Appraisal and Evaluation of the Learning Environment Instruments of the Student Nurse: A Systematic Review Using COSMIN Methodology

Round 1

Reviewer 1 Report

Dear authors,

Thank you very much for the opportunity to review the manuscript Appraisal and evaluation of the learning environment instruments of the student nurse: a systematic review.

Below are my comments

Please describe the section Data synthesis and quality assessment tool better, especially the definitions of quality levels.  In Table 2, the recommendations on the use of the tools are different than in the description in the methodology section.

Author Response

Thank you for the suggestions and for dedicating your time to our research. Please see the attachment for the reply.

Author Response File: Author Response.docx

Reviewer 2 Report

I would like to thank the editor of this prestigious journal for the opportunity to evaluate this study and I would also like to congratulate the researchers for the effort made and the results obtained.

First of all, I find the study interesting and a good starting point for other researchers in the design of future educational proposals. I agree with the researchers that it is very important to evaluate the effectiveness of educational proposals and to focus on their effectiveness.



I would like to know why so many researchers have been involved in an article which is a systematic review and which does not require so much collaboration.

The methodology of the study is very rigorous, I would like to know if it has been considered to include in the discussion the concept of pregancy, that is to say, if forms have been administered to measure knowledge after a considerable time, 4 or 5 months.


I congratulate the researchers for the excellent research they have done and I am grateful for the opportunity to have been able to evaluate this study.

Author Response

Thank you for the suggestions and for dedicating your time to our research. Please see the attachment for the reply.

Author Response File: Author Response.docx

Reviewer 3 Report

Dear authors,

Congratulations for the developed article. The article consists of a systematic review, which brings knowledge about instruments related to the learning environment of nursing students.

The study is relevant to the discipline of Nursing. The article is well written overall, but needs some changes. I leave some suggestions for improvement for further analysis.

Abstract:

It remains to clearly mention the objectives of the review, after background. The same ones mentioned at the end of the introduction.

Line 34 - write COSMIN in full, followed by the abbreviation - Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Also add the year of the COSMIN version.

It is suggested the placement of a sentence that contemplates the discussion, before the conclusion. For example with the number of results relative to the quality of the evidence or with the summary recommendations for using, or not using, the tools.

Keywords:

No population descriptor - nursing or nursing student. It is suggested to include at least one – according to descriptors in health sciences (DeCS).

Introduction:

Line 74 – similarly to what was described for the 2nd review, they should refer (for accuracy) in which databases the searches were carried out in the 1st review referred to.

Line 75 – COSMIN guideline name is not correct. It will be: Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Also add the year of the COSMIN version.

Line 84 – clarify/complete objective 2 “… of tools for measuring learning environments of the nurse students.”

Method:

Overall, well exposed and reproducible.

Line 88 – Add the year of the COSMIN version.

Line 95 – “ver. “Put out in full

Results:

Line 139 – The overall article count does not match. It must be checked. Also check correspondence with figure 1.

Line 147 – CALD name is not the same as shown in Table 1, Table 2 and Figure 1. Standardize throughout the text.

Line 148 - ESEC name is not the same as shown in Table 1, Table 2 and Figure 1 (ESECS). Uniform throughout the text.

Line 317 – CALD or CALDs?

Discussion:

Line 351: 45 or 46 articles? Check with line 139 and figure 1 !

Line 362 – standardize the name of the CALD.

Conclusions: Nothing to consider.

Figure 1:

Confirm 45 or 46 articles? Both in the included box and in the list below!

Associated with the number of CALD articles is a “*”. Can't understand why?

Line 411 – the figure name should be clearer and read by itself and not just “PRISMA”. The sentence at the top of the figure must be removed and added to the name of the figure to be placed on line 411.

Table 1:

Remove the word “scale” from the CLE. Keep the tool names consistent.

The term of the evaluated concept “Educational climate”, in the DREEM and EAPAP tools should be replaced by “Educational environment”.

Line 424 – put it in the plural (of the instruments) and remove the “.” .

References:

References 36 and 37 are the same.

References 38 and 39 are the same.

Check the reordering of numbers in the entire list of references.

Citations:

References 37 and 38 are not cited (because they are repeated…)

Check, throughout the text, the reordering of citation numbers and the correct correspondence with the references.

Best wishes for the future!

Author Response

Thank you for the suggestions and for dedicating your time to our research. Please see the attachment for the reply.

Author Response File: Author Response.docx

Reviewer 4 Report

The work tackled a very difficult challenge - an attempt to systematically assess the instruments evaluating the education environment of nursing students. Every effort related to the process of evaluating research instruments and tests is burdened with a great risk, which is the great variety of existing instruments, their theoretical assumptions, the process of their construction and measurement of accuracy and reliability, the cultural context, the way the results are used, but above all, the subject matter of the study.

Despite a very correct methodological approach (the description of the selection of papers is clear, the criteria for including and excluding papers from the analysis are presented in detail) and the use of a very well-developed method of evaluating selected papers based on the COSMIN study (which could be indicated in the title of the paper), the final set of instruments is quite highly differentiated.

I will give only one example - I started the analysis of the results with the works: CALDs and DREEM, both received the highest A grades; A = recommended for use. In my opinion, these two instruments examine different issues: CALDs -  4 Subscales: Orientation into clinical placement, Role of student, Cultural diversity in the clinical learning environment, Linguistic diversity in the clinical learning environment and DREEM - 5 subscales: Perception of learning, Perception of teachers, Social self-perception, Perception of atmosphere, Academic self-perception. This is mentioned by the authors of lines 316 - 329.

This may cause controversy and requires a deeper description of the analysis - adding a qualitative analysis of instruments in terms of their purpose and measurement areas.

Author Response

Thank you for the suggestions and for dedicating your time to our research. Please see the attachment for the reply.

Author Response File: Author Response.docx

Round 2

Reviewer 4 Report

Thank you for corrections you made. The article can be published in present form.