Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Nursing Unit Managers
, Hafdís Skúladóttir 2, Thórey Agnarsdóttir 3 and Sigrídur Halldórsdóttir 2Round 1
Reviewer 1 Report
The ms reports results from a survey of Nursing Unit Managers in Iceland hospitals exploring the relationships between work factors, stress, musculo-skeletal complaints and sleep. The work is novel and represents an important early step in better understanding role of sleep in workers that don't do night shift (where the emphasis has mostly been).
I hope the below notes assist in a revision.
Intro
Health services is a focus of the paper so I suggest it be represented in the title?
'Insulting employee righteousness' – I am not familiar with this concept, please can the authors expand?
2006 survey – nothing more recent? Are things likely to have changed in 13 years? If not, probably need to say so in order to explain to reader that this survey still relevant. Eg are the other surveys mentioned more recent?
Workday length the only working time arrangement assessed? Not timing of workday? Does shift length vary with start time? Early starts impact on sleep more than normal start times. Also, if shift timing varies, then workload might also vary?
Methods
Adequate sleep measured with one question. Not separated by work and non-work days. Include in discussion.
Strong response rate.
Results
Good, well presented, clear.
Discussion
It would be interesting to know how factors like autonomy and control at work also impact these relationships.
Some additional detail about sleep would also be useful in a subsequent study. As well as some longitudinal or time series analyses.
A few small grammar and spelling issues. One throughout – mental and physical exhaustion in place of mentally and physically exhaustion.
Author Response
REVIEWER 1
Response to review: Manuscript ID: ijerph-673951
We, the authors, appreciate the review on our paper: Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Middle Managers. We have now responded to the review and please find below our detailed responses the revews.
Reviewer 1:
Open Review
(x) I would not like to sign my review report
( ) I would like to sign my review report
English language and style
( ) Extensive editing of English language and style required
(x) Moderate English changes required – we have made the required English languane changes
( ) English language and style are fine/minor spell check required
( ) I don't feel qualified to judge about the English language and style
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Does the introduction provide sufficient background and include all relevant references? |
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Is the research design appropriate? |
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Are the methods adequately described? |
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Are the results clearly presented? |
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Are the conclusions supported by the results? |
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Comments and Suggestions for Authors
The ms reports results from a survey of Nursing Unit Managers in Iceland hospitals exploring the relationships between work factors, stress, musculo-skeletal complaints and sleep. The work is novel and represents an important early step in better understanding role of sleep in workers that don't do night shift (where the emphasis has mostly been). Authors:Thank you, you made the an useful point which we have added to our paper.
I hope the below notes assist in a revision. – Authors:They are, thank you.
Intro
Health services is a focus of the paper so I suggest it be represented in the title? Authors: We agree and we have changed the title to: Stressful factors in the Working Environment, Lack og Asequate Sleep and Musculoskeletal Pain among Nursing Unit Managers.
'Insulting employee righteousness' – I am not familiar with this concept, please can the authors expand? Authors: we now say: ...when employee sense of righteousness is seriously compromised....
2006 survey – nothing more recent? Are things likely to have changed in 13 years? If not, probably need to say so in order to explain to reader that this survey still relevant. Eg are the other surveys mentioned more recent? Authors: Yes you are right, this survey is old, but this survey has changed in more recent years and been conducted in a different way. But in our opinion, the results from 2006 rather underestimate the situation, the workload and stress, as it is now rather than overestimated it. So we keep this old study in our text but we now quote more recent study,(from 2014 and 2017) to back up our statement from Iceland (see 15 and 16 in References. We canged the text to: The results also revealed that health care workers experience the highest stress levels [14]. Although, the results of the Icelandic survey are from 2006, they are in line with other more recent studies showing that stress is a significant problem in the health services [15, 16], especially among nursing unit managers [16].
Workday length the only working time arrangement assessed? Not timing of workday? Does shift length vary with start time? Early starts impact on sleep more than normal start times. Also, if shift timing varies, then workload might also vary? Authors: This is a good point but every nursing unit managers in Iceland start their workday at 8 o‘clock and are supposed to work 8 hours but some need to work longer days to finish their tasks. We have added this information to the text: In Iceland, nursing unit managers does not work on nightshifts or weekends. The workday does not vary with start time and therefore, we only measure the length of the workday.
Methods
Adequate sleep measured with one question. Not separated by work and non-work days. Include in discussion. Authors: Yes we only used one question to measured adequate sleep, self-evaluation of how many nights pr. week they get enugh sleep. In discussion we have added: It can been seen as a weakness that only one question was used to measure adequate sleep. Since the nursing unit managers only work during the day and not on weekends and the workday does not vary with start time, self-evaluation of adequate sleep per week was considered appropriate measurement at the time. It may be helpful in future research to include more questions about the sleep.
Strong response rate. Authors: Thank you
Results
Good, well presented, clear. Authors: Thank you.
Discussion
It would be interesting to know how factors like autonomy and control at work also impact these relationships. Authors: we have added this idea to the discussions: In future studies it would be interesting to know how factors like autonomy and control at work also impact the relationships of stressful factors in the working environment, lack of adequate sleep and musculoskeletal pain.
Some additional detail about sleep would also be useful in a subsequent study. As well as some longitudinal or time series analyses. Authors: Thank you for your suggestion, we have includ it in our paper now. Some additional detail about sleep would also be useful in a subsequent studies, as well as some longitudinal or time series analyses.
A few small grammar and spelling issues. One throughout – mental and physical exhaustion in place of mentally and physically exhaustion. Authors: Thank you, we have made the required English language changes in the text as best we can.
Author Response File: 
Author Response.docx
Reviewer 2 Report
The article entitled “Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Middle Managers”: shows unpublished data regarding the effects of stressfull factors in the work environment, sleep and musculoskeletal pain in middle managers. However, I would like to make a few comments:
You need to better explain the mechanisms that underline work-stress responses in different kind of work. In particular you could analyze the influence of work-stress on emotionality, and the influence of the epigenetic factors that sharpen work-related stress responses. For this aim, you could consult the work by Cannizzaro et al., 2018 EuroMediterranean Biomedical Journal 13(41), 181-184; Cannizzaro et al., 2019 International Journal of Environmental Research and Public Health 16(20), 4031
In materials and methods you should evaluate the presence of concomitant pathologies both in the osteoarticular apparatus (discus protrusions, previous dislocations of the shoulder, possible traumas suffered), and neuropsychiatric (anxiety, depression, sleep disorders ....)
It is also useful to consider the body weight and the body mass index in the different samples taken into consideration.
Author Response
REVIEWER 2
Response to review: Manuscript ID: ijerph-673951
We, the authors, appreciate the review on our paper: Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Middle Managers. We have now responded to the review and please find below our detailed responses the revews.
Reviewer 2:
Open Review
(x) I would not like to sign my review report
( ) I would like to sign my review report
English language and style
( ) Extensive editing of English language and style required
( ) Moderate English changes required
( ) English language and style are fine/minor spell check required
(x) I don't feel qualified to judge about the English language and style
|
Yes |
Can be improved |
Must be improved |
Not applicable |
|
|
Does the introduction provide sufficient background and include all relevant references? |
(x) |
( ) |
( ) |
( ) |
|
Is the research design appropriate? |
( ) |
(x) |
( ) |
( ) |
|
Are the methods adequately described? |
( ) |
( ) |
(x) |
( ) |
|
Are the results clearly presented? |
( ) |
(x) |
( ) |
( ) |
|
Are the conclusions supported by the results? |
( ) |
(x) |
( ) |
( ) |
Comments and Suggestions for Authors
The article entitled “Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Middle Managers”: shows unpublished data regarding the effects of stressfull factors in the work environment, sleep and musculoskeletal pain in middle managers. However, I would like to make a few comments:
You need to better explain the mechanisms that underline work-stress responses in different kind of work. In particular you could analyze the influence of work-stress on emotionality, and the influence of the epigenetic factors that sharpen work-related stress responses. For this aim, you could consult the work by Cannizzaro et al., 2018 EuroMediterranean Biomedical Journal 13(41), 181-184; Cannizzaro et al., 2019 International Journal of Environmental Research and Public Health 16(20), 4031. Authors: Thank you for your advise. After consideration, we decided not to consult the work by Cannizzario et al., 2018, but we now include the work of Cannizzaro et. al. from 2019 and added this to the text in the discussion: As Cannizzaro et al. [58] point out, in the professional work environment, there are non-specific psychosocial and environmental risks that can determine different organic and behavioural disorder and therefore, it highlight the demand for further research to detect the specific neuroendocrine and genetic factors that subtend and predict vulnerability to the work-related stress response.
In materials and methods you should evaluate the presence of concomitant pathologies both in the osteoarticular apparatus (discus protrusions, previous dislocations of the shoulder, possible traumas suffered), and neuropsychiatric (anxiety, depression, sleep disorders ....). Authors: Unfortunatelly, we can not evaluate these factors in our study as we have no information about this in our data but thank you for our comment, we have added this comment in our discussion chapter: It would also be useful in future studies to evaluate the presence of concomitant pathologies both in the osteoarticular apparatus (discus protrusions, previous dislocations of the shoulder, possible traumas suffered), and neuropsychiatric (anxiety, depression, sleep disorders).
It is also useful to consider the body weight and the body mass index in the different samples taken into consideration. Authors: Yes you are right, but unfortunatelly we have no information about the body weight or the body mass index in our data but, we have added this comment in our discussion chapter: Finally, it would be useful to take into consideration the body weight and the body mass index in future samples.
Submission Date
05 December 2019
Date of this review
16 Dec 2019 09:55:51
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
I accept the explanations and modifications made by the authors. I believe that the manuscript has been significantly improved and can now be published in IJERPH.
