PONE-D-25-01292Knowledge, Attitudes, Practice and Perceived Barriers of Critical Care Nurses Regarding Pain Management for Intubated Patients in Southern West Bank Hospitals.PLOS ONE

Dear Dr. aqtam, 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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We look forward to receiving your revised manuscript.

Kind regards,

Othman A. Alfuqaha, Ph.D.

Academic Editor

PLOS ONE

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When submitting your revision, we need you to address these additional requirements.

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Additional Editor Comments:

The manuscript has significant merit but requires clarification and methodological refinements before acceptance. Please follow my comments as well as reviewer comments.

1. Title Revision: Please, refine the title to be more concise and engaging while maintaining clarity.

2. Discussion Enhancement: Please compare your findings more explicitly with international pain management guidelines and discuss the broader implications.

3. Methodological Justification. Please more detsailas are needed regarding your methods. Be aware to answer 5 W questions in your method section.

4. Address the selection bias concern, either by acknowledging its limitations or justifying why the sample is still representative.

5. The response rate calculation should be corrected based on the total number of critical care nurses in participating facilities.

6. A clear explanation of subgroup analyses should be added to the Methods section.

7. Generalizability Consideration: Discuss the limitations introduced by selection bias and suggest how future studies could enhance external validity.

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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: No

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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: 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: it was good articles need some minor changes as it was attached , Clarity in Title: The title is too descriptive; it needs to be shortened to make it more readable the findings of the study were set against the backdrop of global trends in pain management in intubated patients to establish a broader importance of the study. Discuss deeper the comparison of the identified systemic and attitudinal barriers in relation to international standards or guidelines on pain management.

Reviewer #2: Pain management is a critical aspect of healthcare, and research aimed at achieving high-quality pain management is equally essential. The authors investigated nurses' knowledge, attitudes, practices, and perceived barriers regarding pain management. These factors constitute vital information for delivering high-quality pain management. However, there are several methodological concerns that warrant consideration.

Major Comment

This study employed convenience sampling, and it can be inferred that the questionnaires were predominantly distributed to nurses with a particular interest in pain management. Consequently, this sampling method may have introduced selection bias, potentially affecting the generalizability of the findings.

Given that the target population consists of critical care nurses, the denominator for calculating the response rate should be the total number of critical care nurses in the participating facilities rather than the number of distributed questionnaires.

Minor comments

All subgroup analyses performed should be explicitly described in the Methods section, including the rationale for the analyses and the specific statistical methods employed.

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Reviewer #1: No

Reviewer #2: Yes:  Takeshi Unoki, PhD

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Attachments

Attachment

Submitted filename: Article review.docx

PONE-D-25-01292R1Barriers and Practices in Pain Management for Intubated Patients: A Study of Critical Care Nurses in Southern West Bank HospitalsPLOS ONE

Dear Dr. aqtam, 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 03 2025 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,

Othman A. Alfuqaha, Ph.D.

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:

Thank you for your revised manuscript to PLoS ONE. Before proceeding with the acceptance of your manuscript, we kindly request that you carefully address the reviewers’ comments and provide a point-by-point response to their feedback. Ensuring that all concerns are adequately addressed will strengthen your work and enhance its contribution to the field.

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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

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: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

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 #1: Yes

Reviewer #2: 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

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 #1: The study provides valuable insights into pain management practices for intubated patients in critical care settings. To enhance clarity, the introduction could better highlight the study's gaps in existing literature. Additionally, the methodology section would benefit from further explanation of the sample's inclusion/exclusion criteria and the data analysis approach. The results section is well-organized, but incorporating more visual aids and direct quotes from participants would strengthen it. In the discussion, a comparison with other regional studies and more detailed practical recommendations for overcoming identified barriers would be beneficial. Finally, including ethical considerations and directions for future research would enhance the manuscript’s overall impact.

Reviewer #2: While some aspects have been revised, the discussion of response rates and the impact of selection bias remains unclear.

The study appears to capture data primarily from critical care nurses with a specific interest in pain management. This raises concerns about whether your findings truly represent the broader population of hospital critical care nurses. The potential self-selection bias suggests that your sample may not adequately reflect the perspectives, practices, and attitudes of the general critical care nursing population.

The authors should clearly state:

1.the total number of critical care nurses in the population

2.the number of surveys distributed

3.the number of surveys returned

Furthermore, they should thoroughly examine how selection bias may have influenced their findings. The potential impact of selection bias needs to be adequately addressed in the discussion.

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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

Reviewer #2: Yes:  Takeshi Unoki, PhD

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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.

Barriers and Practices in Pain Management for Intubated Patients: A Study of Critical Care Nurses in Southern West Bank Hospitals

PONE-D-25-01292R2

Dear Dr. Ibrahim,

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,

Othman A. Alfuqaha, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors, Im satisfied with the revision process, and hence I recommend approving this paper for publication. Thanks for your valuable work and best of luck.

Reviewers' comments: