-->PONE-D-26-10273-->-->Unveiling the Psychological Network of Work Alienation Among Nursing Interns: A Resource Conservation Perspective and Network Analysis-->-->PLOS One

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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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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: No

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

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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: Thank you for the opportunity to review this manuscript examining work alienation among nursing interns using a psychological network analysis framework. The topic is important and clinically relevant. The manuscript is generally well-structured, and the sample size is adequate. The use of validated instruments and an attempt to move beyond simple linear models are commendable.

However, several concerns remain regarding the study’s contribution and interpretation:

1. Limited incremental insight relative to existing literature:

While the application of network analysis is technically appropriate, the findings largely confirm well-established relationships (e.g., workload, burnout, moral distress, and compassion fatigue are interrelated and associated with alienation). The manuscript would benefit from a clearer articulation of what new knowledge is gained from the network approach beyond confirming known associations.

2. Interpretation of centrality and bridge metrics:

The identification of “central” and “bridge” nodes is presented as actionable, but the practical implications are not fully justified. In cross-sectional network models, centrality does not imply causality or intervention priority. This limitation should be more explicitly acknowledged, and the discussion should avoid over-interpreting these metrics as targets for intervention.

3. Cross-sectional design limits claims of system dynamics:

The manuscript frequently refers to “dynamic interactions,” “cycles,” and “resource depletion pathways.” However, the study design is cross-sectional and cannot support temporal or causal claims. The language throughout the discussion and conclusion should be revised to reflect associative rather than dynamic or causal interpretations.

4. Model justification and methodological clarity:

Although the statistical methods are described, the rationale for selecting this specific network approach is not fully developed. Additional justification for using subscale-level aggregation rather than item-level data, the choice of regularization parameters, and the applicability of resulting edges would strengthen the methodological transparency.

5. Sampling limitations:

The use of convenience sampling from a single geographic region limits external validity. While this is acknowledged, the discussion occasionally implies broader applicability (e.g., implications for nursing education more generally). These claims should be moderated.

6. Intervention implications are generic:

The proposed interventions are reasonable but not clearly derived from the network analysis itself. As written, the recommendations could be made without the current modeling approach. Clarifying how the network findings uniquely inform intervention prioritization would improve the manuscript.

7. Language and phrasing:

The manuscript is generally understandable, but some phrasing remains awkward or overly literal (e.g., “this study map the psychological network…”). A final round of language editing would improve readability.

Overall assessment:

This is a technically competent and methodologically transparent study addressing an important topic. However, the contribution is incremental, and the interpretation of network metrics should be more cautious. With revisions to clarify limitations and moderate claims, the manuscript would be suitable for publication.

Reviewer #2: This study explores the mechanism of work alienation among nursing interns using psychological network analysis, which holds certain significance for nursing education and mental health interventions for interns. The research design is relatively rigorous and the network analysis method is appropriately applied. However, further refinement and polishing are required in terms of research design details, result interpretation, depth of discussion and writing standardization. Major revisions are required before the manuscript can proceed to the subsequent review process.

1. Study Design and Participants

The manuscript fails to supplement the basic demographic characteristics of the valid sample, nor does it explain the potential selection bias of convenience sampling and the corresponding bias control measures. In addition, it is necessary to clarify whether the four tertiary hospitals include general hospitals and specialized hospitals, as this information directly affects the representativeness of the sample.

The existing inclusion and exclusion criteria only exclude interns with psychological disorders or severe mental illnesses, but do not formulate clear evaluation criteria and screening methods for "psychological disorders/severe mental illnesses" (e.g., whether standardized scales or clinical diagnoses are adopted). Specific screening procedures need to be supplemented to ensure the homogeneity of the basic psychological status of the research subjects.

2. Methodology

Insufficient description of network analysis operation details: The manuscript mentions constructing a regularized network model based on partial correlation and adopting the EBICglasso method for regularization, but does not report the specific parameter settings in the analysis process.

Inadequate control of common method bias: This study is a cross-sectional survey based on self-reported scales, which is prone to common method bias. However, the manuscript does not mention any common method bias control measures adopted in the research design stage, nor conduct statistical tests for common method bias in the data analysis stage. The corresponding test results and explanations need to be supplemented.

3. Results

The manuscript only lists the top three core nodes and top four bridge nodes, but does not provide the specific values of node strength and bridge strength for all nodes, nor explain the statistical significance test methods for the differences in node strength/bridge strength.

The manuscript fails to explore the differences in the psychological network structure of work alienation among groups with different demographic characteristics. Subgroup analysis results need to be supplemented to further enrich the research findings and provide a basis for formulating more targeted intervention suggestions.

4. Discussion and Study Limitations

The manuscript only briefly mentions that the research results verify the core viewpoints of the Conservation of Resources Theory, but does not combine the core nodes and bridge nodes of the network to deeply analyze how they reflect the process of "resource loss - resource protection - resource depletion" among nursing interns. It is necessary to explain the theoretical connotation of the research results in combination with the specific network connection characteristics, so as to further expand the application of the Conservation of Resources Theory in the research field of nursing interns.

The manuscript does not compare the research results with previous network analysis studies on work alienation/moral distress/compassion fatigue of nursing staff, nor explain the similarities and differences between the current research results and previous studies and the reasons for the differences. A comparative discussion with existing studies needs to be supplemented.

The manuscript proposes intervention strategies such as "ethical support, trauma-informed care, and competence feedback", but does not design targeted strategies combined with the core nodes and bridge nodes of the network, nor explain the implementation paths and expected effects of the strategies. The intervention strategies need to be refined to make them more in line with the clinical practice of nursing interns and have practical operability.

Specific and feasible suggestions for improving future research should be put forward for each limitation.

5. Writing Standardization

Unification of the expression of professional terms and abbreviations: Some terms in the manuscript are used in abbreviated form after their first appearance (e.g., STS, UKA), but there are problems such as individual abbreviations not being defined at their first appearance and inconsistent expression of the same term. A full manuscript check is required to standardize the definition of abbreviations (uniformly marked in the abstract and keywords) and unify the expression of the same term.

Supplement missing references and standardize citation formats: Some statements in the manuscript lack the support of corresponding references, and the citation formats of references are not completely unified. High-quality missing references need to be supplemented.

Optimize figure and table descriptions: The manuscript mentions Table 1 and Figures 1-3, but the descriptions of the figure and table legends are not detailed enough. The figure and table legends need to be optimized with necessary notes added to ensure that the figures and tables can be understood independently without referring to the main text.

6. Abstract and Keywords

The abstract is overly lengthy, and the results section only qualitatively describes the core nodes and bridge nodes without reporting key quantitative results (e.g., the specific bridge strength value of STS). It is recommended to streamline the content of the background and methods sections, delete repetitive statements, and supplement core quantitative data in the results section to make the abstract more concise and informative.

The current keywords are "nursing interns; work alienation; compassion fatigue; moral distress; ethical sensitivity", lacking the core research method keyword ("psychological network analysis") and the core research variable keyword ("workload") of the study. It is recommended to add the above two keywords and adjust the order of keywords according to the importance of the research content.

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Reviewer #1: No

Reviewer #2: No

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Unveiling the Psychological Network of Work Alienation Among Nursing Interns: A Resource Conservation Perspective and Network Analysis

PONE-D-26-10273R1

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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Ahmed Abdelwahab Ibrahim El-Sayed,

Academic Editor

PLOS One

Additional Editor Comments

Dear Authors,

Thank you for your efforts in revising and improving your manuscript. I am pleased to inform you that your manuscript has been accepted for publication in PLOS ONE in its current form.

Congratulations on this achievement, and thank you for choosing PLOS ONE as the venue for your work.

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 #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 #2: Yes

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

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 #2: No

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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 #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 #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 #2: No

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