PONE-D-24-02427The organizational dimensions of rationing nursing care in intensive care unitsPLOS ONE

Dear Dr. Antoszewska,

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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Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear authors,

I hope this message finds you well. I am writing to provide feedback on the recent review of your manuscript submitted to our journal. The reviewer has offered valuable insights and recommendations for improving your work, and I kindly request your attention to address these suggestions in your revision.

In particular, the reviewer highlighted the importance of thorough proofreading to ensure linguistic accuracy and clarity. Additionally, it was noted that careful attention should be given to the statistical methodologies employed in your study to ensure their correctness and validity.

I highly recommend that you carefully consider these points and make the necessary revisions to enhance the quality and rigor of your manuscript. Your attention to these details will greatly contribute to the overall strength of your work and its suitability for publication in our journal.

I look forward to receiving your revised version and am available to provide any further guidance or assistance you may require throughout the revision process.

Thank you for your attention to this matter.

Best regards,

Dr. Alfuqaha

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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: Yes

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

Reviewer #1: No

Reviewer #2: Yes

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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: Dear authors

Thank you for your efforts to do this research. Please See my comments in below.

General Comment:

The manuscript should be edited by a person who fluent in English language.

Additional Comments:

Title:

� The phrase " the organizational dimensions" could be removed from the title. Additionally, it is better to add the phrase "and organizational factors"

Abstract:

� Please add the study time.

� line 30: If the journal guidelines allow, remove the word "discussion"

Introduction section:

� In general, I did not understand why the authors addressed only the number of beds and the type of hospital among the organizational factors. Because I think other organizational factors can contribute to the rationing of nursing care. The authors have also collected data on the number of work shifts, working hours, and patients under care, which are also considered organizational factors. Therefore, I wonder why the organizational factors were limited only to the number of beds and the type of hospital. I suggest that if there is no specific logic for choosing these two types of factors, it is better to state the organizational factors instead of emphasizing these two factors. In addition, it is better to clearly define the organizational factors in the introduction section.

� The introduction section is not written logically and coherently. It does not show the importance and necessity of conducting the study.

� A brief review of the literature on the research topic is necessary.

� I think that nursing workload in ICUs is a key factor in rationing nursing care. Therefore, I suggest that the introduction be developed using a related literature review of nursing workload in ICUs. For example, authors can use the following articles:

https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.785

https://onlinelibrary.wiley.com/doi/abs/10.1111/nicc.12548

Method section:

� I was surprised to see so many decimals in this manuscript. Please enter numbers to two decimal places in all sections of the manuscript.

� Please explain how to estimate the sample size.

� Line 80: Is the number 14 above 2014 related to the reference? Please correct it.

� I strongly recommend using appropriate regression models in data analysis.

Results section:

� I emphasize the data analysis must be checked by a statistical consultant.

� Table 1: please merge the (N) and (%) columns. as follows: N (%).

� Table 1: please delete the percent (%) from the numbers. for example, write 88.78 instead of 88.78%.

� Table 2: Does the letter M mean "Mean"? Please write in full.

� Table 2: Please merge "M" and "SD" columns.

� Table 2: Please write the p-value of 0.00000000005 as below. P <001. AS WELL AS, please apply this comment for table 5.

� This type of P-value reporting is not correct. In such a situation, the follow-up is reported as P <001. Please apply this comment in similar sections as well.

Discussion section

� I suggest that the discussion section be developed using a related literature review. For example, authors can use the following articles:

https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.785

https://onlinelibrary.wiley.com/doi/abs/10.1111/nicc.12548

Best Regards

Reviewer #2: The manuscript titled "The organizational dimensions of rationing nursing care in intensive care units" presents a significant contribution to the field of nursing and healthcare management by exploring the impact of hospital organizational factors on the extent of nursing care rationing in intensive care units (ICUs). The study is well-structured, with a clear aim to examine the influence of the number of beds and type of hospital on nursing care rationing, alongside exploring organizational factors affecting this issue.

One of the strengths of the study is its comprehensive methodology, utilizing the Perceived Implicit Rationing of Nursing Care (PRINCA) standardized questionnaire to collect data from a substantial sample of nurses. The findings are insightful, highlighting that a larger number of beds and voivodeship hospital settings are associated with a greater extent of nursing care rationing, pointing towards significant organizational influences on care quality.

However, there are several areas where the study could be improved:

The study is conducted in a specific region of Poland, which may limit the applicability of its findings to other regions or countries with different healthcare systems and organizational structures. Future research could benefit from a broader geographical scope to enhance the generalizability of the results. Maybe add this point to the limiatation section.

While the quantitative approach provides a solid overview of the extent of care rationing, integrating qualitative methods could offer deeper insights into the reasons behind care rationing and the subjective experiences of nursing staff. This could include interviews or focus groups with nurses to explore the nuances of organizational factors affecting care rationing.

The manuscript could be enriched by discussing potential intervention strategies or recommendations based on the findings. Identifying actionable steps that hospitals can take to mitigate the rationing of nursing care would provide practical value to hospital administrators and policymakers. Maybe you should add this into the discussion of the results.

The cross-sectional design of the study provides a snapshot of the situation but does not account for changes over time. A longitudinal study design could offer insights into how organizational changes within hospitals affect the rationing of nursing care over time.

The manuscript states that all relevant data are within the manuscript and its Supporting Information files. Ensuring the accessibility of this data for verification and future research would enhance the manuscript's transparency and credibility.

By addressing these areas, the manuscript could offer a more comprehensive view of the organizational factors influencing nursing care rationing in ICUs, providing valuable insights for improving nursing care quality and patient outcomes in these critical settings.

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Reviewer #1: No

Reviewer #2: Yes: Izabella Uchmanowicz

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PONE-D-24-02427R1Rationing nursing care and organizational factors in intensive care unitsPLOS ONE

Dear Dr. Antoszewska,

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. One of the original reviewers has provided some further recommendations that should be addressed in another revision of the manuscript.

Please submit your revised manuscript by Jul 19 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.

We look forward to receiving your revised manuscript.

Kind regards,

Sascha Köpke

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.

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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: 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 #1: Yes

**********

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

Reviewer #1: 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 #1: Yes

**********

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

**********

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: Dear authors

Thank you for addressing my comments. I have some comments as follows:

• Page 2, line 19: please change “Omitted nursing care” to “rationing of nursing care”

• Page 2, lines 21-22: Please add the abbreviation “intensive care units” in parentheses as follows: Intensive Care Units (ICUs).

• Page 2, line 40: please use the “ICUs” instead of the “intensive care units”.

• Page 2, line 41: add the term of “organizational factors” to keywords.

• Page 3, lines 44-45: I suggest removing the abbreviations MCN and MNCM because they are used only once in the entire manuscript.

• Page 7, line 147: Please write "neonatal ICUs" instead of "ICUs for neonates".

• I suggest that the text of lines 156 to 162 be moved to the ethical considerations section and merged with it so that sentences do not become repetitive. Because some sentences overlap.

• Table 1: Please mention the age unit in the related column in the table in parentheses as follows: age (years)

• Table 1, the column related to "the number of hours spent at work per month": please put the word "hours" in parentheses in the first column and remove it from the rest of the columns as follows: number of hours spent at work per month (hours): write "100-180" instead of "100-180 hours" ,....

• Table 3: Please mention the age unit in the related column in the table in parentheses as follows: age (years)

Best regard

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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 #1: No

**********

[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.

Rationing nursing care and organizational factors in intensive care units

PONE-D-24-02427R2

Dear Dr. Antoszewska,

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,

Sascha Köpke

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: