organization. WHO launches first ever global report on infection prevention and control. 2022. Accessed January 3, 2026. https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control
- 2.Rodziewicz TL, Houseman B, Vaqar S, et al. Medical Error Reduction and Prevention. StatPearls. Accessed February 21, 2026. https://www.ncbi.nlm.nih.gov/books/NBK499956/ [PubMed] [Google Scholar]
- 3.Aghighi N, Aryankhesal A, Raeissi P, Najafpour Z. Frequency and influential factors on occurrence of medical errors: a three-year cross-sectional study. J Educ Health Promot. 2023;12(1):422. doi:10.4103/jehp.jehp_1726_22 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kulju S, Morrish W, King L, Bender J, Gunnar W. Patient misidentification events in the Veterans Health Administration: a comprehensive review in the context of high-reliability health care. J Patient Saf. 2022;18(1):e290-e296. doi:10.1097/PTS.0000000000000767 [DOI] [PubMed] [Google Scholar]
- 5.The Joint Commission. National Patient Safety Goals 2026. 2026. Accessed January 3, 2026. https://www.jointcommission.org/en-us/standards/national-patient-safety-goals
- 6.Centers for Disease Control and Prevention. Clinical safety: hand hygiene for healthcare workers. 2024. Accessed January 3, 2026. https://www.cdc.gov/clean-hands/hcp/clinical-safety/index.html
- 7.World Health Organization. First-ever WHO research agenda on hand hygiene in health care to improve quality and safety of care. 2023. Accessed January 3, 2026. https://www.who.int/news/item/12-05-2023-first-ever-who-research-agenda-on-hand-hygiene-in-health-care-to-improve-quality-and-safety-of-care
- 8.Gholizad Gougjehyaran H, Motaarefi H, Sakhaei S, Ashrafi M, Zeinalpoor S. The effect of an educational program on hand hygiene compliance among nursing students. BMC Nurs. 2025;24(1):411. doi:10.1186/s12912-025-03075-z [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Schroers G, O’Rourke J. Nursing students' medication administration: a focus on hand hygiene and patient identification. J Nurs Educ. 2023;62(7):403-407. doi:10.3928/01484834-20230614-01 [DOI] [PubMed] [Google Scholar]
- 10.World Health Organization. Hand Hygiene Technical Reference Manual. 2009. Accessed January 3, 2026. https://iris.who.int/server/api/core/bitstreams/bcd5e67e-e7cb-467d-9a97-9d6392d580f1/content
- 11.Janeiro-Ochoa E, Huertas-Zurriaga A, Perpiñan-Grogues M, Mota-Rodríguez Y, Martínez-Gómez M, Castellà-Creus M. Impact of a multimodal intervention to improve patient identification in health care: a quasi-experimental study. J Nurs Care Qual. 2025;40(3):257-263. doi:10.1097/NCQ.0000000000000846 [DOI] [PubMed] [Google Scholar]
- 12.ECRI. Patient identification: executive summary. 2016. Accessed January 3, 2026. https://www.ecri.org/Resources/Whitepapers_and_reports/PSO%20Deep%20Dives/Deep%20Dive_PT_ID_2016_exec%20summary.pdf
- 13.Jarvill M. Nursing student medication administration performance: a longitudinal assessment. Nurse Educ. 2021;46(1):59-62. doi:10.1097/NNE.0000000000000828 [DOI] [PubMed] [Google Scholar]
- 14.Blomgren PO, Leo Swenne C, Lytsy B, Hjelm K. Hand hygiene knowledge among nurses and nursing students: a descriptive cross-sectional comparative survey using the WHO’s “Hand Hygiene Knowledge Questionnaire”. Infect Prev Pract. 2024;6(2):100358. doi:10.1016/j.infpip.2024.100358 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.American Association of Colleges of Nursing. The essentials: core competencies for professional nursing education. 2021. Accessed January 3, 2026. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
- 16.Irvine S, Whiteing N, Andrew S. Assessment of undergraduate nursing students' medication administration competency: a systematic review. Nurse Educ Today. 2025;151:106744. doi:10.1016/j.nedt.2025.106744 [DOI] [PubMed] [Google Scholar]
- 17.Schroers G, Pfieffer J, Tell D, Johnson KD, O’Rourke J. Deliberate practice of medication administration among nursing students: a pilot study. Int J Nurs Educ Scholarsh. 2025;22(1):1. doi:10.1515/ijnes-2024-0056 [DOI] [PubMed] [Google Scholar]
- 18.Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100(3):363-406. doi:10.1037/0033-295x.100.3.363 [Google Scholar]
- 19.Ericsson KA, Harwell KW. Deliberate practice and proposed limits on the effects of practice on the acquisition of expert performance: why the original definition matters and recommendations for future research. Front Psychol. 2019;10:2396. doi:10.3389/fpsyg.2019.02396 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Arrogante O, Ríos-Díaz J, Carrión-García L, Samith S, González-Romero GM, Caperos JM. Deliberate practice in resuscitation training using a feedback device, and the effects of the physical characteristics of the rescuer on the acquisition and retention of cardiopulmonary resuscitation skills: randomized clinical trial. Int Emerg Nurs. 2021;58:101037. doi:10.1016/j.ienj.2021.101037 [DOI] [PubMed] [Google Scholar]
- 21.Schroers G, Vanderzwan K, Kilroy S, et al. Deliberate practice of medication administration among nursing students: a multisite study. Nurs Educ Perspect. 2025;46(5):284-289. doi:10.1097/01.NEP.0000000000001451 [DOI] [PubMed] [Google Scholar]
- 22.Vanderzwan K, Schroers G, Pfieffer J, et al. Deliberate practice of nurse handoff using simulation: a multi-site study. Nurse Educ Pract. 2026;90:104664. doi:10.1016/j.nepr.2025.104664 [DOI] [PubMed] [Google Scholar]
- 23.Oermann MH, Kardong-Edgren S, Odom-Maryon T, et al. Deliberate practice of motor skills in nursing education: CPR as exemplar. Nurs Educ Perspect. 2011;32(5):311-315. doi:10.5480/1536-5026-32.5.311 [DOI] [PubMed] [Google Scholar]
- 24.Schroers G, Vanderzwan K, Klenke-Borgmann L, et al. Use of the Stay SAFE Interruption Management Strategy: a multisite multi-methods study. Nurse Educ. 2025;50(6):291-296. doi:10.1097/NNE.0000000000001932 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Des Jarlais DC, Lyles C, Crepaz N; TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004;94(3):361-366. doi:10.2105/ajph.94.3.361 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Schroers G, Pfieffer J. Tool development and testing: an objective measurement of medication administration competency. Nurs Educ Perspect. 2025;46(5):E37-E39. doi:10.1097/01.NEP.0000000000001452 [DOI] [PubMed] [Google Scholar]
- 27.INACSL Standards Committee. Healthcare simulation standards of best practice™: simulation design. Clin Simul Nurs. 2021;58:14-21. doi:10.1016/j.ecns.2021.08.009 [Google Scholar]
- 28.Tatel CE, Ackerman PL. Procedural skill retention and decay: a meta-analytic review. Psychol Bull. 2025;151(6):696-736. doi:10.1037/bul0000481 [DOI] [PubMed] [Google Scholar]
- 29.Schroers G, Shrikanth S, Pfieffer J. Undergraduate nursing student experiences in American clinical learning environments: a descriptive study. Nurse Educ Today. 2023;129:105895. doi:10.1016/j.nedt.2023.105895 [DOI] [PubMed] [Google Scholar]
- 30.Aldridge MD. Is deliberate practice a feasible method for reinforcing indwelling urinary catheterization skill? A pilot study. Teach Learn Nurs. 2024;19(4):342-346. doi:10.1016/j.teln.2024.05.011 [Google Scholar]
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