Nursing Project Intake Form

Please use this form to request or inquire about services from the Stephens Family Clinical Research Institute (SFCRI) at Carle for nursing evidence-based quality improvement (EBQI), innovation, or research projects. This is not a Carle IRB form nor a submission to the Carle IRB. The Research Nurse Specialist will reply to your inquiry.

*Initial inquiries for nursing graduate degree projects should also use this form. We can provide initial review, guidance and final approval for the project during the course of the degree program. Our overall expectation is that MSN or DNP projects will be designed as EBQI (not research). After submitting the form, we recommend a phone/on-line meeting between the student, faculty advisor, and Carle specialist to expedite the process.

First Name

Last name

Current Professional Credentials/Certifications

Expand

Preferred Email

Preferred Phone

Employer

Department/Practice Area

Manager/Director

School

Degree Program

Faculty Advisor/Mentor

Preferred Email

Preferred Phone

Name

Credentials

Expand

School or Organization

Preferred Email

Preferred Phone

I am requesting the following:

Consultation or guidance on starting an evidence-based project

Assistance in identifying a mentor/collaborator

Consultation on research collaboration/design

Provision of a survey platform for a project

Statistical consultation

Clinical/Service Area or Population of choice for project

Preferred Carle Mentor or Preceptor

name & role if known or we can suggestion options

Project Title/Topic Description

Expand

Project Goals/Aims

Expand

Anticipated Date for Implementation

* estimate of month/year for student projects or priority level for others

COMPARISON OF THE CHARACTERISTICS OF RESEARCH & QUALITY IMPROVEMENT

*Criteria used by SFCRI and Carle IRB. Nursing graduate projects must fall within EBQI criteria.

	Research	Evidence-Based Quality Improvement/Innovation
Intent/Purpose	Designed to develop or contribute to generalizable knowledge (e.g., answer a question or test a hypothesis)	Designed to implement already available knowledge to assess a practice or program within a particular institution by using established/accepted standards
Deviation from Standard of Care	May involve significant deviation from standard of care; informed consent is typically required, unless waived by an IRB	Unlikely to involve significant deviation from standard of care; patient consent beyond what is already obtained in clinical practice is usually not necessary
Design	Follows a rigid protocol that remains unchanged throughout the research; may involve randomization of individuals to different treatments, regimens, or processes	Adaptive, flexible design that generally does not involve randomization to different treatments or practices
Effect on Program/Practice Evaluated	Findings of the study are not expected to directly affect institutional or programmatic practice	Findings of the study are expected to directly affect institutional practice and identify corrective action(s) needed
Population	Usually involves a sample of the target population – universal participation of an entire clinic, program, or department is not expected; no obligation to participate; may involve statistical justification of sample size to achieve endpoints	Responsibility to participate as a component of the program; information is collected on all or most of the target population to compare a practice or program to established standards
Benefits	Participants may or may not benefit directly; intended to benefit future individuals	Directly benefits a process, program, or system; participants may or may not benefit
Risks	May expose participants to risks greater than ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests	Does not increase risk to patients, with exception of possible data privacy or confidentiality concerns
Dissemination of Results	Intent to publish or present generally presumed at outset of project as part of professional expectations, obligations; dissemination of information usually occurs in research/scientific publications; results are expected to develop or contribute to generalizable knowledge by filling a gap in scientific knowledge or supporting, refining, or refuting results from other research studies	Intent to disseminate results generally not presumed at outset of project; dissemination often does not occur beyond the institution evaluated; when published or presented to wider audience the intent is to suggest potentially effective models, strategies, assessment tools or provide benchmarks rather than to develop or contribute to generalizable knowledge; QI results may be shared through publications or presentations, but must always be referred to as QI and not research

Table adapted with permission from Children’s Hospital of Philadelphia Research Institute

Please direct any questions on use/functionality of this form to research@carle.com

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.