Assessment of the Psychometric Characteristics of the Italian Version of the Nurse Manager Actions Scale

Round 1

Reviewer 1 Report

Comments for Authors

Accept after minor revision. Details are as follows:

Thank you for the opportunity to review the manuscript entitled: “Assessment of the psychometric characteristics of the Italian version of the Nurse Manager Actions scale”.

 

A very interesting study, conducted with great accuracy.

Just a few minor remarks:

Abstract

1-2 sentences of background are missing.

Usually, abbreviations are not used in abstracts.

Keywords: too many, please indicate 4-5, but specific.

Purpose of the study

The authors state the aim of the study three times:

1. Line 35-37

2. Line 145-149

3. Line 387-388

The whole work shows that the purpose of the study was to validate the NMA scale, so please be very specific about the purpose of the study and use it consistently throughout the manuscript.

Introduction, very general, it is worth adding information on how nurses’ function in Italy since the validated scale will be used there.

From 145- this is rather a summary/research strengths or implications for practice than an introduction.

Discussion

Line 410-420

This is rather summary and implications for practice than a discussion.

Discussion is a comparison of your own results with the results of other researchers in this area.

Indeed, as the authors point out, the project has limitations that should be taken into account when conducting proper research.

I've included the annotated manuscript. 

Comments for author File: Comments.pdf

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear Authors,

I have thoroughly reviewed your article "Assessment of the Psychometric Characteristics of the Italian  2 Version  of the Nurse Manager Actions Scale”. I want to provide constructive feedback and comments. Firstly, I commend you on your efforts to evaluate the validity and reliability of the Nurse Manager Actions Scale (NMAs) in the context of the Italian healthcare system. The study's aim to contribute to the nursing leadership literature and its potential implications for nursing practice and research are commendable.

One notable strength of your study is the rigorous adaptation and translation process of the NMAs for the Italian context, ensuring the instrument's cultural relevance and applicability. Additionally, your use of Mokken Scale Analysis (MSA) for psychometric validation is commendable, providing a robust method to assess the scale's validity and reliability.

However, I would like to highlight some areas that could benefit further consideration and clarification. Firstly, the relatively small sample size of nurse managers could limit the findings’ generalizability. It may be valuable to address this limitation in the discussion section and discuss any implications on the study's conclusions.

Furthermore, while the hypothesis testing approach to examine the construct validity of the NMA scores is valuable, it would be helpful to provide more detailed explanations of the criteria used to establish construct validity and the rationale behind selecting external criteria (satisfaction levels and intention to leave). This could enhance the readers' understanding of the validity assessment process.

Additionally, in the discussion section, you mentioned that some items were removed from the nurse version due to potential differences in perception between nurses and nurse managers. Further exploration of these differences and their impact on the validity of the NMAs could be beneficial for future studies.

Lastly, consider the limitations of the cross-sectional design in establishing causal relationships in the hypothesis testing for construct validity. Discussing the potential for future longitudinal studies to address causality may be valuable.

Overall, your study presents valuable insights into nurse managers' actions and their influence on professional autonomy and job satisfaction among nurses in Italy. Addressing the above-mentioned points further strengthens the impact and applicability of your research findings.

Thank you for being so dedicated to advancing nursing leadership and management knowledge, and I hope my comments will enhance your valuable work.

 

 

Is particular:

 

 

The abstract is informative but could be improved for clarity and conciseness. Below are some suggestions:

• State the exact number of participants in your study - Instead of simply mentioning that data were collected among nurses and nurse managers, you could specify how many individuals participated. This gives the reader an idea of your research’s scale and potential statistical robustness.
• Clarify the findings - It's mentioned that the NMAs scores were correlated with satisfaction and decreased intention to leave, but it's unclear if these are outcomes for the nurses or the nurse managers or both. Also, the significance or implications of these findings should be provided.
• Clarify the purpose of the study and its relevance - The importance of the study could be emphasised more. For example, why is it essential to measure nurse managers' actions, and how will the validated NMAs scale benefit the Italian healthcare system?

 

 There is a comprehensive introduction to the topic and research objectives. However, some areas can be improved for clarity and precision. Here are some suggestions:

• Objective Clarity: The study’s objectives are well-defined, but presenting them as a clear and concise list might be beneficial. This can help readers grasp the main goals of the research quickly.
• Citation Formatting: The in-text citations need to be more consistent. It would be better to use a consistent citation style throughout the article, a specific kind required by the journal.
• Definition and Rationale: While the introduction provides a good context for the importance of nurses' autonomy and the role of nurse managers, it might be helpful to explicitly define what is meant by "Nurse Manager Actions" and "Nurse Manager Actions scale (NMAs)" earlier in the subsection to avoid confusion.
• Literature Review: The subsection contains some literature review elements but would benefit from a more structured presentation. Instead of interspersing various research findings, consider grouping relevant studies and discussing the key findings of each group. This will help readers better understand the existing gaps and how this study aims to address them.
• Methodology Clarification: In the section where the study aims and objectives are mentioned, briefly explaining the methodology used to achieve those objectives would be helpful. For example, citing the use of Mokken scale analysis and the rationale behind its selection.
• Flow and Structure: The subsection can be further improved by ensuring a smoother flow of ideas and logical transitions between paragraphs. This will help readers follow the progression of the argument and the research objectives more easily.
• Language and Clarity: Some sentences could be revised for clarity and conciseness, avoiding unnecessary repetitions or complex sentence structures.
•  

The "Materials and Methods" section describes the study design and data collection process. However, there are a few areas where improvement can be made:

 

• Clarity on Methodological Steps: While the subsection "Collaborative and iterative translation" provides some insight into the translation process, it would be beneficial to elaborate on the steps taken during the translation and adaptation process outlined by Douglas and Craig [30]. This will help readers understand the rigor of the translation process and its implications for the instrument’s validity.
• Description of the Sample: In the "Sample and Setting of the cross-sectional study" subsection, consider providing additional information about the number of participants and the distribution of participants across different healthcare settings. Also, specify whether nurse managers and nurses were from different hospitals or units and how they were recruited.
• Justification of Sample Size: While it is mentioned that a minimum sample size of 110 participants per analysis is required for Mokken scale analysis (MSA), it would be helpful to include a rationale for selecting this sample size. Additionally, mention any efforts to exceed the minimum sample size to achieve more accurate results.
• Data Collection Details: In the "Data collection" subsection, provide more information about the nature of the online survey, such as the types of questions asked, the format of the Likert scale, and how the participants were approached to ensure voluntary and anonymous participation.
• Statistical Analysis Clarity: The "Statistical analysis" subsection is well-detailed, but some parts could be further clarified. For example, you can explain the reason for using Loevinger’s H coefficient and Molenaar-Sijtsma rho to assess scalability and reliability, respectively. Consider providing brief definitions of these statistical measures for readers who may not be familiar with them.
• Flow and Structure: As with the other sections, ensure a smooth flow of ideas and logical transitions between subsections. This will help readers follow the progression of the research methodology more easily.

 Results" provides a clear and organized presentation of the findings, but there are some areas that could be improved for clarity and completeness:

 

• Inconsistent Abbreviations: Some abbreviations used in the subsection need to be more consistent. For example, the abbreviation "NMs" is used for both "nurse managers" and "nurses managers." It is important to use clear and consistent abbreviations throughout the article to avoid confusion.
• Subsection "3.2. Mokken Scale Analysis": The subheadings (3.2.1, 3.2.2, 3.2.3) under this subsection should be formatted consistently with other subheadings in the "Results" section.
• Statistical Significance: Ensure that the level of statistical significance is consistently represented throughout the subsection (e.g., "p<0.05" or "*p<0.05"). This will help readers quickly identify significant results.
• Grammar and Clarity: Review the text for grammatical errors or awkward phrasing. Ensure that the descriptions of the statistical analyses and results are clear and easy to understand.

 

The Discussion section comprehensively analyses the study's findings and their implications. However, there are a few areas where the subsection can be improved:

 

• Conciseness: Some sentences are lengthy and complex. Consider breaking them into shorter, more focused sentences to improve readability and comprehension.
• Organizing Findings: While provides valuable insights into the implications of the findings, it might be helpful to manage the discussion around specific themes or research questions. This can make it easier for readers to follow and understand the main takeaways from the study.
• Elaborate on Differences in Hypothesis Testing:  you mentioned that the hypotheses were fully accepted in the subsample of nurses but only partially accepted about nurse managers. It would be beneficial to discuss further the reasons behind these differences and their potential implications for nursing leadership and future research.
• Generalizability: While the Discussion touches upon the generalizability of the findings, consider expanding on this point further. Discuss the potential transferability of the results to other cultural contexts and healthcare settings, and acknowledge any specific limitations in applying the findings in different environments.
• Future Research Directions: You briefly mention some future research directions related to re-testing the shortened version and establishing dimensionality using factor analysis. Consider elaborating on other potential research avenues that could build upon this study, such as investigating the relationships between nurse manager actions and specific patient outcomes or exploring the effectiveness of interventions based on the NMAs results.
• Language and Clarity: Review the "Discussion" section for any grammatical errors or unclear phrasings. Ensure that the arguments are presented logically and that the discussion flows smoothly from one point to another.
• Citations: In the "Discussion" section, when discussing implications and comparisons to previous studies, make sure to cite relevant literature to support your points. This helps strengthen the validity of your interpretations and findings.

 

 

The Conclution provides a concise summary of the main findings and implications of the study. However, there are a few areas where it can be improved:

• Specific Findings: While the subsection mentions that the NMAs is a valid and reliable instrument, it does not explicitly mention the psychometric characteristics that support this claim. Consider briefly mentioning key findings, such as the Cronbach's alpha values, scalability coefficients, and results from hypothesis testing, to provide more concrete evidence of the instrument's validity and reliability.
• Clarity on Versions: The subsection mentions that two different versions of the NMAs were developed for nurses and nurse managers. To enhance clarity, specify the differences between these versions and briefly discuss the rationale for developing two separate performances.
• Implications for Practice and Research: While the subsection mentions the potential benefits of using the NMAs for nursing practice and research, consider elaborating on specific ways the instrument can be utilized in these contexts. For example, how can the NMAs results be used to improve professional autonomy among nurses and nurse managers? How can it be used to design targeted interventions for enhancing multidisciplinary teamwork or reducing intention to leave?
• Practical Implementation: Discuss any practical considerations or challenges when implementing the NMAs in the Italian healthcare system or other contexts. Address potential barriers and suggest strategies to overcome them.
• Comparison with Prior Research: If available, consider comparing the psychometric characteristics of the Italian 2 version of NMAs with the original version and any previous adaptations in other cultural contexts. This comparison can help readers understand the similarities and differences in the instrument’s performance across different populations.
• Future Directions: Offer suggestions for future research based on the study's findings. For example, are there specific aspects of nurse manager actions that could be further explored in future studies? Are there opportunities to investigate the impact of interventions based on NMAs results on patient outcomes or nurse satisfaction over time?
• Limitations and Recommendations: Briefly discuss the study’s limitations and provide recommendations for researchers and practitioners to address these limitations in future studies or applications

Overall, the English used in the article is clear and understandable. The authors effectively convey their research findings and implications for nursing practice and research. The article maintains a formal tone appropriate for academic writing, and the language is generally free of significant grammatical errors. The use of technical terms and concepts is well-balanced, making it accessible to readers familiar with nursing and psychometrics.

However, there are some areas where the English could be improved:

• Sentence Structure: Some sentences are quite long and complex, which may make it challenging for readers to follow the main point. Breaking down lengthy sentences into shorter ones or using clearer punctuation can enhance readability.
• Clarity of Expression: In some parts of the article, the phrasing could be simplified to ensure clarity. Removing unnecessary jargon and using more straightforward language can make the content more accessible to a broader audience.
• Consistency in Terminology: Ensuring consistency in terminology throughout the article can enhance clarity and avoid confusion.
• Proofreading: While the article is generally well-written, a few minor typos and punctuation errors could be corrected carefully.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Dear Authors,

I want to extend my heartfelt thanks for accepting my comments and considering them for revision in your manuscript. Thank you once again, and I look forward to seeing the final version of your paper.