Interpersonal and communication skills development in nursing preceptorship education and training programmes: a scoping review protocol

Introduction

The preceptorship model is a teaching and learning strategy frequently employed internationally to educate undergraduate and graduate nursing students in the clinical environment. Billay & Myrick’s (2008, pg. 259) defines preceptorship as:

“an approach to the teaching and learning process within the context of the practice setting which allows students to develop self-confidence while increasing their competence as they become socialised into the profession of nursing”.

Acknowledging that up to 50% of undergraduate nursing curriculums take place in the clinical environment, the preceptorship model plays a pivotal role in the education of student nurses (McSharry & Lathlean, 2017; NMBI, 2016a; NMC, 2018). The preceptorship relationship is a purposeful short-term professional partnership in the practice setting between the preceptor (staff nurse) and a nursing student (preceptee) and is based on the provision of providing patient care. Hence within the preceptorship model, there are three members: the preceptor, the student nurse, and the patient, forming a triadic professional relationship. This relationship provides opportunities for nursing students’ socialisation into nursing practice and helps to integrate theory into practice, under the guidance of the preceptor (McSharry & Lathlean, 2017; Muir et al., 2013; Ward & McComb, 2017). The Nursing and Midwifery Board of Ireland (NMBI, 2016b) states that effective interpersonal relationships are not only essential for the foundation of effective patient care but also a successful teaching and learning environment. Therefore, the quality and support within this relationship contribute significantly to nursing student’s socialisation into the nursing profession and their learning (Ward & McComb, 2017) whilst also ensuring quality patient care and patients’ satisfaction in their nursing care (Suikkala et al., 2020a). Thus, the formation of a therapeutic interpersonal relationship between the preceptor, nursing student and patient is essential.

Kornhaber et al. (2016 pg. 537) define a therapeutic interpersonal relationship between the nurse and patient as:

“a relationship which is perceived by patients to encompass caring, and supportive non-judgmental behaviour, embedded in a safe environment during an often-stressful period”.

The authors believe that Kornhaber et al.’s (2016) definition of a therapeutic interpersonal relationship can also be applied to the interpersonal relationships between the preceptor and nursing student in which a preceptor provides non-judgmental support and guidance to the nursing student, creating a positive therapeutic professional relationship. Typically, a positive therapeutic relationship portrays characteristics of good interpersonal competence with meaningful dialogue that displays warmth, friendliness, genuine interest, respect, and empathy, while at the same time responding to patients’ emotions and having a desire to provide support and care (Dinç & Gastmans, 2013; Kornhaber et al., 2016; Prip et al., 2018).

In light of the increasing complexity of healthcare delivery, the importance of effective interpersonal relationships between the preceptor, nursing students and patients has grown exponentially. The literature emphasises the benefits of effective interpersonal and communication skills but also highlights the consequences of negative interpersonal interactions. Effective interpersonal relations have been shown to play a pivotal role in building trusting relationships and creating a caring and welcoming environment in nursing (Arnold & Boggs, 2020). This thereby improves communication between the preceptor, nursing student and patient, leading to person-centred care, patient satisfaction, patient empowerment and decreases adverse events among patients (Suikkala et al., 2020a; Suikkala et al., 2020b). Effective interpersonal relations also facilitate the development of knowledge, skills acquisition, and theory- practice integrations for nursing students (Irwin et al., 2018; Ke et al., 2017; Omer & Moola, 2019; Ward & McComb, 2017; Washington, 2013).

However, the literature to date also widely documents negative interpersonal relationships within this professional educational relationship and the clinical environment. Reports from both preceptors and nursing students exist regarding workplace incivilities such as rudeness, humiliation, anger, generational clashes, and inappropriate criticism from experienced preceptors (Dyess & Sherman, 2009; Gardiner & Sheen 2016; Omer & Moola, 2019). These challenging experiences consequently result in a negative learning experience for the student and, in some cases, interpersonal conflict occurs due to a breakdown in the preceptorship relationship (Hugo & Botma, 2019; McCloughen & Foster, 2018). Furthermore, it has been reported that displaying poor interpersonal skills, where there is a lack of emotional intelligence demonstrated by preceptors and student nurses, can result in negative feelings amongst patients, leading to a lack of trust and a possible breakdown in the relationship (Holst et al., 2017; Mukumbang & Adejumo, 2014). As educators, this is concerning to the authors, as fragmented relationships can have not only a negative impact on the student nurses’ learning experience but also on patient care (Cho et al., 2017; Suikkala et al., 2018; Suikkala & Leino-Kilip, 2005).

As with any human skill, interpersonal and communication skills, also referred to as “soft skills” can be improved through conscious effort (Moss, 2020). McConnell (2004, pg. 178) describes soft skills as “those essential skills involved in dealing with and relating to other people, largely on a one-to-one basis”. These include the ability to get along with others at a personal and professional level, and display levels of empathy towards the situation that others may be experiencing (Grant & Goodman, 2019). This process stimulates feelings of support, comfort, and recognition in individuals (Wright, 2007). Enhancement of interpersonal skills concerns several key components, including the individuals’ emotional intelligence, learning to recognise the uniqueness of everyone, empathising with the individual, learning to listen, effective communication, empowering others and building trust (Grant & Goodman, 2019).

Teaching effective interpersonal and communication skills requires providing the relevant knowledge, as well as guiding and coaching learning to develop and enhance these skills. It takes time and experience to build effective interpersonal and communication skills, beginning with foundational skills, for example, knowing when to use open-ended and closed-ended questions. More advanced listening skills paired with sensitivity and empathy generate highly effective interpersonal relationships (Pavord & Donnelly, 2015). Investing in developing preceptors’ interpersonal and communication skills is essential in maintaining good interpersonal relationships, an effective teaching environment and exemplary patient care. Preceptors not only have the responsibility of role modelling effective soft skills but also evaluating student nurses’ competencies in these skills as part of their clinical assessment document (NMBI, 2016a).

Teaching effective interpersonal and communication skills to preceptors requires providing the relevant knowledge, as well as guiding and coaching their learning to develop and enhance these skills. Therefore, the inclusion of such skills is paramount in preceptorship education and training programmes. Preceptors bring their own distinctive set of communication skills, cultural influences, learning styles and life experiences that directly affect their ability to engage in effective interpersonal relationships (Gardiner & Sheen, 2016). Nurse educators must build on preceptors’ strengths and experiences to enhance their interpersonal skills. A preceptor short of adequate interpersonal and communication skills cannot facilitate positive interpersonal relationships with the nursing students and patients (Martinez-Linares et al., 2019). Interpersonal and communication skills are practical skills. Therefore, nursing educators need to adapt teaching strategies that involve activities which allow opportunities for active participation to develop such skills, e.g., experiential learning opportunities (Reid-Searl et al., 2017). Pedagogical approaches observed in the literature include simulation practices such as the use of puppets (Reid-Searl et al., 2017), standardised patients (Lin et al., 2013; Maclean et al., 2017), real patients (Perry et al., 2013) and roleplay (Jackson & Back, 2011; Pearson & McLafferty, 2011). Other methods observed included clinical placement (Purdie et al., 2008), group discussions (Waugh et al., 2014), online discussion (Deering & Eichelberger, 2002), and audiotapes (Sloan, 2003).

The existing evidence outlined provides an overview of the importance of interpersonal and communication skills, particularly in the context of a nursing preceptorship relationship. This literature highlights the need for active development of these skills in preceptorship education and training programmes. However, an initial inspection of the literature demonstrates that the focus of interpersonal and communication skills development centres around nurse-patient relationships and is predominantly completed as part of an undergraduate nursing programme. Given the importance of effective interpersonal and communication skills for preceptors in not only facilitating and guiding such skills among nursing students and the patients, the authors feel it is therefore worthwhile to systematically examine the literature to identify what teaching strategies are being implemented to develop interpersonal and communications skills among trainee preceptors (qualified nurses). It is also important to determine if trainee preceptors are being afforded the opportunity to specifically develop interpersonal and communication skills required to facilitate and guide the triadic preceptorship relationship between the nurse, student nurse and patient.

A scoping review protocol will outline the approach that will be adopted to determine the available literature on the pedagogical approaches to developing interpersonal and communication skills among nursing preceptors as part of their preceptorship education and training programme.

Protocol

An exploratory scoping review approach will be employed to establish the nature and extent of knowledge relating to pedagogical approaches in preceptorship education and training programmes for the development of interpersonal and communications skills among trainee preceptors. Scoping reviews are used to map the concepts underpinning a research area and the primary sources and types of evidence available (Arksey & O’Malley, 2005). Scoping reviews present a broad overview of the evidence concerning a topic and are beneficial when investigating areas that are emerging to clarify key concepts, definitions and identify gaps (Lockwood et al., 2019; Page & Moher, 2017). Scoping reviews are also implemented to examine the breadth of the literature, as well as the conduct of research on a specific topic to inform the design of future research studies (Lockwood et al., 2019).

To the best of the authors’ knowledge, there are currently no scoping reviews examining the educational practices of nurse educators in developing interpersonal and communication skills among trainee preceptors. Therefore, the findings of this exploratory review will contribute to existing literature regarding current pedagogy for interpersonal and communications skills development in preceptorship education and training programmes. The findings of this review may benefit the wider society, considering that interpersonal relationships of a preceptorship not only play an essential role in providing effective patient care, but also in facilitating nursing education in the clinical environment. It will also contribute a theoretical and empirical basis for the future development of pedagogical approaches that aim to enhance interpersonal and communication skills in preceptorship education and training programmes. The scoping review protocol introduced by Arksey & O’Malley (2005) that encompasses a six-stage iterative framework, as well as Peters et al. (2020) updated approach to conducting scoping reviews, will guide this review protocol and subsequent scoping review.

Conclusions

This scoping review protocol has been designed in line with the latest literature and evidence (Arksey & O’Malley’s, 2005; Peters et al., 2020; Tricco et al., 2018) to create and perform a systematic scoping review. The distinguishing features of a scoping review will permit the authors to answer the specified research question, applying a systematic and evidence-based approach to identify the current knowledge on educational practices for the development of interpersonal and communication skills as part of preceptorship education and training programmes. It will also permit the authors to identify gaps in our knowledge base in this field which could justify new research and also inform the design, conduct and reporting of future research.

While this scoping review will not formally evaluate the quality of evidence available, it will provide an overview of the available literature that will inform the researcher on current educational practices for the development of interpersonal and communication skills as part of preceptorship education and training programmes. This knowledge may identify the gaps in training that are contributing to interpersonal conflicts in preceptorship relationships that are widely reported throughout the literature. Only articles in English will be used; however, there will be no restrictions on the country of origin where the publications were produced, which should therefore provide a diverse range of opinions and experiences. Following the open peer-review process and achieved approval, the authors will commence the systematic scoping review.

Data availability

No data are associated with this article.