PONE-D-23-00352Choice, Attitudes, and Perceptions of Undergraduate Nursing Students towards the Nursing ProfessionPLOS ONE

Dear Dr. Iramiot,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Joyce Jebet Cheptum

Academic Editor

PLOS ONE

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Additional Editor Comments:

This is well written paper that highlights choices, attitudes and perceptions of nursing students towards nursing profession.

The methodology, especially for the qualitative section needs to be improved to include reliability , validity and trustworthiness. Ae you sure a pilot study was done? If so, this is a mini study and their findings should also be published.

What was the response rate? How many students were enrolled per class? In the methodology, preferably mention proportionate sampling , if it was done

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript describes the context and approach of the study and is conducted in a rigorous manner. The data provided supports the conclusions. The statistical analysis if rigorously conducted and presentation is appropriate for the type of data being presented. The authors have provided a link for the data access for scrutiny. It is written in standard English with very few grammatical errors. The language is clear. The manuscript will contribute to this area of scientific research if published in the website. The authors have consulted a wide range of current works that has been publish to support the study and findings.

Reviewer #2: Dear authors,

Thank you for giving me such great opportunity to review this manuscript.

In general, the topic is interesting one and there is a much effort undertaken. I have some inquires and some comments that will strengthen your manuscript.

I need to know why researchers conduct this study in Uganda. Numerous studies conducted and published concerning attitudes and perceptions of nursing students toward nursing profession. Also, factors shaping these attitudes and perceptions were also investigated too much. Results of the current study are the case of the vast majority of studies concerning attitudes and perceptions of students toward nursing profession. Is the context of nursing profession in Uganda is different?- what are the factors that make researchers to address this issue now in Uganda despite availability of solid background regarding attitudes and perceptions of different stakeholders of healthcare toward nursing profession.

This manuscript is too long and need major revision.

I know the effect of mixed research design in writing manuscript but this manuscript could be focused and summarized.

Please follow the following comments;

Abstract:

- Sampling technique and timing of data collection need to be given.

Introduction:

- Context of nursing profession in Uganda should be reflected enough ( regulation of profession, admission criteria, vital statistics, role of nursing in healthcare delivery system in Uganda)

- What about the attitudes and perceptions of students toward nursing profession from other regions?

- Conceptual framework not clear( on which base researchers develop this framework)

- Dependent and independent variables need to be addressed in introduction

- I find results about determinants of attitudes of students toward nursing which is not reflected clearly in the aim of study

- Why researchers ignore to add research question in this study?

Method:

- Why researchers choose the purposive sampling to select participants of focus group?

- Recruitment measures for participants should be mentioned - Sample representativeness, response rate is needed.

- Timing of conducting the study should be stated

- What are the measures used to ensure validity and trustworthy of data collected from subjects?

- What is the standard of focus group discussions; is it just point of view telling or data saturation?

- What about the structure of interview questions used in focus group discussion?

Results:

- Qualitative results need to be summarized ( many verbatim quotes not needed )

- I feel if quantitative analysis used to reflect percent of students in each theme of attitudes yielded from focus group, it will give powerful impression since researchers depend only on 16 nurses to give us results about perceptions and attitudes which is questionable

- Comparison of attitudes obtained from ASNP using mean scores did not give value to the readers. It is better to use mean score percent.

- What is the meaning of "relationship between students gender, marital status, religion, entry scheme and their attitudes was negligible but significant" ?

Discussion:

- It cannot find an interesting effective debate in discussion (researchers must keep their own voice too much using effective debate guidelines).

- Some results need to be discussed as why 6.1% only of students plan to join bedside nursing after graduation

Implications:

- What are the implications from this study for both clinicians and healthcare leaders?

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Reviewer #1: Yes: Jane W Kabo

Reviewer #2: No

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PONE-D-23-00352R1Choice, Attitudes, and Perceptions of Undergraduate Nursing Students towards the Nursing ProfessionPLOS ONE

Dear Dr. Iramiot,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Please submit your revised manuscript by Jul 21 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Joyce Jebet Cheptum

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

Please address comments from the third reviewer after the first revision of the initial document

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: No

Reviewer #3: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #3: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Dear Authors Dear authors

I am more than pleased to review this manuscript

Thanks a lot for considering first review comments

This manuscript is now well coordinated, focused, and could be published in PLOS ONE

Absolutely, politicians, healthcare leaders and nursing leaders in Uganda will find a valid evidence to make a sound reform in nursing profession.

Again, thanks a lot for this fruitful paper that try to upgrade nursing profession in Africa countries.

Reviewer #3: Choice, Attitudes, and Perceptions of Undergraduate Nursing Students towards the Nursing Profession

Review

Comments to the Author

I noticed major issues that needs to be concerned

Title

The Title should be modified as remove as choice, “Attitudes and Perceptions of Undergraduate Nursing Students towards the Nursing Profession “ because they are already engagement of the profession.

Abstract

Background: please try to describe precise information about perception and attitude and finaly show the gap here

Methods: you describe only Attitude but what about perception related questionnaires, and please incorporate data analysis information in methodology part

Result: first write the prevalence then significant variable. what is your justification:- poor academic performance in high school, desire to pursue a medical course, failure to get admitted for Medicine and Surgery, low cut-off points for the course and interest in nursing.

Attitude result shows 81.8% what about perception and choice?

Conclusion: totally your conclusion wrong <pre-nurse about="" accurate="" acquisition="" an="" and="" counseling="" courses="" enhance="" introductory="" maintenance="" nursing="" of="" perception="" profession="" the="" to=""> they discuss not being included in your finding. Add please concise and short recommendation in the conclusion.

Background

Please describe in detail factors magnitude of attitude, perception in background.

Methods

Please replace study setting with study setting and period

Despite you used a self-administered survey that took two months to complete, your sample of 165 people is genuine

Study participants

Please write in the form of source population and study population than study participants.

Sampling strategy

� Please write sampling strategy in clear and concise way. In general it is not clear the strategy

� I'm not understanding how to take 160 samples please write with evidence based .

� Your sample sizes are not adequate and dose not representative this small size sample. So it is difficult to accept your finding for scientific evidence purpose.

� It is even possible to include other national-level universities.

Sampling procedure

Please write clearly show your sampling procedure in clear and specific schematic way

Quantitative data collection

For attitude type use a five-point Likert-type but what about perception.

Please write attitude and perception tools in a separated and clearly way

The response rate was 91.6%; what had happened prior to these results?

Your Pilot study samples size not be correct. Because 15% of your sample is12 replace by 24

Quantitative data analysis

Completely unclear data analysis procedure; please rewrite again; it would be wiser to start with a clean check and enter and so…..

Result

First the prevalence then the response rate in the result?

It is better to write majority 89.1% Christian and Busitema University students around half like (50%) and so….

Marital status and religion should have more than two add others (specify)

Father education level tertiary it need operationalized

Overall, the respondents perceived nursing as a good and enjoyable course (nursing is profession or course) not clear to me

Discussion

The first paragraph no need of write the objective here it is better to write general information about attitude and perception.

In the second paragraph these results are in agreement with a similar study in choice what is your justification in general your result look like possibility not real finding.

Attitudes of nursing students towards the nursing profession

The mean attitude score was 129.9±12.3 (minimum 87, maximum 153).but in data collection show that It is a five-point Likert-type scale with a minimum score of 40 and maximum of 200)

Before compare your result first writes the prevalence and range of attitude

Your study prevalence 81.8% had positive attitudes towards the nursing profession then how 62.07% similar Hue University of Medicine and Pharmacy need clarification

In general the whole discussion need detail description compare and contract

Conclusion

Your conclusion part not be focus your result. Please avoid terms like receive pre-nurse counseling and introductory courses about the profession, to enhance acquisition and maintenance of an accurate perception related variable, and conclude in line with your finding.

Limitations to the study

The findings cannot be generalized private but also the governmental nursing institutions in Uganda, because your sample size is very small.

Implications of this study

In general the implication of your study not based on your results

Reference

Most of the reference out dated eg Ref 14,15,23 ….

In general, I am interested in paper and recommend publication with major modifications.</pre-nurse>

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: No

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Attitudes, and Perceptions of Undergraduate Nursing Students towards the Nursing Profession

PONE-D-23-00352R2

Dear Dr. Iramiot,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Joyce Jebet Cheptum

Academic Editor

PLOS ONE

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