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School of Public Service Leadership
Scientific Merit Process
Learners who are doing action research for their dissertation will use this form to go through the
process of scientific merit review. The goals of this process are: (1) to facilitate the planning of
the details of your action research project, (2) to ensure that the proposed project has rigor and
allows for scientific merit review, and (3) to facilitate your progress through the dissertation. This
is not an addition to your dissertation but rather a step to assist you in obtaining mentor, committee,
school, and IRB approval more efficiently. You must obtain mentor, committee, and school approval of
your Research Plan before submitting your IRB application.
Scientific Merit Criteria
The following criteria will be used to establish scientific merit. The purpose of the review will
determine if the proposed project:
1. Contributes to society by improving a practice
2. Documents need for change by utilizing evidence-based needs assessment
3. Meets certain “Hallmarks” of a good action research project including:
a. Action research design
i. Practical
ii. Participatory
iii. Defined Action Plan
Scientific Merit Approval
Your completed SMART form will be approved, not approved, or deferred for major or minor revisions.
Your committee will use a checklist to determine if the study meets the criteria for scientific merit
and the committee will provide specific feedback designed to identify any issues that need to be
resolved related to the scientific merit. You will have up to three opportunities to submit this form
for committee approval.
Obtaining scientific merit approval does not guarantee you will obtain IRB approval. The IRB review
will focus on ethical issues. A detailed ethical review will be conducted during the process of IRB
approval.
Recommendations for How to Use This Form
The SMART form is intended to help you and your mentor plan the design and details of your
dissertation. Once your mentor approves your SMART form, your entire committee will review the form for
scientific merit. When the entire committee approves your SMART form, then it will be submitted for
school approval. It is recommended that you use this form in a step-by-step way to help plan your
design. Expect that you will go through a few revisions before your mentor and committee approve this
form.
Tips for filling out the SMART form:
• Prepare your answers in a separate Word document, as editing and revising will be easier.
• Copy/paste items into the right-hand fields when they are ready.
• Don’t delete the descriptions in the left column!
• Don’t lock the form, as that will stop you from editing and revising within the form.
• Leave no blank spaces in the form. If an item does not apply to your study, type “NA” in its
field.
• Read the item descriptions carefully. Items request very specific information. Be sure you
understand what is asked (Good practice for your IRB application!).
• Use primary sources to the greatest extent possible as references. Textbooks (Patton, Leedy and
Ormrod, etc.) are not acceptable as the only references supporting methodological and design choices.
Use them to track down the primary sources.
Upcoming Milestone Steps:
Milestone Group 1
Milestone Group 2
Section #1 To be completed by Learner
1.1 Learner Name Yolanda Wright
1.2 Learner Program DHA – Healthcare Leadership
1.3 Learner Email
1.4 Learner Phone
1.5 Mentor Name/Email
1.6 Committee Member #1 Name/Email
1.7 Committee Member #2 Name/Email
1.8 Dissertation Title How Organizational Changes in Nursing Care Affects the Clinical Nurse
Specialists and Patient Outcomes
1.9 Site Selected Children’s Hospital of San Antonio
Christus Santa Rosa Health System
333 North Santa Rosa Street, San Antonio, Texas 78207
http://www.chofsa.org/
1.10 Contact Info for Site Approver & Expected Approval Date NA
Section #2
2.1 Project
Write approximately one paragraph that describes the action research project and the basis for it being
addressed.
In the transformation of health care, clinical nurse specialists (CNS) should be participants
(McHugh, Berez & Small, 2013). From the report of the Institute of Medicine’s (IOM) Committee on the
adequacy of Nurse Staffing in Hospitals and Nursing Homes, the delivery of high quality care for
patients depends on the staffing of nurses, including clinical nurse specialists. Therefore, a crucial
issue of health policy is staffing of nurses. There have been studies reporting on the associations
between staffing of nurses and the patient outcomes (Aiken, Cimiotti, Sloane, Smith, Flynn & Neff,
2011). Clinical nursing specialists are important for any health care organization. Their main
expertise lies in population-based care across influences of nurses/ other professionals, patient/
family, systems (Jennifer Roberts, Cert Nsg, & Sue Floyd 2011). They are also experts in evidence-based
practice and nursing, adapting to a variety of settings and thus, influencing the outcomes of patient
care greatly.
The significance of patient safety for clinical nursing specialists is demonstrated by looking at
changes in the organization where there are multi-faceted interventions and strategies targeted
(Lansisalmi, Kivimaki & Alto, (2006).
This research study seeks to discover how the organizational changes in nursing care affect the
clinical nurse specialists and how this goes on to affect the patient outcomes at Children’s Hospital
of San Antonio – Christus Santa Rosa Health System. This will encompass the revising of roles and
responsibilities, increased staffing and use of multidisciplinary teams in the structural factors being
redesigned.
References
Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). The
effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work
environments. Medical care, 49(12), 1047.
Jennifer Roberts, R. N., PG Cert Nsg, M. N., & Sue Floyd RN, M. N. (2011). The clinical nurse
specialist in New Zealand: how is the role defined? Nursing Praxis in New Zealand, 27(2), 24.
Lansisal mi, H., Kivimaki, M., & Alto, P. (2006). Innovation in healthcare: A systemic review of recent
research. Nursing Science Quarterly, 19(1), 66-72.
McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals with higher nurse staffing had lower odds of
readmissions penalties than hospitals with lower staffing. Health Affairs, 32(10), 1740-1747.
2.2 Contribution to Society
Using citations, answer the following questions in order:
1. How does your project improve a current practice?
2. If your action research project is successful, how could your project impact your field of interest?
3. What are the practical implications of your project? For example, what will be the impact of this
project on your sample, your site location, or your workplace?
1. In current practice, this project will serve as an improvement by ensuring that health care
facilities have adequate staff in terms of clinical nursing facilities. There have been documented
reports highlighting the unprecedented shortage of nurses in relation to the services growing in demand
(Needleman, Buerhaus, Pankratz, Leibson, Stevens & Harris, 2011). The professional and public concerns
on the safety and quality of patient have sparked policy and research reports. Hence, there has been an
increase in urgency on the relationship between staffing and outcomes while also offering health care
professionals’ evidence on the impacts of care provided under varying conditions of nurse staffing.
2. The success of this project will be useful for health care professionals like clinical nursing
leaders and clinical nursing specialists in implementing guidelines with best practices and increase in
staffing to ensure that the patient population is well cared for. The expectation of the researcher is
that the organizational administrators will understand the importance of having adequate staff to cater
to their patients and the heightened risks that are associated with lower staffing levels. Though the
associations may not be identifiable at first, this research expects to find aspects that go beyond
staffing in hospital facilities as they affect patient outcomes.
3. The success of this project will allow the targeted facility administrator and staff to understand
the impact of lower staffing and the associated risks to the patient outcomes. Models of care have been
established to care for patients by the constellation of nursing staff and the dispersal of
responsibilities among other professionals like clinical nursing specialists. The project will use
evidence based practice to compare the conclusions in literature and the findings of this research. In
addition, it will also compare the relationship of findings of other researchers to the study.
References
Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011).
Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045.
2.3 Need and Evidence to Make Change
Provide current information on your needs assessment or analysis for change. Include the cost-benefit
analysis if indicated by design.
The heavy workload experienced by nurses due to increased demand for nurses, reduced staffing
and inadequate supply of nurses negatively affects patient outcomes (Curtin, 2003). As a result, there
is need for change in health care facilities to ensure that patients are well cared for by the nurses
and the outcomes are positive. To restore the patient’s trust in medical care, evidence based nursing
practice becomes indispensable as the degree of compliance and satisfaction by the patient improves.
This becomes vital especially when the medical needs are effectively met. As stated earlier, this study
aims to find out how staffing of clinical nurse specialists in a health care facility influences the
patient outcomes. The findings will enable the facility administrators to incorporate improvement
measures of making sure there are sufficient staff members to cater to their patients for positive
results.
Reference
Curtin, L. (2003). An Integrated Analysis of Nurse Staffing and Related Variables: Effects on
Patient Outcomes. Online Journal of Issues in Nursing. Vol. 8 No. 3. Retrieved from:
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/KeynotesofNot
e/StaffingandVariablesAnalysis.html
2.4 Theoretical Foundation
Describe the theory or theories that serve as the backbone of your project. Provide references for each
theory.
The main theory that will be used is the quality improvement theory, serving as the backbone of
the study. The theory of quality improvement involves a selection of complex interventions with a
variety of activities and elements like collection of feedback, creation of improvement methods and
interventions catering to staffing (Boaden, Harvey, Moxham & Proudlove, 2008). The role of theory is in
explaining the possibility of an occurrence or particular event and in providing reasons for future
outcomes that would possibly occur (Greenwood & Levin, 2007). I health care, quality improvement
theories serve in the adaptation of the environment by using the process of strategic planning for the
changes in the organization (Begun & Kaissi, 2005). This will ensure that the path of the organization
is guided effectively. For this project, the theory can be used effectively in engaging staffing
qualities that would cater to the patient population for improving positive outcomes.
References
Begun, J.W., & Kaissi, A.A. (2005). An exploratory study of healthcare strategic planning in two
metropolitan areas. Journal of Healthcare Management. Retrieved from: http://www.highbeam.com/doc/1G1-
135077972.html.
Boaden, R., Harvey, G., Moxham, C., & Proudlove, N. (2008). UK
National Health Service Institute for Innovation and Improvement. Quality improvement: Theory
and practice in healthcare. Retrieved
from http://www.lj.se/info_files/infosida32905/quality_
Improvement.
Greenwood, D.J., & Levin, M. (2007). Introduction to action research: Social research for social
change, (2 ed.). Thousand Oaks, CA: Sage Publications.
2.5 Researcher Positionality:
• Insider
• Insider w/collaboration
• Reciprocal collaboration
• Outsider, collaboration w/ insiders
Define your role, position, and how positionality will impact your research study.
The position of the researcher will be that of the outsider while collaborating with insiders
to ensure the discovery of what changes are needed to occur so that more clinical nursing specialists
are employed as staff in the health care facility so as to cater to the increasing population of
patients. In relation to the area of study, there should be a clear statement of the position of the
researcher. There has been a blur in separating outsiders and insiders in qualitative research
(Ritchie, Zwi & Blingnault, (2009). Thus, there is significance in defining what position the
researcher holds by the distance created psychologically and physically from the studied phenomena.
By being an outsider, the researcher will make an evaluation of the methods of study being used so that
strategies for improvement can be recommended. It is also important to be an outsider to ensure that
there is no bias due to personal feelings, which might lead to alteration of the study’s interpretation
and thus, hinder progress. By being in collaboration with insiders, the researcher as an outsider will
conduct interviews to get feedback from the staff at the facility on the staffing of clinical nursing
specialists and the patient outcomes related to it.
References
Moore, J. (2012). A personal insight into researcher positionality. Nurse Researcher 19(4) 11-14.
Retrieved from
http://web.ebscohost.com.library.capella.edu
Ritchie, J., Zwi, A. & Blignault, I. (2009) Insider-outsider positions in health development research:
reflection for practice. Development in practice. 19(1) 106-112.
2.6 Research Questions and Project Goals/Objectives
List the research questions or project goals. These should align with the need for organizational
structure or activities/outcomes of the project.
The main focus of this research will be based on evidence-based practice of clinical staffing
of nursing specialists in order to get the positive outcomes of patient care in health care facilities.
1. What are the roles and responsibilities of clinical nurse specialists in a health care
facility?
Objective: To discover what roles are played by the clinical nurse specialists in the facility
2. What are the effects of lower staffing of clinical nursing specialists in nursing facilities?
Objective: To discover the staffing levels of the facility and what effects it has on patient outcomes
3. Is there an association between staffing of clinical nurse specialist and patient outcomes?
Objective: To measure the level of clinical nurse specialist staffing and patient outcomes
Section #3 To be completed by Learner
3.1 Action Plan
Provide detailed steps to implementing your research plan. This should read like a recipe for
conducting your project.
Be sure to include all the necessary details so that someone else would be able to follow this and
replicate the project exactly.
3.2 Results
Describe your program evaluation and dissemination of results plan.
3.3. Measures and Instruments
List and describe each data collection instrument or measurement tool you will use. This includes
questionnaires, formal interview protocols, forms, etc. Include:
a. Data type(s) generated by each measure
b. Available psychometric information (including validity and reliability coefficients)
c. How this data will be used
Attach a copy of each instrument you plan to use as an appendix to your SMART form.
3.4 If Modifying an Instrument:
Describe any pilot test or field test that may be required for any instruments. Type NA if not
applicable. Field tests must be done:
a. For new instruments or questions developed by the learner.
b. With expert panelists. Field tests require no IRB review. A pilot test requires IRB review.
3.5 Assumptions
Identify the key assumptions of the project; use citations to support their adoption.
3.6 Limitations
Evaluate the weaknesses of your project at this time. Indicate areas to be improved before starting
your project and areas that cannot be improved. Give reasons for not redesigning to address any of the
limitations identified.
3.7 Population and Sampling
Describe the key stakeholders or population of your project. Briefly describe the characteristics of
this sample, including:
a. Demographics
b. Inclusion criteria, if any
c. Exclusion criteria, if any
Describe how you plan to select the sample. Include the steps you will take to include participants.
3.8 Sample Size
What is the expected sample size? Provide citations to support the sample size decision.
3.9 Expected Site
Describe the organization or site(s) from which you expect to draw your sample.
3.10 Site Permission
Who is authorized to provide permission to use this organization or site? Does the site have an IRB?
What do you need to do to obtain permission to access the stakeholders, population, or data source?
3.11 Participant Contact
How will potential participants first be contacted? How will participants be contacted following the
study?
3.12 Data Analysis
Describe analysis procedures for each data type including: audiotapes, transcripts, videotape, field
notes, photos, descriptive analysis, other quantitative analysis, etc.
Describe all methods and procedures for data analysis including:
a. Types of data to be analyzed
b. Organization of raw data
c. Management and processing of data
d. Preparation of data for analysis
e. Storage and protection of data
3.13 Ethical Considerations
Describe any ethical considerations given the sample population and/or topic. Please explain as fully
as possible.
Describe any ethical concerns about defined researcher positionality. Address any potential for
coercion.
3.14 Risk Assessment
Is your study more than minimal risk? Refer to your CITI course for more information about minimal
risk. Please explain.
To be completed by Mentor
Mentor: Name Member #1: Name Member #2: Name Date & Reason for Deferral (if needed)
Topic Approval
SMART Approval
First Review
Second Review (if needed)
Third Review (if needed)
Faculty Chair consult (if needed)
NOTES:
Please attach the formal letter requesting permission, and letter of approval (on letterhead) to the
end of this SMART form prior to submission for School approval.
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