Understanding Clinical Learning Quality Aspects in Mental Health Nursing Practice Course among Students: A Comprehensive Examination
Ana María Vázquez Casares
Marília Rua
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe manuscript Nursing Reports2699076 entitled "Understanding Clinical Learning Quality Aspects in Mental Health Nursing Practice Among Students: A Comprehensive Examination" analyzes the quality of mental health student nurses' care practices in mental health units, proposing a model of influencing factors and relationships among them.
The manuscript is clear, brief, accurate, relevant and generally presented in a structured manner. The title gathers important information and is accurate. The presented abstract is adequate and includes relevant aspects and the objectives are adequately stated. The results are presented as expected and are concise in each of the categories. The discussion is presented in an orderly and coherent manner.
However, some aspects to be improved are suggested, especially regarding the information contained in the introduction and the state of the question, as well as completing some aspects absent in the material and methods section. It would also be advisable to give greater consistency to the discussion, supporting the statements made in the results obtained and in the available evidence.
For these reasons, a major revision of the present version is recommended before publication.
Specific remarks:
1- Introduction:
The writing in general terms is concise, however it is necessary to improve the approach to the state of the question, making reference to previous evidence on the object of study including, if any, research background.
It is also necessary to refer to the situational context in which the quality of internships is analyzed, including essential aspects that influence student performance, such as the duration of rotations, the academic conditions in which they are performed, the type of mental health care units in which they are developed. It is relevant to describe the circumstances in which the internships in which the quality is analyzed take place and to include them in a global, situational and temporal context.
The justification of the evaluation model (through the factors contemplated in the CLEQI tool) is adequately presented. It is recommended to improve the presentation with the definition of the 5 factors in a balanced way to help the reader and focus it accurately. What is the concept of experiential learning, what is understood by learning opportunities, what are tutorial strategies, and what is the concept of learning opportunities? The definition of these concepts is essential for the understanding of the manuscript.
It is recommended that these three aspects be included in the introduction.
2. Materials and Methods
In general terms, this section includes aspects that ensure the quality of the manuscript. It describes and estimates the sample correctly, includes the approval of the corresponding ethics committee, and defines and describes the materials.
However, it does not detail the chronological moments of data collection, nor does it provide information on the person in charge of data collection, and the conditions that ensure that the data collected are reliable. How were the students accessed? At what moment? through what channel? How many students were accessed? Was the researcher present while the students were filling in the questionnaire? What was the response rate?
In relation to data collection, it is necessary to detail more extensively, when, by whom and how.
2.3. Mental Health Intervention Conceptual Framework
This information is scarce and needs to be expanded. For example, what is the duration of each of the two training courses? In which course are they carried out? Do they both take place within the same academic year? Is there any complementary training that may influence the results?
2.4. Instruments
The data collection instrument is only partially described, not explaining how the questionnaire is structured for the second section.
The collection instrument needs to be further detailed, especially in relation to the second part of the instrument: the evaluation of the degree of learning reported by the participants in the theoretical course on mental health.
Similarly, reference is made to the relationship between theoretical knowledge and practical performance but the unit or measurement tool for both is not detailed. In L166 (in results) it is described that "The mean exam scores of the mental health nursing practice were 92 (SD=1.54)" What is the maximum and minimum.
L142: "A higher score reflects students' perceptions of a higher quality of learning processes." What is the minimum and maximum score on the CLEQI questionnaire?
3. Results:
They are detailed according to the established categories. Tables and figures are timely. The analyses performed are adequate.
It is necessary to reflect the descriptive data obtained for all the variables analyzed. It would be convenient to include a table or information related to the descriptive data of the variables that make up the questionnaire (section 2 and section 3) to complete table 1 and 2 and that are subsequently used to predict the degree of nursing practice in mental health, by means of multiple regression analysis.
L239 and L243 contain the same information: they are the same sentence. Replace with the corresponding information.
4. Discussion;
The results are adequately discussed, although there is a lack of discussion with a similar study, if any, related to mental health or other subjects.
It is proposed as necessary to improve tutoring strategies to make them more effective, but nowhere in the manuscript is reference made to which aspects of tutoring quality are assessed, and therefore susceptible to improvement. This information would be very valuable to the reader and would add value to the application of the research results. Some of this information is presented in the Conclusion at L299-L301.
The information collected in L260 and L263 is not directly related to the discussion argument previously presented. It is suggested to value its incorporation in the introduction, to describe the object of study and the state of the question.
The statement that " the study found that students' grades in a mental health nursing theory course predicted the grade obtained in a mental health nursing practicum" requires discussion in a more detailed and extended form.
5. Conclusion:
This is a brief and complete statement of a response to the proposed objectives.
In this case, it responds to the three proposed objectives in an orderly manner, but includes information that has not been presented previously. It is recommended to include this information either in the results or in the discussion, before including it in the conclusion. L299-L301.
Author Response
Dear Reviewer, I appreciate your instructive comments and essential insights. The file is attached. The file refers to each comment and gives directions for correcting each comment in the article.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThe entire manuscript needs to be reviewed for sentence structure and grammar.
As I am reading the first few paragraphs after the abstract I am confused as to if this study is looking at nurses who are in a mental health nursing rotation studying mental health, or if the research study is looking at nursing clinical and the student nurse's mental health. This needs to be made clearer. It seems that it is studying the mental health nursing rotation, but it is a bit confusing. I would suggest using the phrase psychiatric or behavioral and mental health clinical rotation so that it is clear you are not referring to the student nurses' mental health.
It is unclear what the CLEQ is measuring for the pre part. Are they measuring past courses and clinical rotations? It is unclear how the pre/post measures clinical learning in the mental health rotation as there was no intervention to measure and the students presumably have not had this rotation previously. So what does the pre/post compare?
I would suggest a paragraph or two in the beginning that describes nursing student clinical rotations, and how mental health nursing clinical rotations are typically conducted and what they involve, what students learn about in the classroom and how this is supplemented by what they learn in the clinicals. What year are they in their studies when they are taking this course? How long are the clinical rotations, where are they usually done? An in-patient hospital? A mental health facility?
Methods.
Section 2.3 does not make sense.
Abstract
Line 18 - address their perceptions of what? Also, mental health nursing practice - class, or clinicals?
Introduction
Line 41, remove 'has' from the first sentence: A multicenter study 'has' assessed nursing student's...
Line 42 does nurse teachers refer to faculty, clinical professors, or preceptors from the clinical unit?
Line 50 - the validity of the tool belongs in the methods section
Line 56 - what does tutorial strategies refer to? Tutoring which is outside of the students regular learning classroom? Or teaching strategies in general used in the classroom?
Line 63, 'Thus is necessity to provide students' needs to be changed to "Students must be provided with experiential learning opportunities...
Line 65 - change to "Another element is self-directed learning. In general this paragraph needs to be reviewed for sentence structure.
Line 76 - change to previous research has explored...
Comments on the Quality of English Language
There were errors in grammar and sentence structure that need to be corrected
Author Response
Dear reviewer, I am very grateful for your instructive comments and important insights. The file refers to each comment and gives directions for the correction of each comment in the article attached.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsThe manuscript needs editing for sentence structure, as in the current format the sentences are too long. The sentences are trying to convey more than one point and therefore the readability is difficult.
Comments on the Quality of English LanguageThank you for the opportunity to review your manuscript. You have researched an important area in nursing education and clinical experience. The research approach, data analysis and discussion are appropriate.
I would encourage you to review the syntax of the current manuscript as the sentences are long and contain several issues. This makes the readability of the paper difficult.
Your research is important and I recommend that you edit the paper to enhance the flow of information. Once again thank you for the opportunity to review the research.
Author Response
Thank you for the comments. I learned a lot. Please see the attached file.
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for AuthorsResearch with great interest to create knolledge about learning in clinical practice, which can be extended to other areas beyond Mental Health.
Author Response
Thank you for the comments. I learned a lot. Please see the attached file.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsAbstract. Suggest changing mental health nursing practice to either mental health nursing practice clinicals or mental health nursing practice courses.
Line 17 - perceptions of what?
Introduction:
Line 33-34 change to which is impacted by various factors including...
Line 36 - does this mean to say 'poor' clinical learning quality? Specify what about the clinical learning quality leads to depression etc.
Line 41 - rewrite to read ' A multicenter study found that students' perceptions of their mental health was shaped by factors .....
Line 47-54- this would go in the methods section and add more detail about the reliability and validity of the tool such as Cronbach alpha et.
Grammar throughout needs to be reworked for example - Line 63- Thus is necessity to' should be changed to "Thus it is necessary to provide students with experiential learning opportunities...
Line 76 change to Previous studies have explored the relationship between theoretical...
Line 127 states 'it combines f two main learning methods....' is the f a typo?
Line 116 move the questionnaire sentence to methods section of how you did the study. Suggest moving to data collection section.
The title on line 125 isn't appropriate as this section is just describing the mental health nursing curriculum not a conceptual framework.
Line 147 specify if the informed consent was electronic or paper and if they signed it. Also add somewhere how they were recruited - how did they know about the study? Do you state how the surveys were distributed? Were they electronic or paper? How were they screened for inclusion/exclusion criteria? Were there specific exclusion criteria? More detail needs to be added to the data collection section - it should be written so that another researcher could replicate the study step by step.
Suggest writing the results section answering each of the research questions.
The abstract states: This study aimed to assess the clinical learning quality of nursing students, predict the impact of theoretical course grades on their grades in mental health nursing practice, and explore the mediating role of learning opportunities, self- directed learning, and safety, and nursing care quality in the relation of learning environment and tutorial strategies quality. Each of these should be clearly addressed/answered in the results section. The introduction states the research aims of the present study are as follows: (1) To evaluate nursing students’ clinical learning quality regarding the aspects of tutorial strategies quality, learning opportunities, self‐directed learning, safety and nursing care quality, and learning environment quality before and after mental health nursing practice. (2) To establish if the grade of a theoretical course in mental health nursing and the student's perception of their theoretical knowledge level predict the grade of mental health nursing practice. (3) To explore the ways in which model learning opportunities, self‐directed learning, and safety and nursing care quality mediate learning environment quality and tutorial strategies quality following mental health nursing practice.
Each of these could be a header and addressed one by one in the results section for clear organization to show how each of the research questions were answered.
Comments on the Quality of English Language
Quality of the English could be improved.
Author Response
Thank you for the comments. I learned a lot. Please see the attached file.
Author Response File: Author Response.pdf
Round 3
Reviewer 2 Report
Comments and Suggestions for AuthorsThe paper is overall improved, but it is still confusing for the reader if the study is about the student's mental health, mental health clinicals, or an in-class course about mental health. It is unclear what gap in evidence the study is addressing.
The aims are listed as This study threefold aims' (1) to assess the clinical learning quality perspectives of nursing students, (2) predict the impact of theoretical course grades on their grades in mental health nursing practice, and (3) explore the mediating role of learning opportunities, self-directed learning, and safety, and nursing care quality in the relation of learning environment and tutorial strategies quality.
However, the introduction starts with describing how poor learning quality is associated with stress and depression/anxiety, and the quality of care on mental health units, but the study seems to have gathered data on if taking a theory course impacts grades, and what their perception of the learning environment is.
Comments on the Quality of English LanguageThe quality of English was improved.
Author Response
Dear Reviewer 2 Please see the attached file.
Thank you very much.
Gizell
Author Response File: Author Response.pdf
