PONE-D-23-28215Innovative behaviour and organizational innovation climate among Chinese clinical first-line nurses during the Omicron pandemic: The mediating roles of self-transcendencePLOS ONE

Dear Dr. Tang,

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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

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

Reviewer #1: N/A

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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

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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

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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 an interesting study done on the first-line clinical nurses who worked during the Omicron pandemic in general and specialized hospitals in China. The background of the study is very thorough in describing the challenges faced by nurses during the pandemic including the risk of contracting Omicron mutant strain of the COVID-19, but also the mental and emotional problems faced by the increased workload such as depression, anxiety and post-traumatic stress disorders.

The pandemic forced nurses to innovate in the work organization, techniques and the roles played inside the hospitals. The good results, quality of attention and improved prognosis offered to patients when nurses went on to innovate in these areas, encouraged the authors to specifically outline the role of innovative behavior in the clinical setting, looking into the factors that favor innovation. Hence, organizational innovation and self-transcendence are taken into consideration to see their role and influence in innovative behavior.

The study has a convenience sample, properly declared in the limitations section, of 1058 nurses who answered the 4 questionnaires: the sociodemographic questionnaire, the Nurse Innovative behavior scale, the Nurse Organizational Innovation Climate Scale and Self-Transcendence Scale. All of which had proper ethical provision taken to obtain data from participants.

The results section presents very neatly the scores in each of the questionnaires and scales and shows the correlations between innovative behavior and organizational innovations climate, as well as between innovative behavior and self-transcendence; a mediating effect test is performed to indicate an indirect effect of self-transcendence between innovative behavior and organizational innovation climate.

The discussion turn out to be very interesting and is well supported on the data reviewed in the background of the study, as well as, the empirical data obtained from the participants. A well treated discussion is undertaken concerning the need of innovative behavior to face the great clinical challenges that rose during the Omicron pandemic. Regular nursing methods and techniques would have not been sufficient to meet this challenge, so there is a suggestion for nursing managers to enhance the innovation capabilities of the nursing staff because their scores in innovative behavior were moderate. A favorable organizational innovation climate stimulates positive responses and attitudes among nurses as found in the study´s results, but also concurring with other relevant literature. A positive correlation was found between these two results.

However, self-transcendence seem to be a more complex variable to take into consideration, it is considered to have relation with the vitality, dedication and the motivations to keep a high-spirited attention to their work and patients. A special and interesting discussion is developed by the authors concerning the role of academic and scientific activities in keep self-transcendence high in nurses. The discussion of the mediating role of self-transcendence between innovative behavior and organizational innovative climate is interesting because it hints possible paths towards improving the latter two.

Considering these remarks on the subject, I would like to make some annotations to specific issues in the manuscript that I believe should be taken into consideration:

1. In the definition of innovative behavior the authors start form the definition of Scott et al [19] which is a wide ranging definition, and later on cite some of the specific literature, but some examples of what specifically are they are conceptualizing as innovative behavior in the Chinese clinical setup would be welcome.

2. When laying out the Space Theory to express a concrete formula for innovative behavior (Bi= f(Pi•Ei)), it seems that the factor taken into consideration in this formula are wider than the ones taken in this study, p.e. Pi which considers personal internal needs of psychological factors can be considered much wider than the results expressed in the Nurse Innovative behavior scale and the Self-Transcendence Scale. The same goes for Ei and the Nurse Organizational Innovation Climate Scale. Therefore, a brief explanation of how the trim is justified would underscore this step, considering that measurement of such wide elements would be very hard.

3. Being that the sample is mostly women nurses, when discussing self-transcendence there is no consideration on gender and what could this complex concept mean to women or if some of the data could be disaggregated in this respect.

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Reviewer #1: No

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PONE-D-23-28215R1Innovative behaviour and organizational innovation climate among Chinese clinical first-line nurses during the Omicron pandemic: The mediating roles of self-transcendencePLOS ONE

Dear Dr. Wang,

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 May 18 2024 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Myriam M. Altamirano-Bustamante

Academic Editor

PLOS ONE

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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 #1: (No Response)

Reviewer #2: (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 #1: Partly

Reviewer #2: Partly

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

Reviewer #1: N/A

Reviewer #2: No

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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 #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: Yes

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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 #1: I thank the authors for the changes made to the manuscript in attention to the previous observations. The manuscript has improved where it made those changes. I appreciate the attention paid to question 1., and the further details provided by Bao’s definition of nurses innovative behavior. In this regard, I consider the matter resolved.

Concerning Q3, I think that not taking in consideration the matter of gender in such a sample is a limitation, but of course, the authors may legitimately choose to keep the study in such fashion and not consider analyzing the data considering differences between genders, however this could be explicitly stated in the limitations section.

It is in Q2 where I found some difficulty to review the response of the authors, as they say “the range of variables included in Bi, Pi and Ei of the Space Theory is indeed very wide, and we also refer to the variables included in previous similar studies, which may be biased to some extent, and is also a deficiency of this study.” But when trying to trace how the other studies defined the Bi, Pi or Ei variables, I wasn’t able to read those study as they were mostly written in Chinese (language that I am unable to read). Therefore, I’m unable to follow the argument presented and therefore cannot judge the sufficiency of the changes made or the antecedents put forward, perhaps the argument should be made explicit in the text.

Consider correcting the following: pg. 25 “Innovation behaviour.among clinical first-line nurses.”

Reviewer #2: REVIEW

This study delves into the interrelationships among "innovative behavior," "organizational innovation climate," and "self-transcendence" in front-line clinical nurses in China during the Omicron pandemic, underpinned by field theory. Using a cross-sectional design, it incorporates a convenience sample of 1,058 nurses from seven hospitals and assesses the mentioned constructs through validated scales. The statistical analysis focuses on these dimensions to explore their correlations and the mediating role of "self-transcendence" between "organizational innovation climate" and "innovative behavior."

While it's crucial to gather data on nurses' experiences in Chinese hospitals during the Covid-19 pandemic to assess and improve nursing in China under crisis conditions, this draft has several areas that require rectification for potential publication in PLOS ONE.

MAJOR ISSUES

1. Samples: The mere mention of "seven hospitals in China" without details on their location, size, or administrative level significantly undermines the study's generalizability. Moreover, while nurse characteristics are described, information on the hospitals is notably absent but essential.

2. Sample Size: The method described for calculating sample size is incorrectly attributed to Kendall's "Multivariate Analysis," confusing the number of items with variables. The approach is inappropriate for this study's aims, specifically concerning the precision of correlation coefficient estimation. Moreover, the cited page range (251-306) does not exist in Kendall's work, which casts doubt on the draft's accuracy.

3. Theoretical Foundation: Although leveraging field theory is intriguing, its application to the authors' mediating variable model is inadequately justified and discussed.

4. Statistical Model: The core model may be overlooked potential confounders other than "organizational innovation climate" and "self-transcendence" that might significantly affect "innovative behavior."

5. Table 1: The inclusion of P-values and the unclear meaning of "Z/H" are problematic. Descriptive information should not intertwine with inferential statistics, contrary to what STROBE guidelines advocate (Item 14, Explanation).

6. Mediating Effect of Self-Transcendence: This section and Figure 2 inadequately report the direct effects between "organizational innovation climate" and "innovative behavior," requiring a clearer presentation in both figure and table formats.

MINOR ISSUES

1. References: Several citations are incomplete or incorrect, such as the nonexistent "Review of Principles of Topological Psychology" and the misquoted page range in Kendall's work. Additionally, the "PROCESS" program used for mediation analysis is not cited. A thorough review and correction of the reference list are recommended.

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Reviewer #1: No

Reviewer #2: Yes: Chiharu Murata

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PONE-D-23-28215R2Innovative behavior and organizational innovation climate among the Chinese clinical first-line nurses during the Omicron pandemic: The mediating roles of self-transcendencePLOS ONE

Dear Dr. Wang,

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 Jun 21 2024 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,

Myriam M. Altamirano-Bustamante

Academic Editor

PLOS ONE

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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

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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: Partly

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

Reviewer #2: Yes

**********

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

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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

**********

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: Major concerns

1. The introduction of the manuscript is verbose. The authors should consider the following suggestions:

-First, the background information provided is excessively detailed. The detailed descriptions of COVID-19, particularly the Omicron variant, are well-known and seem unnecessary in this manuscript. Since the intended audience of this study is likely already familiar with this information, it could be omitted. Instead, briefly state why the characteristics of COVID-19 and the Omicron variant are relevant in the context of this study.

-Second, there is repetitive information. The necessity for innovation in nursing and quality improvement is mentioned multiple times without each mention providing new information. While it is important to emphasize key points, repetition can scatter the reader's attention. Avoiding repetition and stating each point clearly once would enhance the clarity of the text.

-Lastly, unnecessary detailed descriptions should be avoided. Several cited studies are described in excessive detail. Unless these details are directly necessary for understanding this research, it would be more appropriate to succinctly state the main findings and how these studies contribute to the discussion of the paper. This approach would make the text more focused and easier to read.

2. There are some discrepancies between the statistical analysis design and the sample size calculations. In order to enhance the clarity, completeness, and scientific rigor of the study, it would be beneficial to consider the following points:

Analysis of Mediating Effects: The purpose of this study is not only to explore the correlation between innovative behavior, organizational innovation climate, and self-transcendence, but also to investigate the mediating role of self-transcendence between innovative behavior and organizational innovation climate. Given this objective, the sample size calculation should include considerations specific to mediation analysis. This type of analysis requires a sample size that adequately addresses the relationships among the independent, mediating, and dependent variables, taking into account the expected effect sizes of the paths involved. The description of sample size calculations in the current manuscript does not appear to meet these requirements. The following book is recommended as a reference: Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. 3rd ed. New York. : Guilford Publications; 2022 Jan 24. ISBN 9781462549030.

-Model Selection for Sample Size Calculation: The manuscript mentions that a "point biserial model" was used to calculate the sample size. However, this model is usually employed when one variable is binary and the other is continuous. In a mediation analysis, where usually all variables involved are continuous, the choice of this model may not be appropriate. A more detailed explanation of why this model was chosen and its suitability for the reported analysis is needed.

-Sample size discrepancy: the manuscript states that the "point biserial model" was used to calculate a minimum sample size of 266 participants, but the study included 1,058 participants. This large difference in numbers raises questions about the rationale for including such a large sample. While the large sample size may be justified by the requirement for a comprehensive mediation analysis, the manuscript currently lacks an explanation for this discrepancy. Clarifying why 1,058 participants were necessary would greatly enhance the transparency and understanding of the study design, especially in relation to the mediation analysis. understanding of the study design, especially in relation to the mediation analysis.

-Consistency of reporting: In my previous review I noted that the reporting of descriptive statistics should avoid mixing information from inferential statistics, and that this has been noted in STROBE as well. The authors accept this point and exclude the reporting of p-values from the summary of descriptive statistics results as seen in Table 1. If this is the case, reference to inferential statistical methods for between-group comparisons should also no longer be included, as it may confuse the reader or imply analytical methods not employed in the study.

Minor concerns

-"3.1. Research Design and Setting" should include detailed information about the setting. It is necessary to specify the time period (year and month) during which the study was conducted. Rather than merely stating 'China,' providing a more detailed location, such as the province or city, would be beneficial. Additionally, references to STROBE should be concise, only noting whether this report of the study is STROBE compliant.

-It is recommended to divide the section "3.2. Participants and Sample" into two different sections: “Participants” and “Sampling Methods and Sample Size Calculation.” In the “Participants” subsection, the inclusion and exclusion criteria should be detailed. In the “Sampling Methods and Sample Size Calculation” subsection, the focus should be on the procedures used to recruit participants and how the sample size was calculated. This restructuring will enhance the logical flow of the sections and make the information more organized and accessible.

-Although this is not a comment about the writing of the paper itself but rather about the authors' responses to my comments, I feel compelled to add one point. The authors frequently conclude their responses with the phrase, 'And our writing ability is limited, I hope you can be magnanimous.' While I understand this might stem from cultural differences, it is crucial to remember that the peer review process is designed to ensure the quality of research and provide objective feedback based on the content of the manuscript, not on the personal capabilities or feelings of the authors. I encourage the authors to focus on addressing the scientific feedback directly and ensure that communication remains professional and focused on the research itself. Such references to personal limitations in writing do not align with the professional standards expected in scholarly communication.

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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: Yes: Chiharu Murata

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Innovative behavior and organizational innovation climate among the Chinese clinical first-line nurses during the Omicron pandemic: The mediating roles of self-transcendence

PONE-D-23-28215R3

Dear Dr. Wang,

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.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Myriam M. Altamirano-Bustamante

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

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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

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

Reviewer #2: Yes

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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: Yes

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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

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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: I have made high-level demands of the authors during this peer review process, and you have responded well to those demands. In my judgment, you have submitted manuscripts that are suitable for publication in PLOS ONE. I would like to endorse PLOS ONE's acceptance of this version.

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Reviewer #2: Yes: Chiharu Murata

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