Communication among Nursing Students in South Korea: A Qualitative Content analysis

Communication among Nursing Students in South Korea: A Qualitative Content analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Communication among Nursing Students in South Korea: A Qualitative Content analysis Hyunju Kim, Mihae Im This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5315323/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study explores the characteristics and significance of communication for nursing students during the COVID-19 pandemic. Methods Focus group interviews were conducted with 10 participants and the data were analyzed using content analysis. Results Three main categories emerged: “Communication characteristics of nursing students,” “Communication process of nursing students,” and “The meaning of communication to nursing students.” Participants acknowledged that effective communication is crucial for nurses to understand and assist patients. They emphasized that nursing students must develop strong communication skills to prepare for their future roles as nurses. Conclusions The study highlights the importance of education, program development, and practical application to enhance communication competency among nursing students. Reinforcing these skills is seen as vital to the professional growth and readiness of nursing students by ensuring that they are able to provide high-quality patient care in their future careers. Qualitative Content Analysis Communication Nursing students Group interviews Figures Figure 1 Background Nurses are medical professionals who are in close contact with their patients, and the aim of nursing is to combine the art and science of caring to protect, promote, and optimize health, prevent illness, facilitate healing, alleviate suffering, and advocate for individuals and communities by recognizing the interconnectedness of humanity, which involves empathic understanding and emotional and ethical behavior [ 1 ]. Subsequently, communication is vital for accurately assessing the patient’s physical, mental, and emotional condition and resolving it efficiently [ 2 ]. The medical field is where experts come together, and when communication is effective, it can enhance cooperation and ensure the best outcomes for patients [ 3 ]. Humans need communication to create and develop relationships with others, achieve their goals, and live in society. Communication is also a crucial factor in nurses’ development of positive relationships with patients and providing quality nursing care, as nurses can improve treatment outcomes and increase trust while receiving necessary information through effective patient communication [ 3 , 4 ]. In addition, to care for patients, nurses must communicate within their respective healthcare teams, exchange information, coordinate work, and mediate with various departments [ 5 ]. Therefore, continuous communication must occur throughout the nursing process, and a nurse’s communication ability can facilitate efficient problem-solving [ 6 ]. Nursing students must interact with many people and work as part of a healthcare team in the field during their undergraduate studies and after graduation. Accordingly, the Korean Accreditation Board of Nursing Education [ 7 ] stated that communication and cooperation skills are the core competencies of nurses. Subsequently, all nursing departments in South Korea have enhanced students’ communication skills by establishing a curriculum that aligns with these new core competencies of nurses. Meanwhile, the non-face-to-face situation caused by COVID-19 that began in 2020 brought about changes in students’ communication patterns. Social distancing has led to decreased interaction between people in non-face-to-face classes, resulting in the widespread use of email, SNS, and mobile phone messengers as a means of communication [ 8 ], which has led to difficulties in forming various human relationship experiences and emotional consensus. As a result, 58.4% of people in their 20s preferred non-face-to-face communication, such as text messages, and 29.3% presented a phenomenon known as “call phobia,” where they are afraid of talking to others on the phone [ 9 ]. Nursing students must have a more meticulous and careful approach to observing and analyzing patients’ thoughts, feelings, and behaviors and be capable of accurately understanding and conveying the obtained information. Additionally, the COVID-19 outbreak has affected current nursing students who have finished high school and the first year of college and often prefer non-face-to-face communication. Therefore, it is necessary to investigate the significance of communication challenges among nursing students to develop a curriculum that reflects current communication characteristics and improves communication competency not only during clinical practice but also for future nurses. Previous research related to communication among nursing students includes quantitative research related to the communication capabilities of nursing students [ 10 , 11 ] and qualitative research on communication experiences during clinical practice and subjective research on nursing students’ communication types [ 12 , 13 ]. However, there has been little qualitative research on the communication skills of nursing students after COVID-19. Reflecting this historical background, in-depth research is needed into nursing students’ experiences related to communication in school or clinical practice. Accordingly, this study aims to understand and explore the characteristics and meaning of communication using nursing students’ perspectives in the context of COVID-19 to provide primary data for improving the curriculum to strengthen nursing students’ communication capabilities. The research questions for this study are ‘What is communication like for nursing students?’ and ‘What is communication like for nurses after experiencing COVID-19?’ Methods Study design The design involved a qualitative study using a content analysis to identify the nature of the communication among nursing students following COVID-19. Sample and setting The subjects were selected as nursing students enrolled in nursing departments in Ulsan and Changwon cities with clinical field practice experience. Purposive sampling was used for those who met the selection criteria. The selection criteria for research participants are as follows: Nursing students a) who are currently enrolled in a nursing department, b) have experience in clinical field practice for at least one semester, and c) agreed to participate in this study after being informed of the purpose and procedures of the study. A focus group consists of groups with similar characteristics who can freely share opinions on topics. This process allows for the understanding of not only individual thoughts but also the ideas and dynamics of the group. For this study, if data were collected from a single group, the unique factors of the group could not be controlled, so the respondents were divided into two groups. The number of participants was 5 people per group for a total of 10, in accordance with the heuristic that 4 to 12 people per group are suitable [ 14 ]. Data collection Data were collected through focus group interviews (FGI) between October 10 and November 30, 2023. The two groups were formed by coordinating the participants’ schedules from each college. Each group received the interview content and questions by email two days before the interview, and they were instructed to organize their experiences and thoughts on the interview content. Before the interview, an email explaining the participation in the study was sent to confirm whether the participants wanted to participate. Afterward, before starting the interview, written consent was obtained after the researcher informed them about the study’s purpose, procedures, and ethical considerations. The FGI process was conducted based on Krueger’s methods [ 15 ]. The interview questions comprised opening, introductory, transitional, core, and closing questions in line with the five types of FGI questions (Table 1 ). Table 1 Open-ended questions for the FGI Category Contents Question Opening questions Daily college life Can you tell me about your college life? Introductory questions Daily communication style What is your typical way of communicating at college? Transitional questions Communication experience Can you share your communication experiences in college and at the clinic? Key questions Communication awareness, importance, difficulties, and other factors What do you think communication means in college or at the clinic? In college or at the clinic, what communication difficulties or stresses have you encountered? What do you consider to be crucial when communicating in college or at the clinic? Have there been any changes in your communication experience before or after COVID-19? Ending questions Other related queries Is there anything else you’d like to share? Interviews were held twice for each group, and each interview lasted 90 to 120 minutes. After the FGI with the first group, analysis was performed immediately. After that, the FGI was carried out with the other group to constantly check the saturation status of the study. To confirm the meaning of unclear information during the discussion, the participants were re-asked questions to ensure the validity of the collected information. A small reward was given to the research participants. Data analysis Descriptive statistics were calculated to obtain the participants’ general characteristics using SPSS 24.0. The qualitative data were analyzed using the conventional content analysis method suggested by Hsieh and Shannon [ 16 ]. First, the researcher read the transcribed interview data repeatedly to understand the overall meaning of the communication experiences of nursing students. Codes were derived by reading the data word-by-word and highlighting words that demonstrated significant ideas or concepts. The second step involved creating codes based on keywords in the derived statements and integrating codes with similar content to create subcategories. Third, depending on the relationships between subcategories, the researchers could combine or organize large numbers of subcategories into a smaller number of categories. Lastly, definitions for each category, subcategory, and code were developed. Researcher’s training and preparation For more than nine years, the researchers have been teaching nursing students as university instructors, assigning student advisors, and providing regular counseling, and as a result possess an understanding of nursing students. Furthermore, all researchers have taught relevant courses in graduate programs and have abundant experience in conducting workshops, presenting at academic conferences, and conducting qualitative research projects. Additionally, they have experience publishing FGI research. Regular research meetings and exploration of qualitative research published in various fields are ongoing ways for them to enhance their skills. Rigor of the research results To increase the reliability and validity of this study, the four criteria proposed by Lincoln and Guba [ 17 ] were confirmed: credibility, transferability, dependability, and confirmability. To guarantee credibility, the data were transcribed word for word straight after recording to avoid distortion and omissions. Furthermore, two participants validated the themes and quotes, demonstrating that they were suitable for the research findings. To increase transferability, efforts were made to include participants who could fully express their experiences. Furthermore, the data were collected until the participants’ statements were repeated and saturation was reached without any new statements being made. To enhance dependability, we adhered to the content analysis method recommended by Hsieh and Shannon [ 16 ], kept a record of the atmosphere, and quoted the participants’ words during their statements. In addition, the research method, data collection, and analysis process were detailed. Confirmability can be assured by ensuring the reliability, transferability, and dependability of the research. We intended to maintain a neutral attitude and avoid bias by not manipulating or interfering in the participants’ experiences. Ethical considerations Ethical approval was obtained from the bioethics committee at the college of the first author (IRB No. 1044386-A-2023-002). Nursing students who directly expressed their intention to participate through the research description were chosen as research participants. The research description included information on the purpose and method of the study, the interview content, the need for recording, the benefits and risks expected from the study, guarantees of the anonymity and confidentiality of the collected data, storage and disposal of the data, and the possibility of discontinuing research participation without any negative repercussions. The researcher explained that they would safely dispose of all research data and recordings after completing the study. Before conducting the study with those who provided written consent, the researcher explained the contents again. The researcher conducted interviews with students who were not part of their university, and it was fully explained that participation in this study would not have any benefits or disadvantages for future grades, evaluations, or relationship formation. Results General characteristics of participants All participants were women, and their average age was 22.30 years old. Their average overall GPA was 3.56, and their average clinical practice GPA was 4.14 points (Table 2 ). The content analysis yielded three categories and nine subcategories (Fig. 1 ). The three subcategories were: “Communication characteristics of nursing students,” “communication process of nursing students,” and the “meaning of communication to nursing students.” Table 2 Characteristics of Participants ( N = 10) Characteristics Categories N (%) or M ± SD Age (year) 22.30 ± 1.06 Gender Female 10(100%) Male - Overall GPA 3.56 ± 0.56 4.0 1(10%) Clinical practice GPA 4.14 ± 0.30 3.5–4.0 5(50%) > 4.0 5(50%) Communication patterns of nursing students The communication characteristics mentioned included group activities as an opportunity for communication, participation varying depending on purpose, and the use of various types of communication. Group activities as an opportunity for communication The participants said that the communication they experienced at college more often took the form of mandatory group assignments than of communicating with colleagues. This was said to be due to the large number of students compared to other departments, busy academic schedules, and fewer opportunities to meet each other and form relationships due to COVID-19: There are many students, so I have no friends unless I participate in practical training or group activities. Without the opportunity to communicate with each other, I don’t believe we can achieve that without participating in group activities and practicing. (FGI 2, P4) The group activities involved students dividing their roles into members of each group and fulfilling their responsibilities. It was reported that there was no smooth communication between them: Cooperative learning is through group assignments. But when your role is decided, you feel like you’re just playing your role and you don’t do the rest. Strictly speaking, I don’t think we communicate well in group assignments. (FGI 1, P4) Participation varies depending on the purpose Compared to group activities where communication is forced, groups that are actively formed according to their members’ goals have varying levels of participation. During the clinical practice period, they have a natural attitude toward actively engaging in communication: An interview study is a group of people who want to do it independently. After studying for 2 hours, even after class, I met them on Zoom at home and studied actively so I could communicate well, and I felt that it helped a lot during interviews. (FGI 1, P3) I made an effort to communicate effectively during the training period. I smiled brightly while listening to the stories of older patients. Also, the younger kids liked it because I reacted a little louder. (FGI2, P3) Use of various means The primary means of communication with peers mentioned by the participants included text, phone calls, mobile messengers, and social network services (SNS), but the means used differed depending on the weight of the topic. Each individual had different preferred methods, but when accurate communication is required, face-to-face contact is said to be the most effective: When we are together like this, we communicate by looking at various communication styles, such as facial expressions. The phone now only allows you to send your voice. So, I think I have started to think more about mistakes and things like that when I am on the phone. (FGI1, P1) The participants reported that COVID-19 did not cause any significant changes in communication. Instead, they said that they have become accustomed to one-way communication, such as online lectures, and that communication without location restrictions is possible using online calls and real-time online conferences. Consequently, they adapted by creating a new culture where they could easily meet and communicate online when required: I can’t meet friends from other regions, so I just say, “Let’s meet on the screen, let’s talk.” Zoom is kind of like, you can see that person’s expression, you can hear their voice. But it’s different now than when we meet and talk face-to-face. Still, I think it's much better to be able to talk face to face. Because I can see the facial expressions. (FGI1, P4) Tips for effective communication The participants asserted that relationship formation is the first step in the communication process and that it requires efforts to establish and sustain good relationships. They stated that overcoming stereotypes about each other is necessary for smooth and accurate communication, which requires flexible perspectives. Beginning of communication: Building relationships According to the participants, building a relationship is crucial for smooth communication, and starting a relationship requires getting to know others. In this process, conversation is a significant means of communication, indicating the importance of mutual roles between relationships and communication. The participants started a relationship by approaching each other, learning each other’s preferences, and eliciting and sharing interests. The relationship progressed gradually after a consensus was established: When we usually talk about what’s popular these days or something, we come up with a common interest, and now that we’ve become friends, I tend to move on to talking about that friend a little more. (FGI1, P1) It’s difficult to understand the type of person you’re talking to in person. The way I thought about that person before talking to them was slightly different after we formed a relationship through talking. (FGI, P5) Commitment to interaction: empathy, listening, creating a comfortable atmosphere, and nonverbal communication As communication involves getting to know others and reaching an agreement, it was acknowledged that it should be achieved through interactions. The things necessary for good communication include empathy, listening, and creating a comfortable atmosphere. The participants stated that they can see other people’s facial expressions better now than when they had to wear masks due to COVID-19, which aids in understanding their emotions. Consequently, the intimacy and understanding of conversations have significantly improved. As obstacles, it was suggested that no one asked questions but only talked about themselves. In this context, the participants said that they were trying to exchange accurate information, such as clearly conveying words and actively expressing their opinions: In my opinion, communication is a constant process that requires one to graduate from a nursing department and move forward in society. Whether it’s face-to-face or not, or KakaoTalk, I may have to listen or I may have to voice my opinion myself. My belief is that it’s one of those diverse procedures. (FGI2, P1) My speech is unclear. I have a tendency to turn things around. When I speak, the other person can’t understand what I’m saying. It’s crucial to be precise and convey it effectively. Practice and hard work are necessary to avoid making mistakes in the hospital. (FGI2, P2) Perceptual flexibility: Critical thinking, eliminating biases According to the participants, ideal communication requires abandoning opinions or dichotomous thinking and adopting an accepting attitude and understanding based on mutual understanding. However, they said that it is necessary to learn how to communicate using your own thoughts based on critical thinking rather than following other people’s opinions. It was suggested that communication is hindered by various factors, such as identifying others based on their generation or personality type, verifying it with prejudice and stereotypes, and using buzzwords or abbreviations that only one person is familiar with. The younger generation is often portrayed as being able to speak their mind without hesitation; however, they are cautious about making mistakes while speaking or whether their opinions are incorrect. Because they unquestioningly believe in MBTI, T-type people cannot empathize with their emotions. Saying F-type is too emotional. It seems to me that our generation must eliminate this because it has become so ingrained in our perception. (FGI1, P4) It is my belief that we must eliminate the prejudice that exists between generations. The old generation was referred to as “condescending” by us. The older generations used to call us “MZ.” In my opinion, we need to break things like this down. The truth is that everyone is unique. (FGI1, P2) It was a little challenging for me to give my opinion one on one during group work. I think that’s right, but I was a little careful now that others wouldn’t think it was. (FGI2, P3) The meaning of communication to nursing students The participants stated that communication is crucial for understanding and performing the role of a nurse who helps others effectively. Furthermore, they believed that communication required learning and experience with the curriculum. They said they were unique as nursing students because they applied what they had learned about communication. Understanding and helping others The participants said that if rapport is good during communication, the patient’s needs can be met by learning what they want. During the practice, students utilized their communication skills to provide objective information to patients and ease their anxiety. They said that, for observation and communication skills, not missing the smallest parts is important: In my view, the more positive the communication, the more the patient expresses their desires. The duty of a nurse is to provide care for those needs. That could have very big results. So, we must communicate positively to identify even the most minor needs and provide nursing care accordingly. (FGI1, P5) The patient was deaf, so we communicated by making circles and X-tags with our hands. That’s how I communicated and helped them organize their luggage. Later, they thanked me by contacting me later after being discharged from the hospital. I believed that we could communicate effectively during that time. (FGI2, P3) Pride and experience as a nursing student According to the participants, communication is a crucial medium for patient care, and they acquired communication skills in undergraduate courses to become nurses. They asserted that they utilized the communication content or skills they acquired effectively in daily life or clinical practice. The participants reported that their perceptions and attitudes toward communication differed from those of students from other majors: It was my first time writing an interview report during my practicum, and it was very difficult. So, for the first time, I used what I learned in class about therapeutic communication, such as non-verbal and verbal communication. The patient said it was easy to talk to me because I nodded and repeated what they said. (FGI2, P2) When we go out to practice, we talk with patients and nurses, and we recognize that empathy is important. However, when I look at my friends from other departments, I see that those who graduated from engineering schools have a lot of personal things, so they only think about themselves when they say things, and if the other person is offended, they say sorry, that’s all. They only think about themselves first. So, I thought it was a little different from nursing school. (FGI1, P4) Preparation to become a nurse The participants asserted that communication is a means of comprehending patients. Communication is a preparation process for becoming a nurse because nurses must always communicate with patients, colleagues, and other people: Nurses are in the profession of meeting patients, and considering that they are sensitive patients, the ability to talk is the most important thing, so I think I learned like this. (FGI1, P5) I think the communication I usually do at school is to practice before starting my social life. When I do assignments, I often work in teams and practice things like that. Working as a team is necessary in the clinical field. (FGI2, P4) Discussion This study examined nursing students’ thoughts and experiences in communication using FGI. This section focuses on the communication patterns, tips for effective communication, and the meaning of communication to nursing students. In this study, the communication patterns of nursing students were found to be group activities as an opportunity for communication, participation varying depending on purpose, and use of various means. According to nursing students, group assignments are the main way they experience communication. This arose from a situation in which it was difficult for students to naturally form relationships due to the large number of students in the nursing department and busy academic schedules, as well as the lack of face-to-face opportunities due to COVID-19. During group activities, students focused on performing their respective roles during group task activities because their roles were divided and then collected. Consequently, there were many instances where communication was not smooth. These findings indicate that group activities may not suffice to foster real-world communication. This result does not align with previous studies that demonstrate that team learning enhances communication [ 18 ]. This might be because the group activities mentioned in this study were not designed to enhance communication, students assigned their own roles for convenience and the instructor did not intervene. The success of group activities is dependent on the group’s composition, task, and motivating members [ 19 ], and poorly structured group activities can hinder communication and learning. Therefore, an appropriate group size must be set, and the operation of group activities and members’ roles and responsibilities must be clearly defined and divided. Furthermore, members should be capable of evaluating their communication abilities to offer opportunities for improvement. Students demonstrated a natural interest in actively participating in communication during the clinical training period. The student's efforts to lead when dealing with patients were apparent throughout this entire period. According to previous studies, students gain an active communication attitude during clinical practice, which enhances their learning experience and communication skills [ 20 , 21 ]. Clinical practice is an important educational process in which nursing students apply academic knowledge to clinical situations and strengthen their practical skills through communication with patients and medical staff [ 22 ]. To develop communication competencies as future professional nurses, students need to focus on acquiring and improving communication skills in curricular and extracurricular courses. Furthermore, it was discovered that students engage in more active communication when they have a shared objective. Active participation and effective communication were present in study groups that were formed voluntarily, indicating that communication quality is enhanced when students are goal-oriented and voluntarily participate. This result indicated that nursing students can enhance their communication skills through goal-oriented learning in clinical settings [ 23 ]. Nurses must continuously encourage team activities that align with common goals and provide opportunities to enhance communication skills because communication with patients, colleagues, and other departments is crucial. The students used a variety of means of communication with their peers, which varied depending on the importance of the topic. A new communication culture was established during the COVID-19 pandemic due to the increased use of non-face-to-face communication methods. The use of real-time videoconferencing platforms in lectures, practical training, and team projects has facilitated communication without any physical limitations [ 24 ]. Despite this, the participants maintained that face-to-face communication was the most effective form of communication. To achieve in-depth understanding, empathy, and relationship formation, it is crucial to communicate face-to-face using non-verbal communication and direct feedback beyond simply information transmission [ 19 , 25 ]. According to students, non-verbal facial expressions, gestures, and eye contact are crucial for communication and cannot be accurately conveyed using phone or video calls. Through non-verbal communication, nurses quickly detect the patient's anxiety, pain, or discomfort and react appropriately to maximize the effectiveness of treatment [ 26 ]. Nonverbal communication is a critical factor in building trust between patients and nurses, meeting patients’ emotional needs, and improving the overall quality of the nursing process [ 27 ]. An analysis of the communication patterns of nurses who care for patients with chronic diseases indicated that 44% included nonverbal communication, such as laughter, smiles, and eye contact [ 28 ]. Students were aware that they needed both observation and communication skills to recognize even the slightest changes in patients. The evidence indicates that high-quality nursing care requires both verbal and non-verbal communication, and the students recognize this in their future roles as nurses. As a result of this study, students were positively aware of various communication methods and the convenience of changes in communication after COVID-19. Students were able to choose communication methods depending on their purpose, so they used their time more efficiently and felt less burdened by communication than before the pandemic. In particular, the importance of face-to-face communication was taken for granted as nurses needed to interact face-to-face with patients. Nurses must continually develop and strengthen their communication skills. Previous research indicates that communication skills improved after applying an extracurricular coaching program [ 29 ] and can be improved through education or training [ 30 ]. The participants suggested some tips for effective communication. For effective communication, they asserted that building relationships is crucial for smooth communication. This means that relationship formation is not just a medium for communication but a critical factor in determining the quality of communication and essential in developing long-term collaboration and teamwork [ 31 ]. Mutual understanding and flexible perception are necessary for forming relationships, which can be achieved through empathy and sharing interests through conversation [ 32 ]. Establishing mutual understanding and trust within the nursing team can lead to smoother cooperation among team members, improving patient care quality [ 33 ]. Students need opportunities to recognize the significance of relationship formation and practice it in nursing education. While communication can be improved through interactions, the participants stressed the importance of empathy, listening, creating a comfortable atmosphere, and an attitude without prejudice. The students stated that their understanding of conversations had significantly improved since COVID-19, when they could remove their masks and observe the other person’s facial expressions, reiterating the importance of nonverbal communication once again. The participants suggested both necessary and hindering factors for effective communication. Furthermore, it was stated that students should continuously strive to improve their communication shortcomings and prepare for a social life after graduation. Departments need to provide opportunities for students to identify their own communication styles and participate in programs that can strengthen or supplement their styles to further improve their communication skills. According to the participants, ideal communication is about letting go of opinions or dichotomous thinking and instead focusing on critical thinking with an accepting attitude and mutual understanding. This is crucial for overcoming intergenerational prejudice or stereotypes based on personality type, which can hinder communication. Ideal communication requires a receptive attitude and critical thinking that respects others’ opinions and accepts diverse viewpoints with an open mind. This approach can minimize conflicts that may arise during communication and improve mutual understanding [ 34 ]. To build communication and cooperative relationships between people from various backgrounds in the clinical field, it is necessary to develop receptive and broad thinking by providing an opportunity to experience and understand the other person through volunteering and various program activities as well as the curriculum. For nursing students, the meaning of communication was understanding and helping others, the pride and experience of being a nursing student, and the preparation for becoming a nurse. The participants recognized that for nursing students, communication plays an important role in understanding patients’ needs and providing appropriate care. Nursing education involves students learning various communication skills and strategies that help them build trust with patients, convey accurate information, and provide emotional support [ 2 ]. The communication skills they learned in undergraduate courses were used effectively in practice and daily life, and they use the communication skills they learned during their practicum period in interactions with actual patients, which allows them to better understand and respond effectively to patients’ needs [ 13 ]. The findings indicate that students use the skills they learned in undergraduate courses for practical work and further enhance their communication skills through these experiences. Their experience in clinical practice helps them solve the varied communication problems that might arise when dealing with actual patients, which can improve the quality of patient care and increase confidence in nursing practice [ 35 ]. The participants further developed their communication skills by actively utilizing and practicing the skills they learned in their undergraduate courses. Nursing students reported having different perceptions and attitudes toward communication than did students in other majors. To perform the role of a nurse without mistakes, they learned about communication in greater detail than students in other majors, and they felt proud that they were practicing better than their peers in other fields. In the nursing curriculum, nursing students are encouraged to fully comprehend the significance of communication and practice it actively. Nursing students recognize communication as crucial in understanding and supporting patients’ needs, not just as a technical process [ 13 , 35 ]. However, despite understanding the importance of communication in other fields, students in other majors often lack practical training in the practical application of communication in such domains as nursing [ 36 ]. When communicating with patients, nursing students tend to practice more empathy and listening, in which respect researchers have shown them to differ from students in other majors [ 32 , 36 ]. Therefore, nursing students’ positive perceptions and attitudes toward communication result from their experience and training during education and practice, suggesting that nursing must go beyond simply conveying technical knowledge to emphasize the importance of communication through in-depth interaction with patients. The participants mentioned that communication is an important means of understanding patients and is an essential element in the process of preparing to be a nurse. This reflects that communication skills are essential due to the nature of nurses’ jobs, where interaction with patients and colleagues is important in clinical settings [ 37 ]. Nurses accurately understand patients’ conditions through effective communication with patients, identify their needs, and provide appropriate care and support [ 3 ]. Nurses use active listening and empathy to gain patients’ trust, which helps reduce patient anxiety and motivate treatment [ 38 ]. Therefore, nursing students must learn about communication during the curriculum and develop that ability during clinical practice to grow into high-quality nurses. Additionally, the nursing students in this study recognized the importance of communication in their interactions with colleagues and actively applied communication skills to increase the effectiveness of teamwork and collaboration. Having this experience as a foundation is crucial for developing expertise as a nurse and creating a collaborative treatment environment. In conclusion, communication is an essential skill in a nurse’s job performance, and nursing students’ sufficient learning and practice during the preparation process significantly impacts successful patient management and collaboration among colleagues in clinical settings. Nursing education’s core goal is to provide excellent nursing services through effective communication in future practice, and students should continue to strive to achieve this goal. This study confirmed that nursing students are aware of their own communication characteristics and the need to develop communication competencies. Developing and applying a program that reflects the levels and needs of students will provide nursing students with the communication skills required not only in college life but also in the workplace. Conclusions This study aimed to provide primary data for nurse education curricula and enhance communication competency by identifying the communication properties of nursing students. The analysis yielded three categories of communication among nursing students: “Communication patterns of nursing students,” “Tips for effective communication,” and “Meaning of communication to nursing students.” Most of the nursing students’ communication was conducted through group tasks, and there were differences in active participation depending on purpose and spontaneity. Due to COVID-19, more diverse communication methods were used, but face-to-face communication was the preferred method for efficient communication. To communicate, it is necessary to form relationships, strengthen methods for smooth communication, exclude distracting factors, and accept and understand the other party. Communication is a medium for understanding and helping others, and for nurses, communication is essential for qualitative nursing. Subsequently, strengthening communication skills at this level is essential for future nurses. The significance of this study lies in its provision of primary data for nursing students to comprehend their perceptions and meanings, as well as suggesting ways to improve communication skills. However, repeated research is necessary for generalization because this study targeted students at only two universities; this geographical limitation raises concerns about the generalizability of the findings globally. Further studies are needed that take into account the characteristics of the diversity of students. Second, because the subjects of this study are students who entered school at the beginning of COVID-19, it is necessary to repeat the study with a broader range of subjects. Third, developing and implementing programs that can enhance communication capabilities in addition to the curriculum is necessary. Abbreviations FGI focus group interviews Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of Choonhae College of Health Sciences (approval number1044386-A-2023-002). The researchers directly explained the purpose of this study and obtained voluntary consent from those who met the selection criteria. Consent for publication The datasets generated and analyzed during the current study are not publicly available due to privacy of participants but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions HK contributed to the conception or design of the work, was involved in data acquisition, analysis, or interpretation for the work, drafted and revised the manuscript, and approved the final version of the manuscript. MI substantially contributed to the conception or design of the work, was involved in data acquisition, analysis, or interpretation for the work, and provided final approval of the manuscript version to be published. Acknowledgements None References American Nurses Association. Nursing: Scope and standards of practice. 4th ed. American Nurses Association; 2021. Kourkouta L, Papathanasiou IV. Communication in nursing practice. Mater Sociomed. 2014;26(1):65–7. 10.5455/msm.2014.26.65-67 . Afriyie D. Effective communication between nurses and patients: An evolutionary concept analysis. Br J Community Nurs. 2020;25:438–45. 10.12968/bjcn.2020.25.9.438 . Noviyanti LW, Ahsan A, Sudartya TS. 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It’s okay to call if you’re not close: Text-oriented communication is increasing, and the burden of talking is increasing. Trendmonitor. 2023. https://www.trendmonitor.co.kr/tmweb/trend/allTrend/detail.do?bIdx=2511&code=0401&trendType=CKOREA . Accessed 21 Oct 2024. Kim J-I. Factors affecting nursing students’ communication skills. J Korea Acad Ind Coop Soc. 2021;22(3):118–28. 10.5762/KAIS.2021.22.3.118 . Suh MS, Kim JP, Kim SM. A subjectivity study on communication types of nursing students. J Korean Nurs Res. 2018;2(4):11–23. Kim DH, Song HB, Son HK. A phenomenological study on the experiences of nursing students’ communication in clinical nursing practicum. J Health Commun. 2018;13(2):195–204. 10.15715/kjhcom.2018.13.2.195 . Liu Y, Wang L, Shao H, Han P, Jiang J, Duan X. Nursing students’ experience during their practicum in an intensive care unit: A qualitative meta-synthesis. Front Public Health. 2022;10. 10.3389/fpubh.2022.974244 . Gray JR. Qualitative research methods. In: Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). Amsterdam: Elsevier. pp. 251–83. Krueger RA. Designing and conducting focus group interviews. 2002. https://www.eiu.edu/ihec/Krueger-FocusGroupInterviews.pdf Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. 10.1177/1049732305276687 . Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Prog Eval. 1986;1986(30):73–84. 10.1002/ev.1427 . Alberti S, Motta P, Ferri P, Bonetti L. The effectiveness of team-based learning in nursing education: A systematic review. Nurse Educ Today. 2020;97:104721. 10.1016/j.nedt.2020.104721 . Stieger S, Lewetz D, Willinger D. Face-to-face more important than digital communication for mental health during the pandemic. Sci Rep. 2023;13(1). 10.1038/s41598-023-34957-4 . Arkan B, Ordin Y, Yılmaz D. Undergraduate nursing students’ experience related to their clinical learning environment and factors affecting to their clinical learning process. Nurse Educ Pract. 2018;29:127–32. 10.1016/j.nepr.2017.12.005 . Munangatire T, Tomas N, Asino HMM. Nursing students’ experiences and expectations of clinical learning: A qualitative study. Nurse Educ Today. 2023;124(105758):105758. 10.1016/j.nedt.2023.105758 . Carless-Kane S, Nowell L. Nursing students learning transfer from classroom to clinical practice: An integrative review. Nurse Educ Pract. 2023;71:103731. 10.1016/j.nepr.2023.103731 . Virpi V, Anna-Maria T, Kristina M. Practical nursing students’ learning and assessment during work-based placement: A qualitative study. Nurs Open. 2023;10(9):6150–64. 10.1002/nop2.1849 . Vandenberg S, Magnuson M. A comparison of student and faculty attitudes on the use of Zoom, a video conferencing platform: A mixed-methods study. Nurse Educ Pract. 2021;54(103138):103138. 10.1016/j.nepr.2021.103138 . Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E, et al. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract. 2015;69(11):1257–67. 10.1111/ijcp.12686 . Benbenishty JS, Hannink JR. Non-verbal communication to restore patient–provider trust. Intensive Care Med. 2015;41(7):1359–60. 10.1007/s00134-015-3710-8 . Keutchafo ELW, Kerr J, Baloyi OB. A model for effective nonverbal communication between nurses and older patients: A Grounded Theory inquiry. Healthc (Basel). 2022;10(11):2119. 10.3390/healthcare10112119 . James S, Desborough J, McInnes S, Halcomb EJ. Nonverbal communication between registered nurses and patients during chronic disease management consultations: Observations from general practice. J Clin Nurs. Jul; 2020;29(13–14):2378–87. 10.1111/jocn.15249 . Bae SH, Park JS. Development and evaluation of extracurricular coaching programs for improving communication skills and leadership among nursing students. J Korean Acad Soc Nurs Educ. 2015;21(2):202–14. 10.5977/jkasne.2015.21.2.202 . Kerr D, Ostaszkiewicz J, Dunning T, Martin P. The effectiveness of training interventions on nurses' communication skills: A systematic review. Nurse Educ Today. 2020;89:104405. 10.1016/j.nedt.2020.104405 . Bragadóttir H, Kalisch BJ, Flygenring BG, Tryggvadóttir GB. The relationship of nursing teamwork and job satisfaction in hospitals. SAGE Open Nurs. 2023;9. 10.1177/23779608231175027 . Atta MHR, Hammad HA-H, Elzohairy NW. The role of empathy in the relationship between emotional support and caring behavior towards patients among intern nursing students. BMC Nurs. 2024;23(1). 10.1186/s12912-024-02074-w . Baek H, Han K, Cho H, Ju J. Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study. BMC Nurs. 2023;22(1). 10.1186/s12912-023-01592-3 . Thornhill-Miller B, Camarda A, Mercier M, Burkhardt J-M, Morisseau T, Bourgeois-Bougrine S, et al. Creativity, critical thinking, communication, and collaboration: Assessment, certification, and promotion of 21st century skills for the future of work and education. J Intell. 2023;11(3):54. 10.3390/jintelligence11030054 . Expósito JS, Costa CL, Díaz Agea JL, Izquierdo C, Rodríguez JD. Ensuring relational competency in critical care: Importance of nursing students’ communication skills. Intensive Crit Care Nurs. 2018;44:85–91. 10.1016/j.iccn.2017.08.010 . Lee H, Kim IS, Lee TW, Kim GS, Cho E, Lee KH, et al. Differences between perceived readiness for interprofessional learning in nursing and other health-related students. J Korean Acad Soc Nurs Educ. 2019;25(3):312–20. 10.5977/jkasne.2019.25.3.312 . Kerr D, Martin P, Furber L, Winterburn S, Milnes S, Nielsen A, et al. Communication Skills Training for nurses: Is It Time for a Standardised Nursing model? Patient Educ Couns. 2022;105(7):1970–5. 10.1016/j.pec.2022.03.008 . Babaii A, Mohammadi E, Sadooghiasl A. The meaning of the empathetic nurse–patient communication: A qualitative study. J Patient Exp. 2021;8. 10.1177/23743735211056432 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5315323","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371923319,"identity":"792a3152-e731-4e68-b27c-e083da32fff6","order_by":0,"name":"Hyunju Kim","email":"","orcid":"","institution":"Choonhae College of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hyunju","middleName":"","lastName":"Kim","suffix":""},{"id":371923320,"identity":"56e545de-475e-4047-9c72-9002ebfab8ba","order_by":1,"name":"Mihae Im","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIie3RsWrCUBTG8RNOyXSia4Jin0CIBC5IA76KIWAfoFDuKAg3iw/g4msUR9MzdDmQ1VKHTt2EjEIpNKFjy23cHO5/+IYDv+kAuFzXGFIzOqU+YvkeLH9uHYgshlHh53E3Ag3xzHMaV6TCTmRcBGVdy56ASenTjqFf7DHRFqK4l0cbfSRv5T++boUhlDlmYiUUD0g+CBGf3gLDAAfAcmknyeeXYfIR1ENLbjsQNfAaQnijsCVxQ7L/yHQtCwrRz6OtuaeJZKuJlVSSHM46nc0qLuuTuRuNXpgjG/lV+6aLgMvlcrn+6BugZkteJF5aMwAAAABJRU5ErkJggg==","orcid":"","institution":"Daegu Haany University","correspondingAuthor":true,"prefix":"","firstName":"Mihae","middleName":"","lastName":"Im","suffix":""}],"badges":[],"createdAt":"2024-10-23 03:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5315323/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5315323/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69245432,"identity":"74d803f6-0c38-4d97-be93-b82912fb8b68","added_by":"auto","created_at":"2024-11-18 11:02:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":543202,"visible":true,"origin":"","legend":"\u003cp\u003eCategories and subcategories of participants’ experiences\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5315323/v1/77ffa6b68104ea86fa6707f8.jpeg"},{"id":102484727,"identity":"913cc528-06af-4b36-9199-6948ee70c47f","added_by":"auto","created_at":"2026-02-12 07:27:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1224399,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5315323/v1/13bf9153-e6bb-4974-9910-947ecf6599ff.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Communication among Nursing Students in South Korea: A Qualitative Content analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eNurses are medical professionals who are in close contact with their patients, and the aim of nursing is to combine the art and science of caring to protect, promote, and optimize health, prevent illness, facilitate healing, alleviate suffering, and advocate for individuals and communities by recognizing the interconnectedness of humanity, which involves empathic understanding and emotional and ethical behavior [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Subsequently, communication is vital for accurately assessing the patient\u0026rsquo;s physical, mental, and emotional condition and resolving it efficiently [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The medical field is where experts come together, and when communication is effective, it can enhance cooperation and ensure the best outcomes for patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHumans need communication to create and develop relationships with others, achieve their goals, and live in society. Communication is also a crucial factor in nurses\u0026rsquo; development of positive relationships with patients and providing quality nursing care, as nurses can improve treatment outcomes and increase trust while receiving necessary information through effective patient communication [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, to care for patients, nurses must communicate within their respective healthcare teams, exchange information, coordinate work, and mediate with various departments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, continuous communication must occur throughout the nursing process, and a nurse\u0026rsquo;s communication ability can facilitate efficient problem-solving [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNursing students must interact with many people and work as part of a healthcare team in the field during their undergraduate studies and after graduation. Accordingly, the Korean Accreditation Board of Nursing Education [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] stated that communication and cooperation skills are the core competencies of nurses. Subsequently, all nursing departments in South Korea have enhanced students\u0026rsquo; communication skills by establishing a curriculum that aligns with these new core competencies of nurses.\u003c/p\u003e \u003cp\u003eMeanwhile, the non-face-to-face situation caused by COVID-19 that began in 2020 brought about changes in students\u0026rsquo; communication patterns. Social distancing has led to decreased interaction between people in non-face-to-face classes, resulting in the widespread use of email, SNS, and mobile phone messengers as a means of communication [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which has led to difficulties in forming various human relationship experiences and emotional consensus. As a result, 58.4% of people in their 20s preferred non-face-to-face communication, such as text messages, and 29.3% presented a phenomenon known as \u0026ldquo;call phobia,\u0026rdquo; where they are afraid of talking to others on the phone [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNursing students must have a more meticulous and careful approach to observing and analyzing patients\u0026rsquo; thoughts, feelings, and behaviors and be capable of accurately understanding and conveying the obtained information. Additionally, the COVID-19 outbreak has affected current nursing students who have finished high school and the first year of college and often prefer non-face-to-face communication. Therefore, it is necessary to investigate the significance of communication challenges among nursing students to develop a curriculum that reflects current communication characteristics and improves communication competency not only during clinical practice but also for future nurses.\u003c/p\u003e \u003cp\u003ePrevious research related to communication among nursing students includes quantitative research related to the communication capabilities of nursing students [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and qualitative research on communication experiences during clinical practice and subjective research on nursing students\u0026rsquo; communication types [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, there has been little qualitative research on the communication skills of nursing students after COVID-19.\u003c/p\u003e \u003cp\u003eReflecting this historical background, in-depth research is needed into nursing students\u0026rsquo; experiences related to communication in school or clinical practice. Accordingly, this study aims to understand and explore the characteristics and meaning of communication using nursing students\u0026rsquo; perspectives in the context of COVID-19 to provide primary data for improving the curriculum to strengthen nursing students\u0026rsquo; communication capabilities. The research questions for this study are \u0026lsquo;What is communication like for nursing students?\u0026rsquo; and \u0026lsquo;What is communication like for nurses after experiencing COVID-19?\u0026rsquo;\u003c/p\u003e "},{"header":"Methods","content":"\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eThe design involved a qualitative study using a content analysis to identify the nature of the communication among nursing students following COVID-19.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample and setting\u003c/h2\u003e \u003cp\u003eThe subjects were selected as nursing students enrolled in nursing departments in Ulsan and Changwon cities with clinical field practice experience. Purposive sampling was used for those who met the selection criteria. The selection criteria for research participants are as follows: Nursing students a) who are currently enrolled in a nursing department, b) have experience in clinical field practice for at least one semester, and c) agreed to participate in this study after being informed of the purpose and procedures of the study.\u003c/p\u003e \u003cp\u003eA focus group consists of groups with similar characteristics who can freely share opinions on topics. This process allows for the understanding of not only individual thoughts but also the ideas and dynamics of the group. For this study, if data were collected from a single group, the unique factors of the group could not be controlled, so the respondents were divided into two groups. The number of participants was 5 people per group for a total of 10, in accordance with the heuristic that 4 to 12 people per group are suitable [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected through focus group interviews (FGI) between October 10 and November 30, 2023. The two groups were formed by coordinating the participants\u0026rsquo; schedules from each college. Each group received the interview content and questions by email two days before the interview, and they were instructed to organize their experiences and thoughts on the interview content. Before the interview, an email explaining the participation in the study was sent to confirm whether the participants wanted to participate. Afterward, before starting the interview, written consent was obtained after the researcher informed them about the study\u0026rsquo;s purpose, procedures, and ethical considerations.\u003c/p\u003e \u003cp\u003eThe FGI process was conducted based on Krueger\u0026rsquo;s methods [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The interview questions comprised opening, introductory, transitional, core, and closing questions in line with the five types of FGI questions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOpen-ended questions for the FGI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpening questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily college life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan you tell me about your college life?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntroductory questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily communication style\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat is your typical way of communicating at college?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransitional questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan you share your communication experiences in college and at the clinic?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKey questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication awareness, importance, difficulties, and other factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat do you think communication means in college or at the clinic?\u003c/p\u003e \u003cp\u003eIn college or at the clinic, what communication difficulties or stresses have you encountered?\u003c/p\u003e \u003cp\u003eWhat do you consider to be crucial when communicating in college or at the clinic?\u003c/p\u003e \u003cp\u003eHave there been any changes in your communication experience before or after COVID-19?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnding questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther related queries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs there anything else you\u0026rsquo;d like to share?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInterviews were held twice for each group, and each interview lasted 90 to 120 minutes. After the FGI with the first group, analysis was performed immediately. After that, the FGI was carried out with the other group to constantly check the saturation status of the study. To confirm the meaning of unclear information during the discussion, the participants were re-asked questions to ensure the validity of the collected information. A small reward was given to the research participants.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were calculated to obtain the participants\u0026rsquo; general characteristics using SPSS 24.0. The qualitative data were analyzed using the conventional content analysis method suggested by Hsieh and Shannon [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. First, the researcher read the transcribed interview data repeatedly to understand the overall meaning of the communication experiences of nursing students. Codes were derived by reading the data word-by-word and highlighting words that demonstrated significant ideas or concepts. The second step involved creating codes based on keywords in the derived statements and integrating codes with similar content to create subcategories. Third, depending on the relationships between subcategories, the researchers could combine or organize large numbers of subcategories into a smaller number of categories. Lastly, definitions for each category, subcategory, and code were developed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearcher’s training and preparation\u003c/h3\u003e\n\u003cp\u003eFor more than nine years, the researchers have been teaching nursing students as university instructors, assigning student advisors, and providing regular counseling, and as a result possess an understanding of nursing students. Furthermore, all researchers have taught relevant courses in graduate programs and have abundant experience in conducting workshops, presenting at academic conferences, and conducting qualitative research projects. Additionally, they have experience publishing FGI research. Regular research meetings and exploration of qualitative research published in various fields are ongoing ways for them to enhance their skills.\u003c/p\u003e\n\u003ch3\u003eRigor of the research results\u003c/h3\u003e\n\u003cp\u003eTo increase the reliability and validity of this study, the four criteria proposed by Lincoln and Guba [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e17\u003c/span\u003e] were confirmed: credibility, transferability, dependability, and confirmability. To guarantee credibility, the data were transcribed word for word straight after recording to avoid distortion and omissions. Furthermore, two participants validated the themes and quotes, demonstrating that they were suitable for the research findings. To increase transferability, efforts were made to include participants who could fully express their experiences. Furthermore, the data were collected until the participants\u0026rsquo; statements were repeated and saturation was reached without any new statements being made. To enhance dependability, we adhered to the content analysis method recommended by Hsieh and Shannon [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e16\u003c/span\u003e], kept a record of the atmosphere, and quoted the participants\u0026rsquo; words during their statements. In addition, the research method, data collection, and analysis process were detailed. Confirmability can be assured by ensuring the reliability, transferability, and dependability of the research. We intended to maintain a neutral attitude and avoid bias by not manipulating or interfering in the participants\u0026rsquo; experiences.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eEthical approval was obtained from the bioethics committee at the college of the first author (IRB No. 1044386-A-2023-002). Nursing students who directly expressed their intention to participate through the research description were chosen as research participants. The research description included information on the purpose and method of the study, the interview content, the need for recording, the benefits and risks expected from the study, guarantees of the anonymity and confidentiality of the collected data, storage and disposal of the data, and the possibility of discontinuing research participation without any negative repercussions. The researcher explained that they would safely dispose of all research data and recordings after completing the study. Before conducting the study with those who provided written consent, the researcher explained the contents again. The researcher conducted interviews with students who were not part of their university, and it was fully explained that participation in this study would not have any benefits or disadvantages for future grades, evaluations, or relationship formation.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGeneral characteristics of participants\u003c/h2\u003e \u003cp\u003eAll participants were women, and their average age was 22.30 years old. Their average overall GPA was 3.56, and their average clinical practice GPA was 4.14 points (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The content analysis yielded three categories and nine subcategories (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The three subcategories were: \u0026ldquo;Communication characteristics of nursing students,\u0026rdquo; \u0026ldquo;communication process of nursing students,\u0026rdquo; and the \u0026ldquo;meaning of communication to nursing students.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Participants (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e(%) or \u003cem\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall GPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0\u0026ndash;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.51\u0026ndash;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eClinical practice GPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5\u0026ndash;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCommunication patterns of nursing students\u003c/h2\u003e \u003cp\u003e The communication characteristics mentioned included group activities as an opportunity for communication, participation varying depending on purpose, and the use of various types of communication.\u003c/p\u003e \u003cp\u003eGroup activities as an opportunity for communication\u003c/p\u003e \u003cp\u003e The participants said that the communication they experienced at college more often took the form of mandatory group assignments than of communicating with colleagues. This was said to be due to the large number of students compared to other departments, busy academic schedules, and fewer opportunities to meet each other and form relationships due to COVID-19:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThere are many students, so I have no friends unless I participate in practical training or group activities. Without the opportunity to communicate with each other, I don\u0026rsquo;t believe we can achieve that without participating in group activities and practicing. (FGI 2, P4)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe group activities involved students dividing their roles into members of each group and fulfilling their responsibilities. It was reported that there was no smooth communication between them:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eCooperative learning is through group assignments. But when your role is decided, you feel like you\u0026rsquo;re just playing your role and you don\u0026rsquo;t do the rest. Strictly speaking, I don\u0026rsquo;t think we communicate well in group assignments. (FGI 1, P4)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipation varies depending on the purpose\u003c/p\u003e \u003cp\u003e Compared to group activities where communication is forced, groups that are actively formed according to their members\u0026rsquo; goals have varying levels of participation. During the clinical practice period, they have a natural attitude toward actively engaging in communication:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAn interview study is a group of people who want to do it independently. After studying for 2 hours, even after class, I met them on Zoom at home and studied actively so I could communicate well, and I felt that it helped a lot during interviews. (FGI 1, P3)\u003c/p\u003e\u003cp\u003eI made an effort to communicate effectively during the training period. I smiled brightly while listening to the stories of older patients. Also, the younger kids liked it because I reacted a little louder. (FGI2, P3)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eUse of various means\u003c/p\u003e \u003cp\u003e The primary means of communication with peers mentioned by the participants included text, phone calls, mobile messengers, and social network services (SNS), but the means used differed depending on the weight of the topic. Each individual had different preferred methods, but when accurate communication is required, face-to-face contact is said to be the most effective:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen we are together like this, we communicate by looking at various communication styles, such as facial expressions. The phone now only allows you to send your voice. So, I think I have started to think more about mistakes and things like that when I am on the phone. (FGI1, P1)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e The participants reported that COVID-19 did not cause any significant changes in communication. Instead, they said that they have become accustomed to one-way communication, such as online lectures, and that communication without location restrictions is possible using online calls and real-time online conferences. Consequently, they adapted by creating a new culture where they could easily meet and communicate online when required:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI can\u0026rsquo;t meet friends from other regions, so I just say, \u0026ldquo;Let\u0026rsquo;s meet on the screen, let\u0026rsquo;s talk.\u0026rdquo; Zoom is kind of like, you can see that person\u0026rsquo;s expression, you can hear their voice. But it\u0026rsquo;s different now than when we meet and talk face-to-face. Still, I think it's much better to be able to talk face to face. Because I can see the facial expressions. (FGI1, P4)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTips for effective communication\u003c/h2\u003e \u003cp\u003e The participants asserted that relationship formation is the first step in the communication process and that it requires efforts to establish and sustain good relationships. They stated that overcoming stereotypes about each other is necessary for smooth and accurate communication, which requires flexible perspectives.\u003c/p\u003e \u003cp\u003eBeginning of communication: Building relationships\u003c/p\u003e \u003cp\u003e According to the participants, building a relationship is crucial for smooth communication, and starting a relationship requires getting to know others. In this process, conversation is a significant means of communication, indicating the importance of mutual roles between relationships and communication. The participants started a relationship by approaching each other, learning each other\u0026rsquo;s preferences, and eliciting and sharing interests. The relationship progressed gradually after a consensus was established:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen we usually talk about what\u0026rsquo;s popular these days or something, we come up with a common interest, and now that we\u0026rsquo;ve become friends, I tend to move on to talking about that friend a little more. (FGI1, P1)\u003c/p\u003e\u003cp\u003eIt\u0026rsquo;s difficult to understand the type of person you\u0026rsquo;re talking to in person. The way I thought about that person before talking to them was slightly different after we formed a relationship through talking. (FGI, P5)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eCommitment to interaction: empathy, listening, creating a comfortable atmosphere, and nonverbal communication\u003c/p\u003e \u003cp\u003e As communication involves getting to know others and reaching an agreement, it was acknowledged that it should be achieved through interactions. The things necessary for good communication include empathy, listening, and creating a comfortable atmosphere. The participants stated that they can see other people\u0026rsquo;s facial expressions better now than when they had to wear masks due to COVID-19, which aids in understanding their emotions. Consequently, the intimacy and understanding of conversations have significantly improved. As obstacles, it was suggested that no one asked questions but only talked about themselves. In this context, the participants said that they were trying to exchange accurate information, such as clearly conveying words and actively expressing their opinions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn my opinion, communication is a constant process that requires one to graduate from a nursing department and move forward in society. Whether it\u0026rsquo;s face-to-face or not, or KakaoTalk, I may have to listen or I may have to voice my opinion myself. My belief is that it\u0026rsquo;s one of those diverse procedures. (FGI2, P1)\u003c/p\u003e\u003cp\u003eMy speech is unclear. I have a tendency to turn things around. When I speak, the other person can\u0026rsquo;t understand what I\u0026rsquo;m saying. It\u0026rsquo;s crucial to be precise and convey it effectively. Practice and hard work are necessary to avoid making mistakes in the hospital. (FGI2, P2)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePerceptual flexibility: Critical thinking, eliminating biases\u003c/h2\u003e \u003cp\u003e According to the participants, ideal communication requires abandoning opinions or dichotomous thinking and adopting an accepting attitude and understanding based on mutual understanding. However, they said that it is necessary to learn how to communicate using your own thoughts based on critical thinking rather than following other people\u0026rsquo;s opinions. It was suggested that communication is hindered by various factors, such as identifying others based on their generation or personality type, verifying it with prejudice and stereotypes, and using buzzwords or abbreviations that only one person is familiar with. The younger generation is often portrayed as being able to speak their mind without hesitation; however, they are cautious about making mistakes while speaking or whether their opinions are incorrect.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBecause they unquestioningly believe in MBTI, T-type people cannot empathize with their emotions. Saying F-type is too emotional. It seems to me that our generation must eliminate this because it has become so ingrained in our perception. (FGI1, P4)\u003c/p\u003e\u003cp\u003eIt is my belief that we must eliminate the prejudice that exists between generations. The old generation was referred to as \u0026ldquo;condescending\u0026rdquo; by us. The older generations used to call us \u0026ldquo;MZ.\u0026rdquo; In my opinion, we need to break things like this down. The truth is that everyone is unique. (FGI1, P2)\u003c/p\u003e\u003cp\u003eIt was a little challenging for me to give my opinion one on one during group work. I think that\u0026rsquo;s right, but I was a little careful now that others wouldn\u0026rsquo;t think it was. (FGI2, P3)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe meaning of communication to nursing students\u003c/h2\u003e \u003cp\u003e The participants stated that communication is crucial for understanding and performing the role of a nurse who helps others effectively. Furthermore, they believed that communication required learning and experience with the curriculum. They said they were unique as nursing students because they applied what they had learned about communication.\u003c/p\u003e \u003cp\u003eUnderstanding and helping others\u003c/p\u003e \u003cp\u003e The participants said that if rapport is good during communication, the patient\u0026rsquo;s needs can be met by learning what they want. During the practice, students utilized their communication skills to provide objective information to patients and ease their anxiety. They said that, for observation and communication skills, not missing the smallest parts is important:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn my view, the more positive the communication, the more the patient expresses their desires. The duty of a nurse is to provide care for those needs. That could have very big results. So, we must communicate positively to identify even the most minor needs and provide nursing care accordingly. (FGI1, P5)\u003c/p\u003e\u003cp\u003eThe patient was deaf, so we communicated by making circles and X-tags with our hands. That\u0026rsquo;s how I communicated and helped them organize their luggage. Later, they thanked me by contacting me later after being discharged from the hospital. I believed that we could communicate effectively during that time. (FGI2, P3)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ePride and experience as a nursing student\u003c/p\u003e \u003cp\u003e According to the participants, communication is a crucial medium for patient care, and they acquired communication skills in undergraduate courses to become nurses. They asserted that they utilized the communication content or skills they acquired effectively in daily life or clinical practice. The participants reported that their perceptions and attitudes toward communication differed from those of students from other majors:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt was my first time writing an interview report during my practicum, and it was very difficult. So, for the first time, I used what I learned in class about therapeutic communication, such as non-verbal and verbal communication. The patient said it was easy to talk to me because I nodded and repeated what they said. (FGI2, P2)\u003c/p\u003e\u003cp\u003eWhen we go out to practice, we talk with patients and nurses, and we recognize that empathy is important. However, when I look at my friends from other departments, I see that those who graduated from engineering schools have a lot of personal things, so they only think about themselves when they say things, and if the other person is offended, they say sorry, that\u0026rsquo;s all. They only think about themselves first. So, I thought it was a little different from nursing school. (FGI1, P4)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ePreparation to become a nurse\u003c/p\u003e \u003cp\u003e The participants asserted that communication is a means of comprehending patients. Communication is a preparation process for becoming a nurse because nurses must always communicate with patients, colleagues, and other people:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNurses are in the profession of meeting patients, and considering that they are sensitive patients, the ability to talk is the most important thing, so I think I learned like this. (FGI1, P5)\u003c/p\u003e\u003cp\u003eI think the communication I usually do at school is to practice before starting my social life. When I do assignments, I often work in teams and practice things like that. Working as a team is necessary in the clinical field. (FGI2, P4)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined nursing students\u0026rsquo; thoughts and experiences in communication using FGI. This section focuses on the communication patterns, tips for effective communication, and the meaning of communication to nursing students.\u003c/p\u003e \u003cp\u003e In this study, the communication patterns of nursing students were found to be group activities as an opportunity for communication, participation varying depending on purpose, and use of various means. According to nursing students, group assignments are the main way they experience communication. This arose from a situation in which it was difficult for students to naturally form relationships due to the large number of students in the nursing department and busy academic schedules, as well as the lack of face-to-face opportunities due to COVID-19. During group activities, students focused on performing their respective roles during group task activities because their roles were divided and then collected. Consequently, there were many instances where communication was not smooth. These findings indicate that group activities may not suffice to foster real-world communication. This result does not align with previous studies that demonstrate that team learning enhances communication [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This might be because the group activities mentioned in this study were not designed to enhance communication, students assigned their own roles for convenience and the instructor did not intervene. The success of group activities is dependent on the group\u0026rsquo;s composition, task, and motivating members [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and poorly structured group activities can hinder communication and learning. Therefore, an appropriate group size must be set, and the operation of group activities and members\u0026rsquo; roles and responsibilities must be clearly defined and divided. Furthermore, members should be capable of evaluating their communication abilities to offer opportunities for improvement.\u003c/p\u003e \u003cp\u003e Students demonstrated a natural interest in actively participating in communication during the clinical training period. The student's efforts to lead when dealing with patients were apparent throughout this entire period. According to previous studies, students gain an active communication attitude during clinical practice, which enhances their learning experience and communication skills [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Clinical practice is an important educational process in which nursing students apply academic knowledge to clinical situations and strengthen their practical skills through communication with patients and medical staff [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. To develop communication competencies as future professional nurses, students need to focus on acquiring and improving communication skills in curricular and extracurricular courses.\u003c/p\u003e \u003cp\u003eFurthermore, it was discovered that students engage in more active communication when they have a shared objective. Active participation and effective communication were present in study groups that were formed voluntarily, indicating that communication quality is enhanced when students are goal-oriented and voluntarily participate. This result indicated that nursing students can enhance their communication skills through goal-oriented learning in clinical settings [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Nurses must continuously encourage team activities that align with common goals and provide opportunities to enhance communication skills because communication with patients, colleagues, and other departments is crucial.\u003c/p\u003e \u003cp\u003eThe students used a variety of means of communication with their peers, which varied depending on the importance of the topic. A new communication culture was established during the COVID-19 pandemic due to the increased use of non-face-to-face communication methods. The use of real-time videoconferencing platforms in lectures, practical training, and team projects has facilitated communication without any physical limitations [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Despite this, the participants maintained that face-to-face communication was the most effective form of communication. To achieve in-depth understanding, empathy, and relationship formation, it is crucial to communicate face-to-face using non-verbal communication and direct feedback beyond simply information transmission [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. According to students, non-verbal facial expressions, gestures, and eye contact are crucial for communication and cannot be accurately conveyed using phone or video calls. Through non-verbal communication, nurses quickly detect the patient's anxiety, pain, or discomfort and react appropriately to maximize the effectiveness of treatment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Nonverbal communication is a critical factor in building trust between patients and nurses, meeting patients\u0026rsquo; emotional needs, and improving the overall quality of the nursing process [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. An analysis of the communication patterns of nurses who care for patients with chronic diseases indicated that 44% included nonverbal communication, such as laughter, smiles, and eye contact [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Students were aware that they needed both observation and communication skills to recognize even the slightest changes in patients. The evidence indicates that high-quality nursing care requires both verbal and non-verbal communication, and the students recognize this in their future roles as nurses.\u003c/p\u003e \u003cp\u003eAs a result of this study, students were positively aware of various communication methods and the convenience of changes in communication after COVID-19. Students were able to choose communication methods depending on their purpose, so they used their time more efficiently and felt less burdened by communication than before the pandemic. In particular, the importance of face-to-face communication was taken for granted as nurses needed to interact face-to-face with patients. Nurses must continually develop and strengthen their communication skills. Previous research indicates that communication skills improved after applying an extracurricular coaching program [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and can be improved through education or training [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The participants suggested some tips for effective communication. For effective communication, they asserted that building relationships is crucial for smooth communication. This means that relationship formation is not just a medium for communication but a critical factor in determining the quality of communication and essential in developing long-term collaboration and teamwork [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Mutual understanding and flexible perception are necessary for forming relationships, which can be achieved through empathy and sharing interests through conversation [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Establishing mutual understanding and trust within the nursing team can lead to smoother cooperation among team members, improving patient care quality [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Students need opportunities to recognize the significance of relationship formation and practice it in nursing education.\u003c/p\u003e \u003cp\u003e While communication can be improved through interactions, the participants stressed the importance of empathy, listening, creating a comfortable atmosphere, and an attitude without prejudice. The students stated that their understanding of conversations had significantly improved since COVID-19, when they could remove their masks and observe the other person\u0026rsquo;s facial expressions, reiterating the importance of nonverbal communication once again. The participants suggested both necessary and hindering factors for effective communication. Furthermore, it was stated that students should continuously strive to improve their communication shortcomings and prepare for a social life after graduation. Departments need to provide opportunities for students to identify their own communication styles and participate in programs that can strengthen or supplement their styles to further improve their communication skills.\u003c/p\u003e \u003cp\u003e According to the participants, ideal communication is about letting go of opinions or dichotomous thinking and instead focusing on critical thinking with an accepting attitude and mutual understanding. This is crucial for overcoming intergenerational prejudice or stereotypes based on personality type, which can hinder communication. Ideal communication requires a receptive attitude and critical thinking that respects others\u0026rsquo; opinions and accepts diverse viewpoints with an open mind. This approach can minimize conflicts that may arise during communication and improve mutual understanding [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. To build communication and cooperative relationships between people from various backgrounds in the clinical field, it is necessary to develop receptive and broad thinking by providing an opportunity to experience and understand the other person through volunteering and various program activities as well as the curriculum.\u003c/p\u003e \u003cp\u003eFor nursing students, the meaning of communication was understanding and helping others, the pride and experience of being a nursing student, and the preparation for becoming a nurse. The participants recognized that for nursing students, communication plays an important role in understanding patients\u0026rsquo; needs and providing appropriate care. Nursing education involves students learning various communication skills and strategies that help them build trust with patients, convey accurate information, and provide emotional support [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The communication skills they learned in undergraduate courses were used effectively in practice and daily life, and they use the communication skills they learned during their practicum period in interactions with actual patients, which allows them to better understand and respond effectively to patients\u0026rsquo; needs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The findings indicate that students use the skills they learned in undergraduate courses for practical work and further enhance their communication skills through these experiences. Their experience in clinical practice helps them solve the varied communication problems that might arise when dealing with actual patients, which can improve the quality of patient care and increase confidence in nursing practice [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The participants further developed their communication skills by actively utilizing and practicing the skills they learned in their undergraduate courses.\u003c/p\u003e \u003cp\u003eNursing students reported having different perceptions and attitudes toward communication than did students in other majors. To perform the role of a nurse without mistakes, they learned about communication in greater detail than students in other majors, and they felt proud that they were practicing better than their peers in other fields. In the nursing curriculum, nursing students are encouraged to fully comprehend the significance of communication and practice it actively. Nursing students recognize communication as crucial in understanding and supporting patients\u0026rsquo; needs, not just as a technical process [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. However, despite understanding the importance of communication in other fields, students in other majors often lack practical training in the practical application of communication in such domains as nursing [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. When communicating with patients, nursing students tend to practice more empathy and listening, in which respect researchers have shown them to differ from students in other majors [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, nursing students\u0026rsquo; positive perceptions and attitudes toward communication result from their experience and training during education and practice, suggesting that nursing must go beyond simply conveying technical knowledge to emphasize the importance of communication through in-depth interaction with patients.\u003c/p\u003e \u003cp\u003e The participants mentioned that communication is an important means of understanding patients and is an essential element in the process of preparing to be a nurse. This reflects that communication skills are essential due to the nature of nurses\u0026rsquo; jobs, where interaction with patients and colleagues is important in clinical settings [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Nurses accurately understand patients\u0026rsquo; conditions through effective communication with patients, identify their needs, and provide appropriate care and support [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Nurses use active listening and empathy to gain patients\u0026rsquo; trust, which helps reduce patient anxiety and motivate treatment [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Therefore, nursing students must learn about communication during the curriculum and develop that ability during clinical practice to grow into high-quality nurses.\u003c/p\u003e \u003cp\u003eAdditionally, the nursing students in this study recognized the importance of communication in their interactions with colleagues and actively applied communication skills to increase the effectiveness of teamwork and collaboration. Having this experience as a foundation is crucial for developing expertise as a nurse and creating a collaborative treatment environment. In conclusion, communication is an essential skill in a nurse\u0026rsquo;s job performance, and nursing students\u0026rsquo; sufficient learning and practice during the preparation process significantly impacts successful patient management and collaboration among colleagues in clinical settings. Nursing education\u0026rsquo;s core goal is to provide excellent nursing services through effective communication in future practice, and students should continue to strive to achieve this goal.\u003c/p\u003e \u003cp\u003eThis study confirmed that nursing students are aware of their own communication characteristics and the need to develop communication competencies. Developing and applying a program that reflects the levels and needs of students will provide nursing students with the communication skills required not only in college life but also in the workplace.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study aimed to provide primary data for nurse education curricula and enhance communication competency by identifying the communication properties of nursing students. The analysis yielded three categories of communication among nursing students: \u0026ldquo;Communication patterns of nursing students,\u0026rdquo; \u0026ldquo;Tips for effective communication,\u0026rdquo; and \u0026ldquo;Meaning of communication to nursing students.\u0026rdquo; Most of the nursing students\u0026rsquo; communication was conducted through group tasks, and there were differences in active participation depending on purpose and spontaneity. Due to COVID-19, more diverse communication methods were used, but face-to-face communication was the preferred method for efficient communication. To communicate, it is necessary to form relationships, strengthen methods for smooth communication, exclude distracting factors, and accept and understand the other party. Communication is a medium for understanding and helping others, and for nurses, communication is essential for qualitative nursing. Subsequently, strengthening communication skills at this level is essential for future nurses.\u003c/p\u003e \u003cp\u003eThe significance of this study lies in its provision of primary data for nursing students to comprehend their perceptions and meanings, as well as suggesting ways to improve communication skills. However, repeated research is necessary for generalization because this study targeted students at only two universities; this geographical limitation raises concerns about the generalizability of the findings globally. Further studies are needed that take into account the characteristics of the diversity of students. Second, because the subjects of this study are students who entered school at the beginning of COVID-19, it is necessary to repeat the study with a broader range of subjects. Third, developing and implementing programs that can enhance communication capabilities in addition to the curriculum is necessary.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFGI \u0026nbsp; \u0026nbsp; \u0026nbsp;focus group interviews\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of Choonhae College of Health Sciences (approval number1044386-A-2023-002). The researchers directly explained the purpose of this study and obtained voluntary consent from those who met the selection criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to privacy of participants but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHK contributed to the conception or design of the work, was involved in data acquisition, analysis, or interpretation for the work, drafted and revised the manuscript, and approved the final version of the manuscript. MI substantially contributed to the conception or design of the work, was involved in data acquisition, analysis, or interpretation for the work, and provided final approval of the manuscript version to be published.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican Nurses Association. Nursing: Scope and standards of practice. 4th ed. American Nurses Association; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKourkouta L, Papathanasiou IV. Communication in nursing practice. 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J Patient Exp. 2021;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/23743735211056432\u003c/span\u003e\u003cspan address=\"10.1177/23743735211056432\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Qualitative Content Analysis, Communication, Nursing students, Group interviews","lastPublishedDoi":"10.21203/rs.3.rs-5315323/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5315323/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study explores the characteristics and significance of communication for nursing students during the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFocus group interviews were conducted with 10 participants and the data were analyzed using content analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003e Three main categories emerged: \u0026ldquo;Communication characteristics of nursing students,\u0026rdquo; \u0026ldquo;Communication process of nursing students,\u0026rdquo; and \u0026ldquo;The meaning of communication to nursing students.\u0026rdquo; Participants acknowledged that effective communication is crucial for nurses to understand and assist patients. They emphasized that nursing students must develop strong communication skills to prepare for their future roles as nurses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study highlights the importance of education, program development, and practical application to enhance communication competency among nursing students. Reinforcing these skills is seen as vital to the professional growth and readiness of nursing students by ensuring that they are able to provide high-quality patient care in their future careers.\u003c/p\u003e","manuscriptTitle":"Communication among Nursing Students in South Korea: A Qualitative Content analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-18 11:02:31","doi":"10.21203/rs.3.rs-5315323/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"129d67a4-fa1f-4fcb-846e-81517a74db28","owner":[],"postedDate":"November 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-12T07:26:52+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-18 11:02:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5315323","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5315323","identity":"rs-5315323","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}