Effectiveness of Mentorship Using Cognitive Behavior Therapy to Reduce Burnout and Turnover among Nurses: Intervention Impact on Mentees

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript is well-written and provides informative findings on how to use CBT to improve nursing burnout.

Strengths:

1. This manuscript provides informative information regarding how to apply CBT to improve nursing burnout. 
2. This manuscript is well-written with only minor English edits needed.

Suggestions:

1. Why did the authors choose a 2-step training model (therapist-mentors-mentees)? It is not clear if the 2-step training model is more effective than the direct model (therapist-mentees). Please explain if there was any evidence in the literature supporting the 2-step model.
2. This study involved 35 mentors and 34 mentees but didn't report any demographic information about the mentors, which needs to be addressed.
3. It is not clear how the authors evaluate if the training for the mentors is successful. If any measurements are used, please address them.
4. It is not clear who was the therapist in this study, one of the authors or a hired therapist. Detail is needed for the therapist and how the therapist trained the mentors. Any training protocols used? How did the therapist determine that a mentor is trained to be a qualified mentor? Any measurements?
5. On line 47, please make the edit as follows: change "...support systems are considered to be crucial..." to "...support systems are considered crucial..."
6. On Line 71. please make the edit as follows: change "Research suggests...." to "Research indicates..."

Author Response

Why did the authors choose a 2-step training model (therapist-mentors-mentees)? It is not clear if the 2-step training model is more effective than the direct model (therapist-mentees). Please explain if there was any evidence in the literature supporting the 2-step model.

⇒　I fixed it as follows. This study chose a 2-step training model involving therapist-mentors-mentees to ensure comprehensive training and support for effective implementation of cognitive behavioral therapy (CBT) among mentees. This study refers to the parent training model of Menda et al [23]. This parent training has a dual structure in which parents provide behavioral therapy intervention to the behavior of children with developmental disabilities. Therapists provide parent training to parents, and parents intervene with their own children. By adopting this model, therapy becomes possible in everyday life.

This study involved 35 mentors and 34 mentees but didn't report any demographic information about the mentors, which needs to be addressed.

⇒We have made the corrections as you pointed out (see Table 3).

It is not clear how the authors evaluate if the training for the mentors is successful. If any measurements are used, please address them.

⇒I fixed it as follows. Ohue and Menda examined the effectiveness of cognitive behavioral therapy for mentors. According to this report, the mentors were given three cognitive behavioral therapy pro-grams, and it was confirmed that the mentors' knowledge and skills regarding cognitive behavioral therapy, as well as their listening skills, improved. This program consisted of the same program as the mentee’s and consisted of an experiential learning program for cognitive behavioral therapy [21].

It is not clear who was the therapist in this study, one of the authors or a hired therapist. Detail is needed for the therapist and how the therapist trained the mentors. Any training protocols used? How did the therapist determine that a mentor is trained to be a qualified mentor? Any measurements?

⇒I fixed it as follows. The content included information on using the originally developed CBT manual, ways to implement CBT, and points to be considered. The author was the therapist for this study. The author is a licensed nurse and certified psychologist and has experience in cognitive behavioral therapy. The second author also served as a supervisor regarding cognitive behavioral therapy.

On line 47, please make the edit as follows: change "...support systems are considered to be crucial..." to "...support systems are considered crucial..."

⇒ We have made the corrections as you pointed out.

On Line 71, please make the edit as follows: change "Research suggests...." to "Research indicates..."

⇒ We have made the corrections as you pointed out.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, 

Congratulations on your manuscript, it contains new ideas and findings, and makes new contributions to the literature, presenting an original and relevant topic. 

I left some suggestions in comments in the PDF file, to contribute to some improvements to your article, to deepen the scientific evidence in relation to mentoring programs, some reflections in the methods and treatment/analysis of data, discussion and I also suggest to clarify the implications for practice, education, research and health policies.

Many congratulations on your manuscript and huge success for publication and future studies. 

Comments for author File: Comments.pdf

Author Response

Consider not repeating the word "effectiveness"

⇒I fixed it as follows. Effectiveness of Mentorship Using Cognitive Behavior Therapy to Reduce Burnout and Turnover among Nurses: Intervention Impact on Mentees

• Before highlighting the gains of CBT, consider arguing the importance of mentoring programs and what already exists.

Please consider presenting some studies that have already highlighted the importance of mentoring in the integration of new nurses? what types of programs already exist to justify the importance of your program due to the lack of evidence of the use of CBT. Highlight the importance of these programs for promoting the mental health of new nurses. Please note that it is different from saying it does not exist with no study or report found.

⇒I fixed it as follows. Organizational support and resources play a pivotal role in promoting nurses' mental health and well-being during the pandemic. Adequate staffing, access to mental health services, and clear communication channels are essential components of a supportive work environment [6]. Interventions such as stress management training, mindfulness-based programs, and psychological debriefing sessions have shown promise in enhancing nurses' coping skills and reducing psychological distress [7].

Considerer to include intervention description

⇒I have added details about the intervention to the study design.

It would also be interesting to present the average age and standard deviation.

⇒This data is on a nominal scale. Therefore, the average value and standard deviation data were not calculated.

Would it make sense to mention that descriptive and inferential statistics were used? What statistical program is used? Did you use One-way ANOVA for the One-factor Analysis of Variance?

⇒I fixed it as follows. One-factor analysis of variance were performed on the above measures at pre-intervention, post-intervention, and 3 months follow-up, with statistical significance set at P ≤ 0.05. Multiple Comparison Procedure was performed Tukey’s honestly significant difference test.

Please consider to include this information in the materials and methods section

⇒Table 3 was displayed in the wrong location.

It would make sense to refer to Ethical principles of

the revised Helsinki Declaration? Consider including information about how the data will be stored and for how long/after how long it will be destroyed.

⇒I fixed it as follows. This research was conducted in accordance with the Ethical principles of the revised Helsinki Declaration. This research was conducted in accordance with the Ethical principles of the revised Helsinki Declaration. Data was saved on a secure USB. The data retention period was 5 years.

Would it make sense to correlate the characteristics of mentors with the results obtained?

Would it make sense to study the influence of the characteristics of the mentors (years of experience, training background, ...) and the mentess results?

⇒I made a mistake in the positions of Tables 1 and 3. I added the following: “3.2. Participants’ characteristics of mentors.”

Does age or length of professional experience influence the results?

⇒The purpose of this study is to examine the effects of cognitive behavioral therapy provided by mentors to mentees. Differences due to individual factors were not considered.

Please note that it is different from saying it does not exist with no study or report found.

⇒I'm adding the following words: "To the best of my knowledge,"

Consider mentioning the limitation to the small sample and the use of non-parametric tests, which conditions generalization. Also consider mentioning the limitations of the type of study. If there was a control group it would be much more robust.

⇒ I fixed it as follows. the number of samples is small. Additionally, there are limitations in the research design, namely the absence of a control group.

Consider highlighting in greater depth the implications for clinical practice, for the training/education of nurses, for research and health policies

⇒ I fixed it as follows. When considering the implications for clinical practice, it is important to recognize that implementing mentoring programs with CBT can significantly impact patient care. By enhancing nurses' mental well-being, such programs can improve patient outcomes and overall healthcare quality. Additionally, integrating these programs into nursing training and education can better prepare future nurses to manage stress and prevent burnout, ultimately benefiting both healthcare providers and patients.