PONE-D-23-02408The Impact of Nursing Shared Governance Educational Program on Women Nurse Managers’ Knowledge for Sustainable Nursing Excellence and Empowerment.PLOS ONE

Dear Dr. Dr. Sally Mohammed Farghaly Abdelaliem,

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 Oct 19 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.

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Omar M Khraisat, Associate Professor

Academic Editor

PLOS ONE

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"yes 

The research was funded by Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2023R279), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia."

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

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: No

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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: No

Reviewer #2: No

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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: Overall, I believe that the topic of shared governance is relevant to nurses and administrators around the world and that there are still many steps to take everywhere. Compliments therefore to the authors for taking up this topic in their environment. However, as to whether the main claim of this manuscript offers a significant contribution to the field of nursing management and organization of care, I have some reservations. My main reservation is that the conclusions of this study are rather logical which makes me doubt the scientific relevance. The goal of the intervention was increased awareness around shared governance and this was indeed achieved, measured immediately after the last meeting. Choosing awareness as an outcome variable of an educational intervention does not add much to the scientific discussions around nurse shared governance, after all, increases in knowledge and awareness about a topic immediately after an intervention is logical. An addition of longitudinal measurements (does awareness remain high over time) or change in behavior in practice (e.g. management style) would have added more value to the scientific discourse. The authors acknowledge this limitation already in the discussion section.

- The title mentions that it is about female managers, however, the relevance of this explicit addition is not made clear in the manuscript. I recommend adjusting the title.

- The reference style does not conform to PLOSONE's guidelines. Recommend to use a reference program.

- A reporting checklist or guideline for conducting study and/or paper is missing.

- The introduction is long and not always succinctly described. For example, the first three sentences are wordy. It is not until sentence 4 that it becomes clear what this paper could be about. Advice is to critically review the introduction and write more concisely.

- In lines 280-290 is referred to a previous study of the authors, however the reference is unclear. Precisely this information is interesting because after the introduction on shared governance, I as a reader am also particularly keen to read about the state of shared governance and nursing management and organizational structure in the research setting/country. This knowledge helps a reader to assess whether I could generalize the results of this study to my setting. Nor is this explained anywhere else in the paper.

- The authors use self-designed questionnaires. About the 'professional nursing shared governance knowledge questionnaire', it is written that it was designed based on literature. There is no reference to which literature. For the 'evaluation' questionnaire it is not described on which basis it was designed. Both questionnaires are missing, no reference also to a supplementary file. With regard to validity, it was stated that face and content validity had been established, but information on which technique was used for this was lacking. Nothing was said about internal consistency or structural validity. This limits the opportunities for replication of the studies methodology for other researchers.

- The tables are clear in structure and design

- The discussion is described in a lengthy manner. I advise the authors to improve readability by making the text more concise.

- The paper is about nurse managers, however in the discussion literature of both nurses and nurse managers is used interchangeably. The rationale for this is sometimes lacking. For example in line 636-641.

Based on the intervention, outcome variable and study design, reflection on effect of training on the outcome variable 'awareness' would be of added value.

Reviewer #2: I would like to thank the authors for the opportunity to review this manuscript. The subject of the article is of interest to the community specialized in health and nursing. However, there are serious problems with formatting and compliance with the journal's standards (tables, citations, data availability) that have not been met. A revision in English is needed, perhaps with the help of a native speaker.

I am putting forward my suggestions point by point so that a version of greater quality and robustness can be presented.

Title: Could be adjusted to make it more objective and focused on the object of study. As it is not a gender study, why do the authors use the word "women"? There is no emphasis throughout the text.

Introduction:

I missed more current references on the subject, the last ones are from 2019. I suggest that you also add other existing interventions in the literature that have increased knowledge on the subject.

It is necessary to review all citations according to the journal's guidelines. The model used is vancouver numeric.

Line 289 - The citation of the study is not clear, there are only a few names (Farghaly, S. M., El-Bialy, G. G., & Dowidar).

Lines 294 - 297. The use of the PICO strategy is interesting, but in this case there would be no comparator, as no analysis is carried out with professionals who are not part of the session. I suggest removing or suppressing the use of C.

Method:

Lines 313-316: Add more information about the institution, for example: number of beds, professionals and level of complexity.

Lines 321-324: Were all the nurse managers invited and did they agree to take part in the survey? Do you work with the population?

Lines 328-354: It would be important for the instruments as well as the database to be added as supplementary documents for a better understanding of how the information was collected.

Lines 356-361: What were the Cronbach's alpha values? I suggest presenting them. And better detail the cut-off value for deciding consensus between the judges and how many rounds of consensus were necessary. How were these experts selected? Describe this section better.

Line 363: Change the title to description of the intervention.

Table 1: Could contain more details of the intervention. For example: types of educational techniques, how many meetings, how long the sessions lasted and the number of participants in each (It's not clear whether all 50 managers took part in all the sessions).

Results:

Line 460: Exclude "predominantly female" wouldn't that be all female? after all there were no male participants in the study.

The results could be written without dividing them into sections, so they don't flow and break the reader's train of thought.

Table 3 - I don't understand why the previous information question is important, since after the intervention it is logical for everyone to answer yes. In the variable "Sources of information" in the item "other sources", put in the table caption what the other sources are. Also in table 3, the satisfaction results are presented here and in table 5.

It's not clear from the method, for example, because the instrument is not attached, how the complete response of concepts was assessed.

Discussion:

The discussion needs more up-to-date references, as well as reflection on the authors' own studies already carried out at the same institution on the subject (https://www.sciedupress.com/journal/index.php/jnep/article/view/12157/7665, https://www.cureus.com/articles/24566-perception-of-shared-governance-among-registered-nurses-in-ambulatory-care-center-at-a-tertiary-care-hospital-in-saudi-arabia#!/).

The discussion needs more in-depth reflections on the results found, as well as the authors' statements. I think that the limitations and implications for practice sections can be part of the discussion, and they are naturally arrived at without having to be divided up.

Conclusion:

Needs to be more concise and more focused on answering the objective.

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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: Yes:  Susanne M. Maassen

Reviewer #2: No

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PONE-D-23-02408R1The Impact of Nursing Shared Governance Educational Program on Nurse Managers’ Knowledge for Sustainable Nursing Excellence and Empowerment.PLOS ONE

Dear Dr. Farghaly Abdelaliem,

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 Apr 13 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,

Omar Mohammad Ali Khraisat, Associate Professor

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 #3: (No Response)

Reviewer #4: (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 #3: Yes

Reviewer #4: Partly

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

Reviewer #3: Yes

Reviewer #4: 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 #3: Yes

Reviewer #4: 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 #3: Yes

Reviewer #4: 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 #3: Regards

Congratulations to the authors of the article

The necessary reforms that the reviewers had proposed have been applied.

It would have been better to highlight the corrections in the revision of the article.

There is still little information about the validity and reliability of the questionnaire. Nothing was said about internal consistency or structural validity. Describe this section better. Because data collection tool, which is a questionnaire, more explanations are needed.

Thank You

Reviewer #4: Despite the effort to adapt the article based on the recommendations previously issued (strengthening it from a scientific point of view and the originality) and relevance in approaching this subject in a geographical area, which is still little studied, the article maintains its main weakness, since the way in which it is approached does not add to the knowledge that already exists on the subject. Analyzing what someone knows after undergoing a training process and realizing that they know more is the logical outcome for a training process. Perhaps an investigation that reports these changes on the ground, comparing before and after the formative process, would be a great contribution to scientific evolution. In this sense, analyzing the conclusion of the study, without evaluating the impact that the training of professionals had in the field, it is not possible to infer that -"consecutively, result in a positive workplace".

Only evaluating the results in the evolution of dynamics in clinical services can contribute to evaluating the effectiveness and efficiency of these processes.

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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 #3: No

Reviewer #4: No

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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.

The Effect of Nursing Shared Governance Educational Program on Nurse Managers’ Knowledge for Sustainable Nursing Excellence and Empowerment.

PONE-D-23-02408R2

Dear Dr.,

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.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

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,

Omar Mohammad Ali Khraisat, Associate Professor

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 #3: 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 #3: Yes

**********

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

Reviewer #3: 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 #3: 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 #3: 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 #3: Regards

Congratulations to the authors of the article. The necessary reforms that the reviewers had proposed have been applied.

Thank You.

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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 #3: No

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