Nursing perspectives on advancing language access in the emergency department: A qualitative study

Daniel Cordova; Jesus R. Torres; Shiou Udagawa; Xin Qi; Tucker Avra; Breena R. Taira

doi:10.1371/journal.pone.0336525

Peer Review History

Original SubmissionNovember 12, 2024
29 May 2025 Decision Letter - Meryem Merve Ören Çelik, Editor Dear Dr. Cordova, 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 Jul 13 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, Meryem Merve Ören Çelik 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. We note that your Data Availability Statement is currently as follows: [All relevant data are within the manuscript and its Supporting Information files.] Please confirm at this time whether or not your submission contains all raw data required to replicate the results of your study. Authors must share the “minimal data set” for their submission. PLOS defines the minimal data set to consist of the data required to replicate all study findings reported in the article, as well as related metadata and methods (https://journals.plos.org/plosone/s/data-availability#loc-minimal-data-set-definition). For example, authors should submit the following data: - The values behind the means, standard deviations and other measures reported; - The values used to build graphs; - The points extracted from images for analysis. Authors do not need to submit their entire data set if only a portion of the data was used in the reported study. If your submission does not contain these data, please either upload them as Supporting Information files or deposit them to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If data are owned by a third party, please indicate how others may request data access. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 4. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files 5. 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. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: This qualitative study of 36 Emergency Department nurses elucidated many potentially surmountable barriers to using interpreters for NELP patients. The reference to the author’s website was probably superfluous, but otherwise the content was appropriate. One of the areas that could have benefited the reader more to investigate was how nurses felt comfortable proceeding with broken Spanish. It also would have been nice to know the split of languages other than English preferred by the patients. Reviewer #2: The study provides important insights into real-world barriers and facilitators to interpreter use in fast-paced clinical settings. The findings are well supported by quotes, and the proposed interventions are concrete and practical. I especially appreciate that the authors also address the burden placed on bilingual staff, which is an often overlooked issue. I recommend minor revisions before acceptance. Please consider the following: Response rate: The number of participants is clearly reported, but the manuscript does not mention how many staff were invited to participate. Adding this information would help readers assess possible participation bias. COREQ checklist – minor gaps: While the authors refer to using COREQ standards, some points could be clarified. For example, it is not clear whether participants reviewed their transcripts or the study findings. The interview guide is mentioned but not shared. Providing a brief summary or attaching it as supplementary material would improve transparency. Future implementation: The manuscript outlines valuable interventions. It would be helpful to briefly mention how the impact of these interventions might be measured in future work (e.g., interpreter usage rates, patient feedback). Champion staff model: The idea of having staff “champions” for language access is strong. Still, a brief note on how this approach could be supported or sustained would make the recommendation more complete. Overall, this is a thoughtful and useful contribution that I believe will be of interest to both researchers and healthcare practitioners. I support publication after minor revisions. ****** 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: Jay M. Brenner Reviewer #2: Yes: Buğra Taygun Gülle ******** [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.0336525.r001
Revision 1
5 Aug 2025 Author Response Dear reviewers, Please find attached our revised manuscript, "Nursing Perspectives on Advancing Language Access in the Emergency Department: A Qualitative Study," submitted for consideration in PLOS ONE. We thank the reviewers for their insightful feedback. We have addressed all requested changes and have listed our response below as requested and believe the manuscript is significantly improved. We are available to provide any further revisions or information if needed. Please see the list of requested changes and author responses below: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. • The requested changes have been made and the PLOS ONE’s style requirements to the best knowledge of the study team. If further changes are required the team is happy to adjust further. 2. We note that your Data Availability Statement is currently as follows: [All relevant data are within the manuscript and its Supporting Information files.] Please confirm at this time whether or not your submission contains all raw data required to replicate the results of your study. Authors must share the “minimal data set” for their submission. PLOS defines the minimal data set to consist of the data required to replicate all study findings reported in the article, as well as related metadata and methods (https://journals.plos.org/plosone/s/data-availability#loc-minimal-data-set-definition). For example, authors should submit the following data: - The values behind the means, standard deviations and other measures reported; - The values used to build graphs; - The points extracted from images for analysis. Authors do not need to submit their entire data set if only a portion of the data was used in the reported study. If your submission does not contain these data, please either upload them as Supporting Information files or deposit them to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If data are owned by a third party, please indicate how others may request data access. • Not applicable, as this is a qualitative study. Also, providing the full qualitative transcripts will increase the risk that the participant could be identified. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. • The requested statement has been added to the methods section. 4. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files • The tables have been added to the end of the main manuscript. 5. 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. • All references are correct to the knowledge of the study team. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: This qualitative study of 36 Emergency Department nurses elucidated many potentially surmountable barriers to using interpreters for NELP patients. The reference to the author’s website was probably superfluous, but otherwise the content was appropriate. One of the areas that could have benefited the reader more to investigate was how nurses felt comfortable proceeding with broken Spanish. It also would have been nice to know the split of languages other than English preferred by the patients. • We thank the reviewers for the suggestion but we unfortunately do not have that information at this time. Reviewer #2: The study provides important insights into real-world barriers and facilitators to interpreter use in fast-paced clinical settings. The findings are well supported by quotes, and the proposed interventions are concrete and practical. I especially appreciate that the authors also address the burden placed on bilingual staff, which is an often overlooked issue. I recommend minor revisions before acceptance. Please consider the following: Response rate: The number of participants is clearly reported, but the manuscript does not mention how many staff were invited to participate. Adding this information would help readers assess possible participation bias. • We did not collect information on total number of nurses approached and those that agreed to participate. A brief statement regarding this has been added to the limitations portion of the manuscript. COREQ checklist – minor gaps: While the authors refer to using COREQ standards, some points could be clarified. For example, it is not clear whether participants reviewed their transcripts or the study findings. • A statement regarding whether participants reviewed their transcripts was added to the manuscript. The interview guide is mentioned but not shared. Providing a brief summary or attaching it as supplementary material would improve transparency. • The study guide was added to the supplementary material. Future implementation: The manuscript outlines valuable interventions. It would be helpful to briefly mention how the impact of these interventions might be measured in future work (e.g., interpreter usage rates, patient feedback). • A statement regarding how the impact of these interventions may be measured in the future was added to the manuscript Champion staff model: The idea of having staff “champions” for language access is strong. Still, a brief note on how this approach could be supported or sustained would make the recommendation more complete. • A brief statement regarding the approach of using staff “champions” has been added to the manuscript. 6. 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. • We as a group would prefer to not publish the peer review history. Thank you very much for your consideration. Sincerely, Daniel Cordova, MD Attachments Attachment Submitted filename: PLOS One Response Letter 25AUG05.docx https://doi.org/10.1371/journal.pone.0336525.r002
27 Oct 2025 Decision Letter - Stephen R. Milford, Editor Nursing Perspectives on Advancing Language Access in the Emergency Department: A Qualitative Study PONE-D-24-46814R1 Dear Dr. Cordova, 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, Stephen R. Milford Academic Editor PLOS ONE Additional Editor Comments (optional): Please note that I have only recently been assigned the role of academic editor for this paper (within the last few days). An academic editorial re-assignment can take place for a number of reasons (editors resign, fall ill etc.) and this invariably delays the process. A new academic editor needs to familiarise themselves with the paper and the reviews/revisions conducted. I have tried to look over the history of this paper. It appears that there was an effort to have the revisions of the paper reviewed by both original reviewers. However, only one of the original reviewers seems to have submitted an acceptance while the second reviewer has not submitted a review of the revisions requested. Considering the second reviewer originally recommended minor edits, and this paper has been submitted almost a year ago, I feel that it is appropriate to issue an acceptance decision at this stage. I appreciate that this process has been lengthy. While I am not in a position to speak for the journal, I appreciate your patience and hope that you are happy with this decision. I wish you all the best. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: I appreciate the revisions. I recommend acceptance for publication. I especially like the study's conclusions. ****** 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 ******** https://doi.org/10.1371/journal.pone.0336525.r003
Formally Accepted
Acceptance Letter - Stephen R. Milford, Editor PONE-D-24-46814R1 PLOS ONE Dear Dr. Cordova, 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. Stephen R. Milford Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0336525.r004

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