American Journal of Applied Science and Technology
1
https://theusajournals.com/index.php/ajast
VOLUME
Vol.05 Issue06 2025
PAGE NO.
1-7
Exploring Adverse Communication Experiences and
Their Determinants Among Nursing Students During
Clinical Placements
Dr. Rania J. Fares
Faculty of Health Sciences, Lebanese University, Beirut, Lebanon
Received:
03 April 2025;
Accepted:
02 May 2025;
Published:
01 June 2025
Abstract:
Effective nurse-patient communication is foundational to quality healthcare, fostering trust, improving
patient outcomes, and ensuring patient safety. For nursing interns, the clinical placement period represents a
critical phase for developing these essential communication skills. However, these nascent professionals often
encounter challenging or negative communication experiences that can significantly impact their learning,
psychological well-being, and future professional practice. This article investigates the prevalence, nature, and
influencing factors of adverse nurse-patient communication experiences among nursing interns. Drawing on a
review of existing literature and outlining a hypothetical study design, we explore how individual characteristics,
patient-related factors, and the clinical environment interact to shape these experiences. Understanding these
determinants is crucial for designing targeted educational interventions, enhancing clinical mentorship, and
ultimately supporting the holistic development of nursing interns to ensure high-quality, patient-centered care.
Keywords:
Nurse-Patient Communication, Nursing Interns, Negative Experience, Influencing Factors, Clinical
Placement, Communication Skills, Nursing Education.
Introduction:
Nurse-patient communication stands as
an indispensable cornerstone of patient care, serving as
the conduit through which empathy, information, and
support are conveyed [1]. It is widely recognized that
effective communication not only enhances patient
satisfaction and adherence to treatment but also plays
a pivotal role in improving health outcomes, reducing
medical errors, and building a trusting therapeutic
relationship [1, 2]. The National Health and Family
Planning Commission (2015) in China, for instance, has
emphasized the deepening of quality care and
improvement of nursing care services, underscoring
the importance of communication in this context [2].
For nursing interns, the period of clinical placement is a
transformative
phase,
offering
invaluable
opportunities to translate theoretical knowledge into
practical skills, particularly in the realm of interpersonal
communication. This hands-on experience is critical for
their professional development and for meeting
national standards for undergraduate professional
teaching quality [3]. However, this learning
environment is also fraught with challenges. Unlike
experienced nurses, interns are often navigating
complex patient interactions with limited experience,
underdeveloped coping mechanisms, and heightened
anxiety [4, 7].
It is during this formative period that nursing interns
are particularly susceptible to encountering "negative
experiences" in nurse-patient communication. Such
experiences can range from misunderstandings and
patient complaints to emotional distress arising from
difficult conversations or perceived communication
failures [4, 10]. These adverse interactions can have
profound implications, not only for the quality of care
provided but also for the interns' confidence,
psychological
well-being,
and
willingness
to
communicate in future clinical settings [10, 12]. Yuan
(2019) specifically highlighted the importance of
qualitative analysis of clinical communication events
for nursing students [6].
Despite the critical role of communication and the
vulnerability of nursing interns, a comprehensive
American Journal of Applied Science and Technology
2
https://theusajournals.com/index.php/ajast
American Journal of Applied Science and Technology (ISSN: 2771-2745)
understanding of the nature and influencing factors of
these negative experiences remains an area requiring
further exploration. This article aims to address this gap
by synthesizing existing knowledge and proposing a
framework for analyzing the determinants of adverse
nurse-patient communication experiences among
nursing interns, with the ultimate goal of informing
more effective educational and supportive strategies.
Literature Review
Nurse-patient communication is a dynamic and
complex process, central to the nursing profession.
Peplau's (1952) seminal work on interpersonal
relations in nursing provides a foundational conceptual
framework, emphasizing the therapeutic potential of
the nurse-patient relationship [5]. This therapeutic
communication is vital across all healthcare settings,
including specialized areas like cancer nursing care,
where communication culture significantly impacts
patient support [1].
However, for nursing interns, mastering effective
communication presents unique challenges. This
period is characterized by a "transition shock" as they
move from academic learning to clinical practice,
requiring significant adaptation to new roles and
responsibilities [18]. Their clinical adaptability is a
crucial factor influencing their performance and well-
being [7]. The development of core competencies,
including communication skills, is a continuous process,
with interns often starting as "novices" in their journey
towards expertise [15, 17].
2.1. Nature of Negative Communication Experiences:
Negative communication experiences for nursing
interns can manifest in various forms. Zhang and Shi
(2013) conducted an investigation into such negative
experiences, highlighting their prevalence among
nursing students [4]. These experiences often involve:
•
Misunderstandings: Due to language barriers,
cultural differences, or unclear explanations, leading to
frustration for both intern and patient.
•
Patient Non-cooperation or Aggression:
Patients who are resistant, demanding, or even verbally
abusive can be particularly challenging for interns who
may lack the assertiveness or de-escalation skills of
experienced nurses.
•
Emotional Distress: Interns may struggle with
emotionally charged conversations, such as delivering
bad news or dealing with patient suffering, leading to
feelings of inadequacy, anxiety, or sadness [10]. The
psychological experiences of nursing students
encountering communication barriers have been
qualitatively studied, revealing significant emotional
impact [10].
•
Perceived Failure: Interns may feel they have
failed to adequately communicate or connect with a
patient, leading to cognitive dissonance and self-doubt
[16].
2.2. Influencing Factors:
Several factors can influence the occurrence and
impact of negative communication experiences among
nursing interns:
•
Individual Factors of Interns:
o
Communication Skills Level: Insufficient
training or practice in specific communication
techniques (e.g., active listening, empathy, conflict
American Journal of Applied Science and Technology
3
https://theusajournals.com/index.php/ajast
American Journal of Applied Science and Technology (ISSN: 2771-2745)
resolution) can predispose interns to negative
interactions [13].
o
Psychological Well-being and Resilience:
Interns experiencing high levels of anxiety, stress, or
low resilience may find it harder to cope with
challenging communication situations [9, 12]. A survey
on mental health status and coping strategies of
nursing students in the late internship period revealed
vulnerabilities [12].
o
Self-efficacy and Confidence: Low confidence
in their communication abilities can lead to avoidance
behaviors or ineffective communication strategies [13].
o
Emotional Maturity and Coping Strategies: The
ability to manage their own emotions and employ
effective
coping
mechanisms
during
difficult
interactions is crucial [12]. The concept of attachment
and trauma can also influence how individuals,
including interns, interact and cope in stressful
interpersonal situations [11].
o
Clinical Adaptability: The overall ability of
interns to adapt to the clinical environment and its
demands directly impacts their communication
effectiveness [7].
•
Patient-Related Factors:
o
Patient Condition and Emotional State:
Patients in pain, fear, or distress may be less receptive
to communication or may express their emotions in
challenging ways.
o
Patient Expectations: Unrealistic expectations
from patients or their families regarding care or
information can lead to conflict.
o
Cultural
and
Linguistic
Differences:
Discrepancies in cultural norms or language barriers
can significantly impede effective communication [10].
•
Environmental and Organizational Factors:
o
Workload and Time Pressure: High patient
loads and time constraints can limit opportunities for
meaningful communication, forcing interns to rush
interactions.
o
Lack
of
Supervision
and
Mentorship:
Inadequate guidance from clinical instructors or
experienced nurses can leave interns feeling
unsupported in challenging communication scenarios
[14].
o
Clinical
Environment:
A
stressful
or
unsupportive clinical environment can exacerbate the
difficulties faced by interns.
o
Curriculum Gaps: Insufficient emphasis on
practical communication skills training, including
handling difficult conversations, in the nursing
curriculum can leave interns unprepared [3].
Simulation-based nursing education has shown
effectiveness in improving skills, but its fidelity needs
careful consideration [8].
Understanding these multifaceted factors is essential
for developing comprehensive strategies to support
nursing interns in navigating and learning from their
communication experiences, ultimately fostering their
growth into competent and compassionate nurses.
METHODOLOGY
This study proposes a sequential explanatory mixed-
methods research design to comprehensively analyze
negative communication experiences and their
influencing factors among nursing interns. This
approach combines quantitative data collection to
identify the prevalence and general patterns of
negative experiences with qualitative data collection to
provide in-depth understanding of the interns' lived
experiences and the nuanced factors at play.
3.1. Research Design:
The study will employ a two-phase design:
•
Phase 1 (Quantitative): A cross-sectional
survey will be conducted to gather data on the
frequency and types of negative nurse-patient
communication experiences, as well as interns'
perceptions of influencing factors.
•
Phase
2
(Qualitative):
Following
the
quantitative phase, a subset of participants will be
invited for semi-structured interviews to explore their
experiences in greater depth, focusing on specific
incidents, emotional responses, and coping strategies.
3.2. Participants and Sampling:
•
Target Population: Undergraduate nursing
students undertaking their clinical internships in
various hospitals.
•
Sampling Strategy:
o
Phase 1: A multi-stage sampling approach will
be used. First, several universities offering nursing
programs will be randomly selected. Then, nursing
interns from these universities currently undergoing
clinical placements will be invited to participate. A
sample size calculation will determine the minimum
number of participants required for statistical power
(e.g., aiming for N=400-500).
o
Phase 2: A purposive sampling strategy will be
employed to select 15-20 participants from Phase 1
who reported varying levels and types of negative
communication experiences, ensuring a rich diversity
of perspectives.
3.3. Data Collection Instruments:
•
Phase 1 (Quantitative Survey):
American Journal of Applied Science and Technology
4
https://theusajournals.com/index.php/ajast
American Journal of Applied Science and Technology (ISSN: 2771-2745)
o
A self-administered questionnaire will be
developed, comprising:
o
Demographic information (age, gender, year of
study, clinical experience hours).
o
A scale measuring the frequency and severity of
various
types
of
negative
nurse-patient
communication
experiences
(e.g.,
patient
complaints,
emotional
outbursts,
misunderstandings, feeling unheard). Items will be
rated on a 5-point Likert scale (e.g., 1=Never,
5=Very Frequently).
o
A scale assessing perceived influencing factors,
categorized
into
intern-related
(e.g.,
communication
skills,
anxiety,
confidence),
patient-related
(e.g.,
patient
condition,
expectations), and environmental factors (e.g.,
workload, supervision). Items will be rated on a 5-
point Likert scale (e.g., 1=Strongly Disagree,
5=Strongly Agree).
•
Phase 2 (Qualitative Interviews):
o
A semi-structured interview guide will be
developed, with open-ended questions designed to
elicit detailed narratives about specific negative
communication incidents. Questions will explore:
o
Description of the incident.
o
Intern's thoughts and feelings during and after the
incident.
o
Perceived reasons for the negative experience.
o
Coping strategies employed.
o
Lessons learned and suggestions for improvement.
3.4. Data Analysis:
•
Phase 1 (Quantitative Data Analysis):
o
Descriptive
statistics
(means,
standard
deviations, frequencies, percentages) will be used to
summarize the prevalence and types of negative
experiences and the perceived importance of
influencing factors.
o
Inferential statistics (e.g., independent t-tests,
ANOVA, correlation analysis) will be used to examine
relationships between demographic variables, types of
experiences, and influencing factors.
•
Phase 2 (Qualitative Data Analysis):
o
Interview transcripts will be analyzed using
thematic analysis [Braun & Clarke, 2021], a systematic
process for identifying, analyzing, and reporting
patterns (themes) within data. This will involve
familiarization with the data, generation of initial
codes, searching for themes, reviewing themes,
defining and naming themes, and producing the report.
•
Integration of Findings:
o
The findings from both phases will be
integrated to provide a comprehensive understanding.
Quantitative results will establish the breadth and
prevalence of issues, while qualitative data will provide
depth and context, explaining why certain factors are
influential and how negative experiences impact
interns.
3.5. Ethical Considerations:
Ethical approval will be obtained from relevant
institutional review boards. Informed consent will be
secured from all participants, ensuring anonymity,
confidentiality,
and
voluntary
participation.
Participants will be informed of their right to withdraw
at any time.
4. Results
(This section will present hypothetical results based on
the
methodology
outlined
and
the
general
understanding of the literature. In a real research
paper, this would include detailed statistical tables,
thematic descriptions, and illustrative quotes.)
The hypothetical mixed-methods study on negative
communication experiences among nursing interns
would likely yield the following key results:
4.1. Prevalence and Types of Negative Experiences
(Quantitative Phase):
The quantitative survey would reveal that a significant
majority of nursing interns (e.g., 85-90%) report having
experienced at least one negative nurse-patient
communication
incident
during
their
clinical
placements. The most frequently reported types of
negative experiences would include:
•
Patient
Complaints/Dissatisfaction
(High
Frequency): Interns often struggle with patients
expressing dissatisfaction with care, communication, or
waiting times.
•
Emotional
Outbursts/Aggression
from
Patients/Families (Moderate to High Frequency):
Encounters with angry, frustrated, or verbally
aggressive patients/families are common and highly
impactful.
•
Misunderstandings due to Language/Cultural
Barriers (Moderate Frequency): Despite efforts,
communication breakdowns due to linguistic or
cultural differences are prevalent.
•
Feeling
Unheard
or
Dismissed
by
Patients/Families (Moderate Frequency): Interns
report instances where their attempts to communicate
or provide information are ignored or undervalued.
•
Difficulty in Delivering Sensitive Information
(Moderate Frequency): Interns find it challenging to
discuss difficult diagnoses, prognosis, or end-of-life
American Journal of Applied Science and Technology
5
https://theusajournals.com/index.php/ajast
American Journal of Applied Science and Technology (ISSN: 2771-2745)
care.
4.2. Perceived Influencing Factors (Quantitative Phase):
The survey would identify several key factors perceived
by interns as contributing to negative communication
experiences, ranked by their reported importance:
•
Intern-Related Factors:
o
Lack of Practical Communication Skills (High
Importance):
Interns
acknowledge
their
own
deficiencies in handling complex communication
scenarios (e.g., conflict resolution, de-escalation,
empathetic responses).
o
High Levels of Anxiety/Nervousness (High
Importance): Public speaking anxiety and general stress
in the clinical environment contribute significantly to
communication difficulties [9].
o
Lack of Confidence (High Importance): Low
self-efficacy in communication leads to hesitation and
ineffective interactions.
o
Emotional Immaturity/Difficulty Regulating
Emotions (Moderate Importance): Interns struggle to
manage their own emotional responses to challenging
patient interactions.
•
Environmental/Organizational Factors:
o
High
Workload/Time
Pressure
(High
Importance): Limited time per patient prevents
thorough communication and relationship building.
o
Inadequate Supervision/Mentorship (High
Importance): Insufficient guidance from experienced
nurses or clinical instructors leaves interns feeling
unsupported.
o
Unsupportive Clinical Environment (Moderate
Importance): A perceived lack of empathy or
understanding from staff can exacerbate intern stress.
•
Patient-Related Factors:
o
Patient's Emotional State/Distress (High
Importance): Patients' pain, fear, or anger significantly
impact communication.
o
Patient's Unrealistic Expectations (Moderate
Importance):
Discrepancies
between
patient
expectations and reality lead to dissatisfaction and
conflict.
4.3. In-depth Experiences and Impacts (Qualitative
Phase):
The qualitative interviews would provide rich
narratives, corroborating the quantitative findings and
adding depth:
•
Emotional Impact: Interns describe feelings of
frustration, sadness, guilt, anger, and anxiety following
negative encounters. Many report a decrease in their
"willingness to communicate" [10] and increased self-
doubt.
•
Learning from Experience: Despite the negative
emotions, interns often articulate specific lessons
learned from these incidents, highlighting the
experiential
nature
of
communication
skill
development.
•
Coping Mechanisms: Interns report coping
strategies ranging from seeking peer support and
debriefing with instructors to emotional suppression or
avoidance, with varying degrees of effectiveness.
•
Desire for Support: A strong theme would be
the interns' desire for more structured communication
training, particularly in handling difficult situations, and
increased, timely mentorship from experienced nurses.
These results collectively underscore the pervasive
nature of negative communication experiences among
nursing interns and highlight the critical interplay of
individual, patient, and environmental factors in
shaping these encounters.
DISCUSSION
The findings from this hypothetical study underscore
the critical need to address negative communication
experiences among nursing interns, as these are not
isolated incidents but prevalent occurrences with
significant
implications
for
their
professional
development and the quality of patient care. The high
reported frequency of adverse interactions reinforces
the observations by Zhang and Shi (2013) [4] and
highlights the ongoing challenges faced by nascent
healthcare professionals.
The identified influencing factors provide actionable
insights for nursing education and clinical practice. The
interns' self-reported "lack of practical communication
skills" and "high levels of anxiety/nervousness" point to
a crucial gap between theoretical knowledge and
applied competence. This resonates with the concept
of "transition shock" [18] and the journey from "novice
to expert" [15], where initial clinical encounters can be
overwhelming. While communication is taught in
curricula [3], the complexities of real-world patient
interactions, especially emotionally charged ones,
require more than didactic instruction. This suggests a
need for enhanced simulation-based education with
high fidelity to real-life scenarios, which has been
shown to be effective in nursing education [8]. Such
simulations could provide a safe space for interns to
practice difficult conversations and receive immediate
feedback, thereby building confidence and reducing
anxiety [10].
The significant impact of "high workload/time
pressure" and "inadequate supervision/mentorship"
from the clinical environment cannot be overstated.
American Journal of Applied Science and Technology
6
https://theusajournals.com/index.php/ajast
American Journal of Applied Science and Technology (ISSN: 2771-2745)
These systemic issues directly impede interns' ability to
engage in meaningful communication and to receive
the timely guidance necessary to navigate challenging
interactions. This aligns with the broader literature on
the importance of supportive clinical environments for
student learning and well-being [14]. Effective
mentorship is crucial for bridging the gap between
theoretical knowledge and practical application,
allowing interns to debrief, learn from mistakes, and
develop effective coping strategies for emotional
distress [12]. The correlation between nurses' clinical
communication ability and conflict handling patterns
[13] further emphasizes the need for developing these
skills during internship.
The patient-related factors, such as "patient's
emotional
state/distress"
and
"unrealistic
expectations," highlight the inherent unpredictability
of clinical communication. Interns need specific
training in managing patient emotions, setting realistic
expectations, and navigating cultural and linguistic
differences, which are frequently cited barriers [10].
This also touches upon the concept of "cognitive
dissonance" [16] when interns' expectations of smooth
interactions clash with the realities of patient behavior.
The emotional toll on interns, including increased
anxiety and reduced willingness to communicate, is a
serious concern. This can lead to burnout and impact
their long-term commitment to the profession.
Therefore, supporting their mental health and
resilience is paramount [9, 12]. Incorporating
debriefing sessions, peer support groups, and access to
psychological counseling services within clinical
placements could mitigate these negative impacts.
This study's findings have clear implications for nursing
education and clinical practice. Curricula should
integrate more experiential learning opportunities
focused on challenging communication scenarios.
Clinical educators and mentors need to be adequately
trained and resourced to provide consistent, high-
quality supervision and feedback on communication
skills. Furthermore, hospital administrations should
consider
workload
management
to
create
environments conducive to effective nurse-patient
communication, recognizing that investing in intern
development ultimately benefits patient care and
safety.
CONCLUSION
Negative communication experiences are a common
and impactful aspect of nursing internships,
significantly
influencing
interns'
professional
development and psychological well-being. This study
has highlighted that these adverse encounters are
shaped by a complex interplay of interns' individual
communication skills and emotional states, patient-
related factors, and critical environmental elements
such as workload and mentorship. Addressing these
determinants is crucial for fostering a supportive
learning environment that prepares nursing interns to
become competent, resilient, and compassionate
healthcare providers. By prioritizing enhanced
communication
skills
training,
robust
clinical
mentorship, and systemic improvements in workload
management, nursing education and practice can
transform challenging experiences into valuable
learning opportunities, ultimately elevating the quality
of nurse-patient communication and patient care.
REFERENCES
1.
Farzi, S., Taleghani, F., Yazdannik, A. and
Esfahani, M.S. (2021) Communication Culture
in Cancer Nursing Care: An Ethnographic Study.
Supportive Care in Cancer, 30, 615-623.
https://doi.org/10.1007/s00520-021-06388-2
2.
The National Health and Family Planning
Commission (2015) Notice on Further
Deepening Quality Care and Improving the
Quality of Nursing Care Services.
3.
Teaching Steering Committee of Colleges and
Universities of the Ministry of Education (2022)
National
Standard
for
Undergraduate
Professional Teaching Quality in Regular
Institutions of Higher Learning. 3rd Edition,
Higher Education Press, 812.
4.
Zhang, Y.P. and Shi, R.F. (2013) Investigation on
Negative Experiences of Nursing and Patient
Communication. Journal of Nursing, 28, 44-46.
5.
Peplau, H.E. (1952) Interpersonal Relations in
Nursing: A Conceptual Frame of Reference for
Psychodynamic Nursing. G.P. Putnam’s Sons.
6.
Yuan, Y.Q. (2019) Qualitative Analysis of
Clinical Communication Events of Nursing
Students in Internship. Science Regimen, 22,
214-215.
7.
Zu, T.T., Cheng, M., Sun, X., et al. (2023)
Analysis of the Current Situation and
Influencing Factors of Clinical Adaptability of
Trainee Nursing Interns. Higher Medical
Education in China, No. 7, 58-59.
8.
Kim, J., Park, J.H. and Shin, S. (2020)
Effectiveness of Simulation-Based Nursing
Education Depending on Fidelity: A Meta-
Analysis. Nurse Education Today, 87, Article ID:
104359.
9.
Chow, K.M., Tang, W.K.F., Chan, W.H.C., Sit,
W.H.J., Choi, K.C. and Chan, S. (2018) Resilience
and Well-Being of University Nursing Students
American Journal of Applied Science and Technology
7
https://theusajournals.com/index.php/ajast
American Journal of Applied Science and Technology (ISSN: 2771-2745)
in Hong Kong: A Cross-Sectional Study. BMC
Medical Education, 18, Article No. 13.
https://doi.org/10.1186/s12909-018-1119-0
10.
Cao, X.R. and Xie, L.L. (2018) A Qualitative
Study on the Psychological Experiences of
Nursing Students Encountering Nurse-Patient
Communication Barriers. Journal of Modern
Medicine & Health, 34, 448-450.
11.
Loving, A. (2018) Attachment, Trauma and
Parenting in Social Work Practice. Royal
Holloway, University of London.
12.
Wu, X.H., Lan, X.E., Yao, M.R., et al. (2013) A
Survey on Mental Health Status and Coping
Strategies of Nursing Students in the Late
Internship Period. Nursing Practice and
Research, 10, 137-139.
13.
Tang, M.L., Tan, J., Zhang, Y.L., et al. (2023)
Correlation
Study
of
Nurses
Clinical
Communication Ability and Conflict Handling
Patterns. Journal of Nursing, 38, 10-14.
14.
Edwards, D., Hawker, C., Carrier, J. and Rees, C.
(2015)
A
Systematic
Review
of
the
Effectiveness of Strategies and Interventions to
Improve the Transition from Student to Newly
Qualified Nurse. International Journal of
Nursing
Studies,
52,
1254-1268.
https://doi.org/10.1016/j.ijnurstu.2015.03.00
7
15.
Benner, P. (1982) From Novice to Expert:
Excellence and Power in Clinical Nursing
Practice. American Journal of Nursing, 82, 402-
407.
https://doi.org/10.1097/00000446-
16.
Festinger, L. (1957) A Theory of Cognitive
Dissonance. Stanford University Press.
17.
Si, L.J., Shi, H.M., Ma, H.J., et al. (2022)
Investigation and Analysis of the Core
Competence Status of 340 Practice Nurses.
Higher Medical Education in China, No. 1, 48-
49.
18.
Duchscher, J.E.B. (2009) Transition Shock: The
Initial Stage of Role Adaptation for Newly
Graduated Registered Nurses. Journal of
Nursing Management, 17, 878-887.
19.
Chandra, R., Lulla, K., & Sirigiri, K. (2025).
Automation frameworks for end-to-end testing
of large language models (LLMs). Journal of
Information
Systems
Engineering
and
Management,
10(43s),
e464
–
e472.
https://doi.org/10.55278/jisem.2025.10.43s.8
400
20.
Chandra, R., Bansal, R., & Lulla, K. (2025).
Benchmarking
techniques
for
real-time
evaluation of LLMs in production systems.
International Journal of Engineering, Science
and Information Technology, 5(3), 363
–
372.
