Post-Traumatic Stress, Compassion Fatigue, and Psychological Well-Being Among Critical Care Nurses in Saudi Arabia: A Cross-Sectional Study
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsFor the sample size estimation you have used 20-25% for non-responses, but from literature you could have seen that response rates are even lower (often way below 50%). For this study, the same number of people responded as the number you have recruited? Could you explain this high response rate?
What was the reasoning for the authors to choose for a survey and not in depth interviews in this study?
Another question regarding the eligibility of the participants, the authors mention a couple of inclusion criteria including at least one year of work experience. Did the participants see these criteria before they actually filled in the questionnaire? Otherwise, I can imagine the number of included persons was at first higher, but you have some dropouts due to these criteria.
The discussion section is really extensive and could be improved regarding readability. First this section needs to start with a summary of the findings, followed by comparison with the literature, strengths and limitations and finally the conclusion. At the moment the findings are scattered in this section, compared with literature and this is confusing for me as a reader.
Also, a whole list of possible improvements are provided, but which ones should really be implemented according to the authors?
Limitations of this study are mentioned, but I miss the strengths.
Author Response
Dear Reviewer,
Kindly findthe attached file.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThis manuscript investigates the relationships between post-traumatic stress disorder (PTSD), compassion fatigue, and psychological well-being among critical care nurses in Saudi Arabia using a cross-sectional design and validated psychometric scales. The topic is timely and relevant to occupational health.
The study addresses a critical issue in healthcare workforce well-being—psychological distress among critical care nurses. Internationally recognized tools like PTSD Checklist for DSM-5 (PCL-5), Professional Quality of Life Scale (ProQOL-V5) and WHO-5 Well-Being Index has been used that strengthen the psychometric credibility and comparability of the findings. I also noticed that the research questions have been designed after carefully identifying research gaps, guiding further analysis and discussions.
However, there are some areas that need attention. In the correlation section the manuscript states: "a significant and positive correlation was observed between PTSD and compassion fatigue (r = -0.72)" This is contradictory. A negative value (−0.72) cannot represent a positive correlation. The regression model states that Model summary: R² = 0.21, F(2,199) = 17.03, however, Table 5 includes multiple predictors, including: age, education, experience, income, work region etc so the degrees of freedom reported are inconsistent. Since you have used convenience sampling which may lead to self-selection and response biases, the biases need to be further discussed, perhaps in the limitations. Also, I see some inconsistent percentages (e.g., male/female counts differ in different sections), formatting errors in tables and missing parentheses in statistical values. The introduction discusses physical well-being, but the study measures only psychological well-being (WHO-5). I recommend you to clarify or remove references to physical well-being unless measured.
Author Response
Dear Reviewer,
Kindly find the attached file.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors Dear authors It was a great pleasure to receive your invitation to review your manuscript. However, I have a few suggestions for improvement: Literature Review The literature review seems adequate to me. The research questions are well formulated. You should have formulated the study objectives based on the research questions. Furthermore, I would suggest that you formulate hypotheses that address these research questions. Method The description of the instruments in the methodology is well done. However, they did not report the psychometric properties of each instrument, including confirmatory factor analysis and reliability. Did they carry out confirmatory factor analysis and test the reliability? If not, they should do so. The data analysis procedure is also very weak. The description needs to be detailed. Results The sample description should be included in the method. As a general rule, it should not appear in the results. In Table 3, the p-values are listed as 0.000. This is incorrect. In such cases, the p-value should be listed as < 0.001. In multiple linear regressions, neither nominal nor ordinal variables should be included as independent variables. To use these variables in linear regressions, they must be coded as dummy variables. In linear regressions, both independent and dependent variables must be quantitative. You should amend the results in Table 5. Discussion The discussion should be divided into the following sub-sections: Practical Implications Theoretical Implications Limitations My Best RegardsAuthor Response
Dear Reviewer,
Kindly find the attached file.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for Authorssubstantial improvements are made.
Reviewer 3 Report
Comments and Suggestions for AuthorsDear Authors
Thank you for implementing the suggestions for improvement that I put forward.
Best regards
