OLOL RMC Nursing Research Council

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Have you received a letter of approval from the department leader where this will be completed?* This field is required.

YESNO

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Letter of Approval* This field is required.

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Has a faculty member reviewed your project prior to this submission?* This field is required.

YESNO

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Instructor's Name* This field is required.

First Name

Last Name

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Instructor's Email* This field is required.

example@example.com

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Thank you for expressing interest in the Nursing Research Council. However, further progress is contingent upon obtaining a Letter of Approval from your respective leader or director in the field of your intended project or study.

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Please Select* This field is required.

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Title of Project* This field is required.

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Title of Study* This field is required.

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Project Lead* This field is required.

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Project Lead Email* This field is required.

example@example.com

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Primary Investigator* This field is required.

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Primary Investigator Email* This field is required.

example@example.com

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Project Co-Lead

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Sub-Investigator(s)

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Other Project Team Members:

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Other Research Study Members:

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Select all that apply related to the intent of the research:* This field is required.

Results will create new knowledge.

Results will be generalizable outside of current setting.

Findings will be published outside of current setting.

Other

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Select all that apply related to the intent of the project:* This field is required.

Current accepted standard of care will be implemented

Results will be generalized to specific internal patient population

Risks no not exceed usual care

Information being collected is routine care

Only de-identified data will be collected

Personal health information (PHI) will not be sent outside organization

Other

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Introduction/Background

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What is the issue?* This field is required.Introduction/Background

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Identify any pre-data that exists related to the issue and time frame data was collected.* This field is required.

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Review of Literature

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What literature exists to address issue?* This field is required.

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Is the current literature applicable to setting?* This field is required.

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Is there research/evidence to support the recommended interventions?* This field is required.

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What is the project goal?* This field is required.

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What is the research question?* This field is required.

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Methods

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What is the indication for change?* This field is required.

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What is the indication for research proposal?* This field is required.

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Who is the sample?* This field is required.Include inclusion and exclusion criteria.

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Identify any data collection/measurement tools to be used in study.* This field is required.Include a statement on the validity and reliability of tool; attach appropriate tools; attach permission from original author to use tool.

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Attach appropriate tools and permission form original author to use tool.

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How will data be collected?* This field is required.

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Identify timeline for project.* This field is required.

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Identify intent to submit to Institutional Review Board (IRB)* This field is required.Required for research.

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Identify intent to submit to Institutional Review Board (IRB)

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Identify how human subjects/data will be protected.* This field is required.Include how data will be handled and confidentiality protected.

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How will consent/assent be obtained? * This field is required.

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Consent Form* This field is required.

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Analysis, Results and Dissemination

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What is the plan for evaluating/interpreting results? * This field is required.

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How will results be disseminated?* This field is required.

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References* This field is required.

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Supporting Documents

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Additional Considerations:

Complete CITI training prior to approval of project; certificate must be submitted
- https://www.citiprogram.org/Default.asp
- Create an account
- Select Franisician Missionaries of Our Lady of the Lake RMC
- Complete Social & Behavioral Research – Basic/Refresher, Basic Course
Signed and dated CV/resume
Verification of current licensure
Contact Fran U Institutional Review Board-Office of Research