ORIGINAL ARTICLE

The Journal of Nursing Research h VOL. 23, NO. 2, JUNE 2015

Relationships Among Communication Competence, Self-Efficacy, and Job Satisfaction in Korean Nurses Working in the Emergency Medical Center Setting Min Sook Park1 & Yeonok Jeoung1 & Hye Kyung Lee1 & Sohyune R. Sok2* 1

RN, Doctoral Student, Department of Nursing, Graduate School, Kyung Hee University, Seoul, Republic of Korea & 2 PhD, RN, Associate Professor, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea.

KEY WORDS:

ABSTRACT Background: The communication competence of nurses working in emergency medical center settings is essential to establish a therapeutic nurseYpatient relationship. Education and strategic development are required to improve the communication competence of emergency room (ER) nurses. Purpose: This study was conducted to determine the relationships among individual communication competence, self-efficacy, and job satisfaction in Korean nurses in the emergency medical center setting. Methods: A cross-sectional descriptive design was adopted. The study sample included 214 nurses at 11 emergency medical centers in Seoul and Kyunggi-Do, Korea. Measures used included the Global Interpersonal Communication Competence, self-efficacy scale, and job satisfaction scale. The collected data were analyzed using the SPSS version 18.0 statistical software program and included descriptive statistics (frequency, percentage, mean, standard deviation, independent t test, analysis of variance, and Pearson’s correlation coefficient). Results: The degrees of communication competence and selfefficacy of ER nurses were good, with higher scores than the median values. However, the degree of job satisfaction was poor, indicating a lower score than the median value. Religious affiliation and previous participation in communication education each had a significant impact on communication competence. Religious affiliation and time of worse duty each had a significant impact on self-efficacy. Length of career (year) in the emergency medical center and type of hospital each had a significant impact on job satisfaction. Positive correlations were identified among communication competence, self-efficacy, and job satisfaction. Conclusions/Implications for Practice: This study supported the presence of significant correlations among communication competence, self-efficacy, and job satisfaction. Thus, it is necessary to develop training programs that are customized to individual characteristics such as self-efficacy and job satisfaction to improve the communicative competence of ER nurses.

emergency room, nurse, communication, self-efficacy, job satisfaction.

Introduction Today’s healthcare market requires cost-effective and differentiated service strategies for competitiveness (Byrne et al., 2012). Considering the characteristics of the modern healthcare environment such as rapid staff changeover, the proactive measures used to satisfy the various needs of healthcare consumers, and the collaborative nature of various occupations, communication plays an important role (Han, Sohn, & Kim, 2009; Merk & Bu¨ker, 2013). A hospital organization consists of various members whose communication with one another may result in conflicts. Because of the typical urgency of tasks, smooth communications among departments and colleagues in relation to patients are essential in a hospital (Kim, 2011; O’Connell & Gardner, 2012). Nurses comprise most staff in most hospitals and come into contact with other hospital staff and departments most frequently. All activities related to patients, the main customers of a hospital, are conducted through nurses (Dinh, Walker, Parameswaran, & Enright, 2012; Lee, 2008). Accepted for publication: October 24, 2013 *Address correspondence to: Sohyune R. Sok, No. 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea. Tel: +82 (2) 961-9144; Fax: +82 (2) 961-9398; E-mail: [email protected] The authors declare no conflicts of interest. Cite this article as: Park, M. S., Jeoung, Y., Lee, H. K., & Sok, S. R. (2015). Relationships among communication competence, self-efficacy, and job satisfaction in Korean nurses working in the emergency medical center setting. The Journal of Nursing Research, 23(2), 101Y108. doi:10.1097/jnr.0000000000000059

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As they are the ones who attend to the outpatients at an emergency medical center with acute or chronic diseases and are the ones who help these patients recover, nurses’ communication skills are essential to establish a therapeutic relationship with patients (Davis, 2012; Jang, 2010). The patients and their families express their requests to, and want them to be supported by, the nurses, and the patients want sufficient information to facilitate their recovery (Lee, 2008; Rose & Ramagnano, 2012). Indeed, communication is important in recognizing and strengthening the needs of patients at the contact point (Merk & Bu¨ker, 2013). Previous studies have shown that nurses with higher selfefficacy tend to have higher functional communication and superior problem-solving skills as well as show problem-centered coping behavior (Bong, So, & You, 2009; Im, 2011; Merk & Bu¨ker, 2013). Self-efficacy may be realized as self-confidence in critical situations at an emergency medical center in the performance of activities such as cardiopulmonary resuscitation or FAST TRACK and may be linked to job satisfaction (Kim, 2006; Lee, Y. O., 2006; Tyler et al., 2012). Considering the job satisfaction status of nurses worldwide, previous studies (Cominetti et al., 2013; Kim, 2011; Tyler et al., 2012) have shown that the job satisfaction of nurses in advanced nations such as the United States is higher than that in underdeveloped countries. In addition, previous studies (Jang, 2010; Kim, 2011) have reported that, in Korea, the current status of job satisfaction among nurses is lower than the global average. Furthermore, previous studies have highlighted further differences between nurses in Korea and in other countries in terms of communication competence, selfefficacy, and job satisfaction based on basic and clinical nursing characteristics (Cominetti et al., 2013; Im, 2011; Kim, 2006, 2011; Tyler et al., 2012). However, these studies focused on clinical nurses’ communication types, communication skills, job satisfaction, integra-

Min Sook Park et al.

tion into the organization, and self-concept as professionals (Bong et al., 2009; Hanafin & Cowley, 2003; Im, 2011; Jang, 2010), whereas other studies focused on various job environments, such as the operating (Kim, 2011; Lee, Chang, & Kim, 2007), emergency (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010; Yun & Park, 2008), and psychiatric (Kim, 2006) wards. Few studies, however, have focused on the correlations among the individual communication competence, self-efficacy, and job satisfaction of nurses in emergency medical centers. Therefore, this study is intended to provide basic data for education and strategic development to improve the communication competence of emergency room (ER) nurses. The research hypotheses are (a) the general characteristics of ER nurses affect their communication competence, selfefficacy, and job satisfaction and (b) communication competence, self-efficacy, and job satisfaction are correlated. Figure 1 shows the conceptual framework of this study. This study aims to (a) examine the general characteristics of study participants; (b) examine the degrees of communication competence, self-efficacy, and job satisfaction of ER nurses; (c) compare and examine the general-characteristic-based differences between nurses; and (d) examine potential correlations among these characteristics.

Methods Participants A cross-sectional descriptive design was adopted. The study sample included 214 nurses in 11 emergency medical centers in Seoul and Kyunggi-Do, Korea. Participants were recruited by random sampling using a coin toss. After research approval from the university, the questionnaires were distributed to 220 nurses who expressed a willingness to participate. The rate of response was 97.3% (214/220). Because of incomplete data

Figure 1. Conceptual framework.

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Communication Competence of Korean ER Nurses

submissions, data from only 214 participants were included in the final data set. The recommended sample size of this study was calculated using G power 3 analysis software (Faul, Erdfelder, Lang, & Bunchner, 2007), with significance = .05, medium effect size = .3, number of variables = 3, and power = .95. The minimum required sample size in this study was 134. Therefore, the sample size used was adequate.

Measures The study questionnaire was designed to measure general characteristics, communication competence, self-efficacy, and job satisfaction. General characteristics consisted of significant variables identified through a review of previous relevant studies. The 10 variables identified and included were age, marital status, religious affiliation, education, years in nursing, years in the emergency medical center, time of worse duty, type of hospital, prior communication education, and type of nursing care. Global Interpersonal Communication Competence developed by Hur (2003) was revised and used to measure the level of communication competency among the participants. The Global Interpersonal Communication Competence consists of 12 questions scored using a 5-point scale. Subscales include self-disclosure, empathy and perspective taking, social relaxation, assertiveness, concentration, interaction management, expressiveness, supportiveness, immediacy, efficiency, conversational coherence, and responsiveness. The possible score range was from 12 to 60, with higher scores associated with a higher level of communication competence. The reliability of this instrument in Im’s (2011) study was reported as Cronbach’s ! = .80. The reliability in this study was Cronbach’s ! = .82. The self-efficacy scale revised by Kim (2006) was used to measure the level of self-efficacy among the participants. It consists of 20 questions scored using a 5-point scale. The possible score range was from 20 to 100, with higher scores associated with a higher level of self-efficacy. The reliability of the instrument in Kim’s study was reported as Cronbach’s ! = .89. The reliability in this study was Cronbach’s ! = .86. Job satisfaction scale developed by Slavitt, Stamps, Piedmont, and Hasse (1978) was revised and used to measure the level of job satisfaction among the participants. It consisted of 30 questions scored using a 5-point scale. The possible score range was from 30 to 150, with higher scores associated with a higher level of job satisfaction. The reliability of the instrument in Song’s (2011) study was reported as Cronbach’s ! = .90. The reliability in this study was Cronbach’s ! = .89.

Data Collection The response data were collected by the author and an assistant researcher from April to September 2011. The survey consisted of a self-reporting questionnaire to be administered by the researcher and the assistant. Study participants completed the questionnaire while on duty. To improve the interrater reliability, the author and an assistant researcher received

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3 hours of training on data collection. Participants took approximately 15 minutes to complete the questionnaire.

Data Analysis The collected data were analyzed using the SPSS version 18.0 statistical software program (SPSS, IBM, Inc., Armonk, NY). General characteristics of the study participants were analyzed using descriptive statistics with frequency and percentage. The levels of communication competence, self-efficacy, and job satisfaction of nurses in emergency medical center were analyzed using mean and standard deviation. Differences in communication competence, self-efficacy, and job satisfaction according to general characteristics of nurses in emergency medical center were analyzed using independent t test and analysis of variance. A Scheffe’s test was used as the post hoc test. Correlations among communication competence, self-efficacy, and job satisfaction of nurses in emergency medical centers were analyzed using Pearson’s correlation coefficient.

Ethical Considerations This study was approved by the institutional review board of a university in Seoul, Korea. The participants were informed about the aims and methods of the study. Furthermore, they were told that their participation was voluntary and that they had the right to withdraw at any point. Participants were informed regarding anonymity and data confidentiality policies. The researchers received completed written consent forms from those who agreed to participate in this study.

Results General characteristics are shown in Table 1. Most of the participants was below 30 years old (64.0%) and single (69.6%). Almost all participants had either a college (52.8%) or university (41.1%) education. The largest group had a career length of less than 3 years (31.7%), followed by 5Y10 years (24.8%). The largest group had a career length in an emergency medical center for more than 5 years, followed by 3Y5 years (20.9%). Nurses on night duty (74.3%) were more burned-out than nurses on daytime or evening duty (25.7%). Most had not received any prior communication education (75.2%). Types of nursing care were team (44.9%) and functional (55.1%) nursing. Mean scores for communication competence, self-efficacy, and job satisfaction are shown in Table 2. The mean scores for communication competence were 41.42 (total score) and 3.45 (Likert score). The mean total score achieved a higher score than the median value score of 36. The mean scores for self-efficacy were 64.37 (total score) and 3.22 (Likert score). The mean total score achieved a higher score than the median value score of 60. Therefore, the communication competence and self-efficacy of participants were ‘‘good’’ based on scores higher than median values. By contrast, the mean scores for 103

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TABLE 1.

General Characteristics (N = 214) Characteristic

n

%

Age (years) G25 25 to G30 30 to G35 Q35

63 74 46 31

29.4 34.6 21.5 14.5

Marital status Married Single

65 149

30.4 69.6

Religious affiliation Yes No

113 101

52.8 47.2

Education College University Graduate school

113 88 13

52.8 41.1 6.1

Nursing career (years) G3 3 to G5 5 to G10 Q10

68 44 53 49

31.7 20.6 24.8 22.9

Emergency medical center career (years) G1 1 to G2 2 to G3 3 to G5 Q5

37 38 35 45 59

17.3 17.8 16.4 20.9 27.6

Time of worse duty Day, evening Night

55 159

25.7 74.3

Type of hospitala Third Second

102 112

48.1 51.9

Prior communication education No Yes

161 53

75.2 24.8

Type of nursing care Team nursing Functional nursing

96 118

44.9 55.1

a In Korea, hospitals are divided into two types according to size: the third and second hospitals. The third hospital is larger than the second hospital.

job satisfaction were 85.45 (total score) and 2.85 (Likert score). The mean score achieved a lower score than the median value score of 90. Thus, the degree of job satisfaction among participants was ‘‘poor’’ based on an achieved score that was below the median value. General-characteristics-based differences in communication competence, self-efficacy, and job satisfaction are shown in Table 3. In terms of communication competence, there were significant differences in terms of religious affiliation (t = 1.994, p = .047) and prior participation in communication education (t = j2.925, p = .004). In terms of self-efficacy, there were significant differences in terms of religious affiliation (t = 2.774, p = .006) and time of worse duty (t = j2.121, p = .035). In terms of job satisfaction, there were significant differences in terms of number of years of service in an emergency medical center (F = 2.654, p = .034) and type of hospital (t = j3.491, p = .001). On the post hoc test, degree of job satisfaction by number of years of service in an emergency medical center differed between the subgroup that had less than 1 year and the subgroup with greater than 1 year of experience. Correlations among communication competence, self-efficacy, and job satisfaction are shown in Table 4. The communication competence of the participants correlated positively with self-efficacy (r = .477, p G .001) and job satisfaction (r = .499, p = .004). In addition, a positive correlation was found between self-efficacy and job satisfaction (r = .313, p G .001).

Discussion In terms of the general characteristics of study participants, tiring night work was the task identified as most difficult (74.3%). ER centers are the only places that provide new patient medical services at night and have a high incidence of emergency treatments. Some studies (Byrne et al., 2012; Lee et al., 2007; Yun & Park, 2008) showed that ER nurses are under greater stress than their peers in other departments. As shown in O’Connell and Gardner (2012), ER nurses are in regular contact with people from widely diverse backgrounds. Therefore, before they become emotionally exhausted, it is necessary to carry out proactive interventions to enhance their communication competency, as poor communication skills lead to communication failure that may result in threatening situations and low job satisfaction. Currently, 55.1% of nurses work in the area of functional nursing. In critical emergency

TABLE 2.

Mean of Communication Competence, Self-Efficacy, and Job Satisfaction (N = 214) Total Score Variable

Likert Score

Item

Range

Communication competence

12

12Y60

41.42

4.72

3.45

0.39

1Y5

27

55

Self-efficacy

20

20Y100

64.37

7.93

3.22

0.40

1Y5

40

89

Job satisfaction

30

30Y150

85.45

11.71

2.85

0.39

1Y5

36

120

Mean

SD

Mean

SD

Likert

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Min

Max

Communication Competence of Korean ER Nurses

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TABLE 3.

Differences in Communication Competence, Self-Efficacy, and Job Satisfaction According to General Characteristics (N = 214) Communication Competence

Self-Efficacy

Job Satisfaction t/F

p/Post Hoc

85.44 12.95 84.78 11.93 85.91 9.14 86.38 12.38

0.168

.918

.254

86.49 9.72 85.00 12.48

0.857

.393

2.774

.006*

86.65 12.89 84.08 10.19

1.604

.110

63.50 7.61 65.24 7.87 66.00 10.53

1.482

.229

86.42 11.01 83.98 12.40 87.08 10.25

1.208

.301

.686

62.66 65.48 64.34 65.80

8.62 7.37 7.13 8.11

1.871

.135

86.28 13.44 85.11 12.68 83.58 8.87 86.82 11.08

0.791

.500

.994

64.24 64.47 62.86 63.93 65.64

8.78 9.89 7.74 7.12 6.68

0.730

.573

90.19 83.50 87.49 84.55 83.36

12.16 14.27 10.61 10.77 10.21

2.654

.063

65.07 62.45

7.46 8.92

j2.121

.035*

85.76 12.41 85.04 11.43

0.392

.306

64.53 64.17

8.18 7.76

0.337

.736

82.58 11.52 j3.491 88.05 11.36

.001*

5.05 j2.925 4.52

.004*

63.02 64.81

8.18 7.87

j1.405

.162

85.61 12.06 85.39 11.69

0.114

909

4.60 4.81

.328

65.34 63.58

8.35 7.52

1.628

.105

84.99 12.00 j0.552 85.83 11.50

.603

Characteristic

Mean

SD

t/F

p

Mean

SD

t/F

p

Age (years) G25 25 to G30 30 to G35 Q35

41.21 41.78 41.41 41.00

4.69 4.85 4.47 4.99

0.269

.848

63.02 64.64 64.85 65.77

8.91 7.37 7.36 7.90

1.02

.385

Marital status Married Single

42.31 41.03

5.01 4.54

1.827

.069

65.31 63.96

7.60 8.06

1.144

Religion Yes No

42.63 40.74

4.45 4.95

1.994

.047*

65.76 62.78

7.74 7.91

Education College University Graduate school

40.87 41.77 43.84

5.01 4.30 4.10

2.788

.064

Nursing career (years) G3 3 to G5 5 to G10 Q10

40.99 42.09 41.55 41.42

4.68 4.72 4.91 4.55

0.496

Emergency medical center career (years) ffi G1 ffl 1 to G2  2 to G3 Ð 3 to G5 ð Q5

41.14 41.47 41.45 41.50 41.61

4.52 5.12 5.08 5.31 3.92

0.059

Time of worse duty Day, evening Night

40.34 41.71

4.97 j1.868 4.54

Type of hospital Third Second

41.76 41.10

4.54 4.89

Prior communication education No Yes

39.75 41.93

Type of nursing care Team nursing Functional nursing

41.77 41.13

1.027

0.980

Mean

SD

034* ffi9ffl Ðð

.696

Note. Type of hospital: In Korea, hospitals are divided into 2 types according to the size: the third and second hospitals. The third hospital is bigger size than the second hospital. Post hoc by Scheffe method. *p G .05

situations in an ER, functional nursing may assist a small number of nurses to perform tasks without confusion. Functional nursing, however, may also result in inconsistent nursing care and cause patient needs to be overlooked, resulting in low job satisfaction.

The communicative competence of participants in this study was 3.45 T 0.39, which is lower than the 3.57 T 0.41 found in a study by Jang (2010) that targeted nurses in surgery and internal medicine and the 3.46 T 0.35 found in a study by Lee (2008) that targeted nurses in internal medicine, surgery, and 105

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Min Sook Park et al.

TABLE 4.

Correlations Among Communication Competence, Self-Efficacy, and Job Satisfaction Variable

Communication Competence

Communication competence

p

Self-Efficacy

p

Job Satisfaction

G.001

1

1

Self-efficacy

.477***

Job satisfaction

.499

G.001 .004

1 .313***

***p G .001

intensive care unit. The ER center is often the first place where patients are received for various internal medicine, surgery, and intensive care unit issues. Because of the crowded nature and urgency of the ER, most nursing activities are functional and performed quickly. As such, most communications are unilateral, without effective interaction (Merk & Bu¨ker, 2013; Yun & Park, 2008). In this regard, it is believed that, although functional nursing helps nurses perform effectively, it lacks the principles such as listening to patients’ needs and offering time to think, as outlined in Morse and Proctor (1998). This study revealed no difference in communication competency attributable to educational background. It is believed that there is little difference in individual preferences because of the functional nursing system, which focuses on partial tasks rather than consistent nursing. This study, however, showed that ‘‘having a religion’’ resulted in a difference in communicative competency, which is different from the result obtained by Jang (2010) and Kim (2006). This result is believed to be because of the individual characteristics of ER nurses. This religion-based difference highlights the effect of philosophy on nursing, through which nurses develop comprehensive perspectives of the human body and mind. This result highlights the need for a nursing philosophy or a vision of individuals, departments, or organizations (Merk & Bu¨ker, 2013). In addition, educating ER nurses on communication resulted in better communication competence. This result is believed to be because of the effect of communication education and is supported by previous studies (Im, 2011; Merk & Bu¨ker, 2013). Thus, communication education program is critical to improving the communication competence of ER nurses. The self-efficacy of the subject nurses in this study was 3.22 T 0.40, which is higher than the 2.83 T 0.32 of the general nurses studied by Bong et al. (2009) and similar to the 3.61 (of 6) of the psychiatric nurses studied by Kim (2006), although a different tool was used in the latter. As with the higher self-efficacy achieved in dealing with difficult patients, self-efficacy typically increases as difficult situations (e.g., acute diseases, emergency situations) are overcome swiftly and accurately while carrying out the nursing tasks and ensuring the survival of patients (Tyler et al., 2012). Although self-efficacy differed between nightshift and other nurses, no significant statistical difference was found among participants in terms of age, marital status, hospital type, total number of years of work, departmental experience, nursing task type, and prior communication training. This result is the same as obtained by Bong et al. (2009) and Tyler et al. (2012),

which found low job satisfaction among three-shift nurses. Night-shift work was found to be the biggest contributor to stress and job change. The change in biorhythms because of night shifts causes fatigue, boredom, and other physical symptoms as well as individual life changes (Lee, 2002; Lee, Hwang, Kim, & Daly, 2004). Thus, it is believed that physical changes and fatigue because of nightshift work lower self-efficacy (Lee, 2006a). In addition, the religious-affiliation-related difference identified in this study highlights the effect of belief, as it is believed that nurses with religion bring their affirmative beliefs into their nursing practice. This result is consistent with previous studies (Im, 2011; Lee, K. J., 2006). The job satisfaction of nurses in this study was 2.85 T 0.39, which is higher than the 2.03 T 0.63 of the ER nurses in the study by Yun and Park (2008) and lower than the 3.17 T 0.37 of the general nurses in the study by Jang (2010). As ER requires swift performance of tasks and emergency treatments to save patient lives, swift communication is required, which may increase self-efficacy if tasks are well performed. ER work also requires strong commitment amidst sudden changes in situation, the need to deal effectively with patients from diverse age groups and backgrounds, and the many variables involved in performing repetitive tasks. Therefore, it is believed that the job satisfaction of nurses will be degraded if they do not have the ability to cope with the foregoing (Cominetti et al., 2013; Hooper et al., 2010). Nurses are essential elements in a hospital organization. As they are the hospital’s spokesperson for the patients, their families, and visitors, they cannot perform effectively without job satisfaction, which will affect the organization (Park, Branch, Bulat, Vyas, & Roever, 2013). Job satisfaction highlights differences based on departmental experience and type of hospital. Departmental experience showed a difference between the 1-year-or-less subgroup and their greater-than-1-year counterparts. In terms of the type of hospital, the job satisfaction of nurses in smaller hospitals was higher than those in larger hospitals. A study by Han et al. (2009) found that the job change rate for nurses is highest among those with between 1 and 2 years of tenure. This study found lower job satisfaction among participants who had been working for over 1 year. This suggests the importance of developing strategies to improve the job satisfaction of nurses with less than 1 year of departmental experience and of those working in smaller hospitals. This study found positive correlations among communication competence, self-efficacy, and job satisfaction. The findings were consistent with previous studies (Im, 2011; Jang, 2010;

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Communication Competence of Korean ER Nurses

Merk & Bu¨ker, 2013; Tyler et al., 2012). It seems that improving communication competence may improve both selfefficacy and job satisfaction. Therefore, the program to enhance communication competence is necessary to improve the selfefficacy and job satisfaction of ER nurses.

Implications for Nursing Practice On the basis of the findings of this study, communicative competence affects and is affected by self-efficacy and job satisfaction. Therefore, increasing the communicative competence of nurses may positively affect the hospital organization and the recipients of nursing services. The ER is a special department where there are communication and therapeutic relationships with patients of various ages with a wide range of medical issues. Therefore, it is advised that communication programs for nurses be established to develop their communication competence and, subsequently, their self-efficacy and job satisfaction.

Conclusions This study identified key correlations among communication skills, self-efficacy, and job satisfaction. It will be necessary to develop field-centered training programs that are customized to the unique characteristics common to ER nurses and that adopt new approaches to the nursing philosophy and organizational vision to improve the communicative competence of these nurses. In addition, further qualitative research is necessary to determine the communication phenomenon by analyzing the interactive nurseYpatient communication process in a clinical context. Finally, repetitive research that extends the current research beyond ER nurses to other special departments is required.

Limitations The generalizability of this study is limited because the data were collected using random sampling from emergency medical centers in Seoul and Kyunggi-Do, Korea. These populations may differ from populations in other areas or regions in Korea. Despite this limitation, this study contributes to the existing literature on communication competence, self-efficacy, and job satisfaction in Korean nurses working in emergency medical centers.

Acknowledgments The authors are grateful to all of the participants who participated in this study.

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Relationships Among Communication Competence, Self-Efficacy, and Job Satisfaction in Korean Nurses Working in the Emergency Medical Center Setting.

The communication competence of nurses working in emergency medical center settings is essential to establish a therapeutic nurse-patient relationship...
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