From education to practice: How attitudes shape communication skills in nursing students

Background: Effective communication is fundamental in nursing practice, particularly in patient-centered care and shared decision-making. However, how nursing students develop communication skills and attitudes remains underexplored, especially in the Italian context. Aim: This study aimed to examine the development of nursing students' communication self-efficacy, attitudes toward patient-centeredness, and communication across different stages of their academic education. Methods: In this cross-sectional study, 57 nursing students (27 third-year Bachelor’s and 30 fifth-year Master’s) completed an online survey assessing self-efficacy, attitudes toward patient-centeredness (Sharing and Caring), and toward communication (positive and negative). Results: Master’s students exhibited lower Negative attitudes toward communication (NAC) and an increased awareness of the importance of shared decision-making. They also reported lower communication self-efficacy, possibly due to their awareness of communication challenges experienced in clinical practice. Positive attitudes toward communication (PAC) significantly predicted self-efficacy only in master’s students. Conclusion: These findings highlight the importance of integrating structured communication training, especially on shared decision-making, into nursing curricula. Active learning and clinical internships may enhance students’ communication abilities, self-awareness, and confidence. Results are discussed considering the practical implications.