Who Is Responsible for Nurse Wellbeing in a Crisis? A Single Centre Perspective

Round 1

Reviewer 1 Report

The article is credible and consistent with other studies about nurses' experiences but needs more detail added. For example, th period of engagement was short and only examined the first wave of COVID-19, which is clearly stated in the introduction, but the rationale for this choice is not.  The results are consistent with other studies in different geographic locations and for other time periods during COVID-19. It would be nice to have seen a little more discussion about the similarities with current COVID-19 studies though the comparisons to SARS is important.

There was no indication that demographic information was collected on the participants. Ideally, there should be a demographic table that includes age, gender, etc. It should also include the type of unit the person was on or redeployed to. Also, a table that includes the semi-structured questions that were asked is needed. Without such a table it is hard to know exactly how the results do compare with other studies.

There should be more detail on the Framework Analysis. My understanding is that a framework analysis is particularly useful when there is a limited timeframe, professional participants, and organizational and integration issues with the intent of describing what is happening. This is not clearly described in the article and should be included. 

The methods and data analysis needs to be clarified. It is unclear to me if the researchers did the interviews or if the interviews were done by someone else, and this was a secondary analysis of interviews as indicated in line 105-6. Within the data analysis were any field notes kept by the interviewers about their thoughts or impressions at the time of the interview. Was triangulation used, if so it was not mentioned.  The interviews were through video conferencing software (which one) and where were the participants when they did the interview (work, home, etc.). Was any compensation offered for doing the interview?

Transferability is important in qualitative research. This requires a little more detail about the clinical setting beyond an inner-city university hospital and about the participants. 

There should be information added on any limitations of the study, such as a convenience sample, one hospital, and others that may have been considered by the authors.

If there is a theoretical framework of conceptual model for the study, it should be described. It may be the BPS model that is mentioned in the discussion. If so, I would add a section before or in the methods section on the model.

Suggested edits by line number:

Line 48, you need [ ] around the reference number

Line 53, I recommend deleting "was the insight into"

Line 110, I suggest that COVID-19 should be consistently used throughout rather then COVID19.

Line 341-2, I recommend rephrasing the sentence. It isn't clear what is meant.

Line 386, the BPS model is mentioned, but it was not in the literature review. If it is the model for the study it would be nice to have a brief description of it. 

Line 388, need [ ] around the reference number.

Author Response

The article is credible and consistent with other studies about nurses' experiences but needs more detail added. For example, the period of engagement was short and only examined the first wave of COVID-19, which is clearly stated in the introduction, but the rationale for this choice is not.  The results are consistent with other studies in different geographic locations and for other time periods during COVID-19. It would be nice to have seen a little more discussion about the similarities with current COVID-19 studies though the comparison to SARS is important.

• Thank you for your comments and taking the time to read our paper. A rationale for the only focusing on the first wave of the pandemic has been added. A comparison to other COVID studies was included in the discussion.

There was no indication that demographic information was collected on the participants. Ideally, there should be a demographic table that includes age, gender, etc. It should also include the type of unit the person was on or redeployed to. Also, a table that includes the semi-structured questions that were asked is needed. Without such a table it is hard to know exactly how the results do compare with other studies.

• We did not collect demographic information other than the level of seniority because this was not required for the evaluation. There was also a risk participants could be identified if we reported at a more granular level. We have included a table summarising the interview questions.

There should be more detail on the Framework Analysis. My understanding is that a framework analysis is particularly useful when there is a limited timeframe, professional participants, and organizational and integration issues with the intent of describing what is happening. This is not clearly described in the article and should be included. 

• More detail of Framework Analysis has been added.

The methods and data analysis needs to be clarified. It is unclear to me if the researchers did the interviews or if the interviews were done by someone else, and this was a secondary analysis of interviews as indicated in line 105-6. Within the data analysis were any field notes kept by the interviewers about their thoughts or impressions at the time of the interview. Was triangulation used, if so it was not mentioned.  The interviews were through video conferencing software (which one) and where were the participants when they did the interview (work, home, etc.). Was any compensation offered for doing the interview?

• Additional details f framework analysis have been added for clarity. Initials have been added of the authors who conducted the interviews and their input into the analysis. No field notes were kept and neither was triangulation. The video software used has been added. In the UK we do not compensate for research participation.

Transferability is important in qualitative research. This requires a little more detail about the clinical setting beyond an inner-city university hospital and about the participants. 

• All the authors are from the same organisation so this will be clear to the reader if they require more information.

There should be information added on any limitations of the study, such as a convenience sample, one hospital, and others that may have been considered by the authors.

• Section 4.1 has been added as a limitations section.

If there is a theoretical framework of conceptual model for the study, it should be described. It may be the BPS model that is mentioned in the discussion. If so, I would add a section before or in the methods section on the model.

• This was part of a service evaluation so there was no conceptual model. More detail of the BPS model has been added for clarity.

Suggested edits by line number:

Line 48, you need [ ] around the reference number

• Added as requested

Line 53, I recommend deleting "was the insight into"

• Deleted as requested

Line 110, I suggest that COVID-19 should be consistently used throughout rather then COVID19.

• Changes made as requested and the manuscript has been checked and corrected throughout.

Line 341-2, I recommend rephrasing the sentence. It isn't clear what is meant.

• Sentence has been rephrased a requested.

Line 386, the BPS model is mentioned, but it was not in the literature review. If it is the model for the study it would be nice to have a brief description of it. 

• Details have been included in the introduction.

Line 388, need [ ] around the reference number.

• Added as requested.

Reviewer 2 Report

Thankyou for the opportunity to review this paper, which examines the role of leadership in ensuring wellbeing for nursing staff during the COVID-19 pandemic-. It poses an important question around the responsibility of leadership to protect healthcare workers in opposition to current discourse around personalised protective mechanisms and responsibilities (e.g. resilience) in healthcare. The paper is well written and an important contribution to health workforce/wellbeing literature and I recommend publication. I do have some suggestions for minor revisions, as follow:

Line 40 – for future readers (and some younger readers) the SARS pandemic will need to be given dates to indicate what time the authors are talking about. Would also recommend the authors remove “current” from description of COVID-19 pandemic as this might make the paper feel dated in the future.

Line 50-51 – for international readers (as this is an international journal) there could be a more detailed outline of the COVID-19 public health context and NHS context in which these nurses were experiencing what they were discussing. Consider outlining major points of the public health response (lockdown, changes to NHS services) here for context.

Line 98 – regarding “convenience sample”, while it is good to see different levels of seniority, was there also further diversity (gender, specialty area, British or International-trained, ethnicity)?

Line 112-13 – go into a little more detail around the video interviewing. Why was this method selected? Why was it good practice? What were the pros and cons of the approach and how were difficulties addressed? (See https://journals.sagepub.com/doi/pdf/10.1177/16094069221105075, or https://pubmed.ncbi.nlm.nih.gov/35672272/ for a health-worker specific reference)

Before conclusions – would expect to see a section on strengths, limitations and directions for future research. It might also be helpful to have an explicit “Policy and Practice Implications” section, to spell out exactly what action or recommendation is arising from the findings.

Author Response

Thankyou for the opportunity to review this paper, which examines the role of leadership in ensuring wellbeing for nursing staff during the COVID-19 pandemic-. It poses an important question around the responsibility of leadership to protect healthcare workers in opposition to current discourse around personalised protective mechanisms and responsibilities (e.g. resilience) in healthcare. The paper is well written and an important contribution to health workforce/wellbeing literature and I recommend publication. I do have some suggestions for minor revisions, as follow:

• Thank you for your comment and taking the time to read our paper.

Line 40 – for future readers (and some younger readers) the SARS pandemic will need to be given dates to indicate what time the authors are talking about. Would also recommend the authors remove “current” from description of COVID-19 pandemic as this might make the paper feel dated in the future.

• Details have been added and changes made as requested.

Line 50-51 – for international readers (as this is an international journal) there could be a more detailed outline of the COVID-19 public health context and NHS context in which these nurses were experiencing what they were discussing. Consider outlining major points of the public health response (lockdown, changes to NHS services) here for context.

• This has been added as requested.

Line 98 – regarding “convenience sample”, while it is good to see different levels of seniority, was there also further diversity (gender, specialty area, British or International-trained, ethnicity)?

• We did not collect this level of information as it was not required as part of the wider evaluation. Not all the participants remain in the hospital now so it would not be possible to retrospectively obtain this information.

Line 112-13 – go into a little more detail around the video interviewing. Why was this method selected? Why was it good practice? What were the pros and cons of the approach and how were difficulties addressed? (See https://journals.sagepub.com/doi/pdf/10.1177/16094069221105075, or https://pubmed.ncbi.nlm.nih.gov/35672272/ for a health-worker specific reference)

• Detail has been added for clarity.

Before conclusions – would expect to see a section on strengths, limitations and directions for future research. It might also be helpful to have an explicit “Policy and Practice Implications” section, to spell out exactly what action or recommendation is arising from the findings.

• We have included a limitations section before the conclusions and the recommendations are included in the conclusion section.