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. 2024 Aug 21;11(8):e70003. doi: 10.1002/nop2.70003

The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses

Suyeon Noh 1, Younhee Kang 2,✉
PMCID: PMC11336653  PMID: 39166373

Abstract

Aims

To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses.

Design

Cross‐sectional descriptive design.

Methods

Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t‐test, one‐way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis.

Results

Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence.

Conclusions

The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence.

Implications for the Profession and/or Patient Care

The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical‐focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses.

Reporting Method

We have adhered to STROBE checklist.

Patient or Public Contribution

Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily.

Keywords: clinical reasoning, communication competence, oncology nurses, professional autonomy

What does this paper contribute to the wider global clinical community?

  • The identified factors influencing the clinical reasoning competence of oncology nurses include problem‐solving ability, communication competence and clinical decision making. However, these related factors have not been sufficiently explored.

  • Clinical experience, communication competence and professional autonomy predicted clinical reasoning competence of oncology nurses.

  • To improve clinical reasoning competence, nurse leaders must consider the need to enhance the communication competence and professional autonomy of oncology nurses. These insights have the potential to elevate the standard of oncology nursing worldwide.

1. INTRODUCTION

As cancer research continues to advance and the incidence of cancer rises, oncology nurses are tasked with ensuring continuity of care and providing more complex and supportive care (Kelly et al., 2020). Throughout the cancer treatment continuum, oncology nurses provide comprehensive care that meets the patient's physiological, psychological and social needs and are also integral partners in the clinical decision‐making process (Coombs et al., 2020). In 2021, there were 277,523 cancer cases in Korea, and the incidence and mortality rate of cancer has been rising steadily. In addition, cancer patients' 5‐year relative survival rate climbed from 65.5% between 2006 and 2010 to 72.1% between 2017 and 2021, thereby increasing the demand for cancer patients' care (Korea Central Cancer Registry & National Cancer Center, 2022). This trend is not limited to Korea, but is increasing worldwide, presenting similar challenges for oncology nurses around the world (WHO, 2023). Oncology nurses understand the complex pathology of cancer patients, manage severe pain and administer the most intensive nursing care to terminal cancer patients with poor prognoses (Duarte & Pinto‐Gouveia, 2017). Oncology nurses provide careful nursing to psychologically sensitive cancer patients and must possess a high level of clinical reasoning competence due to the need for precision in various cancer diagnostic tests and the administration of chemotherapy drugs (Park, 2014).

2. BACKGROUND

Clinical reasoning is a cognitive process used by nurses to collect and interpret data related to a patient's condition, make arbitration decisions and evaluate the effectiveness of mediation and the process itself (Holder, 2018). Clinical reasoning within nursing practice involves not just the individual patient but also embraces a broader, holistic approach that includes the patient's surrounding community (Vreugdenhil et al., 2023). Nurses apply clinical reasoning to interpret information and decide on the most appropriate action during emergencies (Griffits et al., 2023). Clinical reasoning based on critical thinking influences nursing performance positively (Leoni‐Scheiber et al., 2019) and has been presented as an essential element of safe administrative nursing, meeting complex patient needs and providing high‐quality care (Liou et al., 2016; Ruppel et al., 2019). Therefore, efforts are needed to identify the clinical reasoning competence of oncology nurses and explore relevant factors to improve them.

It has been demonstrated that the adequate communication competence of oncology nurses maintains a therapeutic relationship with cancer patients, meets their cognitive and emotional needs (Rochmawati & Minanton, 2020; Wittenberg et al., 2018), and produces high‐quality treatment results (Crist et al., 2022; Mojarad et al., 2019). Conversely, poor communication within the cancer ward can result in missed nursing care (Pan & Lin, 2022), underscoring the critical importance of nurses' communication competence. Communication competence is associated with critical thinking (Kwon & Kim, 2019), and critical thinking is an essential element of clinical reasoning (Griffits et al., 2023). Nurses' communication competence is a vital skill in clinical reasoning (Afriyie, 2020; Barratt, 2019) and is closely linked to professional autonomy (Park, 2018). However, oncology nurses have only been the subject of a limited number of studies.

The concept of professional autonomy refers to the developed capacity to create optimal patient care plans through collaborative interactions with other medical professionals, grounded in one's professional competency (Rouhi‐Balasi et al., 2020). Professional autonomy is related to sufficient communication competence and the ability to make rational decisions (Park & Jo, 2022). Moreover, as medical technology advances, nursing organizations are growing, and nursing professionalism is gaining importance (Son & Kim, 2018). In particular, nurses in cancer hospitals should have a high degree of professional autonomy, as they must prepare for different side effects of chemotherapy drugs, provide individualized care and manage severe cancer pain. Nurses' professional autonomy is statistically correlated with organizational commitment, job satisfaction, work performance and patient safety culture (Labrague et al., 2019; Lee & Choi, 2019). Nurses interact closely with patients, and having a high level of professional autonomy enables nurses to provide high‐quality nursing, thereby impacting the patient's treatment results positively (Lee & Kim, 2017). Prior studies have shown that professional autonomy is statistically correlated with clinical decision‐making (Pursio et al., 2021; Son & Kim, 2018), and the most substantial influence of professional autonomy is analytical competence (Park & Kim, 2019). In the light of this, it is believed that professional autonomy and clinical reasoning competence are closely related, necessitating additional research. The empirical linkage between professional autonomy and clinical reasoning competence is not well‐established in existing literature and presents a significant gap that this study seeks to address.

In summary, communication competence, professional autonomy and clinical reasoning are crucial competencies for oncology nurses, yet existing research often provides only a fragmented understanding of these competencies. Given the notable lack of studies that synthesize these factors within the specialized context of oncology nursing, this study aims to investigate the interrelationships among these competencies and identify the key factors that influence clinical reasoning competence.

3. THE STUDY

3.1. Aims

This study aims to investigate the relationships among communication competence, professional autonomy and clinical reasoning competence and to identify the factors that influence clinical reasoning competence in oncology nurses.

The primary aim of this study is to investigate the relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses. Specifically, we aim to:

(1) Assess the associations among communication competence, professional autonomy and clinical reasoning competence in oncology nurses.

(2) Identify the key factors influencing clinical reasoning competence, particularly the roles of communication competence and professional autonomy.

4. METHODS

4.1. Design

A descriptive correlational, cross‐sectional survey study design was used.

4.2. Participants and procedure

Data were collected during the period between 22 May 2020 and 26 May 2020 from oncology nurses employed in departments classified as cancer wards at secondary hospital (defined as facilities with more than 100 beds) or tertiary hospital (defined as facilities with more than 500 beds) located in South Korea. Participants were nurses with more than 1 year of clinical experience in these wards and who were directly involved in cancer patient care. In line with prior research that emphasizes the necessity of work adaptation and the relationship between practical experience and clinical reasoning competence (Griffits et al., 2023; Kim & Kwon, 2014), only nurses with more than 1 year of experience in cancer wards were selected for participation. Nurse managers and physician assistants were excluded to ensure the study focused specifically on bedside nursing staff. To calculate the appropriate sample size, hierarchical multiple regression analysis with a level of significance of 0.05, power of 0.80, a medium effect size of 0.15 and 13 predictors was performed using G*Power 3.1.9.4 Program (Faul et al., 2009). A minimum sample size of 131 was calculated. 160 nurses were recruited online to participate in this study. Thirteen questionnaires were excluded due to incomplete or insincere data. A total of 147 participants (91.9%) were included in the analysis.

4.3. Measures

Each variable was measured using instruments that were sufficiently proven reliability and validity in previous studies. A detailed description of each instrument is as follows.

4.3.1. Communication competence

Participants' communication competence was measured using Global Interpersonal Communication Competence Scale (GICC), a self‐reporting instrument with 15 questions. It consisted of self‐disclosure, empathy, social relaxation, assertiveness, concentration, interaction management, expressiveness, supportiveness, immediacy, efficiency, social appropriateness, conversational coherence, responsiveness and noise control. The score ranges from 15 to 75 on a 5‐point Likert‐type scale. A higher score indicates higher communication competence. Questions 10 and 11 were converted into reverse as presented in the original instrument. Cronbach's α for the original scale was 0.72 (Hur, 2003) and 0.83 in this study.

4.3.2. Professional autonomy

Participants' professional autonomy was measured using the Schutzenhofer Professional Autonomy Scale (SPAS), a self‐reporting instrument of 30 items. Each question was assigned a point value ranging from 1 to 3 depending on the importance of professional autonomy specified by the instrument developer. It is a 4‐point Likert‐type scale, and the level of professional autonomy is divided into three categories. The total score from 60 to 120 indicates a lower level of professional autonomy; from 121 to 180, a moderate level; and from 181 to 240, a high level of professional autonomy. Cronbach's α was 0.92 for the original scale (Schutzenhofer, 1987), 0.92 for the Korean version scale (Han et al., 1994) and 0.84 for this study.

4.3.3. Clinical reasoning competence

Participants' clinical reasoning competence was measured using the Nurses Clinical Reasoning Scale (NCRS), a self‐reporting instrument with 15 questions consisting of one factor. It is a 5‐point Likert‐type scale with a score from 15 to 75. A higher score indicates better clinical reasoning competence. The original scale had a Cronbach's α of 0.93 (Liou et al., 2016), the Korean version scale was 0.93 (Joung & Han, 2017) and in this study, it was 0.94.

4.3.4. General characteristics

General characteristics included age, gender, type of cancer ward, level of education, advanced oncology nursing certification, total clinical experience, position, the experience of clinical reasoning education, the experience of communication education, experience of working unit change and job satisfaction.

4.4. Ethical considerations

The research was conducted in accordance with the research plan and with the approval of the bioethics review committee of the researcher's organization to ensure the ethical protection of the participants (approval number: ewha‐202,005‐0018‐01). This study adhered to the principles of the Declaration of Helsinki (World Medical Association, 2013). Participants were informed of the study's purpose, method and usability, and informed consent was collected using a standardized form before participating in the study. The survey could only be conducted if they consented to participate voluntarily. It was explained that there would be no disadvantage to withdrawing from participation in the study midway, and gifts were provided as compensation for participants' time loss. To prevent participants' personal information from being exposed, data were collected using an anonymous questionnaire.

4.5. Data analysis

General characteristics and research variables were analysed by finding their frequencies, percentages, means, standard deviations (SD), minimum and maximum values and ranges. Differences in the variables to general characteristics were assessed using independent t‐test, one‐way ANOVA and Tukey's HSD post hoc test. Correlations between the variables were identified using Pearson's correlation coefficients. Factors influencing clinical reasoning competence were investigated by hierarchical multiple regression analysis. This method is selected for its ability to assess the impact of independent variables on a dependent variable while controlling for the effects of other variables (Richardson et al., 2015). These analyses were performed in SPSS Statistics 26.0 (IBM Corp., Armonk, New York, USA).

5. RESULTS

5.1. General characteristics of the participants

Of the 147 oncology nurses, 48.3% of participants were between the ages from 30 to 39, with an average age of 30.7 ± 5.1 year. The majority of the nurses were female (99.3%). Regarding the type of cancer ward, 63.9% of participants worked in a medical unit. The majority of the nurses (94.8%) were staff nurses without management positions, and 73.5% had no advanced oncology nursing certification. The average clinical experience was 6.4 ± 4.2 years, with 47 (32.0%) having more than 5 years and less than 10 years of experience. The percentage of participants who had never taken a clinical reasoning course was 71.4%, who had taken a communication‐related course was 57.1% and who had no experience with rotation was 58.5%. Job satisfaction averaged 6.2 ± 1.5 points, with 74.8% ranging from 4 to 7 points (Table 1).

TABLE 1.

General Characteristics of Participants (N = 147).

Characteristics Categories n (%) or M ± SD Range
Age (years) ≤29 69 (46.9) 23–29
30–39 71 (48.3) 30–39
40–49 7 (4.8) 40–40
30.7 ± 5.1
Gender M 1 (0.7)
F 146 (99.3)
Type of cancer ward Surgical unit 53 (36.1)
Medical unit 94 (63.9)
Education level College 14 (9.5)
University 108 (73.5)
≥Master 25 (17.0)
Advanced oncology nursing certification Yes 8 (5.4)
No 139 (94.6)
Total clinical experience (year) 1.0–2.9 36 (24.5) 1.0–2.9
3.0–4.9 29 (19.7) 3.0–4.9
5.0–9.9 47 (32.0) 5.0–9.9
≥10.0 35 (23.8) 10.0–22.1
6.4 ± 4.2
Position Staff nurse 116 (78.9)
Charge nurse 31 (21.1)
Experience of clinical reasoning education Yes 42 (28.6)
No 105 (71.4)
Experience of communication education Yes 84 (57.1)
No 63 (42.9)
Experience of working unit change Yes 61 (41.5)
No 86 (58.5)
Job satisfaction 1–3 8 (5.4)
4–7 110 (74.8) 1–3
8–10 29 (19.7) 4–7
6.2 ± 1.5 8–9
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5.2. The level of communication competence, professional autonomy and clinical reasoning competence

The participants' communication competence ranged from a minimum of 40 points to a maximum of 70 points, with an average of 56.14 ± 6.24. The professional autonomy of participants ranged from a minimum of 105 points to a maximum of 222 points, with an average of 167.90 ± 21.58 points, indicating moderate professional autonomy. Most of the participants (72.1%) had middle‐level professional autonomy. The clinical reasoning competence of participants ranged from at least 39 to 75 points, with an average of 59.72 ± 8.01 points (Table 2).

TABLE 2.

Level of communication competence, professional autonomy and clinical reasoning competence (N = 147).

Variables Range M ± SD or n (%) Min Max
Communication competence 15–75 56.14 ± 6.24 40 70
Professional autonomy 60–240 167.90 ± 21.58 105 222
Low level (60–120) 1 (0.7)
Middle level (121–180) 106 (72.1)
High level (181–240) 40 (27.2)
Clinical reasoning competence 15–75 59.72 ± 8.01 39 75
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5.3. Differences in communication competence, professional autonomy and clinical reasoning competence according to general characteristics

Significant differences in communication competence were observed by position (t = −2.94, p = 0.004), the experience of clinical reasoning competence education (t = 2.63, p = 0.010), and job satisfaction level (F = 8.94, p < 0.001). The Tukey HSD post hoc test showed that the group with a job satisfaction level of from 8 to 10 possesses higher communication competence than those with job satisfaction levels of from 1 to 3 and from 4 to 7.

There were noticeable differences in professional autonomy based on age (F = 11.06, p < 0.001), clinical experience (F = 7.28, p < 0.001), position (t = −1.99, p = 0.049), the experience of clinical reasoning education (t = 4.64, p < 0.001), the experience of communication education (t = 4.18, p < 0.001), the experience of working unit change (t = 2.03, p = 0.044) and the job satisfaction level (F = 5.96, p = 0.003). The Tukey HSD post hoc test revealed that the groups aged from 30 to 39 and from 40 to 49 had higher professional autonomy than those aged 29 and younger. Those with 10 or more years of clinical experience had higher professional autonomy than those with from 1.0 to 2.9 years, from 3.0 to 4.9 years and from 5.0 to 9.9 years of clinical experience.

Clinical reasoning competence varied significantly with age (F = 4.01, p = 0.020), clinical experience (F = 13.29, p < 0.001), position (t = −3.76, p < 0.001), the experience of clinical reasoning education (t = 2.12, p = 0.036), the experience of communication education (t = 3.03, p = 0.003) and the job satisfaction level (F = 4.97, p = 0.008). The Tukey HSD post hoc test indicated that the age group from 30 to 39 had higher professional autonomy than the group aged 29 or younger. Those with from 5.0 to 9.9 years of clinical experience and those with 10 years or more had higher professional autonomy than those with from 1.0 to 2.9 years and from 3.0 to 4.9 years of clinical experience. The group with a job satisfaction level of from 8 to 10 turned out to have higher communication skills than the group with a level of from 4 to 7 (Table 3).

TABLE 3.

Differences in communication competence, professional autonomy, and clinical reasoning competence related general characteristics (N = 147).

Variables Categories n Communication competence Professional autonomy Clinical reasoning competence
M ± SD t or F (p) M ± SD t or F (p) M ± SD t or F (p)
Age (years) ≤29a 69 55.97 ± 5.84 0.70 (0.501) 160.52 ± 18.49 11.06 (<0.001) a < b, c 57.84 ± 7.4 4.01 (0.020) a < b
30–39b 71 56.04 ± 6.55 172.86 ± 21.55 61.59 ± 8.07
40–49c 7 58.86 ± 7.17 190.43 ± 23.04 59.29 ± 9.83
Gender F 146 56.14 ± 6.26 −0.14 (0.891) 167.89 ± 21.66 −0.10 (0.923) 59.74 ± 8.03 0.34 (0.734)
M 1 57.00 ± 0.00 170.00 ± 0.00 57.00 ± 0.00
Type of cancer ward Surgical unit 53 57.08 ± 6.63 1.37 (0.174) 171.43 ± 23.51 1.50 (0.137) 59.83 ± 8.05 0.12 (0.902)
Medical unit 94 55.62 ± 5.98 165.91 ± 20.28 59.66 ± 8.02
Education level College 14 54.07 ± 6.49 0.87 (0.420) 161.71 ± 18.92 3.01 (0.053) 57.14 ± 8.73 1.83 (0.164)
University 108 56.31 ± 6.31 166.63 ± 22.54 59.52 ± 7.98
≥Master 25 56.60 ± 5.80 176.88 ± 16.16 62.04 ± 7.41
Advanced oncology nursing certification Yes 8 54.13 ± 7.30 −0.94 (0.349) 169.75 ± 18.61 0.25 (0.805) 57.00 ± 13.11 −0.99 (0.325)
No 139 56.26 ± 6.18 167.80 ± 21.79 59.88 ± 7.66
Total clinical experience (year) 1.0–2.9a 36 55.11 ± 5.51 1.95 (0.124) 158.14 ± 18.55 7.28 (<0.001) a, b, c < d 54.39 ± 7.67 13.29 (<0.001) a, b < c, d
3.0–4.9b 29 54.90 ± 6.44 165.21 ± 17.42 57.31 ± 8.52
5.0–9.9c 47 56.21 ± 6.74 167.83 ± 22.27 62.57 ± 6.63
≥10.0d 35 58.14 ± 5.81 180.29 ± 21.45 63.37 ± 5.96
Position Staff nurse 116 55.38 ± 6.42 −2.94 (0.004) 166.09 ± 21.62 −1.99 (0.049) 58.49 ± 8.17 −3.76 (<0.001)
Charge nurse 31 59.00 ± 4.56 174.68 ± 20.39 64.32 ± 5.34
Experience of clinical reasoning education Yes 42 58.24 ± 6.21 2.63 (0.010) 180.14 ± 19.54 4.64 (<0.001) 61.90 ± 7.60 2.12 (0.036)
No 105 55.30 ± 6.08 163.01 ± 20.46 58.85 ± 8.04
Experience of communication education Yes 84 56.99 ± 6.26 1.91 (0.058) 174.01 ± 20.33 4.18 (<0.001) 61.40 ± 7.40 3.03 (0.003)
No 63 55.02 ± 6.08 159.76 ± 20.63 57.48 ± 8.29
Experience of working unit change Yes 61 55.11 ± 6.83 −1.69 (0.093) 172.15 ± 20.99 2.03 (0.044) 59.43 ± 8.06 −0.38 (0.708)
No 86 56.87 ± 5.71 164.90 ± 21.61 59.93 ± 8.01
Job satisfaction 1–3a 8 51.00 ± 6.32 8.94 (<0.001) a, b < c 165.88 ± 20.82 5.96 (0.003) b < c 57.00 ± 8.00 4.97 (0.008) b < c
4–7b 110 55.56 ± 5.72 164.89 ± 20.04 58.86 ± 8.26
8–10c 29 59.76 ± 6.58 179.90 ± 23.90 63.72 ± 5.59
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Note: a,b,c,d = Tukey HSD test.

5.4. Correlations between study variables

Communication competence showed a strong positive correlation with clinical reasoning competence (r = 0.59, p < 0.001) and a moderate positive correlation with professional autonomy (r = 0.38, p < 0.001). Similarly, professional autonomy demonstrated a moderate positive correlation with clinical reasoning competence (r = 0.46, p < 0.001) (Table 4).

TABLE 4.

Correlations between study variables (N = 147).

Variables Communication competence Professional autonomy
r (p) r (p)
Professional autonomy 0.38 (<0.001)
Clinical reasoning competence 0.59 (<0.001) 0.46 (<0.001)
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5.5. Factors influencing clinical reasoning competence in oncology nurses

The hierarchical multiple regression analysis was used to identify the factors influencing oncology nurses' clinical reasoning competence. Clinical reasoning competence was entered into the equation as the dependent variable. The variables included were carefully selected based on prior research findings that underscore their relevance to clinical reasoning competence (Lee & Kwon, 2019; Park, 2018; Son & Kim, 2018; Song & Lee, 2016). Position (staff nurse), experience of clinical reasoning education (no) and experience of communication education (no) were selected as dummy variables in this regression model. This decision was based on their statistical significance, as demonstrated by the findings presented in Table 3. For the first step, general characteristics such as age, clinical experience, position, experience of clinical reasoning education, experience of communication education and job satisfaction were entered in Model 1. The first regression model explained 22.5% of clinical reasoning competence (F = 8.07, p < 0.001), in age, total clinical experience and job satisfaction level in the general characteristics were statistically significant. For the second step, when communication competence and professional autonomy were additionally taken into account, the final regression model explained 48.6% of clinical reasoning competence (F = 18.28, p < 0.001). In the final model, total clinical experience (β = 0.48, p < 0.001) ranked as the most influential factor that affected clinical reasoning competence, followed by communication competence (β = 0.44, p < 0.001), age (β = −0.31, p = 0.002) and professional autonomy (β = 0.27, p = 0.001) (Table 5).

TABLE 5.

Factors influencing clinical reasoning competence (N = 147).

Variables Model 1 Model 2
B SE β t p B SE β t p
(constant) 60.27 5.38 11.21 <0.001 21.21 6.33 3.35 0.001
Age (year) −0.48 0.19 −0.31 −2.58 0.011 −0.49 0.16 −0.31 −3.13 0.002
Total clinical experience (year) 1.07 0.25 0.57 4.38 <0.001 0.91 0.20 0.48 4.56 <0.001
Position a 0.06 1.86 0.00 0.03 0.973 0.57 1.53 0.03 0.37 0.710
Experience of clinical reasoning education b 0.08 1.50 0.00 0.06 0.955 −1.24 1.24 −0.07 −1.00 −0.997
Experience of communication education c 1.77 1.32 0.11 1.33 0.185 0.32 1.10 0.02 0.30 0.770
Job satisfaction 1.02 0.42 0.19 2.41 0.017 −0.06 0.37 −0.01 −0.15 0.877
Communication competence 0.56 0.09 0.44 6.16 <0.001
Professional autonomy 0.10 0.03 0.27 3.68 <0.001
R 2 (adjusted R 2) 0.257 (0.225) 0.514 (0.486)
F (p) 8.07 (<0.001) 18.28 (<0.001)
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a

Position (staff nurse = 0).

b

Experience of clinical reasoning education (no = 0).

c

Experience of communication education (no = 0).

The Durbin–Watson statistic in Model 1 was 1.396 and Model 2 was 1.735, close to the reference value of 2, indicating that the error terms were independent from each other, without any autocorrelation. To check for multicollinearity among the independent variables for the hierarchical regression analysis, tolerance and variation inflation factors (VIFs) were calculated. Tolerance was above 0.10, with a range of 0.359–0.815. VIFs were all below 10, with a range of 1.226–3.182, which ruled out multicollinearity. In normalized P–P plot of the histogram and regression analysis standardized residuals, the expected cumulative probability of the observed residuals rises close to a 45°straight line, confirming the normality of the error.

6. DISCUSSION

Oncology nurses who need to identify various symptoms of cancer patients and cope with oncology emergencies must possess a high level of clinical reasoning competence (Coombs et al., 2020). This study aimed to investigate the relationships among communication competence, professional autonomy and clinical reasoning and identify the factors that influence clinical reasoning competence among oncology nurses.

In this study, oncology nurses demonstrated higher communication competence than their counterparts in small and medium‐sized hospitals and university hospitals (Kang & Jung, 2019; Park & Chung, 2016). Among the general characteristics, the position for a charge nurse, those who have taken a clinical reasoning course, and those with higher the job satisfaction were associated with better communication competence. This finding is consistent with that of a previous study (Kim et al., 2019; Pan & Lin, 2022), which reported better communication competence and higher job satisfaction, as well as with the findings of a study that reported charge nurses had better communication competence than staff nurses (Song & Lee, 2016). It can be interpreted as meaning that complex oncology wards require nurses with high communication competence. In this study, however, the experience of communication competence education was not related to communication competence. This result suggests that communication education programmes for nurses should be improved. Recent studies utilizing a communication training programme consisting of simulation exercises and discussions on clinical cases have reported significant increases in communication competence scores (Shin & Cho, 2020). However, research on interventions to improve nurses' communication competence is limited, and their effectiveness is difficult to measure (Kerr et al., 2020). Therefore, in order to improve communication competence, research to design and systematically operate communication programmes reflecting clinical situations and verify their effectiveness is essential.

In this study, oncology nurses had higher professional autonomy than general hospital nurses and haematopoietic cell transplant ward nurses (Lee & Choi, 2019; Lee & Kwon, 2019). Because oncology nurses care for cancer patients with chemotherapy‐related side effects and handle sudden emergencies, they are more likely to work independently than general unit nurses. Among the general characteristics, job satisfaction level was related to professional autonomy in this study. This result was consistent with prior studies conducted on nurses working in medium‐sized hospitals (Lee & Kwon, 2019), indicating that higher professional autonomy of nurses can result in positive job satisfaction.

Participants' clinical reasoning competence scores were higher than those reported in a previous study conducted in Taiwan during NCRS development (Liou et al., 2016). Although NCRS was recently developed, and it was challenging to find other studies using it, the results of this study are in a similar context to those of previous studies in demonstrating that nurses performing complex tasks possess high analytical competencies (Holder, 2018). Greater clinical reasoning competence in oncology nurses have often been associated with older age, more clinical experience, higher position, clinical reasoning education, communication education and higher job satisfaction. The results are consistent with a prior study of paediatric nurses (Andersson et al., 2012) that showed significant differences in clinical reasoning competence depending on clinical experience, clinical reasoning‐related education and position. Interestingly, the findings showed that the group with communication‐related education demonstrated higher clinical reasoning competence compared to the group without training. This result implies a close relationship between communication competence and clinical reasoning competence. The interplay between communication skills and clinical reasoning becomes particularly vital in oncology nursing, where patient information can be complex and nuanced. Oncology nurses with high communication competencies can understand patients' key complaints and use clinical reasoning competencies to elicit additional information through pertinent questions. Enhanced communication competence not only facilitates a clearer understanding of complex patient information but also enables nurses to interpret and integrate these details more effectively into their clinical reasoning processes.

In this study, communication competence, professional autonomy and clinical reasoning competence were correlated significantly, and regression analysis confirmed that communication competence and professional autonomy affect clinical reasoning competence. Nurses with excellent communication competence can elicit and verify meaningful information through smooth interaction with patients who find it difficult to explain their symptoms adequately. Therefore, they are expected to have high clinical reasoning competence. In addition, the higher the level of professional autonomy, the higher the clinical reasoning competence, as the nurse clearly understands the patient's condition and takes the initiative accordingly. Based on the study results, steps to strengthen communication competence and increase professional autonomy should be taken to improve oncology nurses' clinical reasoning competence.

According to one study, when role‐playing and discussion were combined with theoretical instruction in communication education programmes, communication competence scores improved (Shin & Cho, 2020). However, research on developing communication training programmes for clinical nurses remains limited (Kerr et al., 2020). Additionally, 42.9% of the participants of this study reported that they had not received communication training, and there was no difference in communication competence depending on whether or not to take communication education. This means that a systematic communication education programme for nurses is needed. Therefore, in order to improve communication competence, it is necessary to identify areas in which nurses are deficient in communication competence and to develop practical communication education programmes that reflect these deficiencies and provide regular education.

This study showed high levels of professional autonomy in groups with experience of working unit change, similar to the results of the previous study (Kim & Kim, 2018). Having diverse clinical experience in different units can allow nurses to function independently. Professional skills and clinical experience are factors that promote professional autonomy (Pursio et al., 2021). Thus, regular working unit shifts can contribute to the professional autonomy of nurses. Furthermore, participants with high levels of clinical experience and job satisfaction in this study were also found to have high levels of professional autonomy. In the light of this result, efforts must be made to retain experienced nurses and increase job satisfaction in order to increase the professional autonomy of nurses.

In summary, the findings of this study add a novel dimension to our understanding of oncology nursing by explicitly connecting communication competence and professional autonomy with clinical reasoning competence. Prior research has established the value of these competencies independently, but this study draws a direct link between them within the specific context of oncology nursing. To improve nurses' clinical reasoning competence, it is necessary to implement strategies that can enhance their communication competence and professional autonomy. Due to the fact that communication education and communication competencies were not statistically significant in this study, it is crucial to continue developing and implementing communication programmes that reflect clinical situations in detail for nurses to achieve high communication competence. In order to enhance nurses' professional autonomy, it is necessary to create a work environment in which experienced nurses can perform their jobs satisfactorily and build clinical careers through regular changes in working units.

6.1. Strengths and limitations of the work

The research findings not only demonstrate significant positive relationships among communication competence, professional autonomy and clinical reasoning but also identify key predictors. These insights contribute to a more comprehensive understanding of clinical reasoning in the field of oncology nursing. The study has shown that communication competence and professional autonomy are influential factors in the clinical reasoning abilities of oncology nurses. However, our analysis did not account for geographic location or the size of the hospitals, which suggests that the specific regional and institutional contexts of the participants necessitate a cautious approach when extending our findings to oncology nursing populations in different settings. We acknowledge the constraints that may arise from our adherence to the Declaration of Helsinki. For instance, our commitment to the principles of voluntary participation and informed consent may have narrowed the pool of participants and potentially incurred a selection bias. Additionally, the reliance on self‐reported data is another limitation, as it may not accurately reflect actual competencies, given the potential for self‐assessment bias.

6.2. Recommendations for further research

This study's reliance on self‐assessment methods for evaluating communication competence, professional autonomy and clinical reasoning competence suggests the need for future research using more objective evaluation techniques, like peer observations. Additionally, considering the limited research on nurses' clinical reasoning competence, it is recommended that future studies repetitively measure these abilities and explore additional influencing factors, broadening the understanding of this critical competence.

7. CONCLUSION

The study found that communication competence and professional autonomy had a significant correlation with clinical reasoning competence. This study also provided insight into factors that affect the clinical reasoning competence of oncology nurses. The regression analysis revealed that age, total clinical experience, communication competence and professional autonomy accounted for 48.6% of clinical reasoning competence. The results showed that the higher the communication competence and professional autonomy of oncology nurses, the higher their clinical reasoning competence. Therefore, to enhance their clinical reasoning competence, oncology nurses must strengthen their communication competence and professional autonomy.

In order to improve nurses' communication competence, practical‐focused communication education programmes must be designed and deployed systematically and periodically. Educational programmes focusing on effective communication in crisis situations are recommended, as they equip nurses to handle high‐pressure scenarios and support their clinical reasoning during these challenges. Furthermore, training in communication through digital devices is crucial, enabling nurses to effectively utilize modern healthcare technologies for optimal patient care and communication. Additionally, increasing nurses' professional autonomy necessitates expanding their clinical experiences through the regular rotation of working units. Institutions should also make concerted efforts to retain experienced nurses. Establishing a clear rotation schedule is essential to ensure exposure to various clinical settings. Implementing a mentorship programme during these rotations can provide valuable support and learning opportunities, aiding nurses in adapting to diverse healthcare environments. To further foster career advancement, institutions ought to offer specialized training and certification programmes in fields such as oncology, thus enabling nurses to develop targeted expertise. Supporting nurses in research and collaborative healthcare projects can broaden their experience and contribute to nursing innovation, enhancing both their professional growth and patient care.

8. RELEVANCE TO CLINICAL PRACTICE

Oncology nurses play an important role in coping with various emergency situations that may occur during chemotherapy and radiation therapy, so they require a high level of clinical reasoning competence. The results of this study identified the influencing factors of clinical reasoning competence and laid the foundation for improving clinical reasoning competence. It was confirmed that the communication competence and professional autonomy of the oncology nurses were important factors influencing the clinical reasoning competence. In clinical practice, attention should be paid to improving communication competence through systematic communication education and periodic evaluation. In addition, in order to increase professional autonomy, institutional efforts are needed to carry out regular department transfers so that nurses can have various clinical experiences and be satisfied with their work. Effective implementation of these strategies involves addressing logistical challenges such as aligning training schedules with nursing shifts, ensuring resources for education programmes, maintaining patient care during rotations and providing necessary technological support for digital training tools.

AUTHOR CONTRIBUTIONS

Suyeon Noh: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing–original draft. Younhee Kang: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing–review & editing.

FUNDING INFORMATION

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

ETHICS STATEMENT

Ewha‐202005‐0018‐01, Ewha Womans University.

ACKNOWLEDGEMENTS

We are thankful to all the oncology nurses who voluntarily participated in the study.

Noh, S. , & Kang, Y. (2024). The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses. Nursing Open, 11, e70003. 10.1002/nop2.70003

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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