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

Effective communication is a critical professional competency for nursing interns, which needs to be systematically developed in clinical education. Alexithymia is a personality trait characterized by difficulties in identifying, describing, and understanding one's own emotions. This cross-sectional study examined the mediating role of self-efficacy in the relationship between alexithymia and clinical communication competence among 216 nursing interns, with 208 valid responses (96.3% response rate). Using standardized measures (Toronto Alexithymia Scale, General Self-Efficacy Scale, Clinical Communication Competence Assessment Scale), results revealed elevated alexithymia levels (55.48 ± 10.31) alongside moderate self-efficacy (28.21 ± 4.64) and communication competence (84.67 ± 10.66). Spearman analysis demonstrated significant negative correlations between alexithymia and both self-efficacy (P < 0.05) and communication competence (P < 0.05), while self-efficacy was strongly and positively associated with all communication subdomains: relationship-building, active listening, problem identification, and affective validation (P < 0.01). Structural equation modeling identified self-efficacy as a partial mediator between externally oriented thinking (a core alexithymia component) and communication competencies, with mediation effects ranging from - 0.061 to - 0.099 (P < 0.01). These findings suggest that enhanced self-efficacy may mitigate alexithymia's detrimental effects on communication skill development. The study provides empirical evidence for implementing dual-focused educational strategies targeting alexithymia reduction and self-efficacy enhancement in nursing curricula. Such interventions could optimize trainees' clinical communication capacities while supporting psychological adaptation to healthcare environments, ultimately contributing to improved patient care outcomes and professional well-being.