Exploring Burnout among Nursing Students in Bangalore: A t-Distributed Stochastic Neighbor Embedding Analysis and Hierarchical Clustering in Cross-Sectional Data

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Burnout in nursing professionals is an aspect that has been studied, above all, since covid 19, and a broader introductory framework could have been developed.

A very interesting study on two aspects or dimensions of Burnout, burnout and disengagement, in nursing students, which would have been appropriate to contextualise more, in socio-cultural aspects of India, as well as the characteristics of the state of Karnataka, where Bangalore is located, which would have minimised the limitations of the research. Nursing studies have a bias in most countries towards the female gender, and more so in India.

The authors provide a novel insight into the different motivational drivers and academic pressures that relate to students' experiences of burnout, using the clusters, which would have been available from other more familiar approaches in the health field.

 

Author Response

Comment 1: 

Burnout in nursing professionals is an aspect that has been studied, above all, since covid 19, and a broader introductory framework could have been developed.

Response 1: We agree with the reviewer that a broader introductory framework is essential. We have expanded the introduction to include a comprehensive overview of the increased focus on burnout among nursing professionals, particularly since the onset of the COVID-19 pandemic.

Comment 2: 

A very interesting study on two aspects or dimensions of Burnout, burnout and disengagement, in nursing students, which would have been appropriate to contextualise more, in socio-cultural aspects of India, as well as the characteristics of the state of Karnataka, where Bangalore is located, which would have minimised the limitations of the research. Nursing studies have a bias in most countries towards the female gender, and more so in India.

Response 2: 

We appreciate this valuable suggestion. We have added a section in the introduction that provides a detailed socio-cultural context relevant to India and the state of Karnataka. This includes information on the healthcare system, socio-economic factors, cultural expectations, and educational environment in Bangalore. These additions aim to better contextualize the findings and address the limitations highlighted by the reviewer. In addition, we acknowledge the gender bias in nursing studies and its potential impact on our findings. We have included a discussion in the limitations section to address this issue explicitly.

Comment 3: 

The authors provide a novel insight into the different motivational drivers and academic pressures that relate to students' experiences of burnout, using the clusters, which would have been available from other more familiar approaches in the health field.

Response 3: We appreciate the recognition of our novel approach. To enhance clarity, we have revised the discussion section to compare our clustering methodology with other established approaches in health research.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for your hard work in conducting the research. I believe it will become even more meaningful with a few minor adjustments.

1. Abstract: Add information related to the method (e.g., when the survey was conducted, name of the questionnaire, etc.)

2. The introduction is well written and follows a logical flow.

3. Research Methods: The research methods adequately describe the elements necessary for research replication.

4. Results: The results derived from the research analysis method are neatly described.

5. Discussion: Although the limitations of the study are well described, it chould also be acknowledged that this study was conducted at a single institution. Please elaborate on this aspect.

Author Response

Comment 1. 

Thank you for your hard work in conducting the research. I believe it will become even more meaningful with a few minor adjustments.
1. Abstract: Add information related to the method (e.g., when the survey was conducted, name of the questionnaire, etc.)

Response 1: We appreciate your positive feedback and constructive suggestions for improving our manuscript. We have revised the abstract accordingly.

Comment 2, 3 & 4: 

2. The introduction is well written and follows a logical flow.
3. Research Methods: The research methods adequately describe the elements necessary for research replication.
4. Results: The results derived from the research analysis method are neatly described.

Response 2, 3 & 4: Thank you.

Comment 5: . Discussion: Although the limitations of the study are well described, it chould also be acknowledged that this study was conducted at a single institution. Please elaborate on this aspect.

Response 5. 

Thank you. We have acknowledged and discussed this limitation in the current version.

Reviewer 3 Report

Comments and Suggestions for Authors

I felt the article had a good flow, it provided background to demonstrate the significance of the issue being investigated. I had to look up the instrument since in the US that is not a well known survey/instrument and it would appear it has not been used extensively in the US.  I found myself wondering why and if it was culturally sensitive for populations within certain counties and cultures. That could be explained for readers outside of India.  

The statistical section is very technical, which is not my area of expertise so I am unable to comment on the validity of the tests completed in this section.

The results and discussion were very clear to me and as someone who has worked in resiliency and growth mindset among nursing students, this was very interesting to me and has applicability when designing interventions. 

Comments on the Quality of English Language

Why is Exhaustion and Disengagement consistently capitalized?

Author Response

Cooments: I felt the article had a good flow, it provided background to demonstrate the significance of the issue being investigated. I had to look up the instrument since in the US that is not a well known survey/instrument and it would appear it has not been used extensively in the US.  I found myself wondering why and if it was culturally sensitive for populations within certain counties and cultures. That could be explained for readers outside of India.  

The statistical section is very technical, which is not my area of expertise so I am unable to comment on the validity of the tests completed in this section.

The results and discussion were very clear to me and as someone who has worked in resiliency and growth mindset among nursing students, this was very interesting to me and has applicability when designing interventions. 

Response: Thank you very much for your appreciation of our study. 

Reviewer 4 Report

Comments and Suggestions for Authors

The research is interesting and very important, especially these days for nursing education. Today's young people come to nursing studies for slightly different reasons than in the past, and all knowledge and thinking in encouraging joining the profession is necessary.

It's unfortunate that the sample included only female students, as close to 20% of nursing students are men. However, the researchers addressed the limitations of the study.

Good Luck!

Author Response

Comment: 

The research is interesting and very important, especially these days for nursing education. Today's young people come to nursing studies for slightly different reasons than in the past, and all knowledge and thinking in encouraging joining the profession is necessary.

It's unfortunate that the sample included only female students, as close to 20% of nursing students are men. However, the researchers addressed the limitations of the study.

Good Luck!

Response: Thank you for appreciating our research. In this version, we have also expanded the discussion of our limits a little.