Alexithymia and clinical communication competence in nursing interns in China with the mediating role of self-efficacy

Why Feelings Matter in Hospital Training

When we picture nurses in training, we often think about mastering injections, monitors, and medical charts. But for patients, the most memorable part of care is often a conversation, a look, or a kind word. This study from China asks a deceptively simple question: how do young nurses’ own emotions and confidence shape the way they talk with patients—and can strengthening their belief in themselves help them communicate better, even if they struggle to understand their feelings?

Trouble Putting Feelings into Words

The researchers focused on a personality trait called alexithymia, which describes people who find it hard to notice, name, and talk about their own emotions. Rather than a rare disorder, it is a common pattern that varies from person to person, and seems to be especially frequent among medical students. In this study, 216 nursing interns from five large hospitals in China filled out standard questionnaires that measured three things: how much they struggled with emotions, how confident they felt in handling challenges (their self-efficacy), and how skilled they were at everyday communication with patients, such as listening carefully, building rapport, spotting problems, sharing information, and acknowledging feelings.

What the Numbers Revealed

Among the 208 valid responses, many interns showed elevated levels of alexithymia; more than a quarter scored in the clearly high range, and another large group fell into a “possible” range. Their overall communication scores were moderate, leaving room for growth, and their confidence levels sat in the middle of the possible range. When the team examined how these pieces fit together, a clear pattern emerged: interns who had more difficulty with emotions generally reported weaker communication skills. One specific aspect—an outward-focused thinking style that pays more attention to external tasks and details than to inner feelings—was especially tied to poorer communication across several domains, including forming trusting relationships, listening with care, and recognizing patients’ emotional concerns.

The Quiet Power of Confidence

The story did not end there. The researchers also found that interns who struggled more with emotions tended to feel less confident in their abilities. In turn, those with higher self-confidence rated their communication skills more strongly, particularly in sensitive areas like understanding patients’ worries and validating their feelings. Using statistical models, the team showed that this confidence partially “mediated” the link between emotional difficulty and poorer communication. In plain terms, even when interns had a strong outward focus and limited emotional awareness, those who believed in their own competence were better able to connect with patients than those who doubted themselves.

What Helps Young Nurses Grow

Not all experiences were equal. Interns who had served as student leaders, or who had taken part in more communication-skills training sessions, tended to score higher on communication measures. Leadership roles likely push students to speak up, coordinate with others, and see problems from multiple viewpoints, building both skill and confidence. Formal communication training—through role-playing, simulations, and guided practice—also appeared to help. Together, these findings suggest that emotional awareness, confidence, and hands-on practice interact in powerful ways during the fragile transition from classroom to clinic.

Why This Matters for Patients and Nurses

For patients, a nurse’s words, tone, and presence can mean the difference between feeling frightened and feeling understood. This study suggests that many nursing interns secretly wrestle with their own emotions, and that this hidden struggle can quietly undermine how they talk with patients. Yet it also offers hope: by designing education that both supports emotional growth and deliberately builds self-confidence—through mentorship, mindfulness, leadership opportunities, and communication training—schools and hospitals may help new nurses speak with patients more clearly and compassionately. In doing so, they could improve not just clinical conversations, but also the well-being of the nurses themselves as they step into a demanding profession.

Citation: Yu, J., Zhu, C., Ren, Y. et al. Alexithymia and clinical communication competence in nursing interns in China with the mediating role of self-efficacy. Sci Rep 16, 10615 (2026). https://doi.org/10.1038/s41598-026-44952-0

Keywords: nursing interns, clinical communication, alexithymia, self-efficacy, medical education