The TERCAP Tool: Investigation of Nursing Errors in Greek Hospitals

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for submitting your manuscript to Hospitals. You can see my comments below.

Title

Suggest remove “The TERCAP Tool:” as your manuscript focused on nursing errors. The tool was used to examine the nursing errors. In addition, TERCAP should be full-term that will make the title too long

Abstract

-        The background was written with some biases to nurses although nurses are the professional taking care of patients in their daily practice. However, they are expected to provide safe and appropriate care. Try to use another angel to express the introduction and knowledge gap.

-        Methods: what study design was used? The tool TERCAP was used? How about the sampling methods and analytic methods?

-        The number 597 at the beginning should be written in English.

-        “Errors were commonly reported during different shifts.” It’s unclear. This data was from the survey or where?

-        Identification of factors should not used the results with %. The analysis must be re-done

Introduction

-        Same comment that the introduction should not put nurses at the target that may create bias. If the overall study was to investigate the errors among nurses, it’s better to write as nurses are the professionals to provide medical treatment and care safely, it’s important to investigate nursing errors….

-        The introduction is too short. Literature review related to hospital/clinical errors is important to understand the knowledge gap and the study purpose.

Materials and method

-        Study design should go first. What was the study design? Therefore, the participants should be separated and focused on describing the sample. What about the sample calculation? What sampling method to recruit the eligible samples?

-        How to collect the survey?

-        Was TERCAP published? Who developed it? What about its reliability? Description of this tool is necessary.

Ethical consideration?

Data analysis?

Results

-        Regarding the table 2, please explain what the meanings of “I don’t know” and “other(s)” in each respective items related to error were.

-        Regarding Tables 3 to 8, the subjects could select multiple answers related to factors? If so, any max answers? Any further questions related to the responses “None of the above”, “None of the above apply”, “Unknown”, and “other(s)”

-        Further analysis may be needed to understand more about the relationship between error and specific factors. Only % cannot confirm the factors.

-        In the tables, % results should be X.Y not X,Y

-        Errors in writing in-text citation, e.g., Mehrabian et al. (2023) should be written Mehrabian et al. [12]

-        If “Classifying errors based on outcomes, processes, cognitive reasoning, ethical interpretation, and significance provides a comprehensive framework for analyzing errors from multiple perspectives.” The authors should report their individual performance.

Discussion

-        I do not see any analytic methods to examine the correlations. P.15 “In the current study, a significant correlation was found between the frequency of 397 errors and the educational and professional background of nurses.” Please explain.

-        The discussion session should be rewritten as the factor identification should not based on the % results.

Conclusion

Should be rewritten also.

 

 

Comments on the Quality of English Language

minor

Author Response

The authors appreciate the time and effort dedicated to reviewing the manuscript and addressing important aspects that contribute to the study's improvement. We submit a Word file including Responses to Comments and the revised manuscript. Thank you very much!

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The article iw well written and understandable.

Author Response

Reviewer comment: The article iw well written and understandable.

Response: Thank you very much for your kind comment! 

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

The paper is very interesting in highlighting the errors that health professionals can make and thus being able to work to reduce these errors.

I would like to make some comments.

Throughout the text it is not clear what the sample size is. Sometimes it is said that there are 597 professionals, however in the results we work with 364 professionals.

It is said that the choice of participants is for convenience. I guess then, the sampling is non-probabilistic. This type of sampling has limitations that should be indicated.

It should also explain how the convenience sample has been selected. It is a descriptive study, however, in the results section it is stated that a correlation is found between the errors and the level of income and educational training.

I think the wording should be changed because these types of conclusions cannot be drawn in descriptive studies.

I hope and wish that, with these results, you have generated hypotheses and that you continue with the line of research.

Author Response

Comment: Throughout the text it is not clear what the sample size is. Sometimes it is said that there are 597 professionals, however in the results we work with 364 professionals. 

Response: Thank you very much for reviewing my manuscript. Regarding your first comment, I have to mention that throught the text we mention 597 professionals. However, if you refer to Tables and total nurses counted for some questions of the tool, it is very useful to mention that some of the nurses did not answer all of the items (missing values according to statistician), and some items could have more than one answer causing a misleading for the reader regarding the professionals included. We will, of course, check again all the study data and make changes wherever appropriate. 

Comment: It is said that the choice of participants is for convenience. I guess then, the sampling is non-probabilistic. This type of sampling has limitations that should be indicated.

Response: You are correct in noting that the choice of participants for this study was based on convenience, which indeed categorizes the sampling method as non-probabilistic. While this approach has certain advantages, such as ease of access and cost-effectiveness, it also presents several limitations that should be considered. One major limitation is the potential for sampling bias. Since participants are not randomly selected, the sample may not accurately represent the broader population, which can affect the generalizability of the findings. This means that the results might not be applicable to all groups outside of the study sample. There are a few more limitations, which, of course, will be added to the manuscript.

Comment: It should also explain how the convenience sample has been selected. It is a descriptive study, however, in the results section it is stated that a correlation is found between the errors and the level of income and educational training.

Response: Thank you very much for the comment. This method was chosen due to time and area constraints (especially during a pandemic restriction), budget limitations, the need for a quick preliminary understanding and despite these limitations, convenience sampling could still provide valuable insights, especially in exploratory research or when studying hard-to-reach populations. We have achieved, also, to obtain some very useful correlations but these will be in another manuscript only for correlations, so, please excuse us about adding such information in this descriptive phase of the study. The text will be modified in order to present only the appropriate data!

Comment: I think the wording should be changed because these types of conclusions cannot be drawn in descriptive studies.

Response: Ok, thank you for the proposal. We will change this section according to the most appropriate wording. 

Comment: I hope and wish that, with these results, you have generated hypotheses and that you continue with the line of research.

Response: Thank you for your thoughtful feedback and encouragement. Indeed, the results of this study have provided a valuable foundation for generating several hypotheses. We are excited to continue with this line of research, and we plan to build on these initial findings with further studies that will employ more rigorous sampling methods to enhance the robustness and generalizability of the results. Your support and interest in our research are greatly appreciated.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

The revised manuscript has been improved a lot. Only minor comments: a) If the result in table is reported using mean and SD, they can be reported in the paragraph instead or can add a row for mean and SD, then the other data can be n and %. b) If the number starts in the first word of sentences, written format should be used, e.g., 10 subjects should be written as Ten subjects...

Comments on the Quality of English Language

minor editing may be needed.

Author Response

Comment: The revised manuscript has been improved a lot. Only minor comments: a) If the result in table is reported using mean and SD, they can be reported in the paragraph instead or can add a row for mean and SD, then the other data can be n and %. b) If the number starts in the first word of sentences, written format should be used, e.g., 10 subjects should be written as Ten subjects...

Response: Thank you very much for the kind and useful comment! We removed the mean and SD from the tables and inserted them within the paragraph. Also, we changed the format of numbers in the beginning of the sentence. We are sorry to leave some percentages unchanged in the previous round. They are all changed at the last manuscript submitted.

To sum up, we made all the changes proposed from the Round 2. Thank you very much for your contribution!