PONE-D-24-51537Analysis of the emergency response capacity of nursing staff for public health emergencies and the influencing factors: A cross-sectional study in ChinaPLOS ONE

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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: 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: 1. Clarity of Objectives:

While the study's objectives are clear, emphasizing how the findings directly inform the design and implementation of emergency response programs for nurses would enhance their practical relevance. Consider connecting the results to specific programmatic improvements.

2. Sampling Method:

The rationale for using convenience sampling should be elaborated, especially given the large sample size. Discuss potential selection biases and how they might influence the study's results and conclusions.

3. Instrument Validation:

The validation process for the self-designed emergency response capability scale is commendable. However, clarify why this tool was preferred over established, validated scales. Address its unique advantages or alignment with the study’s context.

4. Data Presentation:

While the results are comprehensive, presenting key findings visually (e.g., bar charts, pie charts, or scatterplots) could enhance readability and facilitate better understanding of the data.

5. Influencing Factors:

The identification of significant factors through multiple linear regression is valuable. Discuss how these factors can be operationalized into actionable training programs or policies, providing concrete examples where possible.

6. Generalizability:

The study's findings are specific to Xinjiang. Discuss their applicability to regions with similar healthcare structures or cultural contexts, and suggest areas for further comparative research to test their broader relevance.

7. Discussion Depth:

Gaps in prevention and preparedness scores should be further explored. Suggest targeted interventions such as simulation-based training, policy updates, or community engagement strategies to address these weaknesses.

8. Ethical Considerations:

Ethical approval and participant consent are noted, but provide more detail on the steps taken to ensure confidentiality and protect sensitive information, especially during data collection and analysis.

9. Limitations:

The limitations section should explicitly address the reliance on self-reported data and the risk of response bias. Discuss how these factors might have influenced the findings and what measures were taken to mitigate them.

10. Implications:

Highlight actionable recommendations for nursing administrators and policymakers. For example, propose targeted training modules, stress management programs, and leadership development initiatives to strengthen emergency response capacity.

Reviewer #2: Analysis of the emergency response capacity of nursing staff for public health

emergencies and the influencing factors: A cross-sectional study in China

Xin Gu, Ping Yan, Xia Zhang, Hu Peng, Zhijie Cao, Lina Ma, Li Zhang

This manuscript presents a cross-sectional study that aims to investigate the public health emergency response capacity of nursing staff and relevant influencing factors in order to inform preparedness programs against future emergencies.

Researchers constructed and evaluated an assessment tool that comprised mainly of Likert-scale questions investigating four categories of nurses’ ability to prevent, prepare, rescue and recover from public health emergencies they needed to cope with.

They used convenience sampling to collect data from 4292 nurses whose average score on emergency response capacity scale was 160.42 ± 24.22, with a mean score per item of 4.01 ± 0.61. Multiple linear regression was performed and showed that higher emergency response capacities were observed in male nurses, nurses with 11 or more years of working experience, junior titles, specific positions, rescue experience, participation in emergency drills, and those who were not anxious or fearful and were willing to rescue.

Existing literature on the subject is available for many areas in the world including China, but it deserves further study as public health emergencies seem to be issues that will concern us in the near future. The authors concluded that the emergency response capacity of nursing staff for public health emergencies in Xinjiang was high and that hospital administrators should develop intervention programs targeting the specific areas of weakness that arose from the study and tailored to different levels of emergency response capacity to strengthen education and practical drills for nursing staff.

The study’s main strength is the large sample and the rigorous methodology of the study design. On the other hand, the limitations are apparent as the study was performed in only one region which prevents the generalizability of results, while convenience sampling prevents representativeness even for this area. Also, the statistical approach used requires assumptions that are not easily perceived.

The manuscript adheres to PLOS ONE guidelines for authors and mostly to the STROBE checklist and SAMPL guidelines. In my opinion, the manuscript in general appropriately discusses the claims made and in terms of technical completeness, with an adequate statistical analysis for the available data and can be published after revisions are made.

More details and revision suggestions are presented below, separately for each section.

Abstract and introduction

The abstract is concise and informative, but the background section should include a phrase on the current situation of nurses’ emergency response capacity and not the last sentence which is actually a recommendation.

The introduction section is useful and sets the background for the study. The authors generally identify literature on the topic and how the study relates to it. However, the first paragraph that depicts the global situation regarding public health emergencies is documented with references that are out of scope and their conclusions or results are not about the arguments made in this section (references 1-7).

Methods

While the whole process of designing, assessing and scoring the evaluation tools used is explicitly described, this excerpt “Criteria for emergency ability: the average score of items < 3 points indicates low emergency ability; 3 to 4 points indicates medium emergency ability; > 4 points indicates high emergency ability.” is not well understood and since figure 1 is based on it, it would be better to elaborate. Also, references 16,17 are out of scope and while they refer to the same point, they do not document it.

Finally, the description of dummy variables used in multiple linear regression belongs in the methodology section instead of the results.

Results

The authors choose to use an assessment tool with Likert scales and then translating the scores as a continuous variable and use multiple linear regression in the analysis. While this seems a technically legitimate way to manipulate the results, it makes understanding them rather difficult for the reader because Likert scales lead to ordinal perception of the results. Therefore, I would prefer describing the results, and especially the direction they should be interpreted, in more detail. Furthermore presenting the four categories (preventative, preparation, rescue and recovery ability) with low, medium and high scoring confuses readers’ understanding.

Also nurse rank, job title and position mentioned both in the results and the tables are not familiar to international audiences, which is the target here, and need to be explained.

Discussion

The discussion overall supports the results and uses relatable references to document the arguments, although some exceptions exist. In the first paragraph the clip “During the COVID-19 pandemic, the remarkable performance of Chinese nurses worldwide not only demonstrates the advancement of China's medical and health undertakings but also showcases China's contribution to global public health” not only is not backed by the bibliography as it is not referenced, it also seems irrelevant to the study’s results.

In the second paragraph nurses’ low score in the ability to prevent public health emergencies could be explained mainly by the study’s design which collects data from secondary and tertiary care hospitals, where nurses are not expected to perform health prevention services (at least to my knowledge which does not include the chines health system).

My main disagreement though, is the issue of male-to-female comparison described in the third paragraph. First of all, the fact that only 6% of the respondents are male should make the authors cautious about discussing this result in a conclusive way as the very small male-to-female ratio yields statistical doubts. Then, the justification presented should also be documented with strong arguments and references as it is rather sexist since the authors discuss that “male nurses’ physical strength, rational thinking, and decisive actions enable them to handle heavy workloads and adapt to challenging environments” and “have higher adaptability and resistance to stress, allowing them to remain calm and quickly adjust to sudden, complex situations”. On that note, reference 27 studies only male nurses and cannot build an argument on male-to-female comparison and I cannot find reference 28 to form an opinion.

Limitations

The authors successfully describe the lack of generalizability of their results and the difficulty of addressing causality. Other issues that have to be addressed though, are the method of sampling (convenience sampling) which further limits representativeness, and coping with bias which is not mentioned.

Figures and tables

The tables are complete and self-explanatory. The cruciform grid might benefit from drawing the axes to help the reader better assign the values mentioned in their minds.

References

Some referencing mistakes need to be corrected, e.g.6 and other related issues are reported within the sections referenced.

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Reviewer #1: Yes:  Ateya Megahed Ibrahim

Reviewer #2: No

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Analysis of the emergency response capacity of nursing staff for public health emergencies and the influencing factors: A cross-sectional study in China

PONE-D-24-51537R1

Dear Author,

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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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

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 #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

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 #1: Yes

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 #1: No

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: Thanks alot for your great efforts in addressing all the required comments and congratulations and hope you all success

Reviewer #2: (No Response)

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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: No

Reviewer #2: No

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