A Qualitative Study on Voices of South African Learner Nurses on Occupational Health and Safety during Clinical Learning: Pre-COVID-19 Pandemic

Round 1

Reviewer 1 Report

The paper is titled “Voices of South African learner nurses on occupational health and safety during clinical learning: Pre-Covid-19 pandemic.” The scope of occupational health and safety is vast and complex, even if it is focused only on the nursing profession/occupation. However, the authors seek to focus narrowly only on learner nurses during clinical training. The study is based on 31 learner nurses who were asked a simple question: “Could you kindly explain the health and safety of learner nurses during clinical learning?”. It is unclear whether the respondents were systematically probed about the many systemic aspects of occupational health and safety. It is also unclear whether the authors had a conceptual/theoretical framework guiding the data collection, or they discovered one grounded on the data. Neither is presented. Consequently, the results appear to be simply selective opinions of the sample of nurses that cannot be generalized.  It may summarize the voices of the 31 using a scientific method, but the scientific value of the results appears to be limited.

Author Response

NURSING REPORT REVIEW 1 COMMENT

 

COMMENTS	CORRECTIONS
1.       The paper is titled “Voices of South African learner nurses on occupational health and safety during clinical learning: Pre-Covid-19 pandemic.” The scope of occupational health and safety is vast and complex, even if it is focused only on the nursing profession/occupation. However, the authors seek to focus narrowly only on learner nurses during clinical training. The study is based on 31 learner nurses who were asked a simple question: “Could you kindly explain the health and safety of learner nurses during clinical learning?”. It is unclear whether the respondents were systematically probed about the many systemic aspects of occupational health and safety.	·         Probing questions were added see appendix A
2.       It is also unclear whether the authors had a conceptual/theoretical framework guiding the data collection, or they discovered one grounded on the data. Neither is presented. Consequently, the results appear to be simply selective opinions of the sample of nurses that cannot be generalized.	The study was guided by the experiential learning theory. Line 106 to 119, line 382-384

Author Response File: Author Response.docx

Reviewer 2 Report

Summary: This paper used qualitative research methods to investigate the perceptions of occupational health and safety amongst learner nurses in the Limpopo district of South Africa, with suggestions for further nurse training and safety. I think this is an important area; different contexts will have different problems in occupational safety for nurses, and this appears unique to South Africa, although I believe lessons may be transferable to other regions of the world. There have been other articles on the topic, specific to the countries involved, but the approach discussing training is reasonably novel.

I am surprised the university doesn’t offer vaccinations such as for hepatitis, to avoid students becoming ill from their course, especially if clinical training is (quite rightly) mandatory. Does the university carry out a risk assessment of the clinics involved? It would be good to discuss this.

The methods section was the most well-written (but needs expansion in places). The rest of the article needs a lot of polishing. For your discussion you may want to think more about what the students wanted in terms of education on OHS and what needs changing policy-wise to enable the students to stay safe as separate sections to write about, as the discussion appears to have a lot of ideas without much structure. Think about structure more in the whole paper as it does read as though lots of interesting ideas and comments have been rather thrown together.

Specific comments:

Formatting not perfect

L12 Abstract: ‘determine occupational health and safety among learner nurses’ do you mean their actions or their theoretical knowledge? Not quite clear.

Font size changes in line 20 abstract.

Intro: line 34 you make registered nurses sound like occupational health hazards

Very well written methods section, but needs to expand on field notes: were they observations of the student nurses? Also, data analysis: ‘A list of all the themes was compiled’ how did you come up with those themes?

 

Participant information repeated L147 and L183: once is enough

L196 supported by, rather than supports

L219: what does extend and dire mean? Do you mean dearth instead of dire?

L252 Comments, not measured demonstrated…

Discussion: L328 &329: I wouldn’t write the themes as cut and pasted titles

L339-341: how you have written this comment makes the findings appear generalizable, which qualitative research rarely is.

L426: I think you mean transferability rather than generalizability (not a goal of qualitative research)

 

Author Response

COMMENTS	CORRECTION
Formatting not perfect
L12 Abstract: ‘determine occupational health and safety among learner nurses’ do you mean their actions or their theoretical knowledge? Not quite clear.	corrected
Font size changes in line 20 abstract.	Change effected
Intro: line 34 you make registered nurses sound like occupational health hazards	Change effected
Very well written methods section, but needs to expand on field notes: were they observations of the student nurses? Also, data analysis: ‘A list of all the themes was compiled’ how did you come up with those themes?	Change effected
Participant information repeated L147 and L183: once is enough	Not effected
L196 supported by, rather than supports	Change effected, See line 192
L219: what does extend and dire mean? Do you mean dearth instead of dire?	Changes effected, See line 214
L252 Comments, not measured demonstrated…	Effected, See line 248
Discussion: L328 &329: I wouldn’t write the themes as cut and pasted titles
L339-341: how you have written this comment makes the findings appear generalizable, which qualitative research rarely is.	Effected, See line 337 to 339.
L426: I think you mean transferability rather than generalizability (not a goal of qualitative research)	Changes effected, see line 424 to 427.

Author Response File: Author Response.docx

Reviewer 3 Report

Thank you for the opportunity to review manuscript NR-2079489 titled “Voices of South African learner nurses on occupational health and safety during clinical learning: Pre-Covid-19 pandemic”. This manuscript summarized the results of a “qualitative-exploratory-descriptive and contextual research design” study of 31 learner nurses in Limpopo province South Africa. The strengths of this study are that it evaluated a significant problem in an under-resourced context for which learner nurses were impacted and effective nursing policy advocacy can help. The limitations of this study are it needs strengthened justifications in a number of areas including: nursing specific labor links (i.e. WHO), including key infectious disease stats (i.e. HIV, Hep B/C rates, etc), appropriate methodological citations (no dissertations, need seminal researchers who developed the methods, etc), and English editing. Specific areas for follow-up are listed below. Thank you again for the opportunity to review the valuable topic of South African learner nursing voice.

Abstract

L20. Consider strengthened language: “Effective and innovative occupational health and safety training programmes for learner nurses’ can be developed despite constrained environmental resources.” Last sentence really lacks punch—why should journal publish??

Introduction

L26-30. Consider defining levels of learner nurses (pre-licensure?) so it’s easily relatable to other countries? Practical programs 2-3 years, vs 4-year, vs graduate programs?

L29. nursing competencies?

L46. What are the leading causes and infectious disease rates related to occupational exposures in the region? I.e. HIV/AIDS, Hep B, C, TB?

L46. Please add SDG 3 and SDG 16 also:

·         SDG 3: infectious diseases, health financing and workforce. Targets of Sustainable Development Goal 3 (who.int)

·         SDG 16: helping institutions to function according to legitimate laws, so they do not succumb to arbitrary abuses of power (infrastructure integrity): 16_Why-It-Matters-2020.pdf (un.org)

L47. Link SDGs to State of World’s Nursing 2020 report for additional support: State of the world's nursing 2020: investing in education, jobs and leadership (who.int)

L53. Citation from Australia. Are there other international or S. Africa domestic resources? Here is a US example of the types of stats tracked: Occupational injuries and illnesses among registered nurses : Monthly Labor Review: U.S. Bureau of Labor Statistics (bls.gov)

L99-102. Any statistics?

L104-106. Keep focus on nursing specific stats: State of the world's nursing 2020: investing in education, jobs and leadership (who.int)

L113. What is the research question?

Methods

L116. This is confusing. A qualitative exploratory descriptive study with a contextual research design? (Meaning it’s either QUANT, QUAL or MM, with a specific type of design under the QUAL umbrella). Can you cite the researcher(s) who developed the precedent? Is this a type of ethnography?

L120. Why is a pediatric citation from India used for justifying this study design (for adult learner nurses in S. Africa?)

L136. Polit & Beck (28) citation needs page numbers.

L138-138. Directly conflicting statements, stated the desired “sample population in this study is all learner nurses” vs “excluded level one nurses”. Which is it?

L165. Was a qualitative analysis software program used to facilitate accurate coding and analysis of themes?

Results

 

Recommend inserting a Table 1 with a summary of the demographic characteristics of the learner nurses. 

L320. Typos, unclear: “eish”.

L324. Typos, unclear: “moose”.

Discussion

L344. This is overstepping from the data presented in Results section. Staff nurses as “unapproachable” versus unavailable due to poorly resourced, understaffed, schedule alignments on busy surgery days, insufficient educator/training support for adequately prepared preceptors, etc?

L354. How is preceptorship structured in S. Africa and the region of this study?

L432. Adequate preceptor training for staff nurses to mentor the learner nurses in these areas?

References

-Need to replace dissertation (non-peer reviewed research reports) with stronger peer-reviewed citations.

-Need to ensure that the methods citations are appropriate (i.e. if textbooks, identify which page citing); seminal researchers (i.e. similar to Lincoln and Guba) and key examples for contextual design—not Indian pediatrics.

Author Response

COMMENTS	CORRECTION
Abstract: L20. Consider strengthened language: “Effective and innovative occupational health and safety training programmes for learner nurses’ can be developed despite constrained environmental resources.” Last sentence really lacks punch—why should journal publish??	Change effected
Introduction L26-30. Consider defining levels of learner nurses (pre-licensure?) so it’s easily relatable to other countries? Practical programs 2-3 years, vs 4-year, vs graduate programs?	Change effected
L29. nursing competencies?	Change effected
L46. What are the leading causes and infectious disease rates related to occupational exposures in the region? I.e. HIV/AIDS, Hep B, C, TB?	Change effected
L46. Please add SDG 3 and SDG 16 also:	Changes effected
SDG 3: infectious diseases, health financing and workforce. Targets of Sustainable Development Goal 3 (who.int)	Changes effected
SDG 16: helping institutions to function according to legitimate laws, so they do not succumb to arbitrary abuses of power (infrastructure integrity): 16_Why-It-Matters-2020.pdf (un.org)	Change effected
L47. Link SDGs to State of World’s Nursing 2020 report for additional support: State of the world's nursing 2020: investing in education, jobs and leadership (who.int)	Changes effected
L53. Citation from Australia. Are there other international or S. Africa domestic resources? Here is a US example of the types of stats tracked: Occupational injuries and illnesses among registered nurses: Monthly Labor Review: U.S. Bureau of Labor Statistics (bls.gov)	Changes effected
L99-102. Any statistics?	1.9 million, however WHO did not provide any statistics.
L104-106. Keep focus on nursing specific stats: State of the world's nursing 2020: investing in education, jobs and leadership (who.int)	Changes effected
L113. What is the research question?	Changes effected
Methods L116. This is confusing. A qualitative exploratory descriptive study with a contextual research design? (Meaning it’s either QUANT, QUAL or MM, with a specific type of design under the QUAL umbrella). Can you cite the researcher(s) who developed the precedent? Is this a type of ethnography?	Changes effected
L120. Why is a pediatric citation from India used for justifying this study design (for adult learner nurses in S. Africa?)	Changes effected.
L136. Polit & Beck (28) citation needs page numbers.	Changes were not effected. The Vancouver style does not permit page numbers.
L138-138. Directly conflicting statements, stated the desired “sample population in this study is all learner nurses” vs “excluded level one nurses”. Which is it?	Changes not effected
Results   L165. Was a qualitative analysis software program used to facilitate accurate coding and analysis of themes?	Yes, NVivo was used. Please se the data analysis section.
Recommend inserting a Table 1 with a summary of the demographic characteristics of the learner nurses.	Inserted
L320. Typos, unclear: “eish”.	Corrected
L324. Typos, unclear: “moose”.	Corrected
Discussion   L344. This is overstepping from the data presented in Results section. Staff nurses as “unapproachable” versus unavailable due to poorly resourced, understaffed, schedule alignments on busy surgery days, insufficient educator/training support for adequately prepared preceptors, etc?	Changes were effected
L354. How is preceptorship structured in S. Africa and the region of this study?	Preceptorship is a expensive model for previously disadvantaged NEI. Only few NEIs in SA afford that model. However, in the context of this study, we relay mostly on unstructured peer-mentoring and mentorship by nurses.
L432. Adequate preceptor training for staff nurses to mentor the learner nurses in these areas?	The NEIs in this region does not have a structured preceptorship. However, relay mostly on mentorship by registered nurses.
References -Need to replace dissertation (non-peer reviewed research reports) with stronger peer-reviewed citations.
Need to ensure that the methods citations are appropriate (i.e. if textbooks, identify which page citing); seminal researchers (i.e. similar to Lincoln and Guba) and key examples for contextual design—not Indian pediatrics.	Confirm with journal the referencing style, particularly for books

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The authors' response to my comments is acceptable.

Reviewer 2 Report

This version is much improved.