The Importance of Receiving Training in Computerized Technology for Nurses to Maintain Sustainability in the Health System

Round 1

Reviewer 1 Report (Previous Reviewer 1)

The revision was greatly improved as pointed out in the reviewers' suggestions. I find this now is ready to be published in the journal.

Author Response

Response to Reviewer 1 Comments

Point 1: " The revision was greatly improved as pointed out in the reviewers' suggestions. I find this now is ready to be published in the journal."

Re-proofing corrections were made. Please see the attachment.

 

We thank you for the guidance in the comments and the permission to publish the article.

Best Regards.

Author Response File: Author Response.pdf

Reviewer 2 Report (Previous Reviewer 2)

The paper is well structured and competently written. When compared to the previous submission, there are important improvements in the presentation of the open coding process and results, as well as the study's threats and limitations. The following few minor issues should be corrected by the authors; they should also carry out an additional round of proof-reading, as there are still some typos and small mistakes left.

• Paper jumps from section 2.3 to section 4 directly
• Figures should use a consistent style (e.g., Figures 1 and 2)
• "each interviewee was allowed to present their opinion and position towards the research subject without judgment on the part of the interviewer, to allow the presentation of their true opinion" -- in fairness this is very difficult to judge.
• The final paragraph ("The qualitative study was done on 10 participants…") should be included in the Threats and Limitations section

 

Author Response

Response to Reviewer 2 Comments

Point 1: "They should also carry out an additional round of proof-reading, as there are still some typos and small mistakes left."

Response 1: Corrections were made as required.  Please see the attachment.

Point 2: " each interviewee was allowed to present their opinion and position towards the research subject without judgment on the part of the interviewer, to allow the presentation of their true opinion" -- in fairness this is very difficult to judge."

Response 2: The intent in the sentence was that the interviewer did not intervene when the interviewees expressed their opinions. The sentence corrected to " each interviewee was allowed to present their opinion and position towards the research subject without an interfering by the interviewer, to allow the presentation of their true opinion."  

Point 3: " The final paragraph ("The qualitative study was done on 10 participants…") should be included in the Threats and Limitations section."

Response 3: The paragraph included in study limitations section. Please see the attachment.

We are grateful for the opportunity given to make corrections to improve the content of the article.

Best regards

 

Author Response File: Author Response.pdf

Reviewer 3 Report (Previous Reviewer 3)

Please update the data in your introduction section. I cannot see a significant theoretical contribution regarding your manuscipt. Please hightlight the literature gap clearly. Thank you. 

Author Response

Response to Reviewer 3 Comments

We would like to express our deep gratitude for the time and effort devoted to providing new feedback on the article. In this document are all the changes made in accordance with the review report and the fully revised article is attached.

 

Point 1: " Please update the data in your introduction section."

Response 1: The introduction section in the article has been rewritten. Please see the attachment.

Point 2: " I cannot see a significant theoretical contribution regarding your manuscript."

Response 2: The contribution of the research explained more clearly in conclusion  section. Please see the attachment.

Point 3:" Please highlight the literature gap clearly."

Response 3: The literature gap is explained more clearly in literature review section Sustainability and nursing. Please see the attachment.

We are grateful for the opportunity given to make corrections to improve the content of the article.

Best regards

 

 

 

 

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report (Previous Reviewer 3)

The revised manuscript reads better. Thank you. 

Author Response

We are grateful for the opportunity given to us to improve the article.

Thank You

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

sustainability-1940773

Title: The importance of receiving computerized technology by nurses to maintain sustainability in the health system

The topic of the research is fascinating and appealing. Please review the comments below.

1.      Abstract should be presented in the order of research purpose-analysis method-results of the study without relevant background.

2.      The purpose of the study is confusing. The purpose of the study is explained only in the abstract, but not presented in the introduction.

In the method part, the author reported that “In this article, I will present findings as reflected in the nurses' attitude towards a computerized method of recording and reporting which has influenced the quality of care and enables the improvement and preservation of the health of the population.”

3.      In the introduction, only climate change is explained, and there is no explanation for why nurses should deal with technology in healthcare organizations.

4.      In the introduction section, the necessity of the research, the difference from the previous study or/and research, and the purpose of the study should be clearly written.

5.      Manuscript composition: Instead of #2, it seems like the “Literature review” part would be better.

6.      In addition computerized technology, which was mentioned as a key concept in the study, is not reviewed based on previous studies in healthcare.

7.      The references(sources) are not provided in explaining the related content.

Authors must provide references in the manuscript. For example, In 2018 WHO, presented a special report based on the contribution of the above 80 professionals from various fields such as health, academia, civil society, and international agencies who have examined climate change and their relationship to health (who said?)

The international community of health services sees the concept of sustainability as the guiding milestone in the discussion of how health systems should be designed in the future. (who said?)

8.      I would more like the paper if it is written in more easy-to-follow sentences,  sentence division, uppercase and lowercase letters, and punctuation marks. Overall, there are a lot of errors, making it difficult to read.

ü In 2018 WHO, presented a special report based on the contribution of the above 80 professionals from various fields such as health, academia, civil society, and international agencies who have examined climate change and their relationship to health.

ü --------etc.

9.      Table I is confusing

Age (years) M (SD)                24-65   42.50 (9.51)?

Seniority in nursing (years)M (SD)   1-35   14.87 (9.92)?

9-1: In data collection, 214 samples were mentioned. Hospital department N was 179, so need some explanation.

10.   Methodology: measurement items were not mentioned in the manuscript, but only provided results in Table 3.

11.   I wonder if the study's findings can be applied more generally. Instead of discussing the main conclusion, the authors should give details of academic and practical implications, discussion of results, and future research for practitioners and academicians in the conclusion section.

12.   Authors should present a single conclusion by synthesizing quantitative and qualitative results.

 

13.   A paragraph should be divided into at least 2-3 related sentences, but this study divided one sentence into paragraphs, making it difficult to read.

Author Response

 

We would like to express our deep gratitude for the time and effort devoted to providing feedback on the article. In this document are all the changes made in accordance with the review report and the fully revised article is attached.

1. rewritten abstract

 

The purpose of the study was to check the perception of the nurses regarding the use of computerized technology and the meaning of this technological change in the nurse's work on sustainability.

Analysis Method: The study designed as mixed method and included the research tools of questionnaires for data collection that sent via the Internet and semi-structured interviews of nurses, who were chosen voluntarily and randomly. The data collected from 214 questionnaires, Technology Acceptance Model questionnaire, and the Professional Self-Identity Questionnaire – PSIQ. Also, the data collected from 10 interviews. The data analyzed to understand the influence of personal, professional, and social factors in relation to the use of computer technology in nursing. With the understanding that the participation of nurses is essential for the creation of sustainable developments such as the use of computer technology which will lead to improving the quality of care and the health of the population.

Results: Years of seniority in nursing, ease of use of technology, and technology relevance to the job and higher output quality, were associated with the more perceived benefit of using technology in a positive correlation.

Conclusions: In the professional aspect of nurses, there is an understanding that adopting new behavioral functions for their role will lead to promoting the quality of care and improving the health of the community.  In the aspect of global sustainability there is a need to develop methods of multi-professional teamwork to implement computerized technologies within the country and between countries to improve sustainable conditions in the world.

 

2. The purpose of the study was to check the perception of the nurses regarding the use of computerized technology and the meaning of this technological change in the nurse's work on sustainability. I will explain more broadly as shown

" The purpose of the study was to examine the perception of the nurses regarding the use of computerized technology and the meaning of this technological change in the nurse's work on sustainability. We believe that the current study which examined the perception of nurses regarding the use of computerized technologies in their work and understanding the factors influencing this will contribute to the development of effective mechanisms for introducing computerized technology into the nurse's daily work."

3. Referring to the comment on the importance of using computer technology among nurses, I presented the subject as requested in the introduction - in the revised article. The new paragraph will include as seen -

 " In other words, it can be said that sustainability enables the preservation of the existing or prevents a violation of the existing balance to continue living a good quality and can be achieved in various ways such as avoiding overexploitation of natural resources, changing society's lifestyle, encouraging technological development, and using new technologies.

Modern society today uses computer technologies in almost all areas of life, such as research, education, government, and health services. Information communication technologies serve as a central tool in the health system in many areas such as treatment, monitoring, prevention, training, research, and health education. The main goal of new technologies is to improve patient care and increase the efficiency of health services [15]. The main goal of computerized technology is to allow caregivers in the system, including nurses, quick access to a wide range of data, accuracy in registration and reporting, as well as allowing patients greater control over their health. These technologies prevent errors in treatment, enable more informed decision-making processes regarding the health of patients, and present new possibilities for the diagnosis and management of chronic conditions as well as training to prevent morbidity [5]. We believe that nurses today need to learn how to access new technologies and digital information, using skills to improve nursing practice."

4. Referring to the comment all sections in the note were clearly presented in the introduction - as attached to the revised article.

 An example of that " The purpose of the study was to examine the perception of the nurses regarding the use of computerized technology and the meaning of this technological change in the nurse's work on sustainability. We believe that despite its importance, the concept of sustainability in nursing is not defined yet nor has it been extensively researched therefore the current study which examined the perception of nurses regarding the use of computerized technologies in their work and understanding the factors influencing this will contribute to the development of effective mechanisms for introducing computerized technology into the nurse's daily work."

5. Instead of 2." Sustainability" I change it to "Literature Review"
6. I added a chapter on computer technologies in the healthcare system within the literature review as requested. In the article it will be as section 2.3.

 "2.3 Computerized Technologies in Healthcare

Computerized technologies refer to all electronic and Internet information sources used by the health system teams to optimize access to medical and nursing information. These systems include various categories such as mobile health (mHealth), health information technology (IT), telehealth and telemedicine. The main goal of IT in the healthcare system is to improve the efficiency and quality of care while maintaining the safety of care and reducing costs [5]. Healthcare Information Technology (HIT) enables the improvement of the quality of care through unlimited and fast access to population data and health indicators of individuals in the population, as well as through fast and unlimited access to up-to-date universal information sources.

The main component of HIT is computerized information systems called electronic health records (EHR) that allow expanding access to health services. Electronic health records include electronic medical systems (EMS) [17]. EMS records all of the patients' health data in an electronic version, thus enabling accurate registration and reporting in order to improve the quality and safety of care. A study by Flatow et al., found that prolonged use of EMS in Intensive Care Units (ICU) reduced surgical infections and mortality rates [10].

Out of all the existing information and computer systems, in this study we focused on the electronic registration and reporting system since this issue is of utmost importance for the nurses in order to provide quality care and to prevent errors in treatment.

In conclusion, it can be said that this advantage of maintaining the integrity of the treatment and raising the quality of the treatment are only manifested when the EMS will be used frequently and continuously by the end users. In the health system, nurses are the end users when it comes to treating patients, therefore it is of great importance that they positively accept the use of EMS and use them properly in treating patients."

7. References(sources) in explaining the related content as requested for example :

"In 2018 WHO [28], presented a special report based on the contribution of the above 80 professionals from various fields such as health, academia, civil society, and international agencies who have examined climate change and their relationship to health. The report included recommendations on topics about how to maximize health, what are the benefits of dealing with climate change in relation to improving health and ways to avoid the destructive effects of these changes on health. Dr. Angelina D.L. Tan, Chair of the House Committee on Health, and Member of the house of Representatives of the Republic of the Philippines and Vice-President of the Asia-Pacific Parliamentarian Forum on Global Health emphasized in the framework of the conference the importance of recognizing universal health coverage (UHC), as a sustainable destination for countries, so that in every country everyone can afford to access health services. In addition, consent was obtained from all participants agreed that countries need an established primary health care system there achieving UHC and Sustainable Development Goals(SDGs)."

There are more references added to the article in this issue.

8. To correct the errors, the article is being re-edited and will be attached as part of the corrections form.
9. An explanation of table 1 –

Participants in this study were 214 nurses, 88% females, between the ages of 24 and 65 years. As shown in table 1, nurses were 42 years old on average (SD = 9.51) and have been working in the field for an average of about 15 years (range = 1-35 years, SD = 9.92). Most had a full-time employment (86%) and worked in a hospital (84%). Hospital employment was in diverse departments (N = 179): surgery  (n = 32, 17.9%), children (n = 21, 11.7%), maternity (n = 21, 11.7%), operation room (n = 19, 10.6%), intensive care units (n = 16, 8.9%), internal health (n = 15, 8.4%), psychiatry  (n = 14, 7.8%), obstetrics (n = 11, 6.1%), orthopedics (n = 10, 5.6%), geriatrics (n = 9, 5.0%), and other (n = 11, 6.1). About two thirds of these departments were general ones (e.g., surgery, children, internal) and one third were departments that required professional studies (e.g., intensive care, operating room, psychiatry). Community employment (N = 35) was in a general health clinic (n = 22, 62.9%), or in a professional clinic (n = 13, 37.1%).

• Participants in this study were 214 nurses- Hospital employment was in diverse departments N = 179, Community employment N = 35.

10. Methodology measurements: the explanation is added to the article.

Participants answered two questionnaires, the first one is - Technology Acceptance Model questionnaire - TAM2 Measurement Scales [26] - The purpose of the questionnaire is to examine the process of accepting a change in the professional behavior of the nurses and what causes it.

The questionnaire includes 26 items and measures the perceived benefit of using technology, in relation to social impact and cognitive instrumental processes. The nine subscales of the questionnaire are: intention to use, perceived usefulness, perceived ease of use, job relevance, output quality, result demonstrability, subjective norm, voluntariness, and image. Items are rated on a 7-point agreement scale, ranging from 1-strongly disagree to 7- strongly agree.

The second questionnaire is - Professional Self-Identity Questionnaire- PSIQ [7]. The questionnaire includes 9 items that measure the degree of perceived professionalism. It is a 9-item inventory rated on a 6-point Likert scale, ranging from 1-newly qualified to 6-highly qualified the questionnaire is useful in assessing professional development.

11. The conclusion section rewrite as attached:

" The result of the data analysis in the present study provided an understanding for two main issues, first about the relationship between nursing and sustainability and second about the importance of computerized technology in nursing practice as a tool for sustainability.

In the educational aspect of nursing studies, we see great importance in developing personal and professional abilities with a broad vision for the needs of the population. Since nurses are the first line in treating the population with other health care providers, during emergency situations there is great importance for sustainable education and tools for identifying and treating emergency situations as part of the curriculum for future nurses.

In the technological aspect, the changes that currently exist in all areas of life are also found in nurse's work. Since the findings showed that nurses need more technological knowledge to apply the recording and reporting system maximally, it is very important to create dedicated programs to train nurses how to use computerized technology.

With reference to the concept of sustainability, the application of computerized technologies that preserve the existing and do not harm the future generation will lead to good health on a global level. Achieving this goal at the implementation level should begin already in the teaching stages of the nursing profession. Sustainable nursing methods today should be geared towards preserving the environment and include nursing practice that prevents environmental pollution and waste of energy, such as the use of energy-saving computers, proper maintaining, using, and disposing electronic equipment.

To integrate computer technology into the work of the nurse, it is important to create relevant programs in nursing studies that are designed for nursing students to prepare them for work in a computerized environment. To establish the principles of practice in sustainable methods it is important to create nursing curricula that include familiarity with the concept of sustainability.

In conclusion, it can be said that there is a need for theoretical and empirical studies of sustainability in nursing. It is very important to include in the teaching content of nurse's concepts related to education for ecological justice, education for sustainability, modernity, and capitalism, even though apparently these topics seem unrelated to the nursing profession.

There is also great importance in assimilating advanced work methods and computerized technologies to improve nursing practice both among nursing students and among nurses in the health system.

There is still a long way to go, and more extensive research is needed to understand the relevant application of sustainable nursing methods, but we believe that the integration of these contents will lead to sustainable practice in nursing."

12. The conclusion section is written according to one conclusion for each field with an inclusive conclusion, as attached in the previous section.
13. The article has been re-edited as attached in the file.

 

We are grateful for the opportunity given to make corrections to improve the content of the article.

Best regards

 

 

 

 

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

The paper covers a rather niche, but welcomed subject. It is sensibly structured and written, although significant improvements should be brought to both its writing style as well as contribution. The paper's main weakness is that its main finding appears expected (previous experience with computing technologies makes people understand and appreciate them more readily). There seems to lack a deeper analysis of the gathered data. Grounded theory and open coding are both mentioned and seemed like a sensible approach given the topic, but there is no detailed information, analysis and conclusion regarding the extracted labels. Structure-wise, the paper should state a main objective as well as derived research questions. Threats to validity should be presented in detail. The questionnaire structure, recorded responses and the results of the coding process should be made available in a replication package using a platform such as zenodo/figshare (anonymized and in accordance with the informed consent). With regards to writing style, the paper sometimes presents things from first-person perspective ("I"), which should be avoided, especially since the article was co-authored. Verb tenses are sometimes used inconsistently; activities that have taken place in the past should be reported in the past tense, while the present tense should be reserved for general truths or ongoing events. The Discussion section appears disconnected from the presented case study and reads more like a Related Work section. Some additional observations are below:

• Second phrase of the introduction (regarding climate change) is very strong; there is some debate on the issue, even though scientist are in agreement.
• "Health care systems and its employees are committed to ensuring the safety of patient care through proper environmental management." -- this phrase is again to strong; it should also probably cite a reference
• "presented a special report based on the contribution of the above 80 professionals" -- what does "above" refer to here?
• "and all health care workers in their various roles are committed to ensuring patient safety while maintaining sustainable environmental management " -- this phrase reads like an advertisment
• "while understanding that all doing today should preserve the future. " -- this phrase is unclear, please revise
• "recommendations for reducing, reusing, and recycling the population and thus improving public health " -- please revise this phrase
• Research question appears to presume that working with/without technological support is a choice nurses are free to make, which in most cases it is not.
• Section/subsection titles should not end pages.
• "Notes on Nursing, What It Is and What It Is Not. " -- book was actually written in 1859. If this is a republished edition, this should be made clear
• Authors should double check the references section formatting, as it appears incorrect.
• First paragraph of the conclusion appears to be disconnected from the stated research questions.

Author Response

We would like to express our deep gratitude for the time and effort devoted to providing feedback on the article. In this document is a report about the changes made in accordance with the review report and the fully revised article is attached.

• The expectation that young nurses with a background in computer applications would be more inclined to receive computerized registration and reporting was not reflected in the findings. The outstanding finding on this topic was that nurses with professional experience who thought that computerization would lead to an improvement in the quality of care had a great tendency to accept computerization in registration and reporting as part of their work, even though they reported in interviews that their adaptation was more difficult and longer.
• The analysis of the findings section has been changed and updated in the attached article.
• Section of validity is added to the article.
• The article has been re-edited as attached in the file.
• Section of discussion and conclusions has been changed and updated.
• The introduction is changed.
• In the comments about unclear writing or that does not match the rest of the text, changes were made in the body of the article as required.
• The phrase "while understanding that all doing today should preserve the future" is changed.
• The phrase " recommendations for reducing, reusing, and recycling the population and thus improving public health" is changed .
• The research question presented more clearly.
• Nightingale F. Notes on Nursing, What It Is and What It Is Not. Dover Publications Inc., New York, NY 1859.sorry for the typing error
• The references re written in corrected way , please see the aatachment
• The conclusion section is rewrited , please see the attachment

We are grateful for the opportunity given to make corrections to improve the content of the article.

Best regards

Author Response File: Author Response.pdf

Reviewer 3 Report

Overall, this is an interesting submission but not yet ready for publication. The following are the key problems.

I cannot see the literature gap in your introduction section.

The literature reveiw section is missing.

Conclusions are insipid, superficial and do not add anything substantially new to the knowledge of the sustainability in the health system,  which was, in fact, the main topic of this paper.

In general, although this paper has certain research value, its theoretical significance is still not clear enough, the content of the paper needs to be improved and the depth of the research needs to be further explored. Thank you and good luck.

Author Response

 

We would like to express our deep gratitude for the time and effort devoted to providing feedback on the article. In this document is a report about the changes made in accordance with the review report and the fully revised article is attached.

 

• The literature gap as added to the article.

Despite its importance, the concept of sustainability in nursing is not defined yet nor has it been extensively researched therefore the current study which examined the perception of nurses regarding the use of computerized technologies in their work and understanding the factors influencing this will contribute to the development of effective mechanisms for introducing computerized technology into the nurse's daily work.

• The literature review section is rewritten and re-edited. please see the attachment
• The conclusion section is rewritten and re -edited. please see the attachment
• The article is revised and written one more time. please see the attachment

 

We are grateful for the opportunity given to make corrections to improve the content of the article.

Best regards

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

COMMENTS TO THE AUTHOR:

 

The authors revised the paper titled " The importance of receiving computerized technology by nurses to maintain sustainability in the health system", and this paper has improved significantly both in style and in substance.

 

In this revised version, the authors successfully responded to the reviewers' suggestions. However, as I suggested before,

“#10.   Methodology: measurement items were not mentioned in the manuscript, but only provided results in Table 3.”

Response: “The questionnaire included 26 items and measured the perceived benefit of using

technology, in relation to social impact and cognitive instrumental processes. The nine subscales of the questionnaire are: intention to use, perceived usefulness, perceived ease of use, job relevance, output quality, result demonstrability, subjective norm, voluntariness, and image. Items are rated on a 7-point agreement scale, ranging from '1-strongly disagree' to '7- strongly agree'.

I understand that the manuscript used only “one measurement item”.  Do you think that only one measurement item can sufficiently explain the variable?  My answer is “No”

 

All samples are different: 214? or179?

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

I find the revised article has been improved, with a better focus on its objective and improved descriptions regarding methodology as well as actual participant feedback. However, I feel that two issues still remain to be improved: first, the threats to validity section should also address threats to the study findings' validity -- internally, externally as well as construct-wise. For instance, how could the fact that the study targeted Israeli nurses affect its outcomes? What could happen if the study were repeated in a less developed country, with poorer access to technology. This brings up the second point, in that the study responses nor the authors' analyses are not available. I believe that in these cases, publishing properly sanitised and anonymised data would greatly help with replicating the study in the future.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 3 Report

The revised manuscript reads pretty well and authors responded all my comments in this round. Thanks. 

Author Response

Please see the attachment

Author Response File: Author Response.docx