Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An observational study of ward nurses

Shingo Tanaka; Masatoshi Saiki; Yukie Takemura

doi:10.1371/journal.pone.0309883

. 2024 Nov 8;19(11):e0309883. doi: 10.1371/journal.pone.0309883

Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An observational study of ward nurses

Shingo Tanaka ^1,^*, Masatoshi Saiki ², Yukie Takemura ³

Editor: Fatma Ay⁴

PMCID: PMC11548840 PMID: 39514603

Abstract

Introduction

Discharge planning involves coordinating between different care settings. Failed coordination can lead to delayed care at the facilities receiving discharged patients. Nurses who implement discharge planning must consider the circumstances of the staff receiving the discharged patients.

Objective

This study aims to develop a nurses’ perspective-taking scale for measuring the cognitive process of imagining a staff’s situation when receiving discharged patients.

Methods

An online survey was conducted from September to November 2021 with nurses in Japanese acute care hospitals, using a 20-item questionnaire based on interviews and a literature review. Item reduction was conducted based on inter-item correlations, item-total correlations, and exploratory factor analysis. Confirmatory factor analysis was performed. For the exploratory and confirmatory factor analysis, the samples were randomly split in half and tested. Cronbach’s alpha, intraclass correlation coefficients, and correlation coefficients were calculated using both self-developed and pre-existing measures.

Results

The questionnaire was distributed to 1,289 individuals, and 416 valid responses were obtained. Item reduction and exploratory factor analysis resulted in a 10-item scale with two subscales, “imagine-other” (six items), which is imagining the other person’s situation, and “imagine-self” (four items), which is imagining oneself in the other person’s situation. The goodness-of-fit indices were as follows: comparative fit index, 0.95; root mean square error of approximation, 0.08; and standardized root mean squared residual, 0.06. Correlation coefficients with existing scales were 0.38, 0.57, and -0.33. Cronbach’s alpha was 0.89, and the intraclass correlation coefficient was 0.54.

Conclusion

The newly developed scale proved to be reliable, valid, and suitable for use. This scale can measure the degree of perspective-taking by nurses, which can improve collaboration between facilities and the effectiveness of discharge planning.

Introduction

Discharge planning involves sequential processes, including patient education during the hospital stay and post-discharge care coordination. Ward nurses play a crucial role in planning, coordinating multidisciplinary teams, and educating patients [1, 2]. High-quality discharge planning is needed to ensure continuity of care even after leaving the facility.

Fragmentation of care across acute, post-acute, or home care settings leads to poor discharge planning coordination and delays in care delivery [3, 4]. Nurses’ perceptions of discharge planning vary across different healthcare facilities, leading to dysfunctional inter-facility cooperation systems [5, 6]. This may be due to the wide range of resources, the focus on patients in each care setting, and a lack of consideration for these differences during discharge planning [5, 7, 8]. Improving discharge planning requires enhancing both systems and nurses’ recognition of resources and perspectives of care, depending on the facilities. Proficient discharge planners think beyond their own facilities to ensure continuity of care [9]. To improve the quality of discharge planning, assessing how well nurses in pre-discharge facilities can anticipate situations at post-discharge facilities is essential.

Perspective-taking is the cognitive ability to imagine others’ viewpoints, developed during social interactions [10]. It is a subset of empathy and is crucial for understanding others [11]. It involves imagining the world from another’s perspective—comprehending their viewpoint, thoughts, motivations, intentions, and emotions [12]. Studies in developmental and social psychology state that it includes de-centering and does not require accurate understanding of the other’s perspective [12]. Perspective-taking has two sub-concepts: imagine-other for objective understanding and imagine-self for subjective understanding by placing oneself in another’s situation [13]. The use of these two sub-concepts is realistic as it considers objects both subjectively and objectively.

In healthcare, research on perspective-taking focuses on healthcare professionals’ empathy for patients [14]. Psychology and management studies link perspective-taking with cooperative and helping behaviors [12, 15, 16]. In nursing, understanding the perspective of staff receiving discharged patients can enhance collaboration. The most widely used perspective-taking scale is the Davis’s Interpersonal Reactivity Index [11]. However, no current measures assess perspective-taking for staff receiving discharged patients [12, 17–19]. Thus, there is a need to develop a new instrument to measure this aspect at the discharge planning stage and to test its reliability and validity.

Prior research on discharge planning has focused on nurses’ recognition and knowledge of patients and their families after discharge [20, 21]. As discharge planning requires collaboration with the staff at the post-discharge facility, examining nurses’ perceptions of them is essential. Scale development allows us to measure the extent to which nurses consider the staff’s situation at receiving facilities. The developed scale can help examine the relationship between nurses’ perspective-taking and discharge planning outcomes, contributing to enhancing nurses’ discharge planning competencies. Therefore, this study develops a scale to measure ward nurses’ perspective-taking of the staff receiving discharged patients (Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale) and tests the scale’s reliability and validity.

Methods

This study followed Boateng et al.’s [22] three steps of scale development: item development (literature review and interview), expert evaluation, and scale validation.

Definition

In this study, the staff receiving discharged patients comprise nurses, home care nurses, and public health nurses in the jurisdictional district who receive patients from the hospital after discharge. Referring to previous studies (e.g., Ku et al. [12]), ward nurses’ perspective-taking of the staff receiving discharged patients was defined as the active cognitive process of imagining the perspectives, positions, and situations of the staff receiving discharged patients when ward nurses implement discharge planning (including transfer to another hospital and/or homecare) for patients requiring continued medical care.

Three steps of item development

Item development

The item was created in three steps: 1) establishing sub-concepts, 2) creating items through a literature review and interviews, 3) synthesizing the created items. First, drawing from Wolgast et al. [13], we assumed two sub-concepts of perspective-taking: imagine-other—imagining the other person’s situation—and imagine-self—imagining oneself in the other person’s situation. Second, through a literature review and interviews, we collected data on what nurses consider about the discharge facility during discharge planning and created a draft of items. For the literature review, the following terms were used to search the CINAHL and CiNii databases for relevant articles: “transitional care,” “transition of care,” “discharge planning,” and “nurse.” Based on the results of the literature review [3, 4, 21, 23–27], items such as “We try to imagine how staff receiving discharged patients value the care we give them” (28 items in total) were developed. We then conducted individual semi-structured interviews with nine participants, including ward nurses, discharge-coordinating nurses, and ward nursing managers with at least five years of experience working in hospital wards and discharge planning (mean clinical experience year 16.66±10.75). Purposive sampling was used for recruitment. We asked them questions such as, “To achieve smooth discharge planning, what, in particular, do you consider about the situation of the staff receiving discharged patients?” The extent to which the participants imagine the perspective of the staff receiving discharge patients was ascertained through these methods. Based on the interview results, items such as “Consider the amount of care that can be handled by the staff receiving discharged patients” (17 items in total) were created. Third, items created using literature review and interview data were summarized among those with similar content. “Overall, 28 items (12 imagine-other and 16 imagine-self items) were included based on the abovementioned steps.

Evaluation by experts

In addition to the nine participants interviewed in the item development phase, cognitive interviews [28] were conducted with five ward nurses with discharge planning experience to evaluate surface validity. Additionally, the item content validity index (I-CVI) was calculated to test content validity through nursing researchers’ and nurses’ evaluations [29, 30]. The cognitive interview and I-CVI were conducted twice alternately. Each item was modified accordingly (see Supporting information). The inclusion criteria were participants with clinical experiences of at least 5 years as a nurse and in discharge planning. The exclusion criteria included only having clinical experience in the maternity ward.

In the cognitive interviews, based on their clinical experience, participants were asked about questions that were difficult to understand and ones that should be included.

The I-CVI was evaluated by four nursing researchers and four nurses who were deemed by the researcher to understand perspective-taking in the interviews in the item development phase. Eight participants were evaluated in the first round and seven in the second round (one nursing researcher dropped out). Items with an I-CVI value less than 0.75 (eight participants) in the first round and less than 0.83 (six participants) in the second round were considered for modification or deletion. The criteria for each round were calculated based on the recommendation of a previous study [29].

In the first round, subject and predicate expressions were standardized in response to the cognitive interview results. The I-CVI was calculated for the revised draft, and items that did not meet the criteria were revised and synthesized based on the comments obtained from the cognitive interview and the I-CVI [29]. Through this process, the items were rephrased, integrated with other items, or deleted, resulting in 22 items—down from the original 28. Items with I-CVI values that did not meet the criteria in the second round were similarly reviewed by the researchers and deleted in consideration of feedback from the cognitive interviews. This resulted in 20 items. The researchers reviewed the final draft to confirm the semantic content, and minor phrasing revisions were made to facilitate easy responses from participants. Overall, 20 items were refined through this process (9 imagine-other and 11 imagine-self items).

Scale validation

An online survey was conducted from October to November 2021. The participants were given individual random IDs and surveyed again two weeks later, if they cooperated, for temporal stability verification.

Data collection of scale validation

Sample size. We performed sample size calculations to validate construct validity at time 1 and temporal stability at time 2. Regarding time 1, we observed that 200 participants, 10 times the number of items in the draft scale, were required based on the recommendation of Boateng et al. [22]. Regarding time 2, we found 19 participants were needed to calculate the intraclass correlation coefficients (ICC) between the first and the second surveys with 30 observed variables per participant (the null hypothesis was set at 0.5, the alternative hypothesis at 0.7, the power at 0.8, and the probability of significance at 0.05) [31]. The response rate was assumed to be approximately 20% based on previous discharge planning studies [32, 33]. Therefore, it was determined that a distribution of approximately 1,000 persons was necessary for the analysis.

Surveyed facilities. Overall, 45 facilities that agreed to participate were selected through random sampling of acute care hospitals without medical care beds in the Kanto Koshinetsu, Tohoku, and Tokai Hokuriku Health and Welfare Bureaus areas (selected based on facility reports issued by the Kanto-Shinetsu Regional Bureau of Health and Welfare [34], Tohoku Regional Bureau of Health and Welfare [35], and Tokai-Hokuriku Regional Bureau of Health and Welfare [36]) in Japan). Random sampling involved randomly extracting 200 acute care hospitals from databases provided by each local health authority [34–36] and requesting their cooperation for the survey. Of these, 45 facilities that agreed to participate were selected for the survey.

Participants. The inclusion criteria were ward nurses who had engaged in discharge planning. The exclusion criteria were nurses with less than a year of nursing experience, did not work in wards, worked in obstetric wards and unit care such as intensive care units and emergency wards, and worked as head ward nursing managers.

Ethical considerations

This study was conducted with the approval of the Research Ethics Committee of The University of Tokyo, Clinical Research Review Board (approval no. 2020409NI, 2021137NI). Participants were informed that their cooperation in the survey was voluntary and that their responses would not be used to evaluate their work. Furthermore, it was clarified that their participation and the content of their responses would not be shared with any third party. The survey was administered only to individuals who willingly agreed to participate and provided written informed consent.

Data analysis

Item reduction

Items that were similar or did not adequately measure perspective-taking were removed based on the following criteria: 1) inter-item correlations greater than 0.60 [22]; 2) item total (IT) correlations less than 0.30 [22]; 3) factor loadings in the exploratory factor analysis (EFA) of 0.30 or greater for multiple factors [37]; 4) commonality less than 0.4 in the EFA [38].

Determination of factor structure

To test for cross-validity, the collected sample was randomly divided into two groups. EFA was conducted for one group and confirmatory factor analysis (CFA) for the other. This scale was designed with a multidimensional structure in mind. Therefore, EFA was employed to identify and name the factors from the item pool. Subsequently, CFA was conducted to verify the construct validity by examining whether the model fit statistically across different samples. In the EFA, the number of factors was determined by scree plotting; subsequently, Promax rotation and unweighted least squares were selected. Since a Shapiro–Wilk test of the items did not confirm normality, the unweighted least squares method was selected. The comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean squared residual (SRMR) were used as the evaluation indices for the CFA.

Scale evaluation

Internal consistency was confirmed by Cronbach’s alpha. The criterion for the index was set at 0.7 [39].

Construct validity was verified by calculating correlations between the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and similar concepts [40]. Details of the scales used for validation and the predicted results were as follows: 1) The Japanese version of the Interpersonal Reactivity Index, perspective-taking subscale [11, 41], measures perspective-taking in daily life and therefore although similar, has a slightly different concept from the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale. The correlation was predicted to be weak to moderate. 2) Since there was no golden standard scale to measure comprehensive perspective-taking in discharge planning, we predicted that the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale would have a moderate or high correlation with the self-created single item (named “comprehensive perspective-taking”) “I think about discharge support from the perspective of the receiving staff.” The participants were asked to respond to this statement on a 10-point scale ranging from 1 = not at all true to 10 = very true. 3) The sub-concept of the Self-centeredness Scale, also known as “inadequate empathy for others,” was developed by Hirosawa et al. [42] based on Piaget’s [43] concept of self-centeredness. Self-centeredness and de-centering are paired concepts, and perspective-taking is a de-centering concept [11]. Therefore, a negative correlation between perspective-taking and “inadequate empathy for others” is expected.

The ICC (2, 1) [44] was calculated to verify temporal stability. The online survey did not have any missing data because participants were unable to submit the survey unless they answered all the questions. For statistical analysis, IBM SPSS Statistics (Ver. 28.0.0 [190]) and IBM SPSS Amos (Ver. 25.0.0) were used. The significance level was set at 5%.

Results

Participants

For the first survey (Time 1), the questionnaire was distributed to 1,289 participants, and 416 valid responses were obtained (Fig 1). For the second survey (Time 2), questionnaires were distributed to 172 participants who participated in the first survey and offered to cooperate in the second—61 valid responses were obtained.

In the sample surveyed at Time 1 (n = 416), 93.8% were women, the mean age was 38.90 years, and the mean clinical experience was 15.62 years. Of the total, 67.1% of the participants held a staff position, and 44.2% had participated in discharge planning at least twice a month in the previous year (Table 1).

Table 1. Basic attributes of the participants (n = 416).

		Mean	(Standard deviation)
Age		38.90	(9.49)
Years of clinical experience		15.62	(9.25)
		Frequency	(%)
Gender
	Female	390	(93.75)
	Male	26	(6.25)
Marital status
	Married	224	(53.85)
	Unmarried	192	(46.15)
Certified nurse/certified nurse specialist
	Yes	16	(3.85)
	No	400	(96.15)
Current position
	Staff	279	(67.07)
	Manager (Deputy chief, Chief, Deputy head ward nursing manager)^†	137	(32.93)
Main department of the ward to which the participant currently belongs
	Surgery	96	(23.07)
	Internal medicine	161	(38.70)
	Mixed surgery and internal medicine	151	(36.30)
	Psychiatry and pediatrics^‡	8	(1.92)
Number of times in the past year that the participant has been involved in assisting in the discharge of patients who continue to receive care at another facility after discharge
	Never	20	(4.81)
	Approximately once every 6 months	21	(5.05)
	About once every 2 to 3 months	90	(21.63)
	About once a month	101	(24.28)
	About twice a month	184	(44.23)

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Note.

^† 16 deputy directors, 83 directors, 38 deputy chief nursing officers.

^‡ 3 psychiatry, 5 pediatrics.

Scale validity

In the item reduction phase, no item had an IT correlation of 0.3 or less. Of items with an IT correlation of 0.6 or higher and with overlapping meanings, seven with abstract questions were eliminated. The EFA conducted at this stage confirmed a three-factor structure, unlike the assumed factor structure. Three items had factor loadings of 0.3 or higher on multiple subfactors and were deleted because the questions were documents asking about multiple events. No item had a commonality of less than 0.4. Ten items were removed through the item reduction process. The EFA conducted at this stage confirmed a two-factor structure consisting of items that asked about the assumed sub-concepts (Table 2). The first factor was named “imagine-other” (six items), and the second factor was named “imagine-self” (four items).

Table 2. Results of exploratory factor analysis (n = 208).

Ward Nurses’ Perspective-taking of the Staff Receiving Patients in Discharge Planning Scale (α = 0.90)		Factor 1	Factor 2
Factor 1: Imagine-other (α = 0.89)
	S5 I think about the daily-living care that the staff receiving discharged patients might be able to handle.	0.95	-0.12
	S4 I think about the manpower of the facility receiving the discharged patients.	0.79	-0.07
	S7 I think about what care items are available at the site of the staff receiving discharged patients.	0.73	0.04
	S6 I think about possible procedures and other medical techniques that can be performed by the staff receiving discharged patients.	0.73	0.09
	S8 I think about what information the staff receiving discharged patients already has about the patient.	0.62	0.11
	S2 I imagine what the staff receiving discharged patients would want from our discharge planning.	0.60	0.13
Factor 2: Imagine-self (α = 0.87)
	S12 I think about what information I would need to manage a patient’s condition if I were the staff receiving discharged patients.	-0.14	0.99
	S13 I think about how I would understand the information provided by the hospital where the receiving-patient was located if I were the staff receiving discharged patients.	0.05	0.83
	S11 I think about what patient family information I would need if I were the staff receiving discharged patients.	0.08	0.72
	S15 I think about whether I would need to be careful when interacting with the patient if I were the staff receiving discharged patients.	0.30	0.49
Eigenvalue		5.43	1.38
Factor contribution rate (%)		50.49	10.75

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Note. Kaiser-Meyer-Olkin’s Measure of Sample Adequacy was 0.899. Bartlett’s Sphericity test had a probability of significance of less than 0.01 (approximate Chi-Square = 1196.90, d.f. = 45). Factor extraction was performed by the unweighted least squares method. The rotation method was Promax rotation. Three iterations were used for convergence. α shows Cronbach’s α calculated with n = 208. This scale is a 5-point Likert scale, ranging from “1: Not at all applicable” to “2: Not very applicable,” “3: Can’t say,” “4: Somewhat applicable,” and “5: Very applicable”.

The CFA of the factor structure validated by the EFA yielded a CFI of 0.95, an RMSEA of 0.08, and an SRMR of 0.06 (Fig 2).

Scale reliability

Cronbach’s alpha for the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale, calculated as the sum of the means of the subscales, was 0.89. The correlation coefficients between the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and the Japanese version of the Interpersonal Reactivity Index subscales of “perspective-taking” (excluding reversal items), “inclusive perspective-taking,” and “inadequate empathy for others” were 0.38, 0.57, and -0.33, respectively (Table 3).

Table 3. Descriptive statistics, Cronbach’s alpha, and correlation coefficient for each scale (n = 416).

				Correlation
	Mean	Standard deviation	(α)	②	③	④	⑤	⑥
①Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale (10 items)^a	7.21	(1.16)	(0.89)	0.90**	0.86**	0.38**	0.57**	-0.33**
②Imagine-other (6 items)^b	3.34	(0.72)	(0.88)		0.55**	0.34**	0.59**	-0.32**
③Imagine-self (4 items)^b	3.87	(0.59)	(0.86)			0.32**	0.40**	-0.25**
④Perspective-taking (7 items)^c	3.65	(0.60)	(0.78)				0.35**	-0.42**
⑤Comprehensive perspective-taking (1 item)^d	5.99	(1.68)						-0.32**
⑥Inadequate empathy for others (7 items)^e	2.51	(0.72)	(0.84)

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Note. Correlation coefficients were calculated using Pearson’s correlation. ** p ≤ 0.01.

^a Scores for each subscale (imagine-other and imagine-self) were summed.

^b The average score for each item was calculated.

^c The perspective-taking scale was calculated using the perspective-taking subscale (7 items) of the Japanese version of the Interpersonal Reactivity Index [44], which had a low α = 0.67; therefore, we followed previous research and excluded the reversal items.

^d A self-developed item, “I think about discharge support from the perspective of the receiving staff,” was created and an index was used to rate the item on a 10-point scale, from “1 = not applicable at all” to “10 = applicable very often.”

^e The Self-Centeredness Scale [42], a subscale of the “inadequate empathy for others” scale, was used.

The ICCs (2, 1) for the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and the imagine-other and imagine-self subscales were 0.50, 0.62, and 0.24, respectively. Corresponding t-tests exhibited significantly higher mean scores for the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and the imagine-self subscale in Time 2 than in Time 1 (Table 4).

Table 4. ICC (2, 1) values for the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and paired-samples T-test results (n = 416).

	ICC (2, 1)			Paired-samples t test
		95% CI		mean
	Intraclass correlation	Lower	Upper	Time 1	Time 2	Mean difference^a	p value
Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale	0.50	0.27	0.67	7.45	7.94	0.49	0.02
Imagine-other	0.62	0.39	0.76	3.43	3.72	0.29	<0.01
Imagine-self	0.24	0.00	0.46	4.02	4.22	0.20	0.06

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Note. ICC, intraclass correlation coefficients; CI, confidence interval. ^a The mean of Time 2 minus that of Time 1

Discussion

The reliability and validity of the scale developed in this study to measure ward nurses’ perspective-taking of the staff receiving discharged patients were verified. The EFA and CFA confirmed that the scale consists of two subfactors. Correlation analysis with other scales confirmed its construct validity, whereas Cronbach’s alpha and ICC confirmed its reliability. However, the “imagine-self” subfactor was observed to have low temporal stability.

Participant attributes

The participants’ average years of clinical experience were similar to those of previous studies on nurses’ discharge planning practices [45]. The most common frequency of involvement in discharge support in the past year was “at least twice a month” (44.2%). Prior studies have reported that nurses engage in patient education [46] and the coordination of discharge planning [2, 47]. Furthermore, this study’s results suggest that most nurses engage in discharge support.

Scale validity

The EFA extracted two factors, as expected. Factor 1 included a convergence of items that inferred the situation of the staff receiving discharged patients and corresponded to the predicted “imagine-other” factor. Factor 2 included items that asked participants to imagine themselves in the position of the staff receiving discharged patients. These questions were converged in Factor 2, which corresponded to the predicted “imagine-self.” The CFA revealed that CFI (≥ 0.90; [39, 48]), RMSEA (< 0.10; [39, 49]), and SRMR (< 0.80; [50]) met the criteria. Consequently, the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale was established as consisting of the subscales imagine-other and imagine-self.

Construct validity was assessed by examining correlations with three measures: 1) The Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale correlated weakly with the “perspective-taking” subscale of the Japanese version of the Interpersonal Reactivity Index [11, 41], as predicted. 2) “Comprehensive perspective-taking,” which asked about the overall perspective-taking of the staff receiving discharged patients in discharge planning, was moderately correlated with the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale, as predicted. 3) The measure of self-centeredness, “inadequate empathy for others,” was negatively correlated with the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale, as predicted.

Based on the cross-validity, EFA, CFA, and construct validity results, the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale is considered a valid instrument. It measures nurses’ perceptions of the resources available to the staff receiving discharged patients and the information they desire. Previous scales have measured perspective-taking toward friends in everyday life, staff in other departments of a company, and customers [11, 17, 18]. However, the scale developed in this study differs from other existing ones in that it measures perspective-taking toward staff in other facilities in the medical setting of discharge planning.

Scale reliability

The Cronbach’s alpha of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale met the criterion (> 0.8: good), which indicated internal consistency [39]. The ICCs (2, 1) for the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and the imagine-other subscale were 0.50 and 0.62, respectively, and these values met the criterion of moderate reliability (0.5 ≤ ICC ≤ 0.75; [44]). Conversely, the ICC for the imagine-self subscale was 0.24, which indicated poor reliability. The mean scores for the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and imagine-other were significantly higher in Time 2 than in Time 1. Perspective-taking in daily life has also been reported to change over time [51]. Therefore, nurses’ perspective-taking of the staff receiving discharged patients may also change over time. In experimental studies, perspective-taking is enhanced by instructing participants to think from the perspective of the object [12]. As such, the responses to the first survey may have increased the scores in the second survey because the participants became unconsciously more aware of perspective-taking. In particular, individuals may become more conscious of their imagined others by teaching or answering a questionnaire. Further studies should be conducted on 1) how nurses’ perspective-taking of staff receiving patients changes over time, 2) whether an educational effect was seen in responding to the scale twice, and for how long this effect remains on the nurses.

Scale availability

The scale developed in this study measures the degree to which ward nurses conducting discharge planning consider the situation of the staff receiving discharged patients. Previously, measures for discharge planning were limited to categories such as psychological readiness [52] and discharge planning behavior [53] as the outcome. Prior research on nurses’ perceptions focused on their interest in patients [20, 21]. Additionally, studies on collaboration among medical staff in discharge planning focused on systems and the physical environment [54, 55]. Therefore, the manner in which nurses’ perceptions of the staff receiving discharged patients would affect their collaborations was unclear. The measures developed by this study focus on nurses’ recognition and contribute to clarifying the mechanism whereby the kind of event stimulates the perspective-taking and affects discharge planning [20, 21, 54, 55]. By evaluating perspective-taking, identifying intervention points to improve nurses’ perspective-taking during discharge planning will be possible.

Limitations

The current study was conducted with nurses in acute care hospitals in Japan, which affects the generalizability of its findings. The viability of the scale for nurses other than ward nurses, such as those involved in advanced discharge planning [56], needs to be examined further. The current study met the sample size requirements for time 1 and time 2 [22, 31]. However, the response rate was low, similar to the response rate in another Japanese study of discharge planning [32, 33]. The low response rate may be due to the many questions and participants’ interest. In particular, a selection bias may have occurred if only nurses who expressed a strong interest in discharge planning were assumed to have responded to the study questions.

In the present study, the majority of the participants were female. It has been reported that gender does not affect perspective-taking [18]. Therefore, a bias due to gender is unlikely. However, perspective-taking is affected by the power relationship with the target [57, 58] as well as differences between competitive and cooperative environments [16]. Therefore, future research should not only focus on the attributes of the participant’s population, but also on the relationship between the perspective-taking target and participant population.

In addition, the imagine-self subscale demonstrated low temporal stability; therefore, there is a limitation to using this subscale by itself. Future longitudinal studies are needed to understand the nature of this subscale and explore avenues to recognize temporal trends in its scores.

Perspective-taking does not question the accuracy of understanding the object’s perspective [12]. Consequently, the ideas derived through perspective-taking do not necessarily correspond to what the target individual thinks or the actual situation in which that individual is placed. Future studies should evaluate the relationship between perspective-taking and inter-facility collaboration in detail. To do so, researchers should ask staff receiving discharged patients to evaluate the discharge planning in which the perspective-taking was demonstrated, using the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale.

Conclusions

We developed the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale in order to evaluate ward nurses’ perspective-taking of the staff receiving discharged patients. The scale comprised 10 items, two factors, and two subscales: imagine-other (six items) and imagine-self (four items). Furthermore, the reliability and validity of this scale and its subscales were verified in this study. The scale measures ward nurses’ perspective-taking of the staff receiving discharged patients and allows us to elucidate the relationship between perspective-taking and inter-facility collaboration in discharge planning. This scale can be utilized to measure the extent to which ward nurses engage in perspective-taking to better understand the staff at the facility receiving discharged patients. It can help verify the relationship between perspective-taking and effectiveness of discharge planning practices. Moreover, it serves as a guideline for developing educational programs for nurses to improve discharge planning practices.

Supporting information

S1 Checklist. STROBE statement.

(DOCX)

pone.0309883.s001.docx^{(66.8KB, docx)}

S1 Appendix. Draft questions generated by cognitive interview and I-CVI results (Round 1).

^a The I-CVI (Item content validity index: I-CVI) was calculated by asking respondents to rate the degree to which each question item was related to the concept on a 4-point scale (1: not related to 4: fairly related), and the percentage of the number of respondents who answered 3 or 4 for each question was calculated. The first survey was 8 people rated the items, so items with an I-CVI of 0.75 or less were considered for modification.

(DOCX)

pone.0309883.s002.docx^{(25.6KB, docx)}

S2 Appendix. Draft questions generated by cognitive interview and I-CVI results (Round 2).

Note: One nursing researcher dropped out from round 1. The order of the items was changed based on feedback from the initial cognitive interview. ^aThe I-CVI (Item content validity index: I-CVI) was calculated by asking respondents to rate the degree to which each question item was related to the concept on a 4-point scale (1: not related to 4: fairly related), and the percentage of the number of respondents who answered 3 or 4 for each question was calculated. The second round was 7 people rated the items, so items with an I-CVI of 0.83 or less were considered for modification.

(DOCX)

pone.0309883.s003.docx^{(22.3KB, docx)}

S1 Dataset. Supporting information data set (EFA, CFA, cor).

(XLSX)

pone.0309883.s004.xlsx^{(50KB, xlsx)}

S2 Dataset. Supporting information data set (ICC).

(XLSX)

pone.0309883.s005.xlsx^{(13.9KB, xlsx)}

Acknowledgments

I would like to express my gratitude to all those who cooperated in the research.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Funding Statement

・ST. ・There is no grant number. ・The Global Creative Leaders (GCL) program of The University of Tokyo by the Ministry of Education, Culture, Sports, Science and Technology (MEXT). ・https://www.gcl.i.u-tokyo.ac.jp/faq-2/subsidies/ ・The sponsors or funders did not play any role in the study.

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PLoS One. doi: 10.1371/journal.pone.0309883.r001

Decision Letter 0

Fatma Ay

26 Mar 2024

PONE-D-24-01714Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward NursesPLOS ONE

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Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #1: Comments to the Author

Thanks to the authors for showing us the manuscript of “Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward Nurses”. Overall, this manuscript is interesting. However, there are numerous concerns that need to be addressed.

1. This manuscript weakens the process of developing the scale, and only shows the verification results. The scale development process should be introduced in detail, and the scales obtained from each round of item selection, the items deleted and the final scale can be displayed in the appendix if there are too many contents.

2.The exploratory factor analysis method is commonly employed in scale development. Could you please clarify why the manuscript utilized both exploratory and confirmatory factor analysis methods simultaneously? Kindly provide an explanation within the manuscript.

3.The author should review the usage of technical terminology throughout the entire text, such as replacing "patient transfer" with "patient referral".

4.The full text format should be adjusted to align the two ends, enhancing its aesthetic appeal.

5.Keywords: The keywords should be separated by quotation marks, with each keyword capitalized at the beginning.

6.Abstract: The abstract is excessively verbose. It is advisable to be more succinct.

7.Introduction:

a)The introduction is excessively lengthy. I recommend condensing it logically and merging relevant theoretical content, with a focus on elaborating the significance of nurses' perspective in receiving discharged patients for institutional staff.

b)“It is defined as ‘the active cognitive process of imagining the world from another’s vantage point or imagining oneself in another’s shoes to understand their visual viewpoint, thoughts, motivations, intentions, and/or emotions’ [12 pp. 94-95]”, the utilization of “12pp” in this sentence lacks standardization.

c)“In this study, the staff receiving discharged patients comprise nurses, home care

nurses, and public health nurses in the jurisdictional district who receive patients from the hospital after discharge. ”，the paragraph commencing with this sentence introduces the purpose and significance within the preceding context, rendering it more suitable for placement in the methods section from both a content and structural standpoint.

8.Methods:

a)In the section of “Data collection”, the three subheadings “Item development”, “Evaluation by an expert”, and “Scale validation” did not appear to fall within the scope of data collection. Change is recommended.

b) The section on “Evaluation by an expert” lacks clear inclusion and exclusion criteria for experts, a specific process for evaluating the scale, indicators for making modifications, and a presentation of the obtained scale evaluation in this study.

c) The specific method of randomization used in the manuscript was not specified by the author, and no explanation of the process was provided. The authors are encouraged to provide a more detailed explanation of the randomization method employed and offer a comprehensive program description.

d) The section on "Surveyed facilities" lacks an explicit explanation in the text regarding the criteria and sources employed for selecting the 45 hospitals. It would be beneficial if the author could incorporate a comprehensive clarification within the text.

e) The “Participants” section should be organized and written in a manner that includes clear inclusion and exclusion criteria.

9.Results:

a)The low response rate of the questionnaire may result in sample underrepresentation, leading to bias and compromising the credibility of survey findings. With only 61 participants completing the second survey, it is necessary for the author to provide further explanations and clarifications in their manuscript.

b)The ICC value is unsatisfactory, and it is recommended to discuss in the discussion section for an analysis of the underlying reasons as well as exploration of potential improvement methods.

c)The results section should include a demonstration of the reliability and validity of the scale development process.

10.Discussion:

a) Authors are advised to incorporate a concise summary of the findings section within the introductory paragraph of the discussion section. And insert it into the first paragraph of this section.

b) As previously mentioned, this scale can assess the level of nurses' comprehension regarding the discharge plan staff, thereby enhancing inter-institutional collaboration and discharge plan effectiveness. The concept of perspective-taking originates from inherent human nature and falls within the realm of psychological research. While the impact of various motivations or intervention mechanisms may be more pronounced, this manuscript does not explicitly highlight the significance and value of this scale for discharge referral. Therefore, it is hoped that the author will provide an explanation in the discussion section.

c) "It differs from existing scales that measure the perspectives of other people and colleagues in daily life.", it lacks in-depth discussion on the comparison of scales, which measure the perspectives of other people and colleagues in daily life. I suggest providing specific explanations and conducting a thorough analysis to highlight the differences between this scale and existing ones, as well as exploring the underlying reasons for these distinctions.

Acknowledgments: “This research was supported by XXX”, the expression is not precision enough.

Tables:

a)In table 2, the specific explanation regarding F1 and F2 is currently unavailable.

b)The p-value annotation is not standardized and should be revised to p≤.

Reviewer #2: Thank you for the opportunity to review this excellent article. It is a well written manuscript both in terms of English and academic importance.

I hae a few minor comments which should be considered in order to improve the article.

1. Line 97 to 103 should be part of the methods section. The last sentence of the Background section should be: "the aim of this study...."

2. The limitations paragrahs require expansion, for example can a predominantly female sample also be valid for male nursing staff?

3. Is a response of 32-35% considered a high or acceptable response rate? In both cases of the questionnaire, time 1 and time 2, the response percentage was similar.

4. Line 164-165 Exclusion criteria mentioned - "nurse worked as nursing managers". Despite what is mentioned in the methods chapter, in table 1, it is written that about a third of the respondents to the first questionnaire are in management positions. Shouldn't they have been disqualified?

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Reviewer #1: No

Reviewer #2: No

**********

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PLoS One. 2024 Nov 8;19(11):e0309883. doi: 10.1371/journal.pone.0309883.r002

Author response to Decision Letter 0

21 Apr 2024

April 21, 2024

Fatma Ay

Academic Editor

PLOS ONE

Dear Dr. Ay:

Thank you for inviting us to submit our revised manuscript, “Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward Nurses.”

We thank you and the reviewers for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. I look forward to working with you and the reviewers to move this manuscript closer to publication in PLOS ONE.

We have incorporated a number of changes based on your suggestions, highlighted in yellow. We have also added new supplementary file based on the reviewer’s comments. To facilitate your review of our revisions, the following is a point-by-point response to the questions and comments in your letter dated April X, 2024.

Thank you for your consideration. I look forward to hearing from you.

Sincerely,

Shingo Tanaka

Department of Fundamentals of Nursing, School of Nursing, Yokohama City University, 3-9 Hukuura, Yokohama kanazawa-ku, Kanagawa 113-0033, Japan

Email: tanaka.4n5.res@gmail.com

Dear Editor

I made the following changes in order to adhere to the journal requirements:

1. I have reviewed my paper to check if it fits the PLOS One style.

2. I have added a title page into main manuscript.

3. The Acknowledgements section in title page has been changed as follows:

I would like to express my gratitude to all those who cooperated in the research.

Since no funding information is given in the main manuscript, I think there is no need to change the covering letter for now.

4. I have revised data availability statement.

5. I have verified that the ethics statements are not listed outside of the METHODS section.

6. I have included a separate caption and legend for each figure in my manuscript.

7. I have embedded tables into the main document.

8. I have added captions for supplementary files as an appendix.

[Reviewer(s)' Comments]

Reviewer #1

Thank you for your careful peer review. I have revised the manuscript based on your valuable suggestions. I will respond to each of your comments individually. The revised sections have been marked out in yellow highlight for your convenience.

Thank you for your comment. In line with your suggestion, I have now included the proposed items from the item creation process in the appendix. Additionally, an explanation regarding the process of scale development has been added. For details, please review my response to the comments from you, particularly those related to the method.

2. The exploratory factor analysis method is commonly employed in scale development. Could you please clarify why the manuscript utilized both exploratory and confirmatory factor analysis methods simultaneously? Kindly provide an explanation within the manuscript.

Thank you for pointing this out. In order to clarify, I have added the following explanation to the " Determination of factor structure” section:

This scale was designed with a multidimensional structure in mind. Therefore, EFA was employed to identify and name the factors from the item pool. Subsequently, CFA was conducted to verify the construct validity by examining whether the model fit statistically across different samples.

3. The author should review the usage of technical terminology throughout the entire text, such as replacing "patient transfer" with "patient referral".

Thank you for pointing this out. I have replaced the term "patient transfer" with “discharge planning” in the key word section. I have reviewed previous studies and recognize that discharge planning is a more appropriate term for this study, as described in the main document definition.

4. The full text format should be adjusted to align the two ends, enhancing its aesthetic appeal.

Thank you for advice. I have made the necessary formatting changes.

5. Keywords: The keywords should be separated by quotation marks, with each keyword capitalized at the beginning.

The keywords have now been capitalized and are separated by quotation marks as suggested..

6. Abstract: The abstract is excessively verbose. It is advisable to be more succinct.

Thank you for your advice, I have summarized the Introduction and Conclusion in the Abstract as follows:

Introduction: Discharge planning involves coordinating between different care settings. Failed coordination can lead to delayed care at the facilities receiving discharged patients. Nurses who implement discharge planning must consider the circumstances of the staff receiving the discharged patients.

Conclusion: The newly developed scale proved to be reliable, valid, and suitable for use. This scale can measure the degree of perspective-taking by nurses, which can improve collaboration between facilities and the effectiveness of discharge planning.

7. Introduction:

a) The introduction is excessively lengthy. I recommend condensing it logically and merging relevant theoretical content, with a focus on elaborating the significance of nurses' perspective in receiving discharged patients for institutional staff.

Thank you for advice. In order to focus on perspective-taking, I have now condensed the paragraphs from the fifth paragraph onwards in the Introduction section.

b) “It is defined as ‘the active cognitive process of imagining the world from another’s vantage point or imagining oneself in another’s shoes to understand their visual viewpoint, thoughts, motivations, intentions, and/or emotions’ [12 pp. 94-95]”, the utilization of “12pp” in this sentence lacks standardization.

Thank you for pointing this out, I revised direct quotation style as following:

It is defined as “the active cognitive process of imagining the world from another’s vantage point or imagining oneself in another’s shoes to understand their visual viewpoint, thoughts, motivations, intentions, and/or emotions” [12] (94-95).

c) “In this study, the staff receiving discharged patients comprise nurses, home care nurses, and public health nurses in the jurisdictional district who receive patients from the hospital after discharge. ”，the paragraph commencing with this sentence introduces the purpose and significance within the preceding context, rendering it more suitable for placement in the methods section from both a content and structural standpoint.

Thanks for your suggestion. Based on the same, I have shifted the above text to the Method section as Definition.

8. Methods:

a) In the section of “Data collection”, the three subheadings “Item development”, “Evaluation by an expert”, and “Scale validation” did not appear to fall within the scope of data collection. Change is recommended.

Thank you for suggestion. I have now replaced the “Data collection” subheading with “Three steps of item development.” Additionally, I have added in the “Data collection of scale validation” section to provide information on the online survey.

Thank you for pointing out. I have included the items of each round of cognitive interview and I-CVI as an appendix, and added following explanation in main document:

Eight participants were evaluated in the first round and seven in the second round (one nurse researcher dropped out).

and

The inclusion criteria are participants with clinical experiences of at least 5 years as a nurse and in discharge planning. The exclusion criteria are only having clinical experience in the maternity ward.

In the cognitive interviews, based on their clinical experience, participants were asked about the parts of the questions that were difficult to understand and ones that should be added.

Thank you for pointing out. I have now added the following explanation under “surveyed facilities”:

Only acute-care hospitals were extracted from the hospital databases provided by each local health authority [32–34], and 200 facilities were requested to participate in the survey, and were assigned random numbers.

As mentioned above, I have included the following explanation under “surveyed facilities”:

e) The “Participants” section should be organized and written in a manner that includes clear inclusion and exclusion criteria.

Thank you for advice. This section has been revised as follows:

The inclusion criteria are ward nurses who had engaged in discharge planning. The exclusion criteria are nurses with less than a year of nursing experience, did not work in wards, worked in obstetric wards and unit care such as intensive care units and emergency wards, and worked as head ward nursing managers.

9. Results:

a) The low response rate of the questionnaire may result in sample underrepresentation, leading to bias and compromising the credibility of survey findings. With only 61 participants completing the second survey, it is necessary for the author to provide further explanations and clarifications in their manuscript.

Thank you for advice. From reviewing articles regarding discharge planning especially in Japan, I have determined that a response rate setting of about 20% is appropriate. As such, we have added the following explanations to the Method and Limitation sections, respectively:

(Method)

We performed sample size calculations to validate construct validity at time 1 and temporal stability at time 2. Regarding time 1, we found that 200 participants, 10 times the number of items in the draft scale, were needed based on the recommendation of Boateng et al. [22]. Regarding time 2, we found 19 participants were needed to calculate the intraclass correlation coefficients (ICC) between the first and the second surveys with 30 observed variables per participant (the null hypothesis was set at 0.5, the alternative hypothesis at 0.7, the power at 0.8, and the probability of significance at 0.05) [31]. The response rate was assumed to be about 20% based on previous discharge planning studies [32,33]. Therefore, it was determined that a distribution to approximately 1,000 persons was necessary for the analysis.

(Limitation)

The current study met the sample size requirements for time 1 and time 2 [22,31]. However, the response rate was low, similar to the response rate in a Japanese study of discharge planning. [32,33]. The low response rate may be due to the many questions and participants’ interest. In particular, a selection bias may have occurred if only nurses who expressed a strong interest in discharge planning were assumed to have responded to the study questions.

b) The ICC value is unsatisfactory, and it is recommended to discuss in the discussion section for an analysis of the underlying reasons as well as exploration of potential improvement methods.

Thank you for the suggestion. I have added the following sentence to the Discussion section in the discussion around the reason for the ICC being low.

Further studies should be conducted on 1) how nurses’ perspective-taking of staff receiving patients changes over time, 2) whether an educational effect was seen in responding to the scale twice, and for how long this effect remains on the nurses.

Furthermore, errors in the ICC and paired t-test values have been corrected.

c) The results section should include a demonstration of the reliability and validity of the scale development process.

Thanks you for pointing this out." I have now created subsections for "scale validity" and "scale reliability" in order to revise the paper based on your suggestion..

10. Discussion:

a) Authors are advised to incorporate a concise summary of the findings section within the introductory paragraph of the discussion section. And insert it into the first paragraph of this section.

Thank you for advice. I added following sentences in first paragraph of Discussion section:

The EFA and CFA confirmed that the scale consists of two subfactors. Correlation analysis with other scales confirmed its construct validity, whereas Cronbach's alpha and ICC confirmed its reliability. However, the "imagine-self" subfactor was found to have low temporal stability.

Thank you for kind pointing out. I have now added following sentences in “scale availability” in Discussion section which serve as an explanation:

Prior research on nurses' perceptions focused on their interest in patients [20,21]. Additionally, studies on collaboration among medical staff focused on systems and the physical environment [54,55]. Therefore, the manner in which nurses' perceptions of the staff receiving discharged patients would affect their collaborations was unclear. The measures developed by this study focus on nurses’ recognition and contribute to clarifying the mechanism whereby the kind of event stimulates the perspective-taking and affects discharge planning.

Thank you for advice. I added following explanation to the “scale validity” sub-section in Discussion section:

It measures nurses’ perceptions of the resources available to the staff receiving discharged patients and the information they desire. Previous scales have measured perspective-taking toward friends in everyday life, staff in other departments of a company, and customers [11,17,18]. However, the scale developed in this study differs from other existing ones in that it measures perspective-taking toward staff in other facilities in the medical setting of discharge planning.

11. Acknowledgments: “This research was supported by XXX”, the expression is not precision enough.

Thank you for pointing this out. I have now revised the above as:

I would like to express my gratitude to all those who cooperated in the research.

12. Tables:

a) In table 2, the specific explanation regarding F1 and F2 is currently unavailable.

Thank you for checking. I have revised the terms from F1 and F2 to “Factor 1” and “Factor 2” in Table 2.

b) The p-value annotation is not standa

Attachment

Submitted filename: Response_to_Reviewers_Shingo_TANAKA.docx

pone.0309883.s006.docx^{(51.8KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0309883.r003

Decision Letter 1

Fatma Ay

23 May 2024

PONE-D-24-01714R1Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward NursesPLOS ONE

Dear Dr. Tanaka,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jul 07 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Fatma Ay, Ph.D

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #1: Thanks to the authors for showing us the revised manuscript of “Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward Nurses”. Overall, this manuscript is interesting. But there are plenty of concerns.

1.Please further refine the screening process. Firstly, provide a comprehensive explanation in the manuscript regarding the rationale behind setting the items adjustment criteria at 0.75 and 0.83 (I-CVI). Secondly, if we consider using 0.75 as the screening criterion in the initial round, it would necessitate removing 13 items. Please explain how the 28 items reviewed in the first round were refined to 22 items reviewed in the second round. Also, how the final 20 items were determined.

2.Keywords: The format of keywords still contains some errors, which should be revised to a more standardized format: Hospital nursing staff; Multidisciplinary care team.

3.Introduction:

a) The introduction section remains excessively lengthy and it is advisable to streamline it further.

b) “It is defined as ‘the active cognitive process of imagining the world from another’s vantage point or imagining oneself in another’s shoes to understand their visual viewpoint, thoughts, motivations, intentions, and/or emotions’ [12] (94-95)”, please explain the specific meaning of “(94-95) ”and elucidate it within the manuscript.

4. Methods: In the section of “Surveyed facilities”, while the authors included details of the randomization process for 200 hospitals, they did not clearly state the source of involvement for 45 hospitals. It is necessary to clarify whether these 45 hospitals have any affiliation with the aforementioned 200 hospitals.

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

Attachment

Submitted filename: Second review report..docx

pone.0309883.s007.docx^{(14.8KB, docx)}

PLoS One. 2024 Nov 8;19(11):e0309883. doi: 10.1371/journal.pone.0309883.r004

Author response to Decision Letter 1

31 May 2024

June 1, 2024

Fatma Ay

Academic Editor

PLOS ONE

Dear Dr. Ay:

Thank you for inviting us to submit our revised manuscript, “Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An observational study of ward nurses.”

We have incorporated a number of changes based on your suggestions, highlighted in yellow. To facilitate your review of our revisions, the following is a point-by-point response to the questions and comments in your letter dated May 24, 2024.

Thank you for your consideration. I look forward to hearing from you.

Sincerely,

Shingo Tanaka

Department of Fundamentals of Nursing, Nursing Course, School of Nursing, Yokohama City University, 3-9 Hukuura, Yokohama kanazawa-ku, Kanagawa 113-0033, Japan

Email: tanaka.4n5.res@gmail.com

[Reviewer(s)' Comments]

Reviewer #1

Thanks to the authors for showing us the revised manuscript of “Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward Nurses”. Overall, this manuscript is interesting. But there are plenty of concerns.

1. Please further refine the screening process. Firstly, provide a comprehensive explanation in the manuscript regarding the rationale behind setting the items adjustment criteria at 0.75 and 0.83 (I-CVI). Secondly, if we consider using 0.75 as the screening criterion in the initial round, it would necessitate removing 13 items. Please explain how the 28 items reviewed in the first round were refined to 22 items reviewed in the second round. Also, how the final 20items were determined.

Response: Thank you for pointing this out. The following explanations were added to address your comment:

The criteria for each round were calculated based on the recommendation of a previous study [29]. In both the rounds, items noted to have overlapping semantic content in the cognitive interviews were consolidated, and the use of subjects and predicates for each item was standardized. The researchers reviewed the items with I-CVI values below the criteria in the first round. Based on the results of the cognitive interviews, the items were rephrased, integrated with other items, or deleted, resulting in 22 items, down from the original 28. Items with I-CVI values that did not meet the criteria in the second round were similarly reviewed by the researchers and integrated into other items or deleted based on feedback from the cognitive interviews, resulting in 20 items from 22. The researchers reviewed the final draft to confirm the semantic content, and minor phrasing revisions were made to facilitate easy responses from participants.

2. Keywords: The format of keywords still contains some errors, which should be revised to a more standardized format: Hospital nursing staff; Multidisciplinary care team.

Response: Thank you for this suggestion. The format of the keywords has been revised to a standardized one. We checked with the guidelines and the editorial office and confirmed that there are no guidelines regarding keywords.

3. Introduction:

a) The introduction section remains excessively lengthy and it is advisable to streamline it further.

Response: Thank you for the kind advise. We have reorganized the paragraph introducing prior research on discharge planning.

However, we believe that the paragraphs introducing perspective-taking, considerations on the scale, and the significance of the study are essential for explaining the subsequent development.

b) “It is defined as ‘the active cognitive process of imagining the world from another’s vantage point or imaginingoneself in another’s shoes to understand their visual viewpoint, thoughts, motivations, intentions, and/or emotions’[12] (94-95)”, please explain the specific meaning of “(94-95) ”and elucidate it within the manuscript.

Response: Thank you for this comment. (94-95) refers to the page numbers of the referenced publication. We have ensured that the in-text citation is formatted according to the Vancouver style.

4. Methods: In the section of “Surveyed facilities”, while the authors included details of the randomization process for200 hospitals, they did not clearly state the source of involvement for 45 hospitals. It is necessary to clarify whether these 45 hospitals have any affiliation with the aforementioned 200 hospitals.

Response: Thank you for pointing this out. We have revised the text to indicate that 200 facilities were randomly selected from the database, and the 45 facilities that cooperated were included in the survey.

Reviewer #2:

Thank you for your peer review. We have revised the manuscript in response to the other reviewer's comments. Please check our revised manuscript. We trust that the revisions have brought our manuscript closer to publication in PLOS ONE.

Attachment

Submitted filename: Response_to_Reviewers_Shingo_TANAKA.docx

pone.0309883.s008.docx^{(34.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0309883.r005

Decision Letter 2

Fatma Ay

11 Jun 2024

PONE-D-24-01714R2Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward NursesPLOS ONE

Dear Dr. Tanaka,

Please submit your revised manuscript by Jul 26 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Fatma Ay, Ph.D

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Reviewer #1: Comments to the Authors

1.During the construction of the professional scale, these items should be deleted if items falls below the pre-set standard (I-CVI). If these items are to be reintegrated and rephrased with other items, it is necessary to conduct a survey of the scale again before experts evaluation can be carried out.

2.Introduction:

a) In the section of introduction, 3 to 5 paragraphs primarily show the current research situation about “perspective-taking”, which is excessively lengthy. It is recommended to streamline and summarize the theoretical aspects instead of presenting literature details.

b) The Vancouver style employs superscript numbering and rarely includes the page number of the referenced literature. "12 pp. 94-95" requires further correction, and the entire text should be standardized to a similar format: [1].

Reviewer #3: It is a good topic for Nurse- mangers to apply this developed scale " Staff Receiving Discharged Patients Scale for Ward Nurses at hospitals.

The findings and results benefit all in-charge nurses to have a better plan to discharge the patients .

It is recommended to revise the whole paper by English language in Nursing sciences, It will be better.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

**********

Attachment

Submitted filename: Third review report...docx

pone.0309883.s009.docx^{(13.3KB, docx)}

PLoS One. 2024 Nov 8;19(11):e0309883. doi: 10.1371/journal.pone.0309883.r006

Author response to Decision Letter 2

18 Jun 2024

June 18, 2024

Fatma Ay

Academic Editor

PLOS ONE

Dear Dr. Ay:

We have incorporated a number of changes based on your suggestions, highlighted in yellow. To facilitate your review of our revisions, we have prepared and attached herewith a point-by-point response to the questions and comments in your letter dated June 12, 2024.

Thank you for your consideration. We look forward to hearing from you.

Sincerely,

Shingo Tanaka

Department of Fundamentals of Nursing, Nursing Course, School of Nursing, Yokohama City University, 3-9 Hukuura, Yokohama kanazawa-ku, Kanagawa 113-0033, Japan

Email: tanaka.4n5.res@gmail.com

[Editor Comments]

Response: Thank you for raising this issue. We have updated the reference list in the revised manuscript. Additionally, we have checked whether each reference has been retracted by The Retraction Watch Database.

[Reviewer(s)' Comments]

Reviewer #1

Thank you for your careful peer review. We have revised the manuscript based on your valuable suggestions—the revised sections have been highlighted in yellow for your convenience. Furthermore, we have responded to each of your comments individually.

1. During the construction of the professional scale, these items should be deleted if items falls below the pre-set standard (I-CVI). If these items are to be reintegrated and rephrased with other items, it is necessary to conduct a survey of the scale again before experts evaluation can be carried out.

Response: Thank you for pointing this out. Based on previous research, in the first round, we did not remove items without due consideration. However, we included a process to create revised items from feedback. We have revised the section “Evaluation by experts” to convey this.

2. Introduction:

Response: Thank you for pointing this out. We have streamlined the Introduction based on your comment.

b) b) The Vancouver style employs superscript numbering and rarely includes the page number of the referenced literature. "12 pp. 94-95" requires further correction, and the entire text should be standardized to a similar format: [1].

Response: We agree with the reviewer’s advice and have revised the in-text citations and references as per the Vancouver style using numbers in square brackets according to the journal guidelines.

Reviewer #3:

It is a good topic for Nurse- mangers to apply this developed scale " Staff Receiving Discharged Patients Scale for Ward Nurses at hospitals.

The findings and results benefit all in-charge nurses to have a better plan to discharge the patients .

It is recommended to revise the whole paper by English language in Nursing sciences, It will be better.

Response: Thank you for pointing this out. We have had the revised manuscript checked by a professional proofreading service to ensure good language quality.

Attachment

Submitted filename: Response_to_Reviewers_Shingo_TANAKA.docx

pone.0309883.s010.docx^{(31.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0309883.r007

Decision Letter 3

Fatma Ay

21 Aug 2024

Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An Observational Study of Ward Nurses

PONE-D-24-01714R3

Dear Dr. Tanaka,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Fatma Ay, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

PLoS One. doi: 10.1371/journal.pone.0309883.r008

Acceptance letter

Fatma Ay

9 Sep 2024

PONE-D-24-01714R3

PLOS ONE

Dear Dr. Tanaka,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Fatma Ay

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 Checklist. STROBE statement.

(DOCX)

pone.0309883.s001.docx^{(66.8KB, docx)}

S1 Appendix. Draft questions generated by cognitive interview and I-CVI results (Round 1).

(DOCX)

pone.0309883.s002.docx^{(25.6KB, docx)}

S2 Appendix. Draft questions generated by cognitive interview and I-CVI results (Round 2).

(DOCX)

pone.0309883.s003.docx^{(22.3KB, docx)}

S1 Dataset. Supporting information data set (EFA, CFA, cor).

(XLSX)

pone.0309883.s004.xlsx^{(50KB, xlsx)}

S2 Dataset. Supporting information data set (ICC).

(XLSX)

pone.0309883.s005.xlsx^{(13.9KB, xlsx)}

Attachment

Submitted filename: Response_to_Reviewers_Shingo_TANAKA.docx

pone.0309883.s006.docx^{(51.8KB, docx)}

Attachment

Submitted filename: Second review report..docx

pone.0309883.s007.docx^{(14.8KB, docx)}

Attachment

Submitted filename: Response_to_Reviewers_Shingo_TANAKA.docx

pone.0309883.s008.docx^{(34.5KB, docx)}

Attachment

Submitted filename: Third review report...docx

pone.0309883.s009.docx^{(13.3KB, docx)}

Attachment

Submitted filename: Response_to_Reviewers_Shingo_TANAKA.docx

pone.0309883.s010.docx^{(31.5KB, docx)}

Data Availability Statement

All relevant data are within the paper and its Supporting Information files.

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PERMALINK

Development of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale: An observational study of ward nurses

Shingo Tanaka

Masatoshi Saiki

Yukie Takemura

Roles

Abstract

Introduction

Objective

Methods

Results

Conclusion

Introduction

Methods

Definition

Three steps of item development

Item development

Evaluation by experts

Scale validation

Data collection of scale validation

Ethical considerations

Data analysis

Item reduction

Determination of factor structure

Scale evaluation

Results

Participants

Fig 1. Flowchart of the process of sample extraction.

Table 1. Basic attributes of the participants (n = 416).

Scale validity

Table 2. Results of exploratory factor analysis (n = 208).

Fig 2. Model evaluation of the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale using secondary factor analysis.

Scale reliability

Table 3. Descriptive statistics, Cronbach’s alpha, and correlation coefficient for each scale (n = 416).

Table 4. ICC (2, 1) values for the Ward Nurses’ Perspective-taking of the Staff Receiving Discharged Patients Scale and paired-samples T-test results (n = 416).

Discussion

Participant attributes

Scale validity

Scale reliability

Scale availability

Limitations

Conclusions

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Fatma Ay

Roles

Author response to Decision Letter 0

Decision Letter 1

Fatma Ay

Roles

Author response to Decision Letter 1

Decision Letter 2

Fatma Ay

Roles

Author response to Decision Letter 2

Decision Letter 3

Fatma Ay

Roles

Acceptance letter

Fatma Ay

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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