Nursing Practice Environments in Hospitals: A Comparative Study between Portugal and Brazil

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, thank you for this interesting manuscript.
INTRODUCTION. The introduction is clear, and why this study is needed is well stated. The aim/research questions are very well formulated, and of great interest and importance.
MATERIALS AND METHODS. Design. Was the STROBE tool (line 94-95) used as an instrument for assessing methodological quality? Justify the use of the tool. Substantiate key elements relating to the design of the study, with the aim of increasing the quality of reporting, the transparency of the methods, and the interpretation and reproducibility of the findings.
Setting and Sample. The sample is difficult to understand (line 103-105). Describe the context, locations and relevant dates, including the periods of recruitment, exposure, follow-up and data collection. Explain how the sample size was determined.
Data Collection. The comparability of the evaluation methods is poorly explained. Describe all the statistical methods used.
RESULTS. Describe any other analyses that have been carried out. In relation to the descriptive data, present the follow-up period.
DISCUSSION. Explain the paragraph of lines (361-366) with the main findings, relating them to the objectives of the study.
Thanks

Author Response

Dear Reviewer,

We would like to thank you for the opportunity to improve our article. The suggestions are very relevant and important to us. 
The revised version was prepared and approved by all the authors. Please note that the changes are highlighted in yellow in the main document.
We look forward to hearing your final decision on acceptance and remain at your disposal should you have any questions.

 

On behalf of the co-authors.

Yours sincerely,
Olga Ribeiro, PhD

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors.

I am grateful for the opportunity to review your work. After reviewing and analysing your work, I would like to make a number of recommendations and suggestions.

I would be grateful if you would take my comments into account as I believe that they can complete your manuscript.

- INTRODUCTION: on line 68, reference [18] should go together with [19]. That is: “Developed and validated in 2021, the SEE-Nursing [...] structure, process and outcome [18,19].

- METHODOLOGY: At the end of the heading that talks about the population sample, nurses from different departments in the hospital are included. However, not all are included, for example, oncology or pneumology, among others. Why is this? Was it considered to include nurses from primary or community care centers?

- In the Data Collection section (lines 113-118) you talk about a structured questionnaire for the collection of information consisting of three parts: the first for socio-demographic information, the second the SEE-Nursing Practice scale and they do not refer to the third part of the questionnaire: what does it collect?

- In the Data Analysis section, the last paragraph (lines 154-164) should be in the description of the scale as it is the interpretation of the results of the data collection instrument. 

- RESULTS: Table 1 does not include the mean age (nor is it described in the text). This should be included as it is also referred to in the discussion.

- DISCUSSION: It is curious how, despite the fact that nurses from Portugal have a higher average of both time worked and length of service, in two of the three parts of the SEE-Nursing Practice scale, they score significantly worse than Brazilian nurses with less experience. What could this be due to?

Considering that a higher score on the scale is indicative of a more favourable environment and higher quality of care for nurses, do you think that work experience does not influence how the clinical practice environment in nursing is interpreted?

- On line 264, after Oliveira et al. should be the reference and not at the end. Also on line 320 after the authors Saraiva et al.

Also, in line 267, the reference [26] should be at the end and not in the middle of the sentence.

 

Best regards

Author Response

Dear Reviewer,

We would like to thank you for the opportunity to improve our article. The suggestions are very relevant and important to us. 
The revised version was prepared and approved by all the authors. Please note that the changes are highlighted in yellow in the main document.
We look forward to hearing your final decision on acceptance and remain at your disposal should you have any questions.

On behalf of the co-authors.

 

Yours sincerely,
Olga Ribeiro, PhD

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

 

Your work adds valuable evidence to the field of nursing practice environments. Please, consider the following to improve the quality of your manuscript.

 

Introduction

Describe in short the factors that influence the nursing practice environments and the impact of these environments on work-related variables such as job satisfaction, work productivity, etc.

Since you compare the differences between the two countries it would be very helpful to readers to understand the differences between these two countries regarding hospital environments and especially nursing practice environments. This comparison will help readers to further understand your findings.

 

Methods

Describe more the hospitals that participate in your study, e.g. city of the hospital, bed size, public/private, etc.

Describe how you apply the non-probabilistic convenience sampling.

Describe the nature of the sociodemographic and professional characteristics. For instance, age was a continuous or an ordinal variable.

Add the response rate.

Describe more about the statistical section, e.g. what is the level of statistical significance, what statistical test did you use, how did you handle the missing values, etc.

 

Results

Add p-values in Table 1 to show possible differences between the two countries.

Line 176. What does “source: authors” mean? The same question for all tables. I cannot understand it.

In tables show the statistical tests you performed.

Sociodemographic and professional characteristics may affect the outcome variables such as nursing practice environments scores. Therefore, you should perform multivariable analysis (such as linear regression models) to eliminate these confounders and extract more valid results.

 

Discussion

You collect your data from July to November 2021. Thus, the sentence “….after the critical period of the pandemic…” is not accurate. Please, rewrite this sentence.

The second paragraph in the discussion section is questionable since you did not provide p-values in the results section.

The sixth paragraph in the discussion section is too short and should be expanded.

 

The seventh paragraph in the discussion is too short and should be expanded.

Comments on the Quality of English Language

 Minor editing of English language required

For instance

Page 1, line 33

…differences were found between the two country…

 

Replace country with countries

Author Response

Dear Reviewer,

We would like to thank you for the opportunity to improve our article. The suggestions are very relevant and important to us. 
The revised version was prepared and approved by all the authors. Please note that the changes are highlighted in yellow in the main document.
We look forward to hearing your final decision on acceptance and remain at your disposal should you have any questions.

On behalf of the co-authors.

 

Yours sincerely,
Olga Ribeiro, PhD

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

 

Since you compare the differences between the two countries it would be very helpful to readers to understand the differences between these two countries regarding hospital environments and especially nursing practice environments. This comparison will help readers to further understand your findings.

I have already discussed this disadvantage of your study. You add a few sentences (lines 89-92) without a depth investigation of this issue. Please, further expand this issue and add some references. 

Comments on the Quality of English Language

Minor editing of English language required.

Author Response

Porto, 03 October 2024

Dear Reviewer,

 We would like to thank you for the opportunity to improve our article. The suggestions are very relevant and important to us.

The revised version was prepared and approved by all the authors. Please note that the changes are highlighted in yellow in the main document.

Your sincerly

Author Response File: Author Response.pdf