Perception of Pediatric Nurses on the Use of Standardized Nursing Handover Process in Intra-Hospital Patients Transfer: Attitudes, Barriers, and Practical Challenges
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
Thank you for the opportunity to review the article “Perception of Pediatric Nurses on the Use of Standardized Transfer:Attitudes, Barriers, and Practical Challenges”. The article is part of the establishment of a uniform procedure for transferring a pediatric patient between hospital departments. This is a common situation especially for children under intensive care in the first period and after stabilization of the condition is transferred to another ward for further treatment. The key information provided to the transferring nursing team will allow the initial assessment and implementation of professional measures. The article is part of the problem of many teams and is worth deepening in further research to develop a standard for patient handover.
In the reviewer's opinion, the article should be supplemented with some clarifications:
1.Communication errors-what did the authors mean? Please supplement,
2.Who was the interviewer - from the research team, a person known by the staff?
3.The survey reveals a number of barriers - please briefly indicate?
4. it is unacceptable that the patient's documentation is incomplete - please remove or explain if it is completed,
Author Response
|
Thank you for your time and for reviewing our article. We appreciate your suggestions and comments. In this new version, we hope that everything is correct. Please see the attached file with the answers to your suggestions. |
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
The strength of the article lies in providing a good background information that explored a wide range of literature that offered a detailed overview of the impact of a lack of standardised transfer system within the hospital environment. Similarly, the overall presentation of the work is good, and the authors provided a good rationale for the use of qualitative study to gather the subjective perceptions and experiences of the practitioners. Also, the findings were well presented without exaggerating their claims.
However, additional information about the process of data analysis by further explaining how they arrive at the major themes could be helpful. The authors could also expand on some of the results e.g., the themes relating to motivational aspects and the benefits of using standardised handover, however, this may be due to the limitations imposed by the available word count allowed by the publisher. Finally, the discussion could be expanded to highlight the unique findings in addition to corroborating the existing evidence.
The literature review provides evidence of interaction with a wide range of literature and there is a good justification for the choice of interview as a data collection method.
Consider rephrasing lines 226 - 230 because there is an indication of saturation due to a lack of new insights.
Lines 277 - 280 and lines 282 -285 under the results section contained avoidable repetition.
Author Response
Thank you for your time and for reviewing our article. We appreciate your suggestions and comments.
In this new version, we hope that everything is correct. Please see the attached file with the answers to your suggestions.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors
Dear Authors,
I enjoyed reading the authors' manuscript and I congratulate them on the importance of the topic they chose. With a view to improvement, I present below a set of notes.
Title. The title has two parts: the title and the subtitle. The title presents the main construct of the study and the subtitle of the study topics. In the title, the authors need to clarify to the readers what type of transfer the manuscript refers to. It is suggested to the authors as a hypothesis to improve the clarity of the title: “Perception of Pediatric Nurses on the Use of Standardized Nursing Handover Process in intra-hospital Patients Transfer: Attitudes, Barriers, and Practical Challenges” (The authors identify the Nursing Handover Process as a solution to information gaps in intra -hospitals patient transfers, lines 90-91).
Abstract. Allows readers to give an overall idea of the study. However, the results do not describe the categories that emerged from the analysis of the interviews. Furthermore, it is unclear to readers what type of deficiencies the authors refer to when they say, “the findings revealed significant deficiencies in the communication process”. Authors are asked to specify this statement.
Keywords. "Patient Handoff", "Patient Transfer" and "Qualitative Research" are examples of some significant descriptors for this purpose.
Introduction
Lines 37-39 and 56-57: In these two excerpts, the authors introduce the concepts of Patient Transfer and Patient Handover as a communication process. Generally, Patient Transfer is defined as the transition between institutions, services and teams and involves a communication process of transfer of responsibility. Although the concepts of Patient Transfer and Patient Handover may have overlapping aspects, authors must clarify for readers how they are linked. If the authors want to define the concept of Nursing Handover, there is an analysis of this concept by Kim and Seomum (DOI: 10.1891/RTNP-D-19-00089), that may be useful.
In lines 36, 82 and 127 the authors use the term standardized patient handover protocol. The concept of handover protocol must be explained to readers as it may appear that the authors are referring to the use of mnemonics, such as ISBAR. This mnemonic helps to standardize the handover process and gives rise to some protocols. It is suggested that authors explore some handover protocols, such as the ISBARQ protocol.
Line 125. Since the authors' study is qualitative, it is more appropriate to use the term assumption rather than hypothesis.
Methods.
Lines 137-149. To improve the articulation of ideas, authors are suggested to combine the sentences that justify the use of qualitative methodology with its advantages and the sentences that present the researchers' purpose and the objective of the study.
Lines 19, 158, 195, and 449. Institutional anonymity is important due to the reputation the institution may have in the community for less positive research results. Authors are asked to confirm whether the ethics committee authorized the institutional identification of the study location when disseminating results, particularly in scientific publications. If so, please include this in the text of the manuscript. If there is no authorization, please replace the identification of the institution, for example "hospital institution hosting the study".
Lines 252-260. For readers to conclude that a high standard of quality was maintained in the research process, the authors must explain what was done so that the study complies with the four quality criteria.
Line 173. Please add at the end of the sentence as nurse/nurse.
Line 193. Please clarify what students participated in in this study. Was it during data collection? If students participated in the study, please characterize the participating students and clarify whether the research protocol submitted to the ethics committee identified the students as members of the research team. Finally, explain in the same section how the main researcher guaranteed the quality of the data obtained by the students.
Line 232. Please, specify which author/authors guided the methodological approach followed in the analysis of qualitative data.
Lines 238-248. These are the results of data analysis. Please inform readers of these categories in the study results section.
Results
Lines 282-285. These two sentences are repeated in lines 277-280.
Lines 285-287. Authors are asked to describe here the categories that emerged from the analysis and that were presented above in the methods section. If authors use these categories as subsections to organize results, it will be less confusing for readers.
Excerpts from interviews do not allow readers to verify that they are from different subjects, so it is suggested to identify them with a participant number or other form of differentiation.
Lines 345. Please replace the colon with a period.
Line 346-348. Please make sure that where you wrote "computer system" you did not mean "health information system", "nursing documentation system" or "Electronic Clinical Record". These are the appropriate terms for computerized systems that allow the storage and retrieval of data and information. Sobre a pertin~encia de estes sistemas serem sistemas integrados, sugere-se aos autores consultem o estudo de Johnson sobre “The impact of an integrated nursing handover system on nurses' satisfaction and work practices” (DoI: 10.1111/jocn.13080)
Discussion.
Please, begin this section by reminding readers of the purpose of the study
Lines 480-481. Please complement the previous sentence with known scientific evidence.
Line 492. Please complement the previous sentence with known scientific evidence.
Tables. Table 2 appears to be overlapping with Table 3. As both tables have little information, it is suggested that the authors characterize the participants in a narrative way.
Thank you for your attention and good luck with your research!
Author Response
Thank you for your time and for reviewing our article. We appreciate your suggestions and comments.
In this new version, we hope that everything is correct. Please see the attached file with the answers to your suggestions.
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for Authors
Dear authors,
Thank you for allowing me to review this article of significant importance which focuses on the Perception of Pediatric Nurses on the Use of Standardized Transfer: Attitudes, Barriers, and Practical Challenges.
The title is clear and coherent with the aim and content of the article.
Abstract
I would recommend removing the word background from the beginning of the abstract, as it is underestimated that the initial phase is a framing of the problem. line 11
The keywords selected are not indexed, so I recommend that authors see if it would be more valuable to use indexed terms to make it easier to search for and identify the article in databases.
Introduction
Although the introduction describes the challenges in transferring pediatric patients, it could highlight more clearly how the lack of standardization directly impacts on patient safety and the efficiency of care. A more specific paragraph on these risks would help emphasize the importance of the study, as there are already studies with percentages of errors or even deaths associated with miscommunication between healthcare professionals. These failures represent costs for institutions and loss of quality of care for patients.
The authors only mention SBAR, but there are other tools such as ISBAR or ISOBAR, for example. There are also quality committees that make recommendations on the use of these tools emphasizing the importance of their use.
Materials and Methods
This section of the article is well prepared, with a clear division of the different items, and objective references on how ethical considerations were managed in this study.
Results/ Discussion
In the results section, I think that Table 2 splits the paragraph in half, so I would place the table before the start of point 3.1.
The content is well organized, with excerpts from the interviews published, which enriches the quality of the article and captures the reader's attention.
Conclusion
The article's conclusion is well structured in addressing the main challenges related to patient transfers and the need for a unified system, but it could be more objective. I suggest reducing the repetition of points already discussed, such as the lack of a unified system and the under-utilization of records, to avoid redundancy and keep the conclusion more focused. In addition, the inclusion of more specific recommendations, such as the creation of a committee to standardize transfers or pilot tests of electronic systems, would help provide concrete suggestions for hospital managers.
Finally, adopting a more emphatic tone, emphasizing the urgency of implementing these changes, would reinforce the practical importance of the study's conclusions. The article's conclusion should also highlight the gains in terms of quality of care and, above all, patient safety, given that errors and communication failures are responsible for a high number of deaths in hospital settings, especially in areas as sensitive as pediatrics. Emphasizing that the standardization of transfers and the implementation of unified systems would not only improve efficiency but could also significantly reduce these risks, underlining the importance of patient safety as one of the main benefits of adopting these measures.
References
After analyzing the references in the article, I found that some are recent and appropriate, while others are older. There are references dating back to 2005 and 2007, but there are also more recent relevant studies, such as from 2018 and 2021. Ideally, the bibliographical references of academic articles should be updated to reflect the latest advances in the field of study. I think it would be interesting for the authors to include more sources published in the last five years, especially in the context of patient handovers and patient safety, as new technologies and practices may have been developed. This would reinforce the validity and timeliness of the conclusions.
I congratulate the authors on their article and believe that with a brief revision of some suggested aspects, it is ready to move forward in the publication process.
Author Response
Thank you for your time and for reviewing our article. We appreciate your suggestions and comments.
In this new version, we hope that everything is correct. Please see the attached file with the answers to your suggestions.
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report
Comments and Suggestions for Authors
Dear authors,
I very much enjoyed re-reading your manuscript. I see that you have added all my suggestions to your article. I think your study has become much more consistent. I have no further comments.
Best wishes.
