Nurse Education in Practice 63 (2022) 103371

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Nurse Education in Practice

journal homepage: www.elsevier.com/locate/issn/14715953

Effect of online communication skills training on effective communication

and self-efficacy and self-regulated learning skills of nursing students: A
randomized controlled study
Şeyda Can a, *, 1, Hanife Durgun b, 2, 3, Berna Köktürk Dalcalı c, 4, 5
a
Faculty of Health Sciences, Principles Of Nursing Department, Yalova University, Turkey
b
Faculty of Health Sciences, Medical Nursing Department, Ordu University, Turkey
c
Faculty of Health Sciences, Medical Nursing Department, Bandırma Onyedi Eylül University, Turkey

A R T I C L E I N F O A B S T R A C T

Keywords: Aim: The aim of this study was to determine the effect of online communication skills training conducted for first-
Communication skills year nursing students on effective communication and self-efficacy and self-regulated learning skills.
Self-efficacy Background: Communication skills are an important part of nursing care.
Self-regulated learning
Methods: This research was designed as a pre-test–post-test randomized controlled experimental study. The study
Training
Nursing students
population comprised first-year undergraduate nursing students of a state university in Turkey. A total of 60
students included in the study were divided into the two following groups: experimental (n = 30) and control (n
= 30) groups. The research data were collected between 1 December 2020 and 1 March 2021. Pre-test and post-
test forms were simultaneously provided to the groups. Post-tests were repeated 1 month after the pre-test was
completed. A 2-day (a total of 12 h) communication skills training was conducted online for the students in the
experimental group after the pre-test forms were filled. Information form, Effective Communication Skills Scale
(ECSS), General Self-efficacy Scale (GSE) and Self-regulated Learning Skills Scale (SRLSS) were used to collect the
data.
Results: The effective communication and SRLSS mean scores of the nursing students were high and the GSE
scores were below average. On comparing the groups, the post-test mean scores of the communication skills and
GSE were found to decrease in both the groups compared with the pre-test ones. This decrease was significant
only in the “ego-enhancing language” subdimension of ECSS (p < 0.05). The post-test mean scores of the SRLSS
increased in both the groups, but this increase was not significant (p > 0.05).
Conclusion: Although the SRLSS scores of the students increased in the post-test, the study results show that
communication skills training did not have a significant effect on effective communication and self-efficacy and
self-regulated learning skills. The results of this study are important in terms of guiding research and trainings
that examine the effects of communication skills.

1. Introduction communication and self-efficacy and self-regulated learning skills? We

are aware that a single touch with a magic wand is not sufficient to gain
Where should we begin if we want nursing students to have effective these skills; these skills can be acquired by following a process. The

* Correspondence to: Yalova University, Faculty of Health Sciences Gökçedere Cad, 77400 Yalova, Turkey.
E-mail addresses: seyda.can@yalova.edu.tr, seyda.cann@hotmail.com (Ş. Can), hanifedurgun@odu.edu.tr, hanife.balik@gmail.com (H. Durgun), bernadalcali@
gmail.com, bdalcali@bandirma.edu.tr (B.K. Dalcalı).
1
ORCID: https://orcid.org/0000-0001-9733-133X
2
Ordu University, Health Sciences Faculty, Cumhuriyet mah., Altınordu/ORDU
3
ORCID: https://orcid.org/0000-0003-1622-8184
4
Bandırma Onyedi Eylül University, Faculty of Health Sciences, Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri Fakültesi İhsaniye Mahallesi Kurtuluş Caddesi
No:9B Bandırma/Turkey
5
ORCID: https://orcid.org/0000-0002-2123-3386

https://doi.org/10.1016/j.nepr.2022.103371
Received 22 December 2021; Received in revised form 9 May 2022; Accepted 20 May 2022
Available online 25 May 2022
1471-5953/© 2022 Elsevier Ltd. All rights reserved.
Ş. Can et al.
nursing profession requires not only academic knowledge but also
interpersonal relationships and technical and intellectual skills (Taghi­
zadeh et al., 2018). Also, a change in the belief and senses causes a
change in the behaviors as well because beliefs and values guide the
behaviors of the individuals. (Gürdoğan et al., 2018). It is thought that
effective communication training, which is a dynamic process, will
provide basic competencies about these skills.
Effective communication is one of the skills that nursing students
need to master to be effective in their field (Gedük, 2018). Communi­
cation skills training is recommended to be included in the curriculum so
that nursing students who will establish therapeutic relationships with
their patients gain the necessary experience in the field before starting
their professional career (Flagg, 2015; Gutiérrez-Puertas et al., 2020;
Taghizadeh et al., 2018). In the literature, there are studies that exam­
ined the effect of communication skills training using different teaching
techniques such as role play, lectures, hand-out, video watching, open
discussion, feedback and demonstration (Alhassan, 2019; Dithole et al.,
2017; Sharour, 2019). Studies have shown that communication skills
training affects the communication skills of nurses, the quality of care
and patient satisfaction (Sharour, 2019; Taghizadeh et al., 2018).
Nonetheless, no study has been found in the literature that deals with
the effects of communication education on effective communication,
self-efficacy and self-regulatory learning skills that nurses should have.
For this reason, the effects of communication education on these skills
should be revealed.
2. Background
The literature review starts by first defining effective communica­
tion, self-efficacy and self-regulated learning skills. Finally, the objec­
tives and hypothesis of this research are set forth.
2.1. Effective communication
Nurses are one of the groups of health care professionals that are in
most contact with patients and fulfillment of the nursing role is based on
effective communication skills and teamwork (Kırca and Bademli,
2019). The conceptual framework of effective communication can be
defined as ego-enhancing language, active-participatory listening,
self-knowledge/self-disclosure, empathy and I-language skills (Inven­
tion et al., 2017).
It is important to improve the interpersonal skills of nurses to
develop and enhance their communication skills (Cerit and Öz, 2019).
Human relations and communication curricula conducted in line with a
defined plan increase the communication and problem-solving skill
levels of students (Akan, 2021). Therefore, to improve the communi­
cation skills of university students, it is necessary to include more
communication lessons in their curriculum (Elkin, Karaman and Barut,
2016).
2.2. Self-efficacy
Likewise, the concept of self-efficacy is a concept that must be sup­
ported in the education of the students. The concept of self-efficacy
suggested by Bandura and Ramachaudran (1994) defines the
self-belief, determination and will power of an individual in performing
any behavior. According to Sezgin and Aşağıcan (2020), Bandura stated
that an individual’s self-efficacy is influenced by the following four basic
sources of information: performance achievements, reliable experiences,
verbal persuasion and physiological states. Self-efficacy is a very strong
perception. Low self-efficacy perception negatively affects an in­
dividual’s confidence, achievements and actions (Sarıtaş et al., 2020).
2.3. Self-regulated learning skills
The concept that needs to be handled lastly is the self-regulated
2
Nurse Education in Practice 63 (2022) 103371
learning skills. Self-regulated learning is a complex multidimensional
phenomenon. In general, someone who has self-regulated learning
ability can control his motivation and knowledge and use new strategies
to improve his motivation and knowledge, when necessary (Alpaslan
and Ulubey, 2019). Students with self-regulated learning skills have
realistic learning goals and effective learning strategies to achieve these
goals. They can manage their time and learning resources effectively
(Cho and Heron, 2015). Thus, self-regulation can be considered as tak­
ing responsibility of one’s learning process and planning and controlling
it.
2.4. Study objective
In the current education system, students transform the theoretical
knowledge received in the classroom into skills in clinical settings and
also develop new knowledge, skills and communication experiences.
However, the present study was conducted using online tools during the
COVID-19 pandemic, wherein all trainings were conducted remotely,
there were street curfews except for emergency situations and socializ­
ation was not possible. Considering that the study was conducted during
the pandemic, we aimed to critically evaluate and produce data to
determine the effect of educational interventions on nursing students
and to improve their skills. Thus, the aim of this research was to
determine the effects of online communication skills training on effec­
tive communication and self-efficacy and self-regulated learning skills of
first-year nursing students.
2.5. Hypothesis
The hypotheses for this study were as follows:
H1: Communication skills training is effective in increasing the
effective communication and self-efficacy and self-regulated learning
skills of first-year nursing students,
H2: Communication skills training is not effective in increasing the
effective communication and self-efficacy and self-regulated learning
skills of first-year nursing students.
3. Methods
3.1. Study design
This research was designed as a pre-test–post-test randomized
controlled experimental study.
3.2. Setting and sample
In this study, we included 61 first-year nursing students enrolled in
the Faculty of Health Sciences of a state university in the Marmara re­
gion in the 2020–2021 academic year. The sample size was calculated
using the sample size calculator described by Raosoft (2004). The
sample size was calculated using the following values: Δ: 1.96, SD: 0.65,
power: 0.80, β 0.05 and α: 0.05. The sample size was determined to be 30
nursing students in each group. Finally, 60 students who continued their
education voluntarily agreed to participate in the study and 30 students
were selected for each of the control and experimental groups. The
students were randomly assigned to the groups by the researchers using
the randomization table. The inclusion criteria were first year nursing
student, having no psychiatric illness and volunteering to participate in
the study. The exclusion criteria were students who did not receive any
communication training before. The exclusion criteria of the study were
that the students had communication training previously.
In this study, it was thought that confounding factors, personal fac­
tors (age) and academic factors (having communication training) could
affect the result. As similar age groups were included in the study to
alleviate the effects of confounding factors, individuals who had previ­
ous training on communication were not included in the study.
Ş. Can et al.
Contamination bias in a randomized controlled trial (RCT) may origi­
nate from exposure of those in the control group to the intervention
applied to the experimental group. The control and experimental groups
did not come into contact with each other, since the research was con­
ducted during a period when the training was done remotely due to the
pandemic and was conducted online exclusively for the intervention
experimental group. In addition, the training on communication was
provided by an instructor other than the researchers to avoid biasness.
3.3. Data collection tools
Information form, Effective Communication Skills Scale (ECSS),
General Self-efficacy Scale (GSE) and Self-regulated Learning Skills
Scale (SRLSS) were used to collect the data.
3.3.1. Information Form
The structured information form was created by the researchers in
line with the literature (Sögüt et al., 2018; Molu et al., 2019). Socio­
demographic and baseline characteristics (age, gender, economic status,
etc.) of the nursing students were asked in the information form.
3.3.2. Effective communication skills scale (ECSS)
The ECSS was developed by Buluş et al. in 2017 in the Turkish lan­
guage. The scale consists of 5 subdimensions and 34 items in total. The
ECSS comprises ego-enhancing language (6 items), active listening (8
items), self-knowledge/self-disclosure (5 items), empathy (8 items) and
I-language subdimensions (7 items). Active listening measures the de­
gree of correct understanding of what is said in interpersonal commu­
nication. Self-knowledge/self-disclosure evaluates how people get to
know themselves sufficiently in terms of communication and open
themselves to the other person or people in a correct appropriate way.
Empathy measures the degree of correct understanding of others’
emotions in interpersonal communication and I-language measures
whether a person expresses what he/she thinks and feels using I-lan­
guage. As each subdimension of the scale measures different parameters,
scoring is done on subdimensions, not the total scale score. Items 15, 16,
28, 32 and 33 of the scale are scored in reverse. Thus, the higher the total
score obtained from each subdimension, the higher the level of using
communication skills. The students responded to the situations
mentioned in the items using the five-point Likert-type scale graded as
not appropriate, slightly appropriate, partially appropriate, mostly
appropriate and completely appropriate (Buluş et al., 2017).
The Cronbach’s α internal reliability coefficients calculated for the
subdimensions of the scale range between 0.724 and 0.849. The Cron­
bach α internal reliability coefficients calculated for the subdimensions
in this study ranged between 0.53 and 0.86.
3.3.3. General self-efficacy scale (GSE)
The original 23-item form of the GSE scale was developed by (Sherer
et al., 1982). Yıldırım and İlhan (2010) conducted the validity and
reliability study of the scale in the Turkish language. It is appropriate to
evaluate 17 items of the GSE scale as a whole and to work on a single
total score obtained from the entire scale. The five-point Likert-type
scale includes the question “How well does it describe you?” and the
answers to the question range from the expressions “not at all” to “very
good.” The score for each item ranges from 1 to 5. Items 2, 4, 5, 6, 7, 10,
11, 12, 14, 16 and 17 are scored in reverse. The total score can range
from 17 to 85. The higher the score, the higher the self-efficacy belief.
The Cronbach’s α value of the scale was 0.80 and the test–retest
reliability coefficient obtained from the data of 236 individuals who
could be assessed for the second time was 0.69 (Yıldırım and İlhan,
2010). In the present study, the Cronbach’s α coefficient for the total
scale score was 0.615.
3.3.4. Self-regulated Learning Skills Scale (SRLSS)
The SRLSS was developed by Turan and Demirel (2010) in the
3
Nurse Education in Practice 63 (2022) 103371
Turkish language. The scale comprises four subdimensions and 41 items
to determine students’ self-regulated learning skills. The students
responded on the five-point Likert-type scale graded as “strongly
disagree,” “disagree,” “not sure,” “agree,” and “strongly agree” to be­
haviors related to learning that are expressed in the items of the scale.
The score for each item ranges from 1 to 5. The lowest and highest
possible scores are 41 and 205, respectively. The higher the scores, the
higher the self-regulated learning skills. The scale consists of taking
action for motivation and knowledge (7 items), planning and setting
goals (8 items), using strategy and evaluation (19 items) and learning
addiction (7 items) subdimensions. As the expressions in the “learning
addiction” subdimension are negative, they are scored in reverse.
The Cronbach’s α coefficients for the subdimensions are 0.88, 0.91,
0.83 and 0.76, respectively and the coefficient for the overall scale is
0.91 (Turan and Demirel, 2010). In the present study, the Cronbach’s α
coefficients for the subdimensions and overall scale were 0.729, 0.798,
0.876, 0.579 and 0.931, respectively.
3.4. Data collection
The research was conducted between 1 December 2020 and 1 March
2021. The students who met the inclusion criteria and volunteered to
participate in the study were randomly divided into the experimental
and control groups and each group comprised 30 students. Initially, the
research process was explained in detail to all students, the forms were
submitted online, written consent was obtained, and pre-test forms were
provided. A 2-day online training program was conducted for the
experimental group. The training of the experimental group was con­
ducted in December 19–20, 2021 and there was no intervention in the
control group. One month later (January 21–22, 2021), post-test mea­
surements of both the groups were completed online. Thereafter,
communication skills training was shared with the participants in the
control group. Filling the forms took an average of 15 min
3.5. Intervention
In the curriculum of the department where this research was con­
ducted, courses related to communication start from the second se­
mester. As the study was conducted in the first semester of the first-year
students, the students had not yet taken any course on communication.
For this reason, the applied education was not in the scope of curriculum
and a specific course program of the students.
The training was conducted as online group training and comprised
four sessions (a total of 12 h), each session lasting for approximately 3 h.
The training was carried out in groups, not individually. Every indi­
vidual in the experimental group received the training at the same time.
Online training was held on the Zoom platform. Meeting ID was shared
with the individuals in the experimental group who would participate in
the online training. Students who did not wish to share their names
entered their display names as school numbers in their profiles on the
Zoom® platform. Thus, it was checked whether the students partici­
pated or not. The training was conducted for 2 days on the weekend
because the students had lectures on weekdays. The training was con­
ducted on voluntary basis by an educator with expertize in communi­
cation, apart from the researchers.
The aim of the communication skills training is to provide commu­
nication skills to individuals and to enable them to use these skills in
their lives (Akçam et al., 2019). These skills are the foundation of
communication, self-knowledge/self-disclosure, empathy, body lan­
guage and active listening (Akgün and Çetin, 2018; Hendekçi, 2020;
Molu et al., 2019). The content of training sessions consisted of active
listening, self-knowledge-self-disclosure, empathy, I-language and
ego-supportive language skills. In the training, each communication skill
was discussed in depth in the sessions. During the sessions, information
on the conceptual structure of the relevant skill was provided and
in-group interactions were encouraged via question-and-answer, open
Ş. Can et al. Nurse Education in Practice 63 (2022) 103371

discussion and feedback. In the last session, the participants’ feedback Table 1
about the sessions was evaluated and how they would apply what they Demographic characteristics of nursing students (n = 60).
had learned from the sessions in daily life was discussed. Variables n %

Gender
3.6. Data analysis Female 28 46.7
Male 32 53.3
The data were analyzed with the IBM SPSS 25.0 package program. Age (y)
Frequency distribution table was created for general characteristics. The 17 1 1.7
18 13 21.7
total scores of the scales and subdimensions used in the study were 19 33 55.0
calculated and Shapiro–Wilk’s test was used to determine the suitability 20 12 20.0
of data to normal distribution. Parametric and nonparametric tests were 21 1 1.7
used for the analysis of normally- and non-normally distributed data, Family Income Level
Poor 3 5.0
respectively. To compare the results of the pre-test and post-test of the
Moderate 55 91.7
online communication skills training, dependent samples t-test was used Good 2 3.3
for normally distributed data and Wilcoxon test was used for non- Educational status of the mother
normally distributed data. Illiterate 14 23.3
To analyze the differences in scores of the scales according to de­ Literate 8 13.3
Primary education 22 36.7
mographic characteristics, independent samples t-test was used to Secondary education 12 20.0
compare normally distributed variables of two categories and ANOVA Associate’s degree 4 6.7
was used to compare normally distributed variables with more than two Undergraduate Degree and Above 0 0
categories. Mann–Whitney’s U test was used for comparing variables Educational status of the father
Illiterate 4 6.7
with two categories that did not show a normal distribution and Krus­
Literate 4 6.7
kal–Wallis test was used to compare variables with more than two cat­ Primary education 24 40.0
egories that did not show a normal distribution. Significance level was Secondary education 19 31.7
accepted as p < 0.05. Associate’s degree 5 8.3
Undergraduate Degree and Above 4 6.7
Department Selection Status
3.7. Ethical considerations Willingly 49 81.7
Unwillingly 11 18.3
This study was conducted in accordance with The Code of Ethics of Seeing yourself as a social individual
the World Medical Association (Declaration of Helsinki). Ethical Yes 38 63.3
Sometimes 18 30.0
permission (decision dated 30 October 2020 and numbered 2020–42)
No 4 6.7
and institutional permission from the university, where the study was Difficulties in relationships with friends
conducted, were obtained to conduct the study. Verbal and written Yes 1 1.7
consents of the participants were obtained. They were informed about Sometimes 21 35.0
their right to not participate in the research in any phase of the research. No 38 63.3

It was left to the discretion of the students to turn on their cameras

during the training. Written permission was obtained from the original
authors of the scales to be used in the study. For ethical considerations,
the training given to the experimental group was also given to the
control group after the post-tests.
4. Results
4.1. Demographics
Most nursing students (53.3%) were male and 19 years old (55%).
Family income level of the students was poor, moderate and good for
5%, 91.7% and 3.3%, respectively. Further, 36.7% mothers and 40%
fathers of the students were primary school graduates; 81.7% students
stated that they chose their department willingly; and majority of the
students (63.3%) considered themselves as a social individual. In addi­
tion, 1.7% had difficulty in relationships with their friends, 35% stated
that they did not have difficulty sometimes and 63.3% stated that they
did not have any difficulty (Table 1).
4.2. Findings regarding the distribution of mean scale scores
The mean pre-test scores of ECSS subdimensions were as follows:
ego-enhancing language, 24.60 ± 3.83; active listening, 34.90 ± 4.12;
self-knowledge/self-disclosure, 18.28 ± 4.15; empathy, 33.30 ± 3.98;
and using I-language, 26.36 ± 3.40. The mean post-test scores of ECSS
subdimensions were as follows: ego-enhancing language, 24.35 ± 3.65;
active listening, 34.76 ± 4.52; self-knowledge/self-disclosure, 26 ±
2.59; empathy, 32.50 ± 4.49; and using I-language, 23.61 ± 3.18.
The mean pre-test and post-test scores of Self-efficacy Scale were
45.01 ± 6.12 and 44.65 ± 6.46, respectively. The mean pre-test and
post-test scores of SRLSS were 163.41 ± 17.23 and 167.00 ± 15.43,
respectively. The mean pre-test scores for the subdimensions of the scale
were 29.41 ± 3.67, 32.66 ± 4.39, 77.23 ± 7.96 and 24.10 ± 4.95 for
“taking action for motivation and knowledge,” “planning and setting
goals,” “using strategy and evaluation,” and “learning addiction,”
respectively. The mean post-test scores for the subdimensions of the
scale were 29.86 ± 3.09, 33.45 ± 3.62, 78.90 ± 8.11 and 24.78 ± 4.68
for “taking action for motivation and knowledge,” “planning and setting
goals,” “using strategy and evaluation,” and “learning addiction,”
respectively (Table 2).
4.3. Comparison of the pre-test and post-test mean scores within and
between the two groups
When the pre-test and post-test mean scores of the students in the
experimental and control groups were compared within the group,
statistically significant difference was observed in both the groups in the
ECSS subdimension scores of self-knowledge/self-disclosure and using I-
language (p < 0.05). There was no significant relationship between the
pretest and post-test scores of GSE and SRLSS in the experimental and
control groups (p > 0.05).
When the pretest and post-test mean scores of the students in the
experimental and control groups were compared between the groups, a
statistically significant difference was observed in the ego-enhancing
language scores (p: 0.030; p < 0.05). When the pretest and post-test
scores were compared between the groups, there was no statistically
significant difference between the groups in terms of the mean scores of
GSE and SRLSS (p > 0.05; Table 3).

4
Ş. Can et al. Nurse Education in Practice 63 (2022) 103371

Table 2 nursing students had high average communication skills score and good
Findings regarding the distribution of student nurses’ mean scale scores. communication skills. Hendekçi (2020) found that the communication
Scale and Pretest Post-test score averages of fourth-year nursing students were higher than those of
Subdimensions the first-year students. In the present study, when the comparisons be­
Available Received Mean Min–Max Mean
Min–Max Min–Max ± SD ± SD tween the groups were made, the post-test mean scores of the ECSS
decreased compared with the pre-test ones. This decrease in the
Effective
Communication
ego-enhancing language subdimension of the ECSS was significant. The
Skills Scale results obtained from the study verifies the Hypothesis 2 but do not
Ego-enhancing 6–30 16–30 24.60 14–30 24.35 support the Hypothesis 1. Unlike the findings obtained in the present
language ± 3.83 ± 3.65 study, Atan and Buluş (2020) found a significant increase in post-test
Active listening 8–40 27–40 34.90 21–40 34.76
scores in active listening, empathy, I-language and ego-enhancing lan­
± 4.12 ± 4.52
Self-knowledge/ 5–25 8–25 18.28 5–22 15.26 guage skills in the experimental group, whereas no significant difference
self-disclosure ± 4.15 ± 2.59 was observed in the subdimension of self-knowledge/self-disclosure.
Empathy 8–40 25–40 33.30 22–40 32.50 There was an increase in the scores of communication skills except for
± 3.98 ± 4.49 ego-enhancing language and active listening subdimensions. It was
Using I language 7–35 20–33 26.36 13–31 23.61
± 3.40 ± 3.18
thought that this result might be related to the individual characteristics
Self-Efficacy Scale 17–85 34–63 45.01 33–66 44.65 of the sample group where the research was conducted. Similar to the
± 6.12 ± 6.46 findings obtained from the study, it was determined that 2-day
Self-Regulated 41–205 116–201 163.41 138–198 167.00 communication skills training did not show a statistically significant
Learning Scale ± 17.23 ± 15.43
difference with empathy (Alhassan, 2019). The lack of education and
Taking action for 7–35 19–35 29.41 23–35 29.86
motivation and ± 3.67 ± 3.09 increase in scores of the scale in the experimental group after training
knowledge may be due to the students in the experimental group noticing their
Planning and 8–40 18–40 32.66 24–40 33.45 deficiencies in communication for the first time after the training and
setting goals ± 4.39 ± 3.62 not being able to apply the things they learned in the training. The
Using strategy and 19–95 54–93 77.23 58–95 78.90
evaluation ± 7.96 ± 8.11
contents of the course, which include the correct techniques to improve
Learning addiction 7–35 12–34 24.10 14–35 24.78 students’ communication skills, should be given from the first year of
± 4.95 ± 4.68 nursing education and should be supported by activities that enhance
these skills in professional life (Hendekçi, 2020). The results obtained
from the present research are thought to be important in terms of
5. Discussion
guiding such trainings. At universities in the country, where the study
was conducted, the communication courses start in different years and
The effective communication skills of students in the present study
semesters. It is thought that the results obtained are important in terms
were high in pretest and post-test. In the present study, the mean scores
of guiding the conduct of these trainings from the first semester of their
of ECSS subdimensions (ego-enhancing language, active listening, self-
education.
knowledge/self-disclosure, empathy and I-language) of the experi­
When the mean pre-test and post-test scores of the GSE were exam­
mental and control groups were similar compared with various studies
ined, it was observed that self-efficacy levels were below average.
using the same scale (Atan and Buluş, 2020; Demirtaş, 2020; Gökçe and
Contrary to the results obtained from the present study, there are studies
Keçeci, 2020). Similarly, Akçam et al. (2019) reported that the first-year
reporting that students’ self-efficacy scores are above average (Açıksöz

Table 3
Comparison of the pretest and post-test mean scores within and between the experimental and control groups.
Control Group Experimental group

Mean ± SD t * /z ** p Mean ± SD t * /z ** p p

Effective Communication Skills Scale

Ego-enhancing language Pretest 25.66 ± 3.58 − 0.342 ** 0.732 23.53 ± 3.83 − 0.230 ** 0.818 0.030
Post-test 25.26 ± 3.30 23.43 ± 3.81 0.076
Active listening Pretest 35.50 ± 4.10 − 0.348 * 0.730 34.30 ± 4.12 0.648 * 0.522 0.264
Post-test 35.70 ± 3.85 33.83 ± 4.99 0.111
Self-knowledge/self-disclosure Pretest 18.50 ± 4.21 4.428 * 0.000 18.06 ± 4.15 2.633 * 0.013 0.690
Post-test 15.13 ± 2.02 15.40 ± 3.09 0.694
Empathy Pretest 33.83 ± 4.21 1.482 * 0.149 32.76 ± 3.72 0.758 * 0.455 0.304
Post-test 32.83 ± 4.53 32.16 ± 4.50 0.570
Using I language Pretest 27.06 ± 3.57 − 2.366 ** 0.018 25.66 ± 3.13 − 2.428 ** 0.015 0.076
Post-test 24.13 ± 3.49 23.10 ± 2.82 0.155
Self-Efficacy Scale Pretest 44.76 ± 6.43 − 0.567 ** 0.571 45.26 ± 5.90 − 0.301 ** 0.763 0.755
Post-test 44.40 ± 6.02 44.90 ± 6.97 0.767
Self-Regulated Learning Scale Pre Test 166.13 ± 16.06 − 1.590 ** 0.112 160.70 ± 18.19 − 1.698 ** 0.090 0.169
Post Test 169.66 ± 15.79 164.33 ± 14.84 0.277
Taking action for motivation and knowledge Pre Test 29.80 ± 3.75 − 0.944 * 0.353 29.03 ± 3.62 − 0.217 ** 0.829 0.424
Post Test 30.40 ± 3.10 29.33 ± 3.05 0.185
Planning and setting goals Pre Test 33.16 ± 3.88 − 1.306 ** 0.192 32.16 ± 4.87 − 1.292 ** 0.196 0.383
Post Test 33.83 ± 3.65 33.06 ± 3.60 0.542
Using strategy and evaluation Pre Test 78.70 ± 7.35 − 1.577 ** 0.115 75.76 ± 8.39 − 1.064 ** 0.287 0.155
Post Test 80.46 ± 8.72 77.33 ± 7.27 0.542
Learning addiction Pre Test 24.46 ± 4.76 − 1.035 ** 0.301 23.73 ± 5.19 − 1.571 ** 0.116 0.722
Post Test 24.96 ± 4.62 24.60 ± 4.81 0.994

t: Dependent samples t test

z: Wilcoxon test
p < 0.05

5
Ş. Can et al.
et al., 2016; Bilgiç et al., 2017; Göger and Çevirme, 2019). Yılmaz
Koçak, and Büyükyılmaz (2019) conducted a study with nurses and
reported that the self-efficacy levels of nurses were above average. The
self-efficacy scores in the present study were lower than those reported
in literature; this may be due to the students losing their sense of
competence and control because the data were collected during the
COVID-19 pandemic. Because the perception of self-efficacy is a belief of
a person in himself/herself, determination and will. It is seen that the
implementation of quarantine measures due to the pandemic, the
decrease in social contacts and the increase of unknowns and un­
certainties have negative effects on this competence. In the present
study, when the comparisons between the groups were made, the
post-test mean scores of the GSE were found to decrease compared with
the pre-test mean scores; however, this decrease was not significant. The
results obtained from the study verifies the Hypothesis 4 but do not
support the Hypothesis 3. Molu, Ceylan and Özcan (2019) conducted a
study to determine the effect of drama-integrated communication skills
training on self-efficacy among first-year nursing students and observed
an increase in self-efficacy scores after the training, but this increase was
not statistically significant. There are studies conducted with nursing
students showing that the self-efficacy scores of students in the experi­
mental group significantly increased compared with those in the control
group (Li et al., 2019; Shorey et al., 2019). The contradicting findings in
literature on this subject indicate the significance of the subject. In the
present study, the decrease in self-efficacy scores in both the experi­
mental and control groups in the measurements performed 1 month
later should be evaluated by considering the country where the research
was conducted and the time of data collection. During the COVID-19
pandemic when the data were collected, the number of positive cases
and mortality rates increased in some periods, curfews and restrictions
were applied and students experienced different stressors such as
adapting to new methods as well as concerns for themselves and their
families, which may have affected the study results and should be taken
into consideration while evaluating the results. Self-efficacy, which is
defined as the judgment of individuals about their ability to organize
and execute the actions required for their determined performance
(Dikmen et al., 2016; Yıldırım et al., 2016), is very important in a pro­
fessional group such as the nursing profession where communication is
indispensable. To maintain effective care throughout their professional
lives, nursing students should improve self-efficacy using effective
communication skills within the scope of their education.
5.1. Limitations
As this study was conducted with nursing students, the sample does
not represent all health care students; therefore, the results can only be
generalized to this group.
In addition, since the data were collected during the pandemic
period, the fact that the students could not receive face-to-face training,
the training period was two days and the training was conducted online
constitute the limitations of the research.
6. Conclusion
The effective communication and SRLSS mean scores of the nursing
students were high and the GSE scores were below average. Although
the SRLSS scores of the students increased in the post-test, the study
results show that communication skills training did not have a signifi­
cant effect on effective communication and self-efficacy and self-
regulated learning skills.
It is recommended to conduct further research with different sample
groups, taking into account some variables, such as the pandemic, online
education, training time, etc., that may affect effective communication
skills, self-efficacy and self-regulatory learning skills. ⓘ In addition, it is
recommended to disseminate communication skills training in all
educational settings from the first year, which includes practices aimed
6
Nurse Education in Practice 63 (2022) 103371
especially at developing affective skills as well as cognitive skills. The
results of the present study are important in terms of highlighting the
importance of nursing students in using appropriate techniques to
improve communication in both theoretical courses and practice as well
as guiding future studies that will examine the effects of students’
communication skills.
Conflict of interest
The author declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article. The material
described is not under publication or consideration for publication
elsewhere.
Fundings
This research did not receive any specific Grant from funding
agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Şeyda Can: Data curation, Writing – original draft. Hanife Durgun:
Data curation, Writing – original draft. Berna Köktürk Dalcalı: Data
curation, Writing – original draft. We declare that we have all partici­
pated in the design, execution, and analysis of the paper, and that we
have approved the final version.
Permissions
This study was carried out upon the permissions of the Ethics Com­
mittee of Non Interventional Research (decision dated October 30th,
2020 and numbered 2020–42) and of the provincial directorate of
health.
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