Dear Dr. Groth,

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Additional Editor Comments:

Dear Authors,

Thank you for submitting your manuscript. The reviewers find the topic timely and the qualitative approach appropriate, but they raise several concerns that need to be addressed before further consideration.

Key issues include:

Insufficient clarity in the research gap, aim, and overall focus

Limited methodological transparency (sampling, data collection, analysis) and incomplete alignment with COREQ standards

Predominantly descriptive results with limited interpretive depth

Repetition and lack of precision in parts of the abstract, introduction, and discussion

Please revise the manuscript to strengthen methodological rigor, enhance analytical depth, and improve clarity and structure throughout.

Decision: Major Revision

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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?

Reviewer #1: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: General Assessment

This qualitative study addresses a timely and relevant topic — nurses’ perspectives on video consultations and their influence on the nurse–patient relationship in outpatient cardiology settings. The focus on implementation barriers and relational aspects adds valuable insight to healthcare digitization efforts. The manuscript is well-structured, coherent, and grounded in established qualitative methodology (hermeneutic and thematic analysis).

However, revisions are recommended to strengthen clarity, ensure methodological transparency, align with reporting standards (e.g., COREQ), and enhance the discussion’s critical engagement with existing literature.

Title and Abstract

Strengths:

• The title accurately reflects the study’s focus and design.

• The abstract clearly outlines the aim, methodology, results, and conclusions.

Areas for Improvement:

• The “Materials and methods” section in the abstract could more succinctly indicate the theoretical approach and sampling rationale.

• Include precise information on the analysis method (e.g., “thematic analysis guided by Braun & Clarke”).

• Avoid repetition of aims; integrate the second sentence into a single cohesive aim statement.

• Mention the number of focus groups and participants directly in the abstract for transparency.

Keywords

Comments:

• The selected keywords are appropriate; consider adding “telehealth” or “telemedicine” to align with global terminology and indexing conventions.

Introduction

Strengths:

• Provides clear rationale linking global telehealth trends with the Danish context.

• Demonstrates solid citation of relevant WHO and current literature.

Areas for Improvement:

• The introduction is rich but somewhat dense. Consider tightening for flow and removing minor redundancies (e.g., overlapping statements about the pandemic’s influence).

• The final paragraph should more clearly articulate the gap in existing knowledge leading to this study (e.g., “Few studies have explored nurses’ experiential and relational perspectives in cardiology outpatient contexts…”).

• Clarify the conceptual grounding: Is the study primarily exploring perceptions and relational care or implementation barriers? Both are present but could be better integrated.

Aim and Objectives

Comments:

• The aim is clearly stated but repeated in several sections (abstract, methods, and introduction). Condense to one consistent phrasing.

• Consider adding a secondary objective explicitly addressing “identification of organizational prerequisites for successful implementation.”

Methodology and Theoretical Framework

Strengths:

• Sound use of a hermeneutic qualitative approach and thematic analysis.

• Acknowledgement of the researchers’ preunderstanding interview is excellent for reflexivity.

Areas for Improvement:

• The justification for combining hermeneutics with Braun & Clarke’s thematic analysis needs clarification. How are hermeneutic interpretive principles integrated beyond general reflexivity?

• Clarify sampling rationale beyond convenience (why 12 participants, why two clinics).

• Provide details on inclusion/exclusion criteria for participants.

• Specify the ethical approvals in full alignment with Danish regulations and the institutional ethics process. The statement "did not require approval" should be accompanied by a brief justification and journal number (already present—retain that clarity).

• Explicitly cite the use of COREQ checklist in the methods section rather than only mentioning adherence.

Data Collection

Strengths:

• Well-described focus group structure, with justification for group size and facilitation strategy.

• Inclusion of an interview guide table is helpful.

Areas for Improvement:

• Include recruitment steps (who invited participants, selection criteria) and how voluntary participation was ensured.

• Briefly describe the environment (online/in person, language used) and how confidentiality was maintained during group discussions.

• Indicate whether field notes or memos were kept and how they informed the analysis.

Data Analysis

Strengths:

• Analysis procedure follows Braun & Clarke’s six phases, described in detail.

• Researcher triangulation and peer debriefing enhance credibility.

Areas for Improvement:

• Describe how disagreement among coders was resolved.

• Explain the link between the initial codes and the final 3 themes (the appendix helps but could use a clearer narrative in the results).

• Consider adding brief justification for thematic saturation (how was it determined?).

• Add verbatim quotations’ translation procedure (if Danish; who translated; checked for accuracy).

Results

Strengths:

• Results are well organized around three themes supported by illustrative quotations.

• Provides a rich description of nurses’ perspectives with both consensus and variation among participants.

Areas for Improvement:

• Greater analytical depth could be added: move beyond description to subtle interpretation — e.g., what do these findings imply about nurses' professional identity or care ethics?

• Consider summarizing each theme at the end of its section with a concise interpretive statement connecting it to the study aim.

• Check the balance of direct quotes; some are lengthy and could be trimmed while preserving richness.

• Numbered participant codes are fine but should be presented consistently (e.g., “(P1)” rather than “Participant 1”).

Discussion

Strengths:

• Comprehensive, well-cited, and theoretically grounded.

• Excellent integration of relational nursing philosophy (Løgstrup, Martinsen, Delmar).

• Nice synthesis with motivation theory (Deci & Ryan).

Areas for Improvement:

• The discussion occasionally repeats findings rather than interpreting them further. Focus on why nurses react as they do, not just that they react.

• Could better discuss the organizational implications for nursing leadership and digital implementation strategy.

• Consider grouping discussion under subheadings that reflect the three main themes — improves readability and alignment.

• Limit quotations in the discussion—focus on synthesis.

• Add a short reflection on limitations of generalizability given the Danish context and small sample size.

Strengths and Limitations

Comments:

• Balanced coverage, but could structure more clearly into “Strengths” and “Limitations.”

• Mention possible response bias due to participants’ shared workplace and existing relationships.

• Add comment on data saturation confirmation process.

Recommendations for Further Research

Comments:

• Clear and constructive. Could more explicitly tie recommendations to education, policy, and future longitudinal or intervention studies on nurse adoption of telehealth.

• Suggest testing implementation frameworks (e.g., CFIR or NASSS) in future work.

Conclusion

Strengths:

• Concise, grounded in results, and relevant.

Areas for Improvement:

• Consider emphasizing practical implications for hospital administrators and educators.

• The conclusion could end with a stronger statement connecting relational nursing ethics to sustainable digital transformation in healthcare.

References

Comments:

• Formatting should be as per journal guidelines.

• Ensure uniform use of ampersands (“&”) and en-dashes for page ranges.

• Verify correct DOIs formatting and spacing (some inconsistencies noted).

Tables and Appendix

Comments:

• Table 1 (interview guide) and Table 2 (participant characteristics) are clear and helpful.

• Table 3 effectively demonstrates coding traceability but could include one more example per theme for greater transparency.

• Ensure tables conform to journal typesetting format.

Data Availability, Ethics, and Funding Statements

Comments:

• Appropriate compliance statements are present and consistent with PLOS requirements.

Summary Recommendation

Decision: Major Revision

Rationale:

The manuscript presents a valuable and original qualitative contribution but requires refinement in structure, methodological detail, and interpretive depth before publication. Attention to these revisions will substantially enhance rigor, transparency, and scholarly impact.

Key Priority Actions:

1. Clarify integration of hermeneutic approach with thematic analysis.

2. Strengthen discussion to include interpretive analysis and practical implications.

3. Revise abstract and introduction for concise focus and clear identification of research gap.

Reviewer #2: The manuscript titled 'Exploring Nurses’ Perspectives on Video Consultations and the Nurse–Patient

Relationship' addresses a timely and relevant topic in healthcare, particularly the growing role of video consultations in nursing practice. The qualitative approach provides valuable insights into nurses’ perspectives, contributing meaningfully to the existing body of knowledge. The study is well-structured overall and demonstrates an effort to follow established qualitative reporting standards.

However, this manuscript still requires some major changes for its improvement. The authors are recommended to address the following comments and incorporate the same in the manuscript:

1. The title lacks methodological and contextual specificity, reducing clarity and discoverability, so include the study design and setting (e.g., qualitative focus group study in Danish cardiology outpatient clinics) and correct the grammatical form to “Nurses’ perspectives.”

2. The abstract is descriptive but lacks precision, methodological clarity, and a clearly stated research gap, so explicitly state the gap, refine the aim, include specific methodological details and richer results, and end with a concise, actionable conclusion.

3. The introduction presents fragmented literature without a clearly articulated gap or strong narrative flow, so strengthen the problem statement with evidence, synthesize literature critically, define key terms, and conclude with a clear research gap and research question.

4. The aim is repetitive and lacks precision in defining the study focus, so refine it into a concise and clearly defined statement specifying the dimensions of nurses’ experiences being explored.

5. The rationale for using a hermeneutic approach is insufficiently justified and operationalized, so clearly justify the methodological choice and explain how hermeneutic principles guided the analysis in practice.

6. The sampling strategy lacks justification and does not address potential biases or limitations, so justify the sample size using qualitative principles, clarify inclusion criteria, and discuss limitations such as homogeneity and selection bias.

7. The data collection process lacks sufficient detail to ensure transparency and reproducibility, so provide information on interview setting, pilot testing, probing techniques, and researcher influence on data collection.

8. There is inconsistency and insufficient clarity regarding ethical approval and procedures, so ensure consistency in ethical statements and clearly justify exemption while detailing consent, confidentiality, and data protection measures.

9. The analysis description is overly generic and does not clearly reflect what was actually done, so clarify coding procedures, analytic decisions, researcher roles, and how rigor (credibility and dependability) was ensured.

10. The results are largely descriptive with limited analytical depth and lack subtheme structure, so introduce subthemes, enhance interpretive analysis, reduce excessive quotations, and clearly link codes to themes.

11. The discussion is repetitive and lacks critical engagement with existing literature and theoretical contribution, so focus on interpreting key findings, critically compare with prior studies, highlight theoretical implications, and avoid repeating results.

12. The strengths and limitations section is unbalanced and does not sufficiently acknowledge key study limitations, so clearly separate these elements and critically discuss issues such as small sample size, lack of diversity, and contextual constraints.

13. The recommendations for further research are broad and lack specificity, so provide focused and actionable suggestions such as comparative, interventional, or multi-center studies.

14. The conclusion is lengthy and reiterates earlier sections without delivering a strong final message, so make it concise, highlight key findings, and clearly state practical and policy implications.

15. The tables are complex and not optimally structured for clarity and interpretation, so simplify formatting, ensure consistency, and improve alignment between codes, themes, and supporting data.

16. The manuscript contains grammatical inconsistencies and lacks stylistic precision, so revise for grammar, clarity, conciseness, and consistent academic tone and terminology.

17. Reporting lacks full transparency in alignment with qualitative reporting standards, so ensure complete adherence to COREQ guidelines including reflexivity, researcher roles, and data saturation.

18. Data transparency and reproducibility details are minimal and non-specific, so provide clearer data availability information and consider including supplementary materials such as coding frameworks and the full interview guide.

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what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes:  Dr. Mohammad Fareed

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Exploring nurses’ perspectives on video consultations and the nurse–patient relationship: Findings from qualitative focus group interviews in a Danish cardiology outpatient setting

PONE-D-25-65052R1

Dear Dr. Groth,

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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Kind regards,

Nagendra Kumar Rai, Ph.D

Guest Editor

PLOS One

Additional Editor Comments (optional):

Dear Authors,

Thank you for your careful and comprehensive revision of the manuscript. I appreciate the considerable effort invested in addressing the comments raised during the previous review.

The revised manuscript demonstrates substantial improvement. The research gap and study aim are now more clearly articulated, the methodological descriptions have been strengthened, the rationale for the hermeneutic approach has been clarified, and the reporting has been improved through greater transparency regarding sampling, data collection, ethical considerations, and analytical procedures. The results now provide greater interpretive depth, and the discussion better contextualizes the findings within the existing literature while appropriately acknowledging the study's limitations. The conclusion has also been strengthened with clearer practical and organizational implications.

Overall, I believe that the authors have satisfactorily addressed the major concerns raised during peer review. The remaining minor issues relate primarily to stylistic or editorial preferences and do not affect the scientific quality of the work.

I have no further substantive comments and recommend the manuscript for publication.

Thanks

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: The authors have revised the manuscript as per the comments given to them in the previous review. The content seems fine for acceptance.

**********

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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