Abstract

Objective

This research aimed to determine the relationship between nursing students’ communication skills and their attitudes toward clinical practice.

Method

This descriptive and correlational study involved nursing students who were enrolled in the nursing program at a public university (n=482). Data were obtained via a student ınformation form, the communication skills scale, and the nursing students’ attitudes toward clinical practices scale.

Results

The mean scores of the communication skills scale was 100.95±11.61 and the mean scores of the nursing students’ attitude toward clinical practices scale was 105.94±14.65. Significant differences were found between the students’ grades, finding themselves sufficient in clinical practice, satisfaction with the profession, and receiving training to develop communication skills, and between the students’ grades and satisfaction with the profession and attitude toward clinical practice (p<0.05). Furthermore, a statistically significant positive correlation was identified between the communication skills of students and their attitudes toward clinical practice (p<0.05).

Conclusion

The students’ communication skills and attitudes toward clinical practice were above average, and as their communication skills increased, they had positive perspectives on clinical practice.

Keywords:

Nursing students, communication skills, attitude toward clinical practice

Main Points

• Effective communication is fundamental to nursing care, and nursing students must interact proficiently with patients.

• Effective communication skills contribute to students’ positive attitudes toward clinical practice.

• The student nurses had high communication skills and positive attitudes toward clinical practice.

• As students’ communication skills improved, their approaches to clinical practice became increasingly positive, according to the findings.

Introduction

Communication, a two-way process based on the interaction of two or more people, is the most important way for people to make sense of the surrounding environment (1). Communication involves transmitting information and ideas from one individual to another (2), and the exchange of verbal and non-verbal information is the heart of all interactions (3). It is important for every individual, regardless of profession, to communicate effectively with other individuals (4). However, the intensive use of communication in environments where health care services are provided, especially in the nursing profession, makes it even more special. It is an undeniable reality that patient-nurse communication has important contributions to establishing a meaningful relationship with patients and both care and social needs (4, 5). Therefore, communication skills are considered one of the most important competencies for nurses. Effective interpersonal communication plays a pivotal role in nursing because it directly impacts patient care, teamwork, and overall healthcare outcomes. Therefore, it is essential for not only nurses but also nursing students to possess effective communication skills (2, 6). While they are still in their student years, nurses are required to have advanced communication skills to establish an effective relationship with the individuals they provide health care services and to provide quality care (6).

Communication is a crucial element of patient care, as it improves the relationship between the nurse and patient and improves the patient’s perception of healthcare services and treatment (7). The intensity of patient interaction during care practice reveals the importance of communication skills in nursing. The ability of nurses to effectively communicate increases the quality of patient-nurse interaction and ensures better results (8). In the literature, it is reported that communication forms the basis of patient care (9), and has an important role in providing effective, safe, and quality care to patients (10-12), ensuring patient satisfaction (13), and determining patient needs (14). It is also stated that effective communication reduces the anxiety and depression of patients (15), increases treatment adherence (16), and is effective in disease management (17).

Nursing students may encounter patients from different populations, cultures, or speech styles during clinical practice. This may cause them to experience communication problems (18). For students, clinical practice requires communicating with patients, but it is also known as an environment where they experience negative emotions like anxiety and fear and do not feel ready to communicate with patients (19). In such situations, students must learn empathic, patient-centered, active listening, and communication techniques based on being aware of their concerns and using correct language in critical situations (20, 21).

Nursing education aims to enable students to reach the required level of professional competence before entering the nursing profession (22). Clinical practice is central to nursing education in terms of the acquisition of professional competence (23). The clinical practice aims to develop the knowledge, skills, and attitudes of future nurses, such as research, critical thinking, self-esteem, independent decision-making, and effective interpersonal communication skills (24), and to establish their professional competencies and identities (22, 23). Nursing students can transform the theoretical knowledge learned in the classroom into clinical practice by establishing trust-based relationships with patients and developing professional skills and attitudes (25). This situation reveals that attitude development has an important place in the basis of quality nursing care as much as knowledge and practice. Students’ attitudes toward clinical practice are affected by the clinical environment, the relationship between the student, nurse, and teacher, and the complex structure of the hospital environment. When the student’s attitude toward clinical practice is positive, efficient clinical education develops, whereas in the opposite case, a negative attitude prevents the acquisition of clinical competencies (26). Nurses’ attitudes toward clinical practice begin to develop during their student years (27). Students’ attitudes also enable them to determine how to adapt to the clinical environment and how to improve their knowledge, skills, and attitudes when they encounter difficulties in professional practice (28). The most important learning outcome of clinical practice is to experience real communication with patients and other healthcare team members and the establishment of a professional identity by establishing effective interpersonal relationships (29). The professional relationship between nurses and patients begins to form during student years and continues to develop throughout professional life. Successfully creating this relationship provides professional satisfaction, success, and productivity for nurses, as well as improvements in patient outcomes (30). Effective communication also guides students in adverse situations that they may encounter in clinical settings and contributes to the development of positive attitudes by enabling them to improve themselves (18). Based on this information, this study aimed to assess the influence of students’ communication skills on their attitudes toward clinical practice. This study aimed to answer the following research questions:

1. What communication skills do nursing students possess?

2. What are the attitudes of nursing students toward clinical practice?

3. Is there a relationship between nursing students’ communication skills and their attitudes toward clinical practice?

Material and Method

Design and sample

This descriptive and correlational study investigated the relationship between students’ communication skills and their attitudes toward clinical practice. The study was conducted with students enrolled in the Nursing Department of the Faculty of Health Sciences at a state university between May 10, 2023 and June 10, 2023.

The study included a total of 726 nursing students enrolled in the nursing departments of state universities during the 2022-2023 academic year, representing the population under investigation. The sample included 482 students who willingly agreed to participate in the study and fully completed the data collection forms.

Data collection forms

The data collection instruments employed were the student ınformation form, communication skills scale, and nursing students’ attitudes toward clinical practices scale.

Student information form: The researchers created this form. The form consisted of a total of six questions, comprising the student’s age, grade, place of residence, status of loving the profession, status of feeling competent in clinical practice, and whether the student received training to improve their communication skills (4, 6, 28).

Communication skills scale (CSS): The CSS created by Korkut Owen and Bugay (31) assesses the communication skills of university students is a 5-point Likert scale. The scale comprises 25 items distributed across four dimensions. These dimensions are self-expression (KIE), communication principles and basic skills (IITB), willingness to communicate (IKI), and effective listening and non-verbal communication (EDSOI). The scale ranges from 25 to 125. A higher score on the scale indicate improved communication skills. The calculated Cronbach’s alpha internal consistency coefficient of the scale was 0.81 (31). In this research, the Cronbach’s alpha coefficient for the scale was 0.93.

Nursing students’ attitude scale toward clinical practice (NSASCP): The scale created by Bayülgen and Uysal (32) follows a 5-point Likert scale. Items 11-14, 26, 28, and 30 of the scale consisting of 26 items are coded in reverse. The scale has 4 sub-dimensions: “belief and expectation toward clinical practices (BECP)”, “positive approach toward clinical practices (PACP)”, “negative approach toward clinical practices (NACP)” and “personal development (PD)” the scale allows for scores ranging from 26 to 130. ıt has been reported that as the score obtained from the scale increases, students’ attitudes toward clinical practice increase positively. The calculated Cronbach’s alpha internal consistency coefficient of the scale was 0.93 (32). In this research, the Cronbach’s alpha coefficient for the scale was 0.94.

Data collection process

Ethics approval and institutional permission were obtained to conduct the study. Subsequently, in accordance with the Helsinki Declaration, the purpose, scope, and methodology of the research, as well as the protection of personal information and the voluntary nature of participation, were explained to the students. After these explanations, students who volunteered to participate were engaged in face-to-face interviews within the classroom, where they completed the relevant forms and scales within a 15-20 minutes period.

Statistical Analysis

The data were evaluated using the IBM SPSS package program (version 20.0). The Kolmogorov-Smirnov test indicated that the data did not follow a normal distribution (p<0.05).

In the data analysis, descriptive statistical methods (number, percentages, arithmetic means, and standard deviations) and comparative statistical methods (Mann-Whitney U test and Kruskal-Wallis test) were used. The relationship between the scales was evaluated using Spearman’s correlation analysis. The findings were assessed with a confidence level of 95% and a significance level set at p<0.05.

Ethical considerations

Approval from the Ethics Committee was secured from the Scientific Research Ethics Committee of Trakya University Faculty of Medicine (date: 08.05.2023, no: 08/16), institutional permission was obtained from the institutions where the research would be conducted, and informed consent was obtained from the students.

Results

The average age of the nursing students involved in the study was 20.64±1.54 years. Of the participants, 82.6% identified themselves as female, 33.8% were in their first year of study, and 71.0% resided in dormitories. 57.7% of the nursing students stated that they found themselves partially sufficient in practice, 88.8% stated that they liked the nursing profession, and 77.2% stated that they received an education to improve their communication skills (Table 1).

The academic grades of the students showed a statistically significant contrast with the total scores obtained from both the CSS and the NSASCP (p<0.05). It was concluded that fourth-grade students had a higher mean CSS total score than first- and second-grade students, while fourth-grade students had a higher mean NSASCP total score than the other students (Table 1).

A significant difference was found between students’ perceived adequacy in clinical practice and the total score on the CSS (p<0.05). The CSS total score of the students who found themselves adequate in clinical practice was higher than that of the other students (Table 1).

It was found that there was a notable distinction between the students’ satisfaction with nursing and both the CSS and NSASCP total score (p<0.05). It was found that the CSS and NSASCP total scores of the students who satisfied with the nursing were higher than the other students (Table 1).

It was discovered that there was a notable disparity between the status of receiving training to improve communication skills and the CSS total score (p<0.05). The CSS score of the students who received training to improve their communication skills was higher (Table 1).

It was observed that there was no significant difference based on gender, place of residence, and CSS score and between gender, place of residence, feeling competent in clinical practice, receiving any training to improve communication skills, and NSASCP total score (Table 1).

The average CSS total score of the students was 100.95±11.61, the mean score of the communication principles and basic skills subscale was 41.09±4.73, the mean score of the self-expression subscale was 16.08±2.35, the mean score of the effective listening and non-verbal communication subscale was 24.37±3.11, and the mean score of the willingness to communicate subscale was 19.39±3.06 (Table 2).

The mean NSASCP total score of the students was 105.94±14.65, the mean score of the BECP subscale was 35.22±4.76, the mean score of the PACP subscale was 26.45±5.79, the mean score of the NACP subscale was 27.29±5.57, and the mean score of the PD subscale was 16.97±2.73 (Table 2).

When the relationship between CSS and NSASCP was examined, a moderate positive correlation was found between the total and sub-dimension mean scores of the CSS scale and the total and sub-dimension mean scores of the NSASCP scale, except for the NACP sub-dimension mean score. A weak level of positive correlation was found between the total and sub-dimension mean scores of the CSS scale and the NACP sub-dimension mean score of the NSASCP scale (Table 3).

Discussion

This study aimed to determine the relationship between nursing students’ communication skills and their attitudes toward clinical practice. Results showed that students’ communication skills and attitudes toward clinical practice varied according to class year. Fourth-year students scored the highest on both scales. In addition, although there was a difference between the grades in terms of scale score averages, students in all grades scored above the average, and their communication skills and attitudes toward clinical practice were high. In clinical practice, students must communicate with healthcare teams and patients. When a student does not have effective interpersonal communication skills, he/she may experience anxiety during clinical practice, and as a result, his/her attitude toward clinical practice may be negative (33). In the literature, it has been reported that students with high communication skills adapt better to clinical practice and have a high level of satisfaction and confidence (34). Similar to the literature, the fact that all students in this study received high scores on two scales indicates a positive result in terms of both high communication skills and positive attitudes toward clinical practice. Additionally, as students advance through their class levels, the number of courses they take and the clinical practice they participate in increases. This increase is believed to contribute to students becoming more proficient in patient communication and gaining a better mastery of clinical practice. Studies by Hendekçi (4) and Duru et al. (35) have found that as students’ grade levels increase, their communication skills scores also increase. Similarly, in the review by Özsaban and Bayram (36) and the study by Özdemir et al. (37), it is noted that students’ clinical practice experiences are influenced by their grade level, with perceived stress decreasing as grade level increases. Stress is a significant factor that can adversely affect students’ adaptation to clinical environments. This study suggests that as students progress through their academic levels, the increase in the number of courses they take and the clinical experiences they participate in positively contributes to their learning process. Consequently, it is anticipated that students will better adapt to the complex nature of clinical environments, become more proficient in patient communication, and gain greater mastery in clinical practice. In line with similar findings in the literature, the fact that all students scored high on both scales is a positive outcome, as it indicates both strong communication skills and the development of a positive attitude toward clinical practice.

Another finding of the study was that the communication scores of students who found themselves competent in clinical practice were higher. When an individual feels competent in a subject, it indicates that he/she has developed himself/herself and is successful in that subject (38). On the other hand, effective communication skills can increase students’ self-confidence (39). In the literature, it has been stated that there is a relationship between the high self-efficacy of nursing students and their readiness for clinical practice (40). A previous study found that students with lower communication skills scores had difficulties with patients during nursing care (41). In a study by Pazar et al. (42), the communication skills score of the students was found to be high, and it was reported that students who recognized their feelings and thoughts and felt strong in patient care could use their autonomy and develop new attitudes when faced with new events. A study by Leal-Costa et al. (43) reported a relationship between communication skills and the perceived self-efficacy of nurses and that good interpersonal relationships were effective in making nurses feel competent. In this study, the higher communication skill scores of the students who found themselves competent demonstrated that the students knew themselves and were open to communication with the patient.

In this study, it was determined that both communication skills and attitudes toward the clinical practice of students who liked the nursing profession were more positive. It has been reported that loving the profession has a positive effect on the working environment by increasing job satisfaction and satisfaction. In addition, communication skills were seen as an effective factor in developing nurses’ professional attitudes. In the study conducted with nurses, it was reported that nurses who were satisfied with the nursing had higher professional attitudes, such as communication skills (44). In a study conducted by Tosunöz et al. (45), it was stated that it is important to be satisfied with nursing care and communicate well well with patients, and that these characteristics contribute to improving the quality of care. Zencir and Eşer (46) determined that students who willingly chose their profession had positive attitudes toward the nursing profession. In this study, the fact that the communication skills and attitudes toward the clinical practice of students who like the profession are more positive is a significant finding in terms of showing that the quality of patient care and job satisfaction will be high in the future.

In this study, the communication skill scores of students who received training to improve their communication skills were found to be higher. In Temel and Şişman’s (47) study, Temel and Şişman (47) stated that communication skills training improved students’ interpersonal relationships. Lau and Wang (48) noted that communication skills training provided to nursing students facilitated the enhancement of their communication abilities. In a study by Mercan et al. (49), training for students was found to be effective in improving their communication skills. In this study, the fact that the communication skill score of the students who received training on communication was found to be high is seen as an important finding in terms of clearly demonstrating the importance of communication in nursing education and practice.

Another significant finding of the study is that student nurses demonstrate high communication skills and hold positive attitudes toward clinical practice. Additionally, as communication skills improve, there is a positive increase in their attitudes toward clinical practice. Communication in nursing is a basic competence for determining the needs of the patient, quality of care, and patient satisfaction and is at the center of nursing care (13). Nursing students must have developed communication skills to effectively fulfill their roles and establish the desired level of relationship with patients by adapting to the clinical environment (34). It has been reported that student nurses feel reluctant to communicate with patients in clinical practice, have difficulty initiating or maintaining a conversation, and are anxious (50). However, nursing students’ communication skills must be developed to provide appropriate nursing care, empower patients, and increase satisfaction (19). In particular, effective communication skills are extremely important in the personal and professional development of students and contribute to their satisfaction with the profession, willingness, and motivation to learn, that is, to develop a positive clinical attitude (32, 51). The communication skills of nursing students were classified as medium (31) or high (52). This study found that the communication skills and attitudes of nursing students were high, and there was a positive relationship between students’ communication skills and their attitudes toward clinical practice. The results suggest that the high communication skills of students contribute to their ability to adapt to the complex nature of the clinical environment, leading to better performance. Additionally, students who adapt well to the clinical environment will feel more secure, experience reduced stress levels, and consequently perform better in patient communication. Based on these findings, the reciprocal relationship between communication skills and clinical adaptation can play a critical role in the professional development of nursing students. Students with strong communication skills are expected to provide more effective patient care, thereby enhancing patient safety and satisfaction.

Study Limitations

The limitations of this study include the fact that it was conducted solely with nursing students from a single state university. Therefore, the findings cannot be generalized to all nursing students. Additionally, the research was based on the self-reports of the participants. This approach suggests that responses could be influenced by personal perceptions or social expectations.

Conclusion

As a result of this study, it was concluded that nursing students’ communication skills were above average, and their attitudes toward clinical practice were positive. It was concluded that enhancing students’ communication skills led to a more positive attitude toward clinical practice, as evidenced by the academic research. These results reveal the importance of developing communication skills, which are important in the nursing profession. In this direction, in future studies, it is recommended that teaching strategies that will support students’ communication skills should be used in nursing education, starting from the first year of nursing faculty. Guidance should be provided to improve communication skills in clinical practice, and students should be supported by receiving feedback from students.

Ethics

Ethics Committee Approval: Approval from the Ethics Committee was secured from the Scientific Research Ethics Committee of Trakya University Faculty of Medicine (date: 08.05.2023, no: 08/16).

Informed Consent: Informed consent was obtained from the students.

Footnotes

Author Contributions: Surgical and Medical Practices – S.B.K., Ş.B.; Concept – S.B.K., Ş.B., E.P.G.; Design – Ş.B., E.P.G.; Data Collection and/or Processing – S.B.K., Ş.B.; Analysis and/or Interpretation – S.B.; Literature Review – S.B.K., Ş.B., E.P.G.; Writing – S.B.K., Ş.B., E.P.G.

Declaration of Interests: No conflict of interest was declared by the authors.

Funding: The authors declared that this study received no financial support.

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The Relationship Between Nursing Students’ Communication Skills and Their Attitudes Toward Clinical Practice: A Descriptive and Correlational Study

Abstract

Introduction

Material and Method

Results

Discussion

Conclusion

Ethics

References