Evaluation of the Relationship Between Internet Addiction and Communication Competence Levels of Nurses

: The purpose is to determine the evaluation of the relationship between internet addiction and the communication competence levels of nurses . This descriptive study was conducted with 347 nurses in a Training and Research Hospital in Turkey. Data were collected with the Communication Competence Scale and the Internet Addiction Scale. In the evaluation of the data, the IBM SPSS statistics 22.0 program was used for statistical analysis in the study. At the same time, they were evaluating the study data in addition to descriptive statistical methods. Pearson correlation analysis was used to evaluate the correlation between variables. Internet addiction and communication competence are, respectively, found to be 45.22±14.16 and 98.64±18.98. A negative and weak significant relationship (r=-.270; p˂.05) was found between internet addiction and communication competence levels. The study determined that as the level of internet addiction among nurses increased, their communication competence decreased. Therefore, awareness of the effect of internet addiction on occupational functions is essential.


INTRODUCTION
Communication is a process that involves two people understanding each other by sharing their feelings, thoughts, and information 1 . Communication is an element that should be used effectively in both nurse-patient relations and healthcare practices among health professionals. While the nurse theorist Peplau 2 defined nursing as a therapeutic interpersonal process, Watson 3 stated that the nurse and the patient are in therapeutic communication. The importance of interpersonal relations and communication in nursing practice was emphasized by other nurse theorists 4,5 . In the nursing theory of lack of selfcare, it is emphasized that nurses should have practical communication skills. At the same time, it is stated that technological development is required 5 . As a matter of fact, in the field of health, The use of the internet for recording patient data, accessing up-to-date information, communication, and patient education is becoming more and more common 6 .
With the increase in the use of the internet in business and social life, smartphones have become a part of daily life, along with computers and tablets. Smartphones, widely used for reasons such as communication, social relations, and access to information,

MATERIALS AND METHODS
It was conducted descriptively to determine nurses' communication proficiency and internet addiction levels, as well as the level of relationship between them. This study was conducted in a Training and Research Hospital in northwest Turkey. Five hundred nineteen nurses work at the hospital. Nurses who agreed to work from each hospital unit were included in the study. The study sample consisted of 347 nurses, 138 males, and 209 females, 50.4% of whom were undergraduates, with an average age of 32.2±6.08 years, an average of 6.2±4.09 years of employment, who agreed to participate in the study (Table 1).
In this study, nurses' data collection form, communication competence scale, and internet addiction scale were used to collect data. The personal data collection form: It is a form prepared to learn the age, gender, educational status, marital status, and working year of nurses. Communication Competence Scale (CCS): In this study, the communication competence scale developed by Wiemann 20 and adapted into Turkish by Koca and Erigüç was used to determine communication competence. As the scores on the scale increase, communication competence increases. While Cronbach's alpha reliability coefficient of the scale was 0.868 21 , it was found to be 0.766 in this study.

Internet Addiction Scale (IAS):
The IAS was developed to measure the internet addiction levels of individuals by Hahn and Jerusalem 22 . The Turkish validity and reliability study of IAS was done by Sahin and Korkmaz 23 . The sum of the scores obtained from the three subscales gave individuals' levels of internet addiction summarized as low (20-51), medium (52-67), and high (68-100) 24 . In the Turkish validity and reliability study of IAS, the Cronbach's alpha coefficient was 0.86, the loss of control subscale was 0.90, the tolerance development subscale was 0.88, and the negativity in the social relation subscale was 0.92 23 . In our study, Cronbach's alpha coefficient of IAS was 0.82, the loss of control subscale was 0.78, the tolerance development subscale was 0.81, and negativity in the social relation subscale was 0.74.
This research was conducted following ethical principles. Written permissions were obtained from the scale authors before the study. The ethics committee of this research was given with the approval letter of Taksim Training, and Research Hospital Clinical Research Ethics Committee dated 12.06.2019 and numbered 71. Participants who voluntarily accepted to participate in the study were informed about the research and their rights as necessary. Their "informed consent" and written consent were obtained before the research. All the rights of the participants were respected, and the principles of voluntariness and confidentiality were paid attention to specific statistics computer program was used for statistical analysis in the study. In contrast, they evaluate the study data in addition to descriptive statistical methods (mean, standard deviation, frequency, range). Pearson correlation analysis was used to evaluate the correlation between variables. The results were evaluated at the 95% confidence interval and the significance level of p<0.05. Internet addiction and communication competence levels of nurses are given in Table 2. The total mean score of the nurses' internet addiction scale was 45.22±14.16, and internet addiction was found to be at a low level. The scores of the nurses from the three sub-dimensions of the internet addiction scale were; loss of control at 16.88±6.31, the desire to stay online more at 10.29±4.12, and impairment in social relations at 18.06±7.2. The total mean score of the nurses from the communication competence scale was 98.64±18.98 (Table 2).  The relationship between nurses' internet addiction and total communication competence level scores is shown in Table 3. There is a negative and weakly significant correlation between the total score of nurses' internet addiction and communication competence total score (r = -.270, p < 0.05). It was determined that there was a negative and weakly significant relationship between nurses' loss of control score and communication competence score (r = -.174, p < 0.05); a negative and weakly significant relationship between the desire to stay online more and the communication competence score (r = -.259, p < 0.05), and a negative and weakly significant relationship between the impairment in social relations score and the communication competency score (r = -.230, p < 0.05) ( Table 3).

RESULTS AND DISCUSSION
With globalization and increasing technology, nurses use technology and the internet to learn, improve themselves, inform patients and their families, and follow evidence-based research and social relations. However, the widespread use of the internet in all areas brings the risk of internet addiction. Social media/smartphone/internet addiction, which has been determined to negatively affect work engagement in nurses 18 ( Table 2) and lead to procrastination and burnout 17 , has critical importance in terms of nursing practices. Therefore, this study investigated the relationship between nurses' internet addiction and communication competence level ( Table 2,3).

Table 3. The Relationship Between Nurses' Internet Addiction and Communication
Competence Scores*

Communication Competence Total Score
Loss of control r -,174 p ,001 The desire to stay online more r -,259 p ,000 The impairment in social relations r -,230 p ,000 Internet addiction total score r -,270 p ,000 * Pearson correlation analysis According to the scale used in this study, a score between 20-51 is low, a score between 52-67 is medium, and a score between 68-100 is defined as high internet addiction 23 . The total score of internet addiction of the nurses in the study was 45.22±14.16, indicating low-level internet addiction. However, this score is very close to medium-level internet addiction, which is between 52-67 ( Table 2). Similar results were found in previous studies conducted with nurses on the subject. In previous studies, It was determined that nurses had a low level of internet addiction 25 , a social media addiction below the average 17 , and a moderate level of mobile phone addiction 18 . According to these results, it can be said that internet addiction is a significant problem that should be addressed in the field of nursing.
According to the Self-Care Deficit Nursing Theory, the nurse's social, interpersonal, and professional-technological abilities are the leading indicators of nursing agency 5 . While technology increases nursing agency, its excessive use harms interpersonal relations. With the nurses staying online more, the time spent by the patient to increase their self-care agency of the patient decreases, and their communication with the patient weakens. In studies conducted with nurses, It has been determined that there is a negative relationship between nurses' internet addiction and time management score averages 16 , social media addiction reduces work engagement 17 , and mobile phone addiction causes procrastination.
In this study, a negative and weakly significant relationship was found between the internet addiction scale total score and all sub-dimension scores (loss of control, desire to stay online more, and deterioration in social relations) and communication competence level scale scores. It was determined that the communication competence levels of the nurses whose internet use control decreased, who wanted to stay online more, and who had problems in social relations due to excessive internet use decreased (Table 3). A study examining the relationship between internet addiction and communication competence in nurses could not be found. However, the result of this study supports the results of studies conducted in different sample groups. In the study conducted by Kırag and Guver 10 with nursing students, they found that internet addiction negatively affects interpersonal relationships. Nageeb and Al Enzi 12 found that communication skills