Patterns of Communication Competence Among Nursing Students Interacting with Older Patients During Clinical Placements: A Cross-Sectional Study

Abstract Background Population aging underscores the need to develop nursing students’ communication competence with older patients during clinical placements. However, conventional variable-centered approaches that focus primarily on overall competence scores may obscure the heterogeneity in how communication competencies are combined and expressed across learners. This study aimed to identify distinct communication competence patterns among nursing students interacting with older patients during clinical placements, characterize the defining features of each pattern through persona-based representations, and examine the factors associated with pattern membership. Methods A cross-sectional study was conducted among nursing students undertaking clinical placements at a tertiary teaching hospital in China. Data were collected through an online survey assessing general characteristics and nursing students’ communication competence with older patients. The elbow method with K-means clustering was used to identify distinct communication competence patterns, and discriminant analysis was used to assess the classification accuracy of the clustering solution. Persona-based visualizations were used to characterize the defining communication behaviors of each statistically identified pattern, and multinomial logistic regression was used to examine factors associated with pattern membership. Results Three distinct communication competence patterns were identified: Passive Responders, Rapport Builders, and Proactive Facilitators. The three patterns differed in their item-level configurations of communication behaviors when interacting with older patients. The frequency of caring for older patients during clinical placements, perceived gerontological nursing climate, and daily duration of socio-emotional communication were significantly associated with pattern membership. Conclusions Three distinct communication competence patterns were identified among nursing students, demonstrating heterogeneity in how communication competence is expressed during interactions with older patients. Persona-based representations provided an interpretable representation of the defining communication behaviors within each pattern, supporting differentiated communication education and targeted educational support during clinical placements.