Determining the Innovativeness of Nurses Who Engage in Activities That Encourage Innovative Behaviors

Round 1

Reviewer 1 Report

Dear authors,

your topic is really current and will be interesting for international readers. Manuscript was checked for plagiarism and results showed 3% of overlaping which is very satisfactory. 

Title is clear. In abstract do not use abbreviations. Introduction is clear presented, methodology very well,. Result are clear too. Discussion and conclusion without any problems. references are current. 

Thanks for nice research and manuscript. 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for the opportunity to review your manuscript. Please consider the following remarks below listed by line number:

14-16: unclear sentence, Are you comparing based on the nurses’ innovativeness score, or only on self identification of being an innovator?

37: Please define “wicked problems”

41: Is it correct that not every nurse “has the ability” to be innovative, or more accurate to state “is allowed (or encouraged in) the ability”? As you later discuss  them being “inherently innovative” versus a “behavior that can be developed”

55-57: It is very likely possible to determine without these measures. The sentence should be rewritten to reflect that this data will facilitate prediction and cultivation.

66: unclear meaning “to show similarities and differences related to innovativeness” Do you mean according to score? Or aspects of score? 

79: should add “are” before licensed

83-84: Sampling error: Intended sample does not match stated goal: Goal to sample only those  nurses  “who showed interest in innovation by engaging in activities supporting innovative behaviors in the last three years” does not match with states measures of 62 Scales for the Measurement addressing “examine their association with individual and organizational characteristics.” This approach also does not match the stated goal at 65-66 where you state your goal was to “compared those who self-identified 65 as an innovator versus those who did not.” Please reconcile why these characteristics are only being sought in those who do engage in innovation rather than exploring these aspects in all types of nurses. 

93: Implicit Bias: Intended sample does not match stated goal: same issue as above, perhaps restate goal in lines 65-66 to reflect a different goal.

Based on the two aforementioned statistical flaws and incongruence of goal and sample/ study design this paper is fatally flawed. I have concluded my review at line 93. This could be rectified by a major revision by the authors based on their data collection. 

Thank you for the opportunity to review your paper.

Minor revisions throughout the paper to facilitate readability and clarity are necessary.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Dear authors,
Thank you very much for the opportunity to review this interesting manuscript that addresses the innovative capacity of nurses.

The comments I will make will follow the recommendations of the STROBE guide as this is a cross-sectional study.

Keywords: Must adjust to MeSH terms for correct indexing of the manuscript. The terms: innovation; nursing innovation; nurse-led innovation; healthcare innovation; and design thinking are not MeSH. You should consider the use of alternative MeSH terms to "human-centered design" ("Unviersal Design") and to "innovativeness" ("Creativity"). 

Abstract: Declarate the aim in the abstract.

Introduction: The objective and the hypothesis should not constitute a new subsection at the end of the introduction. The objective should be clearly described without including information that corresponds to the methodology section.

Materials and methods: You must describe the methodology in an organized manner according to STROBE (study design, setting, participants (including sample, study size, inclusion/exclusion criteria), variables, data sources/measurement (including characterisctis of the instruments, individual characteristics, organizational characteristics), statistical methods (including statistical analysis, EFA), ethics criteria. 

The current subheadings are not adequate as described, since they mix information corresponding to different sections (e.g., ethical criteria appear in sample and screening and consent).

Results: The first sentence of results ("Between December 12, 2022 and January 22, 2023, 662 responses were received") is information that corresponds to the application of the instrument. This information has already been stated in methodology and should not be repeated in results (it is redundant information).

Page 4 (line 165) indicate numerical information with numbers (e.g., the sentece: Three-hundred forty-nine (52.72%) respondents passed the screening survey... as n=349).

The description in the text of Figure 1 should be improved and be more precise with the content of the paragraph. It would be appropriate to increase the font size of Figure 1 to see it better. In the title of Figure 1, do not include the information marked with an asterisk (this information should be reflected in the diagram and it is sufficient to explain it in the previous text).

In the individual characteristics you should not duplicate the information in the table 1 and in the text; it is sufficient to point out in the text only the most relevant. Improve the columns an rows headings in Table 1 (e.g., total population n=329 is not appropriate to head the column). Another example for rows, in the race row, why is the other option before white? For ethnicity only one category? Acronyms should be explained at the bottom of the table (e.g. RN may be a known acronym, but LPN is not). The asterisk at the bottom of the table is not understood. Is it possible to unify in the same column the p-value and the statistical value to improve the aesthetics of the table?

Regarding the results of the organizational characteristics, the same comments apply to both the text and Table 2. Try to decrease the size of the table (by merging the p-value columns with statistical value, it is possible to increase the space for the first column and it would improve the aesthetics. You can try to separate in a new column the information of the categories (for example a first column for Gender and in a second column Female, Male, Other in separate rows). This is a proposal to improve the missing spaces in the tables. 

Same comments for Table 4.

Exploratory factor analysis results. In this section the acronym EFA should not be explained again (it has already been explained in the methodology. Review this aspect for other acronyms throughout the manuscript).

You should not re-explain in results the methodological aspects of the type of EFA analysis carried out (varimax rotation...).

Improve the distribution of table 6 to reduce its length. mean and sd in the same column? (e.g., mean (SD)).

Table 7 and 8 the same comments as previous tables. It would be recommended that the information on the 4 factors be displayed at the same time (not first factor 1 and 2 and then factor 3 and 4 below).

Unify criteria with punctuation marks in tables (0,01 vs 0.01 vs .01) Review double sign (e.g., p==0.07 in page 26). Review if heading the p-value column it is not necessary to indicate p= in each row (it is enough to describe the number).

The description in the text of each of the factors after describing tables 7 and 8 is not correct. The figure with the factors should improve your resolution and organization of the information. After seeing all this information, I wonder if it is essential that tables 7 and 8 be included in the manuscript instead of providing them as supplementary material. Assess this suggestion since the length of the manuscript is excessive (33 pages for a descriptive study).

The paragraphs on factors 1, 2, 3 and 4 (pages 28-29) seem to include discussion of what should be avoided in the results.

Discussion: Despite what was mentioned above, the discussion seems scarce.

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Dear authors

I appreciate the opportunity to review the paper "Determining the Innovativeness of Nurses Who Engage in Activities That Encourage Innovative Behaviors".

The paper was well written and overall is clear to understand. It presents relevant new information that has potential to influence nursing practice.

I would like some clarifications about the scales. Were the scale "Scales for the Measurement of Innovativeness" and the " Innovativeness score" previously validated and developed? Or was one of the goals of the paper to present the scales? Please clarify as the goals of the paper are not clear and did not include an exploratory factorial analysis.

Kind regards,

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

84-98 Please clarify if the sample nurses are all in clinical settings or from a mix of clinical and educational settings 

488-489 sentence would be more clear if dependent clause was moved from beginning to end of sentence

192 has 2 periods at the end of the sentence

193 no space between sentences

Author Response

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Reviewer 3 Report

Dear authors,

Thank you for your improvements to the manuscript. In my opinion additional changes are needed.

Material and Methods: In the design subsection, they should only describe the design information. Information on the clinical and sociodemographic variables of the population should be included in their corresponding sections. They can keep the hypothesis in this section.

subsections 2.5.1; 2.5.2; 2.5.3; 2.5.4 should be headed in such a way that it is clear that they are subsections of 2.5.

Results: add (n= ) for results where appropriate.

The numerical results in the text seem very overloaded (example: 234/305 (76.72%)). I think it is sufficient to show them adequately described in the table without repeating so much information in the text. Review this aspect in all results sections.

Try to minimize the spacing between rows in the tables to reduce their size as much as possible. The same in the width of the columns. This for all tables.

Page 10 (3.3 Self identified as an Innovator). It is not very appropriate to quote table 2 and show the results of the table above. In my opinion table 2 should go after being cited in the text.

Table 4 combines in the same column different statistical results that may lead to confusion (r, Median, SD). Try to improve the editing of the table in this regard.value separating/reorganizing the results of correlations from those of mean differences. In table 4 there are empty cells. Try to avoid this aspect.

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Dear authors

Thank you for revising the paper. All my suggestions were responded to.

Kind regards

Author Response

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Author Response File: Author Response.pdf