Interpersonal communication competence among nursing students*

Objective: To identify the level of interpersonal communication competence among nursing students and to correlate its domains with sociodemographic and academic variables. Method: This is a correlational study, developed through a multicenter research project in six federal universities in Brazil. Data from 1,079 nursing students were collected through a questionnaire with sociodemographic and academic variables and the Interpersonal Communication Competence Scale. Data were analyzed using descriptive and inferential statistics. Results: The mean of the sum of the Interpersonal Communication Competence Scale was 63.74 (± 7.6). The domains “availability” and “environment control” had, respectively, the highest and lowest averages. There was a statistically significant difference between the sum of the Interpersonal Communication Competence Scale and the variables age, marital status, participation in a research/extension group, and paid professional activity. Conclusion: This study contributed to identify the level of interpersonal communication competence of nursing students in the Brazilian reality, providing useful information for education in the area.


Introduction
Competencies can be defined as behaviors learned during an educational process, which involves the development of knowledge, skills and attitudes for professional practice. Knowledge corresponds to the set of learning and information acquired by individuals, skills are related to the ability to put acquired knowledge into practice, and attitudes are related to the way knowledge is put into practice (1)(2) .
In Brazil, the five general competencies and skills advocated by the Diretrizes Curriculares Nacionais (DCN, National Curriculum Guidelines) for nursing education are decision making, leadership, administration and management, continuing education, and communication (3) . Communication stands out among these competences because nurses' practice is centered on the interpersonal relationship with patients, the nursing team and the multiprofessional team, both to perform care activities and to manage care and health services. In addition, communication permeates and enhances the development and exercise of the other professional nursing skills (4)(5) . However, many nurses report difficulty in communicating, especially in contexts that constantly require decision making (6) .
In this sense, it is important that the development of communication competence permeates the teaching-learning process throughout the nursing course. However, each student experiences this learning differently, considering the knowledge acquired and life-long experiences, which makes it challenging for teachers to create circumstances and teaching strategies to develop communicative skills among nursing students (7) .
Given the complexity of developing communication skills, researchers have emphasized the need to use active methodologies and teaching methods that stimulate critical and reflective thinking, based on theoretical and practical integration in nursing (8)(9) . Despite the importance of competence in interpersonal communication of nursing students, scientific production on this subject is still scarce in Brazil. The available literature mainly includes studies on communication teaching-learning strategies (8)(9) , which highlights the need for further investigations on this problem (5)   for communication (10) .

The ECCI measurement scale consists of a 5-point
Likert scale. To get the full score, the items "I have a hard time defending myself" and "It's hard to find the right words to express myself" are reverse code and need to be recoded. So, for example, score 5 would be marked as 1 in the final score (4 = 2, 3 = 3, 2 = 4, 1 = 5). The total scale score ranges from 17 to 85, and the higher the score, the greater the interpersonal communication ability (10) .
Descriptive analyses were performed for all variables. Spearman's correlation was used to assess the relationship between age and the outcomes assessed. The following tests were used: Student's t, Anova, Kruskal-Wallis and Mann-Whitney to compare outcome variables between the groups analyzed. For gross analysis, linear regression was used, estimating the gross regression coefficient (β) with its respective 95% confidence intervals (CI).

This study was approved by the Research Ethics
Committee of the proposing institution (CAAE:

Results
The study included 1,079 nursing students (58% of the population  in research and extension group, and paid professional activity (Table 3).  were associated with the ECCI sum (Table 4). In the multiple linear regression analysis of the variables associated with ECCI domains, an association between the "environment control" domain and the mean age variable was identified. There was also an association with males and presence of a partner. The domain "selfdisclosure" was associated with non-participation in research and extension group. "Assertiveness" was not associated with any variable. The domain "availability" was less associated with the male sex and more with the presence of a partner. Regarding the participant profile shown in Table 1, the sample investigated was composed of young adults, mostly women, single, with no previous college experience, low engagement with research and extension groups, and absence of scholarship. These findings are in line with those found in the literature about the characterization of nursing students (15) .

Discussion
Regarding the sum of the mean of ECCI  (14) .
This result is positive, since communication, when effective, contributes to nurses' assertive care (16)(17) . In addition, communication competence contributes to nurses' managerial practice, especially for the exercise of leadership (18) .
The domains "availability" and "environment control" had, respectively, the highest and lowest means. From these results, it can be inferred that nursing students are accessible and open for communication. This is important because, in the practice of nursing care, there is a need for availability between professional nurse and patient treated (10) . In addition, adequate and effective communication contributes to the quality of nursing care, especially in unknown procedures that cause fear and anxiety in patients (19) .
In contrast, control over the environment is developed from the professional's integration in the workspace. In this sense, the lowest mean in this domain represents that it is still necessary for nursing students to express themselves more adequately, aiming at a better adaptation to the environment to improve communication and persuade others around them (10) . In addition, this result also reflects the fact that most study participants are first-and second-year students. This stage of education is usually marked by students' first interactions in care settings of health services, and they are not expected to have control over the professional practice environment.
In the results of the bivariate analysis between the sociodemographic variables of the sample and the result of the sum of ECCI, a significant difference was obtained for age, marital status, participation in research or extension group, and paid professional activity.   (20)(21) .
The relationship between a better self-report of interpersonal communication and marital status may be justified by the experience and challenges undergone during a relationship, as already evidenced in a study on nurses' interpersonal skills in nursing care (22) . Couples face important challenges, not only relational problems, but also stress by external factors, and this experience can bring maturation and strengthening of interpersonal communication skills applied to professional practice (22)(23) .
The influence of participation in a research or extension group in the nursing students' interpersonal communication competence reinforces the importance of these activities in the formation of critical, reflective and better prepared professionals for the job market. In addition, it is noteworthy that the inclusion of students in research groups meets the curriculum guidelines that advocate the articulation between teaching, research and extension, reflecting benefits to vocational training and science production (24)(25) . for the undergraduate nursing course (26) .
As a limitation of the study, it can be considered that the variations in size, geographic location and political-pedagogical conception of each institution where the data were collected may have influenced the participants' responses. In addition, the fact that the proposed instrument is a self-report measure can also be pointed as a study limit, since the participants' responses are related to their capacity to reflect on their own performance. Further studies should be developed on this subject given the importance of communication skills in the professional practice of nurses.

Conclusion
The mean of the sum of the Interpersonal