PONE-D-24-49553The effect of health-promoting leadership of nursing managers on the

 work withdrawal behaviors and psychological safety of nursesPLOS ONE

Dear Dr. Mohammadipour,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: I Don't Know

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: 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: 1.SEM model should be more detailed, such as predecessors if the study of SEM model

2.RESULTS：There should be no such thing as “Zero”. It should be precise to the number of women. The number of women is not shown in Table 1. Please complete.

3.The indicators in the table 2. do not meet the requirements, please check

Reviewer #2: Thank you for the opportunity to review this manuscript. The topic of health-promoting leadership and its association with organizational outcomes is both timely and significant. The study has the potential to contribute meaningfully to the literature; however, I would like to provide some feedback to enhance the clarity, rigor, and interpretability of the manuscript.

General Comments

The manuscript demonstrates substantial effort and commitment to exploring an important area in organizational health research. However, the translation to English has introduced some challenges. Specifically:

1. Language and Terminology:

- The manuscript contains instances of imprecise terminology, phrasing, and redundancy that could potentially mislead readers. For example, terms such as "proven" are not typically used in scientific writing when describing findings from correlational studies. Phrases like "associated with" or "linked to" would be more appropriate in this context.

- The language in the manuscript could benefit from significant refinement to improve readability and avoid ambiguity. I strongly recommend seeking the assistance of a professional English editor familiar with scientific writing to ensure clarity and accuracy.

Specific Comments

1. Study Methodology:

- The manuscript would benefit from additional details about the methodology:

- Effect Size: The choice of an effect size threshold of 0.03. Could the authors elaborate on why this threshold was chosen and how it aligns with the study’s objectives?

- Sampling: It is unclear whether the sample was a convenience sample or selected through other means. Additional information on sampling strategy and its implications for generalizability would strengthen the manuscript.

- Please include a table with descriptive statistics of all study variables including participant demographics.

2. Measurement Instruments:

- The manuscript uses several instruments, but more detail is needed to enhance transparency:

- Health Promoting Leadership Questionnaire: Providing a brief description of this instrument, including sample questions, would help readers better understand the construct being measured. The authors should clarify whether they used the employee-perception component, the leader self-assessment component, or both. Additionally, it would be helpful to specify whom the employees were asked to consider when completing the questionnaire (e.g., head nurse, nurse manager) as different organizations use different nursing leadership structures.

- Work Withdrawal Behaviors Questionnaire: Providing a brief description of this instrument, including sample questions, would help readers better understand the construct being measured.

- Edmonson’s Psychological Safety Questionnaire: Similarly, a brief discussion of this instrument and a few example questions would clarify how psychological safety was operationalized.

3. Findings and Interpretation:

- Some of the conclusions drawn in the manuscript are presented in a causal manner, which is not supported by the study’s design. For example, in the Abstract, the statement: "The results of the present study showed that leaders who put health-promoting leadership on their agenda witnessed positive organizational outcomes, including improved psychological safety and fewer withdrawal behaviors" implies causation which the authors extend to organizational outcomes -- which are not examined as an outcome in this study. As this study appears to be descriptive and correlational, it is more appropriate to describe relationships as associations rather than causal effects. This issue may stem from translation challenges rather than conceptual errors, but it requires correction for accuracy.

Suggestions for Revision

1. Revise language and terminology throughout the manuscript for precision and scientific rigor. Focus on using phrasing consistent with correlational findings.

2. Provide more detail on the methodology, including the rationale for the effect size threshold, sampling strategy, and the use of measurement instruments.

3. Clarify how the Health Promoting Leadership Questionnaire was applied, and specify the target leaders employees were asked to evaluate.

4. Include sample items from the Work Withdrawal Behaviors Questionnaire and Edmonson’s Psychological Safety Questionnaire to enhance understanding of the constructs.

5. Ensure that all findings and conclusions are framed in a way that reflects the study’s correlational nature.

6. Ensure that all findings and conclusions are not extended beyond the study's scope to include outcomes that were not measured (e.g. "positive organizational outcomes,"

Concluding Remarks

This manuscript addresses an important topic and has the potential to contribute valuable insights. I hope the feedback provided here is helpful for the authors in refining their work. I look forward to seeing the revised version and commend the authors for their efforts in conducting and presenting this study.

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Reviewer #1: Yes:  guoguo zhao

Reviewer #2: No

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The effect of health-promoting leadership of nursing managers on the

 work withdrawal behaviors and psychological safety of nurses

PONE-D-24-49553R1

Dear Dr. Fatemeh Mohammadipour

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,

Roaa Sabri Gassas

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 #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

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

Reviewer #1: 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 #1: 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 #1: 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: This study focuses on the impact of health promotion leadership (HPL-RRB- on nurses' psychological safety and work withdrawal behaviThe the topic selection is closely related to the practical needs of the high-pressure environment in the nursing industry, which has important practical value.The author has responded well to my questions.

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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

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