Digital nursing and midwifery leadership: Protocol for a multi-method exploration of policy implementation and impact on practice in the WHO European Region

Gillian Janes; Lorna Chesterton; Joanne Reid; Vanessa Heaslip; Michael Shannon; Bente Lüdemann; Rolf-André Oxholm; João Gentil; Clayton Hamilton; Natasha Phillips

doi:10.1371/journal.pone.0332882

Peer Review History

Original SubmissionJanuary 30, 2025
24 Jul 2025 Decision Letter - Moustaq Karim Khan Rony, Editor Dear Dr. Reid, The reviewers raised several major issues, detailed below. Please submit your revised manuscript by Sep 05 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'. 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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, Moustaq Karim Khan Rony, RN, MSS, MPH Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: “Anglia Ruskin University. Award no HCRC24H5208” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 5. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses??> Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: No ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable??> Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. Reviewer #1: 1. The plan of how to recruit the needed sample of using leaders is not clear. 2. It would be better to conduct the key informant interview along with focus group. Reviewer #2: This protocol addresses a highly relevant policy gap in digital nursing/midwifery leadership, with ‎strong alignment to WHO/ICN priorities. However, essential revisions are required to ensure ‎methodological rigor and replicability:‎ ‎(1)‎ Introduction (p. 1): Frame explicit research questions aligned with the priorities and domains ‎in Table 2 (e.g., What barriers do national nursing/midwifery leaders face in implementing X ‎and Y?).‎ ‎(2)‎ Sampling criteria (Table 1): Clarify the inclusion criteria for national leaders (e.g., years of ‎experience, job titles) and replace ambiguous terms like "designates" with specific role ‎definitions. While this sampling strategy aligns with the goal of evaluating deep policy ‎insights, it may miss frontline implementation barriers. Including focus groups with frontline ‎nurses could help triangulate "impact on practice" claims—otherwise, provide a clear ‎justification for their exclusion.‎ ‎(3)‎ Methods section: Attach the survey tool as supplementary material (important for replicability). ‎Although the purposive sampling strategy appropriately targets "information-rich" national ‎leaders, the protocol must define minimum sample ranges to ensure thematic depth and ‎cross-country representativeness. Refer to similar WHO policy studies for guidance.‎ ‎(4)‎ Consider adding inferential statistics for regional comparisons (e.g., Chi-square tests).‎ ‎(5)‎ Study Procedures (p. 4): Address tech equity considerations—such as offering offline ‎alternatives (e.g., phone interviews)—and detail the translation validation process. Also, ‎provide an explicit strategy to mitigate power dynamics within and across focus groups.‎ Reviewer #3: Title: Digital nursing and midwifery leadership: Protocol for a multi-method exploration of policy implementation and impact on practice in the WHO European Region This is an interesting and timely topic that needs attention. Nursing and Midwifery professions • The protocol refers to nursing/midwifery throughout, which seems to infer that midwifery is subsumed into nursing, which is not accurate. The only international professional organisation that is mentioned is the International Council of Nurses (ICN). There are many midwives who are not nurses, and many nurses who are not midwives. It would be preferable to have the inputs from members and leaders of each of the two professions in order to capture the data and issues as fully as possible, and to reflect accurately what the title of the protocol claims. If this protocol is earnest about researching this topic for midwifery and midwives, it should consult the International Confederation of Midwives (ICM) policy documents regarding digital capacity and essential competences for practice, and include midwives in the focus group discussions. • This is a protocol which projects the following timeline: “Recruitment has not been completed. It is anticipated that recruitment will be completed by April 2025, with data collection completed by June 2025, and final results by July 2025”. The protocol was sent for publication review in July 2025. Given the omission of midwifery associations and the International Confederation of Midwives, the protocol has set up an avoidable limitation / weakness, which is unfortunate. This has implications for sampling, the development of the online survey tool, and analysis. Language • Languages are limited to English and Russian (“in line with WHO European Region survey protocols”). This excludes the participation of people who might be information-rich in terms of the topic, but who are not fluent in either of these two languages. Given that WHO has six official languages (Arabic, Chinese, English, French, Russian, and Spanish) https://www.who.int/about/communications/understandable/audiences-language it is puzzling that two European languages (French and Spanish) are not accommodated in this protocol. • Language is not listed as an inclusion or exclusion factor. This should be explicit. • In the focus group discussions (FGD), it is noted that a bilingual facilitator will be required if necessary. However translation facilities will be required for participants so that they can properly engage in a focus group discussion, otherwise they will effectively be excluded even if they are part of the FFD. Focus group discussions • The strategy of summary notes taken by the focus group facilitators being fed back to participants at appropriate points during the discussion, to enable in-group member-checking and verification by participants is welcomed. • Will feedback be done across groups to enrich subsequent FGDs? Privacy While the use of Zoom for FGD supported, one needs to make technical arrangements to ensure that participants’ names are not reflected on screen as part of the video-record. Please ensure that a separate research identifier is used during data collection (FGD) so that the inputs can be ascribed to a participant’s research identifier. This requires explanation. ****** 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: Nada Alaidarous Reviewer #3: 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. https://doi.org/10.1371/journal.pone.0332882.r001
Revision 1
13 Aug 2025 Author Response Feedback/recommendation Response Journal requirements 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: “Anglia Ruskin University. Award no HCRC24H5208” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Thank you for drawing our attention to this. We have added the words: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript P7 This information has been added to the cover letter 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Ethical considerations appears within the methods section, so no action taken regarding its position in the manuscript. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Information added to manuscript page 10 5. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. No action required Reviewer #1 1. The plan of how to recruit the needed sample of using leaders is not clear. Thank you for your comment. To add greater clarity we have re-written the recruitment strategy section page 3 2. It would be better to conduct the key informant interview along with focus group. This is a useful observation, and text added to section headed: phase 2 Online focus groups, p5 . This now includes 1:1 interviews which will be offered to volunteers who are unable to participate in a focus group. A rationale for adding this alternative method of data collection has been added as well. Reviewer #2: This protocol addresses a highly relevant policy gap in digital nursing/midwifery leadership, with ‎strong alignment to WHO/ICN priorities. However, essential revisions are required to ensure ‎methodological rigor and replicability:‎ Thank you for this positive feedback. We have added some text to complement the existing section on rigour on page 6 to discuss replicability of the study When we publish the completed study we will add the online survey as supplementary data, which will again increase the replicability of the study. 1.‎ Introduction (p. 1): Frame explicit research questions aligned with the priorities and domains ‎in Table 2 (e.g., What barriers do national nursing/midwifery leaders face in implementing X ‎and Y?).‎ Thank you for this insightful comment. To address this we have reframed the last paragraph of the introduction to more explicitly show how the research aligns with the strategic priorities in key policy page 2 ‎2.‎ Sampling criteria (Table 1): Clarify the inclusion criteria for national leaders (e.g., years of ‎experience, job titles) and replace ambiguous terms like "designates" with specific role ‎definitions. While this sampling strategy aligns with the goal of evaluating deep policy ‎insights, it may miss frontline implementation barriers. Including focus groups with frontline ‎nurses could help triangulate "impact on practice" claims—otherwise, provide a clear ‎justification for their exclusion.‎ We have clarified our sampling methodology to remove any ambiguity. The sampling strategy deliberately does not specify role or length of service as this would inadvertently exclude participants, in the absence of a universally recognised title. Your comments have strengthened this section, and we are appreciative of your input. ‎3.‎ Methods section: Attach the survey tool as supplementary material (important for replicability). ‎Although the purposive sampling strategy appropriately targets "information-rich" national ‎leaders, the protocol must define minimum sample ranges to ensure thematic depth and ‎cross-country representativeness. Refer to similar WHO policy studies for guidance.‎ Your observations are useful, and we will publish the online survey tool to improve replicability. We have added text to the sampling section and specified a minimum target to ensure thematic depth and regional diversity. ‎4.‎ Consider adding inferential statistics for regional comparisons (e.g., Chi-square tests).‎ Thank you for this interesting point. Just to clarify, this was an exploratory not a comparative study. We were not attempting regional comparisons and the small sample size/number of responses meant this this not appropriate. ‎5. Study Procedures (p. 4): Address tech equity considerations—such as offering offline ‎alternatives (e.g., phone interviews)—and detail the translation validation process. Also, ‎provide an explicit strategy to mitigate power dynamics within and across focus groups.‎ This is a good point. To reflect this view, we have added a new section entitled: Technology Equity page 5 Strategies to mitigate power dynamics added to focus group section on page 7 Reviewer #3: This is an interesting and timely topic that needs attention. Thank you for this positive feedback. Nursing and Midwifery professions • The protocol refers to nursing/midwifery throughout, which seems to infer that midwifery is subsumed into nursing, which is not accurate. The only international professional organisation that is mentioned is the International Council of Nurses (ICN). There are many midwives who are not nurses, and many nurses who are not midwives. It would be preferable to have the inputs from members and leaders of each of the two professions in order to capture the data and issues as fully as possible, and to reflect accurately what the title of the protocol claims. If this protocol is earnest about researching this topic for midwifery and midwives, it should consult the International Confederation of Midwives (ICM) policy documents regarding digital capacity and essential competences for practice, and include midwives in the focus group discussions. Thank you for highlighting the distinction between nursing and midwifery as separate professions. We acknowledge that midwifery is an independent profession in many countries, with its own regulatory frameworks and professional bodies. However, within the WHO European Region, midwifery is often not recognised as a distinct profession separate from nursing; instead, the term “nursing” is frequently used in a broad sense to include midwives, especially in national policy and leadership structures. This reality influences how digital health leadership roles are organised and accessed at the national level, and we do state that we also consulted the Chief nursing and midwifery leadership networks, and European Federation of National Nursing and Midwifery Associations (EFNNMA)across Europe. We have added more text to clarify this issue. • This is a protocol which projects the following timeline: “Recruitment has not been completed. It is anticipated that recruitment will be completed by April 2025, with data collection completed by June 2025, and final results by July 2025”. The protocol was sent for publication review in July 2025. Given the omission of midwifery associations and the International Confederation of Midwives, the protocol has set up an avoidable limitation / weakness, which is unfortunate. This has implications for sampling, the development of the online survey tool, and analysis. The manuscript was submitted on 30/01/2025 and prior to the study commencing. However, we have no influence over the journal’s review/publication timeline. The study funding was time limited, hence the timeline indicated in the manuscript. Language • Languages are limited to English and Russian (“in line with WHO European Region survey protocols”). This excludes the participation of people who might be information-rich in terms of the topic, but who are not fluent in either of these two languages. Given that WHO has six official languages (Arabic, Chinese, English, French, Russian, and Spanish) https://www.who.int/about/communications/understandable/audiences-language it is puzzling that two European languages (French and Spanish) are not accommodated in this protocol. The study has been completed with the support of the WHO policy office, which have given general guidance as to how their surveys and focus groups are routinely administered. We acknowledge that specific projects may include greater inclusivity regarding language translation. Please note that no funding has been received from the WHO to complete this study • Language is not listed as an inclusion or exclusion factor. This should be explicit. Table 1 displaying inclusion/exclusion criteria changed to reflect this point. • In the focus group discussions (FGD), it is noted that a bilingual facilitator will be required if necessary. However translation facilities will be required for participants so that they can properly engage in a focus group discussion, otherwise they will effectively be excluded even if they are part of the FFD In the section headed ‘focus groups’, there is information on bilingual facilitators, and the use of expert translators has been strengthened on page 6 Focus group discussions • The strategy of summary notes taken by the focus group facilitators being fed back to participants at appropriate points during the discussion, to enable in-group member-checking and verification by participants is welcomed. Thank you for this positive feedback. • Will feedback be done across groups to enrich subsequent FGDs? Yes this is a good point, and we have added that insights from each focus group will shape and refine subsequent discussions to deepen the richness of the data collected page 7 Privacy While the use of Zoom for FGD supported, one needs to make technical arrangements to ensure that participants’ names are not reflected on screen as part of the video-record. Please ensure that a separate research identifier is used during data collection (FGD) so that the inputs can be ascribed to a participant’s research identifier. This requires explanation. To protect anonymity, participants will be asked to disable their cameras and remove any identifying information, such as their name or role, from their Zoom profile. Text added to page 7 Attachments Attachment Submitted filename: Response table for reviewers comments.docx https://doi.org/10.1371/journal.pone.0332882.r002
31 Aug 2025 Decision Letter - Oluchukwu Obiora, Editor Dear Dr. Reid, 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 15 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. 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'. 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We look forward to receiving your revised manuscript. Kind regards, Oluchukwu Loveth Obiora, PhD Academic Editor PLOS ONE Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses??> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable??> Reviewer #1: No Reviewer #2: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. Reviewer #1: The sampling process needs to be elaborated. Selection criteria for Phase I study is clear but it should also include how the participants will be selected for phase II. How will the researcher select the minimum of 25 participants from 53 WHO regions? What are the criteria for selection? Is there any incentive for the participants? If yes, please mention. Please in include the guideline for the interview, FGD. Reviewer #2: I have reviewed the authors' responses to the reviewers' comments and the accompanying revisions to the manuscript. I find their responses to be thorough and the revisions have successfully addressed all concerns raised. All the best. ****** 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: Yes: Subina Bajracharya Associate Professor School of Nursing Chitwan Medical College, Nepal Reviewer #2: Yes: Nada Alaidarous ******** [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 https://doi.org/10.1371/journal.pone.0332882.r003
Revision 2
4 Sep 2025 Author Response Reviewers comments 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #2: Yes No action required 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #2: Yes No action required 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: No Reviewer #2: Yes We trust that the additional changes to the sampling section will address Reviewer 2’s view on methodology. Many thanks 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 No action required 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 No action required 6. Review Comments to the Author Reviewer #1: The sampling process needs to be elaborated. Selection criteria for Phase I study is clear but it should also include how the participants will be selected for phase II. How will the researcher select the minimum of 25 participants from 53 WHO regions? What are the criteria for selection? Is there any incentive for the participants? If yes, please mention. Please in include the guideline for the interview, FGD. Reviewer #2: I have reviewed the authors' responses to the reviewers' comments and the accompanying revisions to the manuscript. I find their responses to be thorough and the revisions have successfully addressed all concerns raised. All the best. Thank you for this observation. we have revised the sampling section on page 4 to further strengthen and clarify our approach. With regards to the focus group discussion/interview guide which will be used in Phase 2. This can not be included as it will be developed in light of the responses obtained in phase 1 of the study. This is stipulated on page 6, under the section heading ‘Phase 2 Online focus group. When the study is completed/reported access to the discussion/interview guide used for the study will be provided. Many thanks. Attachments Attachment Submitted filename: response to 2nd review plos one.docx https://doi.org/10.1371/journal.pone.0332882.r004
7 Sep 2025 Decision Letter - Oluchukwu Obiora, Editor Digital nursing and midwifery leadership: Protocol for a multi-method exploration of policy implementation and impact on practice in the WHO European Region PONE-D-25-02701R2 Dear Dr. Reid, 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. For questions related to billing, please contact billing support . 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, Oluchukwu Loveth Obiora, PhD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0332882.r005
Formally Accepted
Acceptance Letter - Oluchukwu Obiora, Editor PONE-D-25-02701R2 PLOS ONE Dear Dr. Reid, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Oluchukwu Loveth Obiora Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0332882.r006

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