The Age of Young Nurses Is a Predictor of Burnout Syndrome during the Care of Patients with COVID-19

Round 1

Reviewer 1 Report

Moya- Salazar et al. present interesting study from Peru. Authors  to determined Burnout Syndrome (BS) in 250 nurses from the COVID-19 medicine units at Hospital Dos de Mayoduring the COVID-19 pandemic. They found relatively low levels of job fatigue in terms of emotional exhaustion and depersonalization- so the conclusion.

There are some point which should be presented in clearer matter.

Authors write that they included 250 nurses. Figure 1 is not clear- it starts with a population of 850 people. What is this population, then they take 250 nurses from Covid 19 unit, select 105 and end with 100 nurses.

When I understand correctly, 250 nurses took part on the survey and 100 of them reported Burn Out?  This should be clearer presented.

100 of 250 are 40%. This is a big proportion if they had Burn Out. In this case the conclusion would be correct that the prevalence of burn out was high even when mostly moderate.

Authors present factors associated with burn out risk like working time, but maybe people who works longer, have higher age, or people who work sine 1 years are young? Why don’t you use a easy logistic regression including these variables adjusting for other variables to see if this was really an effect of working time even after adjustment for age, sex and SARS-CoV-2 Infection?

Author Response

REVIEWER 1

nursrep-2168620

Moya- Salazar et al. present interesting study from Peru. Authors to determined Burnout Syndrome (BS) in 250 nurses from the COVID-19 medicine units at Hospital Dos de Mayoduring the COVID-19 pandemic. They found relatively low levels of job fatigue in terms of emotional exhaustion and depersonalization- so the conclusion.

There are some points which should be presented in clearer matter.

Authors write that they included 250 nurses. Figure 1 is not clear- it starts with a population of 850 people. What is this population, then they take 250 nurses from Covid 19 unit, select 105 and end with 100 nurses.

When I understand correctly, 250 nurses took part on the survey and 100 of them reported Burn Out?  This should be clearer presented.

100 of 250 are 40%. This is a big proportion if they had Burn Out. In this case the conclusion would be correct that the prevalence of burn out was high even when mostly moderate.

RESPONSE: We conducted the study on 100 nurses. This has been modified in the text for better understanding.

Authors present factors associated with burn out risk like working time, but maybe people who works longer, have higher age, or people who work sine 1 years are young? Why don’t you use a easy logistic regression including these variables adjusting for other variables to see if this was really an effect of working time even after adjustment for age, sex and SARS-CoV-2 Infection?

RESPONSE: Although the reviewer's recommendations are correct regarding the variables that could be involved, we believe that the binary regression we performed allows us to respond to the hypotheses posed. Extending the analysis would improve the study but would also extend our initial response.

Reviewer 2 Report

The title as well as the introduction raised expectations about your manuscript and research. The topic you are addressing would be a relevant addition to existing literature. Thank you for this valuable contribution. I will structure my feedback in (a) general remarks (these comments cover feedback applicable in the entire manuscript), and (b) specific remarks (feedback on sentence and/or word level). The specific remarks can include a quote from your original manuscript to refer to a specific section. The specific remarks will refer to page (emphasis added in boldface; e.g., 1.15/16) and row(s; e.g., 11.15/16).

General remarks:

The overall manuscript is neat and written concisely—with relevant information for existing literature. My specific feedback is listed below. Your study has high practical value.

Specific remarks:

p.abstract        COVID-19 health emergency versus COVID-19 pandemic à Keep this consistent. In addition, do not use COVID-19 and COVID-19 pandemic. Select one and stick with that. Apply this throughout your manuscript.

p.1.22              “of both sexes” is redundant. This emphasis creates expectations, namely that you will look at differences between male, female, and other.

p.1.25              Report the M and SD accordingly. The way you present it is not academic. Moreover, these parameters need to be placed in italics (check the remainder of your manuscript as well).

p.1.27              What do you mean with “without previous COVID-19?

p.1.31/32         The advice you give is rather general (and not informative). In addition, the conceptualization of better work environment is too vague. Avoid intensifiers such as “great”. If you feel like you need to add these words, you need to improve your argument. With a valid argument, these intensifiers are redundant.

p.2.48              You use the abbreviation BS without introducing it. Introduce it in row 47 so you can use it after. Keep in mind that back-to-back brackets do not work: (y)(x) = (y; x).

p.2.64              “huge” = redundant.

p.Figure1        N/n needs to be placed in italics. Apply this to the remainder of your manuscript as well.

p.4.137            Present the age with SD (rather than ±).

p.Table1          Why do you have one year unaccounted for: 31 years? Your categories aren’t covering that year (compare 20 to 30 and 32 to 40). The categories in Figure 2 are set up differently.

Moreover, why are the p-values placed in boldface? In Table 3 you do the same, albeit you emphasize the significance twice: boldface and with the asterisk.

p.6                   You need to determine the number of decimal numbers you want to use for your results.

p.7.237            Avoid back-to-back brackets (see example before). Moreover, what does “33:3%” mean? Should that be a comma?

p.references    Main point: consistency (or the lack of). The hyphen needs to be an en dash (compare reference 1 with reference 3). The doi numbers are displayed differently (compare reference 2 with reference 3 and reference 4). Capitalized letters in the titles of the documents (compare reference 6 with reference 9).

Author Response

REVIEWERS 2

nursrep-2168620

The title as well as the introduction raised expectations about your manuscript and research. The topic you are addressing would be a relevant addition to existing literature. Thank you for this valuable contribution. I will structure my feedback in (a) general remarks (these comments cover feedback applicable in the entire manuscript), and (b) specific remarks (feedback on sentence and/or word level). The specific remarks can include a quote from your original manuscript to refer to a specific section. The specific remarks will refer to page (emphasis added in boldface; e.g., 1.15/16) and row(s; e.g., 11.15/16).

General remarks:

The overall manuscript is neat and written concisely—with relevant information for existing literature. My specific feedback is listed below. Your study has high practical value.

Specific remarks:

p.abstract        COVID-19 health emergency versus COVID-19 pandemic à Keep this consistent. In addition, do not use COVID-19 and COVID-19 pandemic. Select one and stick with that. Apply this throughout your manuscript.

p.1.22              “of both sexes” is redundant. This emphasis creates expectations, namely that you will look at differences between male, female, and other.

p.1.25              Report the M and SD accordingly. The way you present it is not academic. Moreover, these parameters need to be placed in italics (check the remainder of your manuscript as well).

p.1.27              What do you mean with “without previous COVID-19?

p.1.31/32         The advice you give is rather general (and not informative). In addition, the conceptualization of better work environment is too vague. Avoid intensifiers such as “great”. If you feel like you need to add these words, you need to improve your argument. With a valid argument, these intensifiers are redundant.

p.2.48              You use the abbreviation BS without introducing it. Introduce it in row 47 so you can use it after. Keep in mind that back-to-back brackets do not work: (y)(x) = (y; x).

p.2.64              “huge” = redundant.

p.Figure1        N/n needs to be placed in italics. Apply this to the remainder of your manuscript as well.

p.4.137            Present the age with SD (rather than ±).

p.Table1          Why do you have one year unaccounted for: 31 years? Your categories aren’t covering that year (compare 20 to 30 and 32 to 40). The categories in Figure 2 are set up differently.

Moreover, why are the p-values placed in boldface? In Table 3 you do the same, albeit you emphasize the significance twice: boldface and with the asterisk.

p.6                   You need to determine the number of decimal numbers you want to use for your results.

p.7.237            Avoid back-to-back brackets (see example before). Moreover, what does “33:3%” mean? Should that be a comma?

p.references    Main point: consistency (or the lack of). The hyphen needs to be an en dash (compare reference 1 with reference 3). The doi numbers are displayed differently (compare reference 2 with reference 3 and reference 4). Capitalized letters in the titles of the documents (compare reference 6 with reference 9).

RESPONSE: All the suggested recommendations have been followed and the article has been improved.

Reviewer 3 Report

Dear Authors 

Thank you for allowing me to review this manuscript. The structure of the manuscript is logical, well understandable. The statistical methods are valid and correctly applied.  

The presentation quality and scientific soundness is satisfactory. The originality, novelty and meaning of the content and overall merit raise doubts - the topic of occupational burnout among nurses has been discussed many times in the literature. The Maslach Burnout Inventory has been used many times in the study of occupational burnout. In my opinion, the article does not bring anything new on this topic. Please add the practical implications of your research.

Author Response

REVIEWER 3

nursrep-2168620

Dear Authors

Thank you for allowing me to review this manuscript. The structure of the manuscript is logical, well understandable. The statistical methods are valid and correctly applied. The presentation quality and scientific soundness is satisfactory. The originality, novelty and meaning of the content and overall merit raise doubts - the topic of occupational burnout among nurses has been discussed many times in the literature. The Maslach Burnout Inventory has been used many times in the study of occupational burnout. In my opinion, the article does not bring anything new on this topic. Please add the practical implications of your research.

RESPONSE:

We appreciate your comment. We understand that Burnout syndrome has been widely studied due to its high prevalence. We also understand that during the COVID-19 lockdown this syndrome has hit health personnel hard. Precisely because it is frequent and affects health professionals, we carried out this study. The nurses at the DDD Hospital have faced the pandemic in a situation of little organization and lack of resources, and on the other hand, high rates of infected, hospitalized and little response with available ICU beds. In this sense, for the understanding of the affectation of the mental health of Peruvian professionals, this study becomes relevant. In addition, based on their findings, programs for managing problems at work can be improved as part of a national post-COVID policy.

Round 2

Reviewer 1 Report

N/A

Author Response

RESPONSE TO ACDEMIC EDITOR

nursrep-2168620

O1: Thank you for providing information on using the Maslach Burnout Inventory
(MBI) questionnaire to assess nurses' burnout. However, based on the subscale
scores you provided; it appears that the total score of 99 points for the MBI
may be inaccurate. The sum of the subscale scores should be 132 (54 for
Emotional Exhaustion, 30 for Depersonalization, and 48 for Personal
Fulfillment, which is reverse-scored, correct ?!). Therefore, it may be
helpful to review the scoring instructions and guidelines for the MBI to
confirm the correct method of calculating scores and interpreting the results
and provide that information in the manuscript.

R1: The manuscript has been reviewed and the scores have been adjusted according to the instrument

O2: We appreciate the information on the number of nurses with burnout by subscale and level, but it is important to know more about the cut-offs for high, low, or medium levels of burnout that were used.

R2: Study cutt-offs have been reviewed

O3: Understanding the cut-offs will help to interpret the scores appropriately and assess the prevalence and severity of burnout in the nursing population. Therefore, we recommend providing additional information about the cut-offs for subscale scores and the method of calculating the total score.  In addition, considering the other comments of the reviewers, please add more specific information about the practical implications of your research in your conclusion, such as: Develop targeted interventions for young nurses: The study found that younger nurses (aged 20-30 years) are more susceptible to burnout. Therefore, interventions such as counselling, mentoring, and training programs could be developed to support younger nurses and help them cope with the demands of their job. Foster a supportive work environment: The study highlights the importance of improving the work environment to prevent burnout. This could include changes to the work system and organization, improving interpersonal relationships, and promoting a culture of self-care.

Provide resources for risk prevention: Providing adequate personal protective
equipment (PPE) and other resources to prevent infection could help alleviate
stress and anxiety in nurses working with COVID-19 patients. This could also
include training and education on infection prevention and control.
Regularly monitor for burnout: Healthcare organizations must regularly
monitor for burnout among nurses and other healthcare workers. This could be
done through regular surveys or check-ins to identify early warning signs of
burnout and provide support as needed. Address gender disparities: The study found that more males were affected by burnout than females. Therefore, strategies should be developed to address gender disparities in the workplace and ensure that all nurses are supported equally.

R3: We appreciate the suggestion and this information has been added creating a subtitle in the discussion section.

We appreciate the suggestions,

Sincerely,