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PONE-D-26-00957

Digital transformation of spiritual care education:A scoping review protocol of technology-enhanced learning for nursing students and professionals

PLOS One

Dear Dr. Cao,

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Academic Editor

PLOS One

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Additional Editor Comments:

In addition to the comments raised by the reviewer, kindly ensure the significance of undertaking this scoping review is made more explicit in the introduction/ background.

[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?

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

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-->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

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-->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

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-->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

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

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-->6. Review Comments to the Author

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.

(Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: PLOS ONE Peer Review Report

Manuscript: PONE-D-26-00957

Title: Digital transformation of spiritual care education: A scoping review protocol of technology-enhanced learning for nursing students and professionals

Article type: Study Protocol

Dear authors,

Thank you for submitting this manuscript. I read it with genuine interest and appreciation. Spiritual care remains one of the most underserved areas in nursing education research, and the attempt to systematically map the role of digital technologies in this space is both timely and commendable. The authors have clearly invested effort in grounding this protocol within established methodological frameworks.

The research team is to be congratulated for taking on a topic that sits at the intersection of several complex fields — digital health education, professional nursing practice, and spiritual wellbeing — and for doing so with a structured, transparent approach.

The comments that follow are intended in a constructive spirit. They aim to strengthen what is already a solid foundation, and I hope the authors will find them useful as they move this important work forward.

1. Summary of the Research and Overall Assessment

In this protocol, the authors present a scoping review that aims to map the state of digital and technology‑enhanced learning in spiritual care education for nurses and nursing students. The topic is timely, as spiritual care remains an underdeveloped competency in nursing curricula, and the integration of digital education approaches in this domain has not yet been systematically explored. The protocol is grounded in established methodological frameworks (JBI + PRISMA‑ScR), and the authors articulate a clear rationale for examining a field at the intersection of nursing education, digital pedagogy, and spiritual care.

The manuscript is generally well structured and provides a solid rationale. Nevertheless, several methodological, structural, and stylistic issues must be addressed to ensure transparency and reproducibility. Clarifications are needed regarding the search strategy, inter‑rater reliability procedures, the accuracy and completeness of references, and the alignment with PRISMA‑ScR guidelines. Strengthening these areas will enhance both the rigor and clarity of the protocol.

2. Major Issues (must be addressed)

1. Search Strategy:

The Population term “nurs” in Table 1 lacks a wildcard (“nurs*”), which will result in missed records. This risks missing common variants such as nurses, nursing, and nursed. The authors should verify that all truncation wildcards are correctly applied across all sets and databases.

More importantly, the strategy as presented does not include MeSH terms alongside free-text keywords, despite the methods section explicitly stating that “controlled vocabulary (e.g., MeSH, Emtree) and free-text keywords” will be combined. The table could be expanded to reflect both, or at minimum the authors should explain that the table is intentionally a simplified illustration and that the full strategy will be made available as supplementary material.

2. Pilot Testing and Inter‑Rater Reliability Not Fully Described

The authors mention pilot‑testing the extraction form on three studies but do not describe:

- how discrepancies were resolved

- whether inter‑rater agreement was assessed

A clear procedure for screening and extraction reliability is essential for protocol transparency.

3. Reference Inaccuracies and Misalignments

Several references cited to support key claims are incomplete, inaccurate, or misaligned with the argument:

- Reference 11 lacks publication details.

- References 12 and 13 should be checked to ensure they support the claim about spiritual care competency at an international level.

- Reference 14 is cited as a systematic review/meta‑analysis but appears to be a single‑country primary study; the citation should be corrected.

- Reference 27 also lacks bibliographic information.

These issues must be resolved for the scientific accuracy of the introduction.

4. Overstatement in Effectiveness Claims for Digital Education

The statement that digital education is “at least as effective as traditional methods” relies on inconsistent evidence (including older studies and a preprint). This should either be updated with stronger evidence or more cautiously worded.

5. Missing Discussion of Digital Education Limitations

The introduction presents an optimistic rationale but omits well‑documented risks (e.g., digital literacy divides, reduced relational depth, engagement challenges, sensitivity to cultural/spiritual nuance). A brief acknowledgment would result in a more balanced justification for the review.

6. PRISMA Checklist Misalignment

The protocol includes a PRISMA‑P checklist. Because this is a scoping review, the appropriate standard is the PRISMA‑ScR checklist.

7. Ambiguity in the Conclusion Regarding Competency Focus

The conclusion conflates digital competence and spiritual‑care competence. These are distinct; the authors should clarify which is central to the review’s aims and contextualize how the two relate.

3. Minor Issues

1. Writing Style and Flow

The Introduction contains repetition between paragraphs two and three regarding competency gaps; these could be tightened for narrative flow.

When citing the health‑outcome relevance of spiritual well‑being, the authors may wish to broaden the cited evidence base and provide brief descriptions of individual study contributions.

2. Structure and Clarification

The logistic timeline for completing the review (8 months total) may be optimistic given the volume of databases and grey literature. Authors may wish to justify or adjust the timeline.

The data extraction plan could be enriched by explicitly noting whether chaplaincy or spiritual‑care practitioners will be captured or coded within the data extraction framework. Given the interdisciplinary nature of spiritual care, this would add valuable dimension.

Lines 165–167 repeat earlier information about database coverage and should be integrated to avoid redundancy.

3. Abstract

The claim that “This will be the first scoping review…” needs support. A brief mention in the Introduction of a preliminary search of PROSPERO and JBI registries would justify the statement.

The abstract refers to pilot‑testing the data extraction form without describing the procedure. Either remove or briefly clarify.

4. Limitations Section

The manuscript could acknowledge the likelihood of publication bias in digital‑education interventions, even if risk‑of‑bias assessment is not part of a scoping review.

5. Team Composition

Although optional, explaining the interdisciplinary background of the research team (e.g., involving chaplaincy, educational design) would strengthen credibility given the topic's multidimensional nature.

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-->7. 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.

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: Niecky Fruneaux - van Amerongen

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Digital transformation of spiritual care education:A scoping review protocol of technology-enhanced learning for nursing students and professionals

PONE-D-26-00957R1

Dear Dr. Cao,

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,

JONATHAN BAYUO, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

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?

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

**********

-->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

**********

-->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: 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 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

**********

-->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

**********

-->6. Review Comments to the Author

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.

(Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Dear Authors,

Thank you for the opportunity to review your manuscript titled “Digital Transformation of Spiritual Care Education: A Scoping Review Protocol of Technology-Enhanced Learning for Nursing Students and Professionals.”

I would like to express my appreciation for the careful and thorough way in which you have addressed the comments raised in the previous review. In my opinion, the revisions have significantly strengthened the clarity and quality of the manuscript.

I find the topic highly relevant and timely, particularly given the increasing importance of (digital innovation in) nursing education and spiritual care. I am confident that this scoping review will provide valuable insights into the current state of technology-enhanced learning in this field.

I look forward with great interest to the outcomes of your study and would like to wish you every success in its execution.

Kind regards.

**********

-->7. 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.

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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