Nurses work in a highly complex and unpredictable environment, where they face changes in patients' needs and work circumstances. They must retain adequate problem-solving abilities to determine the most suitable resolutions to the stressful situations they experience through their day-to-day work [1, 2]. Problem-solving is a critical part of the nursing daily working duties. When encountering a problem, nurses have to apply their intellectual and cognitive abilities to examine and recognize the situation and construct a proposed solution supported by evidence [3, 4].

Problem-solving proficiency is an intellectual and behavioral process requiring an advanced level of questioning that can help the nurse analyze the situation, suggest the most suitable solution, and apply it to solve the problem [5]. Therefore, problem-solving abilities are necessary for formatting, performing, and assessing nursing care [6], and this expertise can be boosted by academic education [7]. Education is the continuous development of individual and professional competency that prepares individuals to face daily life needs. This entails that the individuals be inspired and capable of constructing operative resolutions to their problems. Nursing students should learn to appraise the situations they encounter critically and apply nursing knowledge and skills to solve emerging problems effectively [8]. Problem-based learning (PBL) in nursing is a method of learning that enhances nursing students' abilities to utilize nursing theories in clinical practice through active involvement, problem-solving, and critical thinking. It requires nursing learners to use their knowledge and skills in new situations to achieve their goals [9].

Nursing students' acquisition of problem-solving skills is impeded by many factors, such as gender, personality traits, and the opportunities to practice problem-solving skills [10-12]. It is essential to exercise problem-solving by gathering information and producing knowledge regarding the problems [4]. Therefore, nursing students must identify the significance of communication skills and obtain sufficient capabilities in communication during their education process [4]. Communication is the process of information generating and exchanging between two or more individuals, which is crucial for nurses to provide high-quality and safe healthcare services to patients. Moreover, communication skills are essential to empower nurses to present their knowledge and exhibit it in practice [13]. Previous studies indicated that good communication skills are linked to nursing students' problem-solving abilities [1, 14].

Studying problem-solving and communication skills among nursing students will provide an attempt to offer a better understanding of both problem-solving abilities and communication skills, which will provide an opportunity to enhance nursing education. Although some studies investigated the relationship between nursing students' communication skills and problem-solving skills, this relationship has not been adequately addressed [14]. Therefore, this study aimed (1) to determine the problem-solving abilities and communication skills of undergraduate nursing students and (2) to identify predictors of the problem-solving skills of undergraduate nursing students.

This study investigated predictors of problem-solving skills of undergraduate nursing students. A cross-sectional correlational design was used on a large convenient sample of 489 undergraduate nursing students from six nursing schools in Jordan. The results showed that nursing students have a moderate level of problem-solving skills. They reported high positive and low negative attitudes toward communication skills. Male nursing students and students with negative attitudes toward communication skills have significantly lower problem-solving skills. Nursing students who consider themselves initiative and who have positive attitudes toward communication skills have significantly higher problem-solving skills.

The levels of problem-solving skills in this study were consistent with prior studies in Turkey [4, 20]. Another study conducted in Korea and included a convenience sample of 161 nursing students found that the total mean score for PSI was 119.23. Compared to the current study, nursing students in Jordan reported higher problem-solving skills [21]. A study conducted in Turkey examined the critical thinking and problem-solving skills of 93 nursing students. The study found that the mean total score of PSI was 87. 55(SD=2.65) and 86.32(SD=2.50) in two groups of nursing students [22]. In addition, a study conducted in Iran that included 322 undergraduate nursing students found that the mean score of PSI was 89.52 (SD=21.58) [23]. Compared to the current study, nursing students in Jordan reported lower problem-solving skills.

Nursing students in the current study reported high positive and low negative attitudes toward communication skills. Another study was conducted in Turkey included 170 nurses and 413 students studying at the nursing school. The study found that both groups had moderately good communication [24]. Another study conducted with 246 nursing students in Turkey found that nursing students reported moderate communication skills of 77.325(SD=11.33) [4]. A Finnish study was conducted to examine the effect of a pilot communication skills course on second-year medical students. Using the same tool as in this study, Koponen, Pyörälä & Isotalus [25] found that the median PAS and NAS scores before the course were 45 and 31, respectively. In another study in Spain, PAS and NAS mean scores were examined in a group of first-year medical and nursing students. The results showed that PAS and NAS mean scores were 51.43 and 23.05, respectively [26]. Compared to these results, nursing students in the current study had a comparable PAS mean score; however, these students had higher negative attitudes toward communication skills.

The female gender predicted better problem-solving skills than the male gender. On the contrary, Koc et al. [20] found that the problem-solving skills of male students were higher than those of female students, while no significant differences were found based on gender in other studies [4, 21, 23]. The finding that female students showed better problem-solving skills might be explained in a cultural context as women in the Arab culture face several challenges in the workplace. Despite the higher enrollment rates of females in Jordanian universities, the male-dominant community demands females to make further efforts in their tasks to prove themselves [27, 28]. Nursing students who considered themselves to be initiative reported better problem-solving skills as being initiative is a personality trait that facilitates creative problem-solving [29]. In this study, positive attitudes toward communication predicted higher problem-solving abilities, while negative attitudes toward communication predicted lower problem-solving abilities of nursing students. Kim and Sim [1] found that communication skills significantly affected problem-solving skills among clinical nurses. In addition, communication skills enhance nurses' understanding of patients' conditions and their perception of professionalism. Another study that included undergraduate nursing students also found that good communication skills improve students' problem-solving abilities [14].

The results indicated a moderate level of problem-solving skills, a high level of positive attitudes toward communication skills, and a low level of negative attitudes toward communication skills. Male gender and having higher negative attitudes toward communication skills were significant predictors of lower problem-solving skills while being an initiative having positive attitudes toward communication skills were significant predictors of higher problem-solving skills.