Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

The paper makes a timely and important point - when „precision“ is treated as synonymous with what can be measured, care can become fragmented and, at times, feel dehumanizing -especially in fast-paced clinical environments. The vignettes are engaging and help the manuscript read smoothly. However, I have some suggestions which I would like that you follow, if possible. To strengthen the paper as a scholarly perspective, the main thing you need to do is make it immediately clear what is genuinely new about „precision caring“. As it stands, many readers will recognise strong overlap with established ideas such as person-centred care, relationship-centred care, caring science traditions, and compassionate communication in emergency nursing. A concise definition early on would help a lot- spelling out the core attributes of „precision caring“, its boundaries, and what it adds beyond existing frameworks,and then using the term consistently throughout, without framing precision medicine and caring as simple opposites. The theoretical section would also be stronger with clearer bridge between theory and bedside decision-making. The iceberg metaphor is memorable, but the manuscript needs to show more explicitly how caring functions as a way of knowing and reasoning in real time, rather than only an ethical „extra“ layered onto biomedical decisions. I want to say that readers would take the text more clearer with sharper explanation of what sits „below the waterline“ that data-driven approaches systematically miss, and how „precision caring“ concretely changes assessment, prioritisation, communication, and risk management in practice. Just make it more concrete.

Your vignettes are one of the strongest parts of the manuscript, and they would become even more persuasive if each one ended (or was followed) by a brief, explicit takeaway, in example what the vignette illustrates about „precision caring“, what might have been missed with a purely biomedical/algorithmic lens, and how noticing those elements changed the decision or the patient’s trajectory. The touch/massage vignette, in particular, is powerful but needs more careful framing to avoid sounding universally applicable. It would help to acknowledge consent, professional boundaries, cultural and contextual variation, documentation, and the reality that some patients may not welcome touch (for example due to personal preferences or trauma history). That small addition would make the example clearer and more credible across settings.

Because this is a perspective piece, you do not need a systematic review methodology, but one short clarifying sentence about what the cases represent (composite vignettes versus real cases with details altered) and how confidentiality was protected would improve scholarly and ethical transparency.

I hope that this review will be helpful to you manuscript, good luck with the further steps.

Kind regards

Author Response

Thank you for your insightful review. Please see the attached file.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a thoughtful and necessary position paper that argues for expanding the definition of "precision nursing" beyond the biomedical/technological focus of precision medicine. The authors successfully argue that "caring", the relational and empathetic aspect of nursing, is the necessary counterpart to data-driven precision medicine. The use of clinical vignettes from various emergency care contexts (Ambulance, ED, Ward, Pediatrics) effectively grounds the theoretical argument in clinical reality.

However, the manuscript requires minor revisions to clarify the nature of the clinical examples, reduce repetition, and correct minor typographical errors.

Clarify the article type and “approach/method” (currently missing).
Because this is not an empirical study, please add a short section such as “Approach” / “Paper design” explaining:

that this is a conceptual/position paper grounded in caring science + selected literature;
how the clinical examples were chosen (illustrative vignettes, based on clinical experience/literature, not “data”);
how the discussion is structured (e.g., concept definition → cases → synthesis/implications).

Improve structure and “take-home” contributions. Consider adding either:

a summary table mapping precision medicine vs caring contributions (data/tools vs relational/existential dimensions) across the care pathway (prehospital/ED/ward/paeds), or
a simple conceptual figure (e.g., the “iceberg” metaphor) with 4–6 actionable practice implications.

Repetitive Imagery (The Iceberg Metaphor): The metaphor of precision medicine as the "visible tip of the iceberg" and caring as the submerged portion is effective, but it is repeated almost verbatim in three separate sections:

Abstract: "...visible tip of an iceberg that also comprises caring...".
Introduction: "If precision medicine is the visible tip of the iceberg...".
Final Reflections: "As the visible tip of an iceberg that also comprises caring...".

Consider rephrasing or referencing the earlier mention in the discussion to avoid redundancy.

Comments on the Quality of English Language

Spelling/typos to fix (examples): “Theorethical” → “Theoretical”, “fallows” → “allows”, “precision medicin” → “precision medicine”, “undoubtably” → “undoubtedly”.

Ensure all abbreviations are defined at first use (e.g., ED, EHR, ICU, CRP, PEWS, RETTS, PC).

Author Response

Thank you for your insightful review. Please see the attached file.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript is well-written and pleasant to read, offering a thoughtful and reflective perspective on the concept of precision caring and precision nursing within an emergency care context. The conceptual discussion is engaging and stimulates critical thinking. However, several issues need to be addressed to strengthen the clarity, rigor, and broader applicability of the paper.
1. The current title lacks sufficient contextual specification regarding the perspective from which “precision caring” is discussed. Care perspectives may differ substantially between high-income, middle-income, and low-income countries due to variations in resources, healthcare infrastructure, staffing, and cultural factors.
The authors should consider revising the title to either: specify the country of focus, or include a broader descriptor such as “from a high-income country perspective” or “from a resource-rich healthcare setting.”
2. The abstract does not fully reflect the actual content and emphasis of the manuscript. Some key arguments and examples presented in the main text are not adequately captured, while certain statements in the abstract suggest a broader empirical scope than is actually provided.
The abstract should be revised to more accurately align with the manuscript’s conceptual nature, the use of clinical examples, and the intended contribution to the field of precision nursing.
3. The keyword “patient” alone is too broad and lacks discriminatory value for indexing or retrieval purposes. There are minor spelling errors in the keywords (e.g., “medicin” instead of “medicine”).
4. The introduction is conceptually strong but would benefit from further expansion with additional references, particularly regarding:
existing frameworks of precision nursing, debates on personalized vs. standardized care, and variations in nursing practice across different healthcare systems.
Furthermore, the authors should more explicitly state that the perspective primarily reflects a high-income country / resource-rich setting, if that is indeed the case.
5. The manuscript presents 5–6 patient-based clinical examples. While illustrative, this number appears limited for a perspective aiming to propose a broader conceptual framework.
Currently, it is not entirely clear: What aspects of the existing care system are considered insufficient,
Which specific care standards the authors propose to modify or expand, and What tangible outcomes (clinical, organizational, or educational) are expected from adopting “precision caring.”
The authors should: Clarify the limitations of current care standards,
More clearly articulate what changes are being proposed, and
Discuss potential implications for practice, policy, or education.
6. The discussion raises an important conceptual point, but it remains somewhat descriptive rather than forward-looking.
Could this perspective serve as the basis for a formal project proposal or research agenda? If so, the authors should consider outlining: potential research questions, implementation strategies, or pilot program ideas that could operationalize “precision caring” in emergency settings.

Author Response

Thank you for your insightful review. Please see the attached file.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Summary

This perspective paper argues that precision medicine (biologically optimized, data-driven treatment) should be complemented by a form of “precision nursing” grounded in caring science. The manuscript uses emergency-care vignettes (prehospital, emergency department, wards, paediatric emergency care, and intensive care) to illustrate how relational, contextual, and ethical factors shape what “precision” means in practice.

The core message is clinically relevant and potentially valuable for the journal’s readership. However, the manuscript currently relies more on rhetorical contrast and narrative plausibility than on a clearly specified conceptual contribution. Substantial revision is required to strengthen definitions, make the argument analytically transparent, and improve structure and language.

Major issues (must be addressed)

1) Conceptual clarity: define and operationalize “precision caring” vs “precision nursing”

The manuscript introduces “precision caring” (via the iceberg metaphor) but does not provide a concise definition, boundaries, or operational characteristics that distinguish it from adjacent constructs (e.g., person-centred care, relationship-based care, lifeworld-led care).

Recommended actions:

Add a short subsection defining “precision caring” in one to two sentences.
List its core components (e.g., relational attunement, context elicitation under time pressure, ethical deliberation, co-production of feasible plans).
Specify observable indicators in emergency-care practice (e.g., structured preference elicitation, documentation elements capturing constraints/values, decision support that incorporates non-medical feasibility factors).
Explicitly separate the epistemic layer (how data/knowledge are generated and used) from the ethical-relational layer (how decisions are negotiated and enacted).

2) Provide an explicit analytic framework linking vignettes to claims

Multiple vignettes are presented, but the manuscript does not consistently demonstrate how each example supports the proposed conceptual expansion beyond narrative illustration. The argument would be stronger if each case was analysed using a consistent scaffold.

Recommended actions:

Apply a simple, repeatable framework to each vignette mapping: (i) data inputs, (ii) caring processes, (iii) clinical decisions, and (iv) hypothesised outcomes.
Reduce repetition by summarising common patterns across cases and highlighting only case-specific mechanisms.

3) Novelty claim: specify what is “expanded” compared with existing precision health/nursing literature

The manuscript cites and aligns with precision medicine/nursing discourse but does not clearly state what is new beyond a re-labelling of established caring or person-centred frameworks. The novelty needs to be stated as a set of differentiating propositions.

Recommended actions:

Add a paragraph that contrasts your proposal with established precision health/precision nursing framings that emphasise biomarkers/omics and individualized risk prediction.
State what the caring-science lens uniquely contributes (e.g., interpretive work under uncertainty, ethical prioritisation, feasibility constraints, meaning-making).
Clarify whether “precision caring” is a complementary process layer, a normative correction, or a measurable construct with distinct outcomes.

4) Evidence balance: avoid dichotomies and support outcome-oriented statements

Several passages risk creating a technology-versus-caring dichotomy. Contemporary precision medicine frequently includes environmental, behavioral, and contextual information. Outcome-oriented claims should be anchored either in evidence or framed as testable propositions.

Recommended actions:

Reduce binary framing and acknowledge that precision medicine can incorporate context, while arguing that caring science specifies how context is elicited and enacted ethically.
Add 2–3 concrete mechanisms by which caring processes plausibly improve measurable emergency outcomes (e.g., adherence to oxygen titration plans, reduced agitation/sedation exposure, fewer avoidable revisits, improved appropriateness/timing of therapy).
When evidence is not available, explicitly label statements as hypotheses and propose empirical evaluation.

5) Emergency Department section: integrate antimicrobial resistance as a precision-care use case (insertion of Capsoni et al.)

The emergency department discussion addresses triage and early testing but omits a high-impact ED domain where precision decision-making and caring intersect: empirical antimicrobial therapy under antimicrobial resistance (AMR) risk.

Capsoni N, et al. (Internal and Emergency Medicine, 2025; doi:10.1007/s11739-024-03692-7) provides ED-specific evidence on multi-drug resistant bloodstream infections, risk factors, and outcomes, and it supports the relevance of early risk stratification and timely appropriate empirical therapy while awaiting microbiology.

Suggested insertion point and bridging text:

Insert in the “Reflection and discussion” section, immediately after the paragraph beginning “Precision nursing has not traditionally been a focus in EDs…” (or after the discussion of triage delivering the right care at the right time).
Possible bridging sentence (adapt as needed): “In the ED, precision nursing also includes early infection risk stratification to support timely, appropriate empirical therapy in suspected sepsis/BSI, where local MDRO epidemiology and patient-level risk factors can inform initial antibiotic breadth while microbiology is pending.”

Minor issues (should be corrected)

A) Language, spelling, and consistency

The manuscript contains multiple typos and inconsistencies (spelling, hyphenation, occasional awkward phrasing) that require a careful copyedit. Terminology should be used consistently across the paper (precision caring vs caring; precision nursing vs precision medicine).

B) Structure and redundancy

Several concepts recur (e.g., iceberg metaphor; inseparability of physiological evaluation and lived experience), which dilutes impact. Consider consolidating repeated statements, and add brief signposting at the start of each major section. A concise “Implications” subsection (practice, education, research) would make the paper more actionable.

C) References and contemporary ED domains

Claims about emergency-care processes would benefit from more specific contemporary references, particularly in areas such as digital decision support, rapid diagnostics, and AMR-informed empirical therapy. Adding Capsoni et al. is a strong first step for the ED infection/AMR domain.

Overall recommendation

Major Revision is recommended because the manuscript currently lacks sufficient conceptual operationalisation, does not apply a consistent analytic framework linking vignettes to claims, and requires substantial language/structure improvements to meet scholarly standards. With clearer definitions, a transparent vignette analysis scaffold, strengthened evidence anchoring, and integration of ED AMR risk stratification (supported by Capsoni et al.), the paper would be considerably more compelling and publishable.

Author Response

Thank you for your insightful review. Please see the attached file.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

The revised manuscript has improved considerably compared to the previous version. The title has been appropriately corrected, and the introduction is now clearer, more fluent, and better structured. The objective of the study is presented in a more understandable way. In addition, the examples provided are well aligned with the aim of the manuscript and are clearly explained.

The inclusion of additional interpretations and implications in the discussion section has further strengthened the quality of the manuscript. I would like to congratulate the authors for the improvements made during the revision process.

In its current form, the manuscript is suitable for publication.

Reviewer 4 Report

Comments and Suggestions for Authors

Summary

Major issues (must be addressed)

1) Conceptual clarity: define and operationalize “precision caring” vs “precision nursing”

The manuscript introduces “precision caring” (via the iceberg metaphor) but does not provide a concise definition, boundaries, or operational characteristics that distinguish it from adjacent constructs (e.g., person-centred care, relationship-based care, lifeworld-led care).

Recommended actions:

Add a short subsection defining “precision caring” in one to two sentences.

List its core components (e.g., relational attunement, context elicitation under time pressure, ethical deliberation, co-production of feasible plans).

Specify observable indicators in emergency-care practice (e.g., structured preference elicitation, documentation elements capturing constraints/values, decision support that incorporates non-medical feasibility factors).

Explicitly separate the epistemic layer (how data/knowledge are generated and used) from the ethical-relational layer (how decisions are negotiated and enacted).

2) Provide an explicit analytic framework linking vignettes to claims

Multiple vignettes are presented, but the manuscript does not consistently demonstrate how each example supports the proposed conceptual expansion beyond narrative illustration. The argument would be stronger if each case was analysed using a consistent scaffold.

Recommended actions:

Apply a simple, repeatable framework to each vignette mapping: (i) data inputs, (ii) caring processes, (iii) clinical decisions, and (iv) hypothesised outcomes.

Reduce repetition by summarising common patterns across cases and highlighting only case-specific mechanisms.

3) Novelty claim: specify what is “expanded” compared with existing precision health/nursing literature

The manuscript cites and aligns with precision medicine/nursing discourse but does not clearly state what is new beyond a re-labelling of established caring or person-centred frameworks. The novelty needs to be stated as a set of differentiating propositions.

Recommended actions:

Add a paragraph that contrasts your proposal with established precision health/precision nursing framings that emphasise biomarkers/omics and individualized risk prediction.

State what the caring-science lens uniquely contributes (e.g., interpretive work under uncertainty, ethical prioritisation, feasibility constraints, meaning-making).

Clarify whether “precision caring” is a complementary process layer, a normative correction, or a measurable construct with distinct outcomes.

4) Evidence balance: avoid dichotomies and support outcome-oriented statements

Several passages risk creating a technology-versus-caring dichotomy. Contemporary precision medicine frequently includes environmental, behavioral, and contextual information. Outcome-oriented claims should be anchored either in evidence or framed as testable propositions.

Recommended actions:

Reduce binary framing and acknowledge that precision medicine can incorporate context, while arguing that caring science specifies how context is elicited and enacted ethically.

Add 2–3 concrete mechanisms by which caring processes plausibly improve measurable emergency outcomes (e.g., adherence to oxygen titration plans, reduced agitation/sedation exposure, fewer avoidable revisits, improved appropriateness/timing of therapy).

When evidence is not available, explicitly label statements as hypotheses and propose empirical evaluation.

5) Emergency Department section: integrate antimicrobial resistance as a precision-care use case (insertion of Capsoni et al.)

The emergency department discussion addresses triage and early testing but omits a high-impact ED domain where precision decision-making and caring intersect: empirical antimicrobial therapy under antimicrobial resistance (AMR) risk.

Suggested insertion point and bridging text:

Insert in the “Reflection and discussion” section, immediately after the paragraph beginning “Precision nursing has not traditionally been a focus in EDs…” (or after the discussion of triage delivering the right care at the right time).

Minor issues (should be corrected)

A) Language, spelling, and consistency

The manuscript contains multiple typos and inconsistencies (spelling, hyphenation, occasional awkward phrasing) that require a careful copyedit. Terminology should be used consistently across the paper (precision caring vs caring; precision nursing vs precision medicine).

B) Structure and redundancy

C) References and contemporary ED domains

Claims about emergency-care processes would benefit from more specific contemporary references, particularly in areas such as digital decision support, rapid diagnostics, and AMR-informed empirical therapy. Adding Capsoni et al. is a strong first step for the ED infection/AMR domain.

Overall recommendation