Experiences of Nursing Students Regarding Challenges and Support for Resilience during Clinical Education: A Qualitative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Very interesting research, I congratulate the authors on taking up this topic. The introduction quite comprehensively introduces the reader to the topic of supporting nursing students in the clinical education process.
The purpose of the work is clearly formulated. This study used a qualitative approach and semi-structured individual interviews and analyzed the collected information based on thematic analysis.
The results are presented in an interesting way, cover the topics discussed and are reflected in the conclusions of the work
I did not find any limitations of the study in the study, it would be advisable to write them down, or the strengths and weaknesses of the study.

Author Response

Reviewer 1:

Comments and Suggestions for Authors

Very interesting research, I congratulate the authors on taking up this topic. The introduction quite comprehensively introduces the reader to the topic of supporting nursing students in the clinical education process.
The purpose of the work is clearly formulated. This study used a qualitative approach and semi-structured individual interviews and analyzed the collected information based on thematic analysis.
The results are presented in an interesting way, cover the topics discussed and are reflected in the conclusions of the work
I did not find any limitations of the study in the study, it would be advisable to write them down, or the strengths and weaknesses of the study.

Response from authors:

Dear Reviewer,

Thank you very much for your thoughtful and encouraging feedback on our manuscript. We agreed that discussing the strengths and limitations of our research was vital for providing a balanced view and for guiding future research in this area. Based on your valuable suggestion, we revised our manuscript to include a detailed section on the strengths and limitations (page14-15/line650-686 in revised manuscript). This would comprehend potential biases, the scope of our findings, and any other constraints we encountered during the study.

Once again, thank you for your constructive comments and for the time you have taken to review our manuscript.

Sincerely,

Authors

Reviewer 2 Report

Comments and Suggestions for Authors

The introduction seemed to have a lot of redundancy.  The last paragraph refers to comprehensive studies addressing the challenges, but yet this study does not address it, the data just provides more information for those who may want to start developing strategies. It would appear that this article is specifically focused on clinical, but there is no clear explanation on why that was removed from didactic?  Is there already plenty on the stressors of the didactic and is there evidence to show they should be separated? The second paragraph of the intro does a nice job explaining how clinical adds a complexity to nursing.

Comments on the Quality of English Language

Did not read for grammar

Author Response

Reviewer 2:

 Comments and Suggestions for Authors

The introduction seemed to have a lot of redundancy.  The last paragraph refers to comprehensive studies addressing the challenges, but yet this study does not address it, the data just provides more information for those who may want to start developing strategies. It would appear that this article is specifically focused on clinical, but there is no clear explanation on why that was removed from didactic?  Is there already plenty on the stressors of the didactic and is there evidence to show they should be separated? The second paragraph of the intro does a nice job explaining how clinical adds a complexity to nursing.

 Response from authors:

Dear Reviewer,

Thank you for taking the time to review our manuscript and provide insightful feedback. We greatly appreciated your comments and suggestions, as they would certainly help us improve the quality and clarity of our work.

Regarding your suggestions about the redundancy in the introduction, we restructured the content to ensure a more concise and focused narrative. In addition, we revised this part to emphasize the significance of clinical experiences in shaping nursing students' resilience and to justify our focus on clinical practice over didactic aspects. (page3/line115-134 in revised manuscript)

We appreciated your positive feedback on the second paragraph, which highlighted the added complexity that clinical practice brought to nursing education. We ensured that this point was emphasized throughout the manuscript to maintain a clear focus on the significance of clinical experiences in shaping nursing students' resilience.

Once again, thank you for your constructive comments and suggestions. We have addressed these points and revised our manuscript accordingly. Your review has helped guide our revisions and strengthen the overall quality of our manuscript.

Sincerely,

Authors

Reviewer 3 Report

Comments and Suggestions for Authors

Well framed theme. Meaning, the introduction points the most relevant frames in the area; resilience is a  crucial attribute for nursing students and the authors pointed the intricate relationship between resilience and self-care practices, that could also improve academic success. The referenced authors and sources are actual and pertinent.

Relevant to nursing education. Because at least half of the degree in spend in clinical education (according to European Directive) and the aim was to describe nursing students’ experiences regarding 123 challenges and support for resilience within the context of clinical education. 

Fills a gap in the area of qualitative studies regarding nursing students resilience, higlighted in pos-COVID time. 

Project with ethical review by two Ethics Councils, the Ethics Review Authority in Sweden and  from Srimasarakham Nursing College, serving as a proxy for the Faculty 205 of Nursing Praboromarajchanok Institute, Thailand. Therefore, having ethical revue is a indicatour of quality in the design of project and respect for participantes rights. 

Involvement of students from various institutional contexts. Explicit and robust methodology.  Data analysis was carried out using inductive thematic analysis, according to Braun and Clarke’s approach. It is well explained and the reserachers achieved data saturation within 28 interviews.The data underwent a coding and categorization process that is described. They documented the categories and attribute clear meaning, such as in Navigating Unvertainty in a big ocean or Transcending Professional Struggles. Probably, they could deepen the analysis of the category about Experiences of Meaningfulness, but it is understandable sone categories have more and others less data. 

Well discussed conclusions. Meaning, they discuss their conclusions with other studies; not many because there are not so much findings about the topic, but connect with, like emotional inteligence or wellness.  Probably, they could deepen the analysis of the category about Experiences of Meaningfulness, but it is understandable some categories have more and others less data. 

It is a qualitative study with quality.

Author Response

Reviewer 3:

 Comments and Suggestions for Authors

Well framed theme. Meaning, the introduction points the most relevant frames in the area; resilience is a  crucial attribute for nursing students and the authors pointed the intricate relationship between resilience and self-care practices, that could also improve academic success. The referenced authors and sources are actual and pertinent.

Relevant to nursing education. Because at least half of the degree in spend in clinical education (according to European Directive) and the aim was to describe nursing students’ experiences regarding 123 challenges and support for resilience within the context of clinical education. 

Fills a gap in the area of qualitative studies regarding nursing students resilience, higlighted in pos-COVID time. 

Project with ethical review by two Ethics Councils, the Ethics Review Authority in Sweden and  from Srimasarakham Nursing College, serving as a proxy for the Faculty 205 of Nursing Praboromarajchanok Institute, Thailand. Therefore, having ethical revue is a indicatour of quality in the design of project and respect for participantes rights. 

Involvement of students from various institutional contexts. Explicit and robust methodology.  Data analysis was carried out using inductive thematic analysis, according to Braun and Clarke’s approach. It is well explained and the reserachers achieved data saturation within 28 interviews.The data underwent a coding and categorization process that is described. They documented the categories and attribute clear meaning, such as in Navigating Unvertainty in a big ocean or Transcending Professional Struggles. Probably, they could deepen the analysis of the category about Experiences of Meaningfulness, but it is understandable sone categories have more and others less data. 

Well discussed conclusions. Meaning, they discuss their conclusions with other studies; not many because there are not so much findings about the topic, but connect with, like emotional inteligence or wellness.  Probably, they could deepen the analysis of the category about Experiences of Meaningfulness, but it is understandable some categories have more and others less data. 

It is a qualitative study with quality.

 Response from authors:

Dear Reviewer,

Thank you for your thorough and constructive feedback on our manuscript. We appreciated the time and effort you took to review our work and provide detailed comments. Below, we addressed your feedback point by point:

1. Introduction and Framing

We were glad to hear that you found the theme well-framed and the introduction relevant. We aimed to highlight the vital role of resilience in nursing students and its relationship with self-care practices to emphasize its impact on academic success. We appreciate your acknowledgment of the relevance and modernness of the referenced sources.

2. Relevance to Nursing Education

Your recognition of the study's relevance to nursing education, especially considering the European Directive on clinical education, was greatly appreciated. Our goal had been to illuminate the challenges and supports that nursing students encountered in clinical settings to better inform educational practices.

3. Gap in Qualitative Studies Post-COVID

We were pleased that you recognized our study's contribution to filling a gap in qualitative research on nursing students\' resilience, particularly in the post-COVID context. This period had indeed posed unique challenges, making resilience a critical area of study.

4. Ethical Review

We appreciate your acknowledgment of the ethical rigor of our study, with reviews from both the Ethics Review Authority in Sweden and the Srimasarakham Nursing College in Thailand to ensure ethical standards and protect participants' rights in our research project.

5. Methodology and Data Analysis

Thank you for your positive comments on our methodology. We revised to clarify and strengthen our approach, utilizing Braun and Clarke's inductive thematic analysis to ensure thorough data saturation and meaningful categorization. We noted your suggestion to deepen the analysis of the "Experiences of Meaningfulness" theme and expanded this section to provide a more comprehensive analysis. (page5/line186-220 in revised manuscript)

6. Discussion and Conclusions

We appreciate your feedback on our discussion and conclusions. While the limited existing literature on this topic had posed challenges, we tried to connect our findings with relevant studies. In response to your suggestion to deepen the analysis of the "Experiences of Meaningfulness" theme, we expanded this section to provide a richer understanding of this aspect to enhance the overall depth and impact of our study. (page13-14/line593-654 in revised manuscript)

Once again, thank you for your insightful comments and recommendations. We revised our manuscript based on your feedback and looked forward to submitting a revised version.

Sincerely,

Authors

Reviewer 4 Report

Comments and Suggestions for Authors

I believe that resilience is an important concept in the education of nursing students and deserves to be explored. Sincere well done and support.

Introduction: 

Is this an application of caring theory? 

And maybe you need to be a little clearer about what you are trying to explore or understand.

Discussion:

Like the discussion of the "transcending professional struggles" findings. 

Are new concepts emerging from the overall discussion? This is confusing and needs to be clarified a bit more. 

Author Response

Reviewer 4:

 Comments and Suggestions for Authors

I believe that resilience is an important concept in the education of nursing students and deserves to be explored. Sincere well done and support.

 Introduction: 

Is this an application of caring theory? 

And maybe you need to be a little clearer about what you are trying to explore or understand.

Discussion:

Like the discussion of the "transcending professional struggles" findings. 

Are new concepts emerging from the overall discussion? This is confusing and needs to be clarified a bit more. 

 Response from authors:

Dear Reviewer,

Thank you for your insightful comments and suggestions regarding our manuscript. We appreciate your positive feedback and the opportunity to clarify and improve our work. Please find our responses to your comments below.

Introduction:

1. Application of caring theory

Thank you for raising this point. Our study did indeed draw upon the principles of Jean Watson\'s theory of human caring, specifically the unitary caring science perspective, as a framework for understanding resilience in nursing students. We expanded this point to make this connection more explicit in the revised introduction, elaborating on how caring theory informed our exploration of resilience. (page2/line56-67 in revised manuscript)

2. Clarifying the research focus

We appreciate your suggestion to provide more clarity about what we were trying to explore. We refined our research focus in the introduction part to clearly articulate that we were investigating the challenges nursing students faced during clinical practice, the support systems that contributed to their resilience, and how these experiences shaped their professional development. This would help readers better understand the focus and scope of our study. (page3/line115-134 in revised manuscript)

Discussion: (page12/line540-551, page13/line573-612, page14/line613-654 in revised manuscript)

1. Transcending professional struggles

We were pleased that you found our discussion of "transcending professional struggles" valuable. In the revised manuscript, we further elaborated on how our findings contributed to the existing knowledge on resilience in nursing education. Specifically, we emphasized how understanding the challenges students faced in applying theoretical knowledge to practical scenarios could inform educational strategies to bridge this gap and foster resilience.

2. Clarifying emerging concepts

In the revised discussion, we revised to ensure that any new concepts or themes were clearly defined and their relevance to our research question was explicitly stated. We also reorganized the discussion to improve the logical flow and link our findings to the existing literature, emphasizing the new insights our study provided.

We have addressed your comments to enhance the clarity and impact of our manuscript, making it a more valuable contribution to the understanding of resilience among nursing students within clinical practice experiences.

Thank you once again for your thoughtful review and the opportunity to improve our work.

Sincerely,

Authors