Analysis of the Level of Stress and Methods of Coping with Stress among the Nursing Staff

Round 1

Reviewer 1 Report

The manuscript NURSREP-2543565 entitled "Analysis of the level of stress and methods of coping with stress among the nursing staff" is a descriptive study on the amount of stress reported among nurses, using 2 questionnaires administered to measure perceived stress and describe the coping strategies most commonly employed. 

 

The manuscript presented is relevant, coherent and addresses a topic of interest.

 

However, its writing needs to be improved and the information presented needs to be placed in a coherent and appropriate way to make it easier to read, follow and understand.  

 

Some improvements are suggested to make it more precise, improving the state of the question in the introduction, specifying some aspects in material and methods and the writing of the conclusion. 

 

For these reasons, further revision of the present version is recommended before publication. The following specific comments are provided:

 

Title: is clear, concrete and adequate 

 

0- ABSTRACT:  modify according to the recommendations offered in each of the sections.

 

1- INTRODUCTION:

The introduction gives a brief description of the object of the study, states the objective and complies with the recommendations for length. 

However, it does not include any aspect on the state of the question regarding previous studies on the incidence and/or prevalence of stress in nursing staff in hospitals or in these units. It is necessary to include this aspect in the introduction as well as to report on what this study contributes to the state of the art. 

In relation to the objective, it is recommended to replace the verb "To investigate" with another measurable verb such as "to quantify or describe".It could be useful to state specific objectives. 

 

2. MATERIALS AND METHODS: 

The design is adequately and concretely stated. 

Throughout this methods section, all the requirements attributable to this section are made explicit, including sample, variables and instruments - the analyses and statistics used are adequate. 

It is recommended to include exclusion criteria (if any).

 

3. RESULTS 

The results meet the objectives, but are incompletely presented.  

It is advisable to present the frequency results of the EEP-10 in a table, instead of text, to make them easier to read (information contained in lines 148-163). It will also allow you to assess the differences in each item of the survey.

In relation to the information on the BriefCOPE questionnaire included in lines 182-205, it is repetitive compared to the information presented in table 4. This would make it possible to quickly visualise which coping strategy is most or least used.At the moment, it is difficult to make sense of tables 5 and 6, because neither in the text (nor in the tables) is the value obtained (descriptive) for each strategy in the different groups compared (reflected in tables 5 and 6).

It is suggested that these aspects be modified and the results be presented in such a way that a global visualisation of the dependent variables and the p-value of the inferences is possible.

4.DISCUSSION:

We suggest the inclusion of discussion aspects related to incidence and prevalence predicted in the jobs analysed in other studies and in relation to aspects such as age, gender, or profession. 

It is necessary not to repeat or include information that should be included in other sections of the manuscript (L268-274); this information should be referred to in the section on material and methods, in the subsection on description of the instrument used. 

in lines 332-334 reference is made to " The obtained results indicate that the choice of such solutions as active coping, seeking emotional and instrumental support, positive re-evaluation and planning is significantly correlated with the level of stress perception", but the correlation results are not found in the results section not in the objectives of the study... it is not clear whether he is making a possible association" (not correlation) for discussion or whether he is referring to "omitted correlation results". This statement needs to be clarified.  

The discussion needs to be improved by deepening the "discussion" with results obtained by other researchers and highlighting the contribution generated by this study.

 

5. Conclusions: 

It is recommended that the wording of the conclusion be improved by including a greater degree of precision in relation to the variables analysed and avoiding the inclusion of new assessment elements, such as work shifts as stressors (which have not been included as a dependent variable). 

The conclusion should be written in such a way that the perceived stress and the coping strategies used by the population studied are clearly stated. 

References to other studies (L400-403) should be removed, as this information is part of the discussion, not in the conclusion section.

Author Response

At the beginning, I would like to thank you for the review of my work and the constructive comments that have been used to organize all issues and improve the work. We thank for your time, helpful comments and suggestions, all of which have been effected in the present version of the manuscript. We have carefully reviewed the comments and have revised the manuscript accordingly. Our responses are given in a point-by-point manner. Changes to the text are shown in red in the revised manuscript.

 

0- ABSTRACT:  modify according to the recommendations offered in each of the sections.

1. Thank you for your accurate remark and of course I agree with it. We have written a new abstract for our article.

 

1- INTRODUCTION:

The introduction gives a brief description of the object of the study, states the objective and complies with the recommendations for length. 

However, it does not include any aspect on the state of the question regarding previous studies on the incidence and/or prevalence of stress in nursing staff in hospitals or in these units. It is necessary to include this aspect in the introduction as well as to report on what this study contributes to the state of the art. 

In relation to the objective, it is recommended to replace the verb "To investigate" with another measurable verb such as "to quantify or describe".It could be useful to state specific objectives. 

2. Thank you for your accurate remark and of course I agree with it. We have supplemented the introduction as suggested. We referred to previous research and presented what the research brings to the state of the art.

 

2. MATERIALS AND METHODS: 

The design is adequately and concretely stated. 

Throughout this methods section, all the requirements attributable to this section are made explicit, including sample, variables and instruments - the analyses and statistics used are adequate. 

It is recommended to include exclusion criteria (if any).

3. Thank you for your good point. We checked again whether exclusion criteria could be defined in our research. Unfortunately, in this case it is ambiguous and would significantly limit this research. I think that in the continuation of the conducted research, we will indicate the exclusion criteria for a specific group of respondents.
4. RESULTS 

The results meet the objectives, but are incompletely presented.  

It is advisable to present the frequency results of the EEP-10 in a table, instead of text, to make them easier to read (information contained in lines 148-163). It will also allow you to assess the differences in each item of the survey.

In relation to the information on the BriefCOPE questionnaire included in lines 182-205, it is repetitive compared to the information presented in table 4. This would make it possible to quickly visualise which coping strategy is most or least used.At the moment, it is difficult to make sense of tables 5 and 6, because neither in the text (nor in the tables) is the value obtained (descriptive) for each strategy in the different groups compared (reflected in tables 5 and 6).

It is suggested that these aspects be modified and the results be presented in such a way that a global visualisation of the dependent variables and the p-value of the inferences is possible.

4. Thank you for your accurate remark and of course I agree with it. We have made adjustments to the results so that we can globally visualize the dependent variables and p-values ​​of the conclusions.

 

4.DISCUSSION:

We suggest the inclusion of discussion aspects related to incidence and prevalence predicted in the jobs analysed in other studies and in relation to aspects such as age, gender, or profession. 

It is necessary not to repeat or include information that should be included in other sections of the manuscript (L268-274); this information should be referred to in the section on material and methods, in the subsection on description of the instrument used. 

in lines 332-334 reference is made to " The obtained results indicate that the choice of such solutions as active coping, seeking emotional and instrumental support, positive re-evaluation and planning is significantly correlated with the level of stress perception", but the correlation results are not found in the results section not in the objectives of the study... it is not clear whether he is making a possible association" (not correlation) for discussion or whether he is referring to "omitted correlation results". This statement needs to be clarified.  

The discussion needs to be improved by deepening the "discussion" with results obtained by other researchers and highlighting the contribution generated by this study.

5. Thank you for your accurate remark and of course I agree with it. We have included the results of other authors in the "Discussion" in order to deepen the study. Duplicate items have been removed.

 

5. Conclusions: 

It is recommended that the wording of the conclusion be improved by including a greater degree of precision in relation to the variables analysed and avoiding the inclusion of new assessment elements, such as work shifts as stressors (which have not been included as a dependent variable). 

The conclusion should be written in such a way that the perceived stress and the coping strategies used by the population studied are clearly stated. 

References to other studies (L400-403) should be removed, as this information is part of the discussion, not in the conclusion section.

6. Thank you for your accurate remark and of course I agree with it. We removed items that had no reference to research. In addition, we have introduced conclusions that clearly relate to the perceived stress and coping strategies of the study population.

 

Once again, I would like to thank the reviewer for his right and very factual comments, which undoubtedly contributed to the improvement of the manuscript.

At the beginning, I would like to thank you for the review of my work and the constructive comments that have been used to organize all issues and improve the work. We thank for your time, helpful comments and suggestions, all of which have been effected in the present version of the manuscript. We have carefully reviewed the comments and have revised the manuscript accordingly. Our responses are given in a point-by-point manner. Changes to the text are shown in red in the revised manuscript.

 

0- ABSTRACT:  modify according to the recommendations offered in each of the sections.

1. Thank you for your accurate remark and of course I agree with it. We have written a new abstract for our article.

 

1- INTRODUCTION:

The introduction gives a brief description of the object of the study, states the objective and complies with the recommendations for length. 

However, it does not include any aspect on the state of the question regarding previous studies on the incidence and/or prevalence of stress in nursing staff in hospitals or in these units. It is necessary to include this aspect in the introduction as well as to report on what this study contributes to the state of the art. 

In relation to the objective, it is recommended to replace the verb "To investigate" with another measurable verb such as "to quantify or describe".It could be useful to state specific objectives. 

2. Thank you for your accurate remark and of course I agree with it. We have supplemented the introduction as suggested. We referred to previous research and presented what the research brings to the state of the art.

 

2. MATERIALS AND METHODS: 

The design is adequately and concretely stated. 

Throughout this methods section, all the requirements attributable to this section are made explicit, including sample, variables and instruments - the analyses and statistics used are adequate. 

It is recommended to include exclusion criteria (if any).

3. Thank you for your good point. We checked again whether exclusion criteria could be defined in our research. Unfortunately, in this case it is ambiguous and would significantly limit this research. I think that in the continuation of the conducted research, we will indicate the exclusion criteria for a specific group of respondents.
4. RESULTS 

The results meet the objectives, but are incompletely presented.  

It is advisable to present the frequency results of the EEP-10 in a table, instead of text, to make them easier to read (information contained in lines 148-163). It will also allow you to assess the differences in each item of the survey.

In relation to the information on the BriefCOPE questionnaire included in lines 182-205, it is repetitive compared to the information presented in table 4. This would make it possible to quickly visualise which coping strategy is most or least used.At the moment, it is difficult to make sense of tables 5 and 6, because neither in the text (nor in the tables) is the value obtained (descriptive) for each strategy in the different groups compared (reflected in tables 5 and 6).

It is suggested that these aspects be modified and the results be presented in such a way that a global visualisation of the dependent variables and the p-value of the inferences is possible.

4. Thank you for your accurate remark and of course I agree with it. We have made adjustments to the results so that we can globally visualize the dependent variables and p-values ​​of the conclusions.

 

4.DISCUSSION:

We suggest the inclusion of discussion aspects related to incidence and prevalence predicted in the jobs analysed in other studies and in relation to aspects such as age, gender, or profession. 

It is necessary not to repeat or include information that should be included in other sections of the manuscript (L268-274); this information should be referred to in the section on material and methods, in the subsection on description of the instrument used. 

in lines 332-334 reference is made to " The obtained results indicate that the choice of such solutions as active coping, seeking emotional and instrumental support, positive re-evaluation and planning is significantly correlated with the level of stress perception", but the correlation results are not found in the results section not in the objectives of the study... it is not clear whether he is making a possible association" (not correlation) for discussion or whether he is referring to "omitted correlation results". This statement needs to be clarified.  

The discussion needs to be improved by deepening the "discussion" with results obtained by other researchers and highlighting the contribution generated by this study.

5. Thank you for your accurate remark and of course I agree with it. We have included the results of other authors in the "Discussion" in order to deepen the study. Duplicate items have been removed.

 

5. Conclusions: 

It is recommended that the wording of the conclusion be improved by including a greater degree of precision in relation to the variables analysed and avoiding the inclusion of new assessment elements, such as work shifts as stressors (which have not been included as a dependent variable). 

The conclusion should be written in such a way that the perceived stress and the coping strategies used by the population studied are clearly stated. 

References to other studies (L400-403) should be removed, as this information is part of the discussion, not in the conclusion section.

6. Thank you for your accurate remark and of course I agree with it. We removed items that had no reference to research. In addition, we have introduced conclusions that clearly relate to the perceived stress and coping strategies of the study population.

 

Once again, I would like to thank the reviewer for his right and very factual comments, which undoubtedly contributed to the improvement of the manuscript.

Author Response File: Author Response.docx

Reviewer 2 Report

Stress occurs when individual interacts with the environment. Coping is an important skill, especially for healthcare providers to reduce burnout. This study examined the level of stress and coping skills used by the nursing staff. I have some comments regarding the content of the manuscript.

1. In the introduction, the authors described many about 'what is stress'. However, there was very little about how stress could affect nursing staff in terms of their health, care provided, retention, etc.  You may consider Mao et al. (2021), Tam et al. (2020) to give further introduction.

2. Regarding the selection of measure, PSS-10 is a general scale to assess stress level. I wonder the use of Nursing Stress Scale would be more appropriate (Gray-Toft and Anderson, 1981). 

3. Please show the sample size calculation.

4. Line 129-132, please explain the reasons to convert PSS-10 into Sten scale.

5. What was the response rate? Did all invited nurses participate in this study?

6. Table 1 showed that the participants had different work experience in nursing. How about their experience working in the current ward? They might have a high level of stress if they shifted from other wards a few months ago. 

7. Table 3, did seniority mean the work experience?

8. Line 257 recapped the high level of stress found in this study. Since the study was conducted in Nov 2020 to Aug 2021. Please discuss how COVID-19 would influence the findings.

9. What was the purpose of Line 259-267? How was our findings when compared to other studies?

10. Please summarize Line 268-331 to show whether the coping skills used in our study were same/different form other studies, and why?

11. What was the purpose of Line 358-362? I cannot make connection with previous paragraphs.

12. Line 363, what is SWLS? And what was the purpose of Line 363-370? The connection to previous paragraphs was unclear.

13. Please add a paragraph to discuss the implications of the findings. For example, what could be done to promote the use of coping skills? You may refer to Coulon et al. (2016), Head et al. (2013).

 

Suggested references:

Coulon, S. M., Monroe, C. M., & West, D. S. (2016). A Systematic, Multi-domain Review of Mobile Smartphone Apps for Evidence-Based Stress Management. American journal of preventive medicine, 51(1), 95–105. https://doi.org/10.1016/j.amepre.2016.01.026

Gray-Toft, P. and Anderson, J.G. (1981) The Nursing Stress Scale: Development of an Instrument. Journal of Behavioral Assessment, 3, 11-23. 
https://doi.org/10.1007/BF01321348

Head, K. J., et al. (2013). Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Social Science & Medicine, 97, 41-48. https://doi.org/10.1016/j.socscimed.2013.08.003

Mao, A., et al. (2021). "You Need to Get Over the Difficulties and Stand Up Again"-A Qualitative Inquiry into Young Nurses' Coping with Lateral Violence from the Feminist Perspective. International journal of environmental research and public health, 18(13), 7167. https://doi.org/10.3390/ijerph18137167

Tam, H. L., et al. (2020). "My Friends are at the Bottom of My Schedule": A Qualitative Study on Social Health among Nursing Students during Clinical Placement. International journal of environmental research and public health, 17(18), 6921. https://doi.org/10.3390/ijerph17186921

Please check the whole manuscript as a lot of typos were noted! 

Some sentences were too long, please seek certificated English editing service.

Author Response

At the beginning, I would like to thank you for the review of my work and the constructive comments that have been used to organize all issues and improve the work. We thank for your time, helpful comments and suggestions, all of which have been effected in the present version of the manuscript. We have carefully reviewed the comments and have revised the manuscript accordingly. Our responses are given in a point-by-point manner. Changes to the text are shown in red in the revised manuscript.

 

1. In the introduction, the authors described many about 'what is stress'. However, there was very little about how stress could affect nursing staff in terms of their health, care provided, retention, etc. You may consider Mao et al. (2021), Tam et al. (2020) to give further introduction.
2. Thank you for your accurate remark and of course I agree with it. According to the guidelines, we have referred the indicated aspects to the suggested items.

Mao, A., et al. (2021). "You Need to Get Over the Difficulties and Stand Up Again"-A Qualitative Inquiry into Young Nurses' Coping with Lateral Violence from the Feminist Perspective. International journal of environmental research and public health, 18(13), 7167. https://doi.org/10.3390/ijerph18137167

Tam, H. L., et al. (2020). "My Friends are at the Bottom of My Schedule": A Qualitative Study on Social Health among Nursing Students during Clinical Placement. International journal of environmental research and public health, 17(18), 6921. https://doi.org/10.3390/ijerph17186921

 

2. Regarding the selection of measure, PSS-10 is a general scale to assess stress level. I wonder the use of Nursing Stress Scale would be more appropriate (Gray-Toft and Anderson, 1981).
3. Thank you for your good attention. We have re-analysed our study, unfortunately at this stage of finalized research it is not possible to implement the suggested scale. Thank you very much for your valuable advice. We will certainly use this scale in the continuation of this research.

 

3. Please show the sample size calculation.
4. The research was conducted during the COVID-19 pandemic. As a result, there has been a whole reorganization of work in health care. Elective admissions were limited for a long time, hospitals operated mainly in emergency mode, therefore the number of hospitalized people was very limited. The possibility of cooperation with other hospitals was also very difficult and limited due to safety regulations and rules. Therefore, we were able to collect only such a group of subjects. In addition, the simple size was calculated on the basis of the prevalence of stress and coping strategies (due to the stringent inclusion criteria used in the manuscript) in the general population of nurses in the Kuyavian-Pomeranian Voivodeship, using the available sample size calculator.

 

4. Line 129-132, please explain the reasons to convert PSS-10 into Sten scale.
5. Thank you for your question. The conversion of the PSS-10 scale into Sten was a statistician's decision and it was dictated by the trends in Poland, as most researchers present the PSS-10 in Sten, There are Sten standards for PSS10. They allow you to interpret the scores. According to the Polish standards developed for the Perceived Stress Scale-PSS-10, scores from 0 to 13 (1-4 sten) are considered low, while scores from 20 to 22 (7-10 sten) are considered high.

 

5. What was the response rate? Did all invited nurses participate in this study?
6. The study involved 220 nurses aged 22 to 60. Respondents were informed that the survey is voluntary and free of charge and anonymous. The scientific nature of the research was explained to the respondents research. Questionnaires were collected from the designated place and after were placed in the prepared urn.

 

6. Table 1 showed that the participants had different work experience in nursing. How about their experience working in the current ward? They might have a high level of stress if they shifted from other wards a few months ago.
7. Thank you for such an important question. We considered the aspect of working in another branch. We believe that both the criterion of working in a specific ward and many variables may affect the results of the research. We also considered the influence of family background and previous life experiences. However, our goal was to compare stress levels and coping strategies in these specific wards. We will consider this aspect in great detail in future studies. Thank you for your valuable advice.

 

7. Table 3, did seniority mean the work experience?
8. Yes, in Table 3, seniority mean meant the work experience.

 

8. Line 257 recapped the high level of stress found in this study. Since the study was conducted in Nov 2020 to Aug 2021. Please discuss how COVID-19 would influence the findings.
9. Thank you for this question. In our opinion and after careful observation of the problem, the high level of stress in this study is related to the difficult situation of nurses in Poland. Too few nurses, too many duties and huge responsibility cause consequences. Of course, we were interested in the aspect of whether COVID-19 would affect stress levels. We conducted research in this direction in two hospitals. The results are very similar to the present ones. We think to publish them in the near future.

 

9. What was the purpose of Line 259-267? How was our findings when compared to other studies?
10. Thank you for this question. Reference to our research is provided in the paragraph above. First, we reported our result to be able to relate it to the literature.

 

10. Please summarize Line 268-331 to show whether the coping skills used in our study were same/different form other studies, and why?
11. Thank you for your question. Suggested by the remark, we added a paragraph that summarizes the analysis of strategies for coping with stress in relation to the cited literature.

 

 

 

 

11. What was the purpose of Line 358-362? I cannot make connection with previous paragraphs.
12. Thank you for that question. This study was intended to validate our results. The aim was to indicate the index of the subjects' subjective feelings related to personal problems and events and ways of dealing with them.

 

12. Line 363, what is SWLS? And what was the purpose of Line 363-370? The connection to previous paragraphs was unclear.
13. Thank you for your accurate remark and of course I agree with it. We accidentally referred to the SWLS scale. It is a scale whose measurement result is a general indicator of life satisfaction. After reviewing our research, we have decided to remove this paragraph. We apologize for this error.

 

13. Please add a paragraph to discuss the implications of the findings. For example, what could be done to promote the use of coping skills? You may refer to Coulon et al. (2016), Head et al. (2013).

Suggested references:

Coulon, S. M., Monroe, C. M., & West, D. S. (2016). A Systematic, Multi-domain Review of Mobile Smartphone Apps for Evidence-Based Stress Management. American journal of preventive medicine, 51(1), 95–105. https://doi.org/10.1016/j.amepre.2016.01.026

Gray-Toft, P. and Anderson, J.G. (1981) The Nursing Stress Scale: Development of an Instrument. Journal of Behavioral Assessment, 3, 11-23.

https://doi.org/10.1007/BF01321348

Head, K. J., et al. (2013). Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Social Science & Medicine, 97, 41-48. https://doi.org/10.1016/j.socscimed.2013.08.003

13. Thank you for your good point, and of course I agree with it. In "Discussion" we've added suggested references to give tips to promote coping strategies.

 

Comments on the Quality of English Language

Please check the whole manuscript as a lot of typos were noted!

Some sentences were too long, please seek certificated English editing service.

Thank you for your good point, and of course I agree with it. We rechecked the manuscript for language. A lecturer with extensive professional achievements, employed at a public university (Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń) verified the article again. We apologize for the situation and errors. Many of them resulted from the differences between American and English dialects.

 

Once again, I would like to thank the reviewer for his right and very factual comments, which undoubtedly contributed to the improvement of the manuscript.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The revised manuscript is good. I have no new comment raised.

Author Response

Dear Reviewer,

On behalf of the entire team of authors, thank you for your time and valuable comments. It was a valuable experience for us, which we will use to write further articles.

Sincerely,

Anna Antczak-Komoterska