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

The preceptorship model is an education-focused model for teaching and learning within a clinical environment in nursing. It formulates a professional educational relationship between a staff nurse (preceptor) and student nurse and is based on the provision of providing patient care. Preceptorship is widely acknowledged in the literature as a positive pedagogical approach in clinical nursing education in terms of knowledge and skill acquisition, confidence, and professional socialisation of undergraduate nursing students. However, the literature also widely reports negative interpersonal experiences within this professional educational relationship resulting in negative educational experiences and in some cases, negative patient experiences. Therefore, the authors set out to examine what teaching strategies are being implemented by nurse educators to encourage the development of interpersonal and communication skills in facilitating positive interpersonal relationships between the preceptor, nursing student and patient. This paper outlines the protocol for an exploratory scoping review that aims to systematically and comprehensively map out the available published and unpublished literature on the teaching strategies to develop interpersonal and communication skills in preceptorship education and training programmes. To conduct a systematic and comprehensive scoping review, the review will be guided by the Joanna Briggs Institute and Arksey & O’ Malley (2005) six-stage iterative framework, as well as PRISMA-ScR framework guidelines, to ensure the quality of the methodological and reporting approaches to the review. It is anticipated that the results of the scoping review will inform nurse educators on the current educational practices for developing interpersonal and communication skills in preceptorship education and training programmes and identify any educational practices that are worthy of further consideration for future research.


Introduction
The preceptorship model is a teaching and learning strategy frequently employed internationally to educate undergraduate and graduate nursing students in the clinical environment. Some debate exists regarding the definition and function of preceptorship, for example 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". Carlson (2013, pg.457) further defines preceptorship "as a trusting relationship between preceptor and student.... where the preceptor strives to create a safe and meaningful interactive relationship with the student...... thus supporting the student's ability to implement generalized theoretical knowledge into patient-centered problems". Another key function of a preceptorship not captured in the previous definitions is the preceptor's role in the assessment of students' competencies. Vae et al., (2018, pg.13) states "the students' learning process is dependent on high-quality assessment processes and feedback from preceptors permitting students to critically reflect on their practice and learn for that experience".
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 ( (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 their 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".
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). It is therefore essential that preceptors are proficient in these skills, which will enable them to provide patient-centered care, while also utilising teaching techniques such as role modelling, coaching and contextual questioning to facilitate the student's learning (McSharry, 2013). For this reason, there needs to be a strong educational and trustful professional relationship between the preceptor and student nurse, so that positive therapeutic interpersonal relationships can then be developed with patients. 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 ( . 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

Amendments from Version 1
Many thanks to our reviewers for their suggested comments and suggestions. The article has been updated accordingly to reflect some of this feedback. Version 2 of this scoping review protocol includes minor additions including a broader definition of preceptorship and change in the narrative describing the interpersonal relationship between the preceptor and student nurse. The data extraction template has been modified to include additional items as suggested by the reviewers. 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 engage 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). 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 may be able to facilitate positive interpersonal relationships with the nursing students and patients (Martínez-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 ( 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 ( 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.

Aim and objectives
The overall aim of the scoping review is to identify, explore and map the literature regarding the development of interpersonal and communication skills for preceptors as part of their preceptorship education and training programme. This will be achieved by addressing the following objectives: 1.
Determine the extent and nature of existing literature on the development of interpersonal and communication skills in preceptorship education and training programmes, so that the literature can be examined and mapped out,to identify any gaps.

2.
Examine current educational practices for the development of interpersonal and communication skills in preceptorship education and training programmes, to identify any educational practices that are worthy of further consideration for future research. Joanna Briggs Institute (JBI) three-step process for applying a search strategy will be implemented (Peters et al., 2020). Firstly, an initial search was deployed on CINAHL Plus, the identification of search terms was conceptually based on an oriented search to identify key text words used to address the major concepts which include population (preceptors), concept (interpersonal and communication skills development), and context (nursing preceptorship education and training programme). Synonyms for each of the concepts will also be included. Each search strategy will be adapted to the functionality of each database using specific Boolean operators, truncation markers, and MeSH headings where necessary to broaden the search and capture all literature that may use such terms. McGowan et al. (2020) state the input of a research librarian is invaluable when carrying out a scoping review; the authors worked with an expert university librarian (D.S.) in designing and refining the search strategy. Table 1 outlines the keywords for each search string.  Results from strings 1, 2, 3 will be combined to reveal a full list of articles to be initially screened by title and abstract As per the second stage of the JBI search strategy protocol, the same keywords from Table 1 will be searched in the remaining aforementioned databases. During this stage, the research team will review and 'hand search' the reference list to identify any additional relevant studies. Given that this is an exploratory scoping review, the authors are interested in identifying all literature including RCTs, exploratory studies and discussion papers. Therefore a "web search" of the grey literature will also be conducted using "OpenGrey" and "Google Scholar". Specific educational policy publications by regulatory and professional bodies for preceptorship education and training programmes will also be searched to examine the focus of interpersonal and communication skills required for a preceptorship role. Table 2 outlines the search terms for grey literature and regulatory and professional bodies for preceptorship education and training programmes.

Stage 3: Study selection
Each search conducted will be systematically documented (date, search terms, results per string) and saved by two independent authors (PH, AD), with the findings of the searches compared and then imported into Mendeley (1.19.6 / 2020), a bibliographic reference manager, where any duplicates of literature will be removed before the initial screening of title and extract is divided out and screened by all of the authors. Covidence screening and data extraction software tool (www.covidence. org) will be utilised by the authors for screening. Each article will be required to be approved by two independent screeners before either being included or excluded in the review. A pilot testing of articles (n=50) using Covidence software package and inclusion and exclusion criteria will be undertaken by the authors to ensure consistency of the methodology adopted in the selection process (Peters et al., 2020). Full text screening will then be carried out on all articles that meet the inclusion criteria during the initial screening round by two independent authors (PH, CR). For any articles in which a disagreement may arise a third independent author (AL) known as the "tie-breaker" will further review the article against the inclusion criteria to settle the difference of opinion. The number of articles identified, screened, assessed for eligibility, and included in the review will be captured using the Covidence software package. A PRISMA flow diagram will be created to ensure transparency of reporting, decisions for the exclusion of studies permitting replication and comparison of any further studies.
The inclusion and exclusion criteria, highlighted in Table 3, will be developed through an iterative process based on the PCC elements of the review question, plus a specification of the types of studies that have addressed the scoping review question and discussions amongst the authors (McKenzie et al., 2020). The primary author will record any changes. All authors will utilise and adhere to its criteria during the screening process to ensure consistency. Table 3. Inclusion and exclusion criteria for scoping review.

Inclusion Rationale
Articles written in the English Language Searches will be limited to English language due to increased resource challenges concerning costs, time, and expertise in non-English languages.

Publications between 2000 and 2020
The search will be conducted for literature published within the last twenty years.
Peer-reviewed empirical studies with either qualitative or quantitative data, mixed methods, reviews, book chapters and grey literature with a principal focus on the development of interpersonal and communication skills in preceptorship education and training programmes.
The focus of the review is to examine the development of interpersonal and communication skills in preceptorship education and training programmes; Peer-reviewed empirical studies will provide reliable and a high standard of evidence. Grey literature will capture unpublished works and local evaluation of preceptorship education and training practices.

Non-English Language Studies
The English language is the primary language of the research team. Therefore, all non-English studies will be excluded due to the constraints of time, cost, and translator availability.

Studies relating to the development of interpersonal and communication skills in non-preceptorship nursing education
The focus of this review is to establish current educational practices for the development of interpersonal and communication skills in preceptorship education and training programmes. Therefore, studies that are not specifically part of a preceptorship education and training programme will not be included.

Stage 4: Data charting
In this stage, a data extraction form will be created by the lead author (PH) ( Table 4) based on JBI (2020) data charting form, mapping it with the objectives and research question of the scoping review (Peters et al., 2020) and piloted on two articles by all authors. Any changes to the chart will be documented and reported in the final scoping review for transparency in the reporting.
Stage 5: Collating, summarising and reporting the results Each data charting form will be logged electronically using Microsoft Excel to capture relevant information for each study and will be available for all members of the research team via a shared drive. All authors will discuss the data before a descriptive analysis commences. As recommended by Peters et al.
(2020), the analysis of data extracted should not involve any more than descriptive analysis to achieve the desired outcomes of a scoping review. Therefore, a narrative report will be produced, using a deductive thematic analysis approach summarising the extracted data concerning the objectives and scoping review question, for example, the pedagogy adopted for interpersonal and communication skills development and the impact of such training on trainee preceptors. Identification of areas in which a gap in the literature exists will also be reported. Quality appraisal of studies will not be conducted, as this review aims to explore the general scope of research conducted in the field of interpersonal and communication skills development in preceptorship education and training programmes and identify current pedagogical practices implemented to contribute a theoretical and empirical basis for the future development of preceptorship education and training programmes.

Stage 6: Consultation and dissemination
Initial findings from the scoping review will be presented to several stakeholders. The primary author (PH) will disseminate the results of the review with local academic networks within the authors' place of work (third level institution) and associated clinical settings. The author will specifically report the findings to Clinical Placement Coordinators (CPC), who typically develop and facilitate preceptorship education and training days in the clinical settings in Ireland. The primary author will also share the results at the Clinical Skills Network of Ireland in which he is a stakeholder to reach a national targeted audience. The authors will engage with these groups to share and discuss our findings and interpretations to capture their perspective on the evidence identified. The primary author also aims to deliver an oral or poster presentation at National and International conferences such as the International Nursing & Midwifery Research and Education Conference, scheduled for March 2022. Finally, the authors aim to publish the scoping review findings in a peer-reviewed journal for a wider communication of the results. All data generated and analysed during the scoping review will be included in the published scoping review article; including search results, list of included studies, data extraction spreadsheets and final results, to ensure transparency and reproducibility of the review.

Study status
This study is at Stage 2 -a preliminary search of the literature has been conducted and the software packages Mendeley and Covidence have been trialled. 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 enable 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.

Conclusions
While this scoping review will not formally evaluate the quality of evidence available, it will provide a comprehensive 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 utilised; 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, experiences and cultural contexts. 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.

Karen Poole
Faculty of Health and Medical Sciences, School of Health Sciences, University Of Surrey, Guildford, UK Thank you for inviting me to review this protocol. The authors make a compelling case for conducting a scoping review on the pedagogic practices used to develop communication and interpersonal skills in nurse preceptors. This protocol draws upon the most recent guidance for the conduct of scoping reviews, with a clear and well written account of the planned search strategies, data extraction and dissemination plans.
In terms of "context" scope, it may be helpful to clarify if you are including the educational preparation of preceptors for supporting Newly Qualified Nurses taking part in preceptorship programmes as well as undergraduate nursing programmes.
I agree with Elisabeth Carlson (first reviewer) regarding the difficulty of applying the concept of the therapeutic relationship to the preceptor and nursing student. There are characteristics that are relevant, but I am not sure whether it is a faithful representation of this concept. You may wish to consider a minor revision to this paragraph? Preceptors have a critical role in shaping students' clinical experiences, but are also responsible for assessing their developmental progress both formatively and summatively (often in a placement of short duration). As such, there is a complex relationship between preceptors and nursing students and the use of effective communication and interpersonal skills (in both parties) is essential in negotiating learning opportunities and navigating safe honest formative feedback/feed-forward that enables students to optimise learning in practice placements through their programmes.
Here are a couple of minor suggestions for inclusion in your plans for data extraction: capture of "nursing field" (learning disability, mental health, child, adult).
○ capture of whether the educational strategies include both preceptors and students or preceptors alone.

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This scoping review has the potential to make an important contribution in shaping how preceptors are prepared and support the future nursing workforce. The preceptor holds a dual role of practitioner and teacher. The preceptor must utilise complex teaching strategies to the foster the student's ability to practise nursing competently and compassionately. One of the core competencies inherent in all nursing programmes is the student's ability to communicate effectively and develop positive professional interpersonal relationship with both patients and other health care professionals. It is essential that the preceptor trainee is proficient in these skills in order to be able to provide patient centered care and utilise the teaching techniques of role modelling, coaching and contextual questioning to facilitate the student's learning. Students often find these skills a challenge to learn and preceptors often undervalue their own professional interpersonal communication skills ( Mallik et  al  Preceptorship preparation varies in length and content and some studies have reported that preceptors do not feel adequately prepared for their teaching and assessment role. This scoping review focusing on interpersonal and communication skill development of preceptor trainees will contribute to existing literature that can inform the development of preparation programmes both nationally and internationally. It has the potential to contribute to pedological approaches that enhance both preceptor trainee skills and student's interpersonal and communication skills. Any enhancement in these skills are can only positively contribute to the provision of quality person-centered care. The protocol is clearly written with well-defined aim and objectives, inclusion and exclusion criteria and appropriate search terms. It aligns wells to recent writings on methodological guidance for the conduct of scoping reviews. I have 3 suggestions that the authors may find useful in refining this protocol: Page 3 The definition of preceptorship offered is valuable and constitutes many of the attributes of the preceptorship model. Carlson (2013) definition develops on this definition and may be more appropriate. The preceptorship model in the Irish context further involves an assessment role which is not specified or encapsulated within these definitions as they are presented. ○ Page 3 I would not entirely agree the preceptor-preceptee relationship is a therapeutic interpersonal relationship. This type of relationship is associated with a long term mentorstudent relationship. The preceptor has to ensure the student gains the competencies required to pass the placement and therefore its focus is educational. The paper already sets out that the preceptor relationship is purposeful and short-term therefore I would suggest preceptorship involves a reciprocal student -preceptor relationship based on equality and mutual respect where the student's confidence is fostered( Mc Sharry & Lathlean 2017 3 ). ○ Page 3 and Page 4 there is a sentence that is repeated at the beginning of the paragraph at ○ the bottom of page 3 and at the beginning of the paragraph on page 4. This repetition is not required and just requires some editing.