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a.k.a. “Research Plan”
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 aIDition 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 1: Learner Completed CITI Modules

Milestone 2: Committee approved topic (Sections 1 & 2 of SMART form)

Milestone 3: Mentor Approved Research Plan (complete SMART form)
Milestone Group 2

Milestone 4: Committee Approved Research Plan

Milestone 5: School Approved Research Plan

Milestone 6: University Approved IRB

Milestone 7: Committee Conference Call
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 210-381-5219
1.5 Mentor Name/Email Dr. Terry Karjalainen

1.6 Committee Member #1 Name/Email Dr. Magdeline Aaagard

1.7 Committee Member #2 Name/Email Dr. Dana Moretz

1.8 Dissertation Title How Organizational Changes in Nursing Care Affects the Registered Nurses (RNs) 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

1.10 Contact Info for Site Approver & Expected Approval Date Anticipated Expected Approval Date is 2016.
Section #2

2.1 Project

Write approximately one paragraph that describes the action research project and the basis for it being aIDressed.
Clinical nurse specialists (CNS) are active participants in the delivery of high quality care, in the collection of pertinent feedback from stakeholders, and in the provision of affordable and timely interventions, especially during periods of organizational changes (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 primarily on population-based care across specialized domains of competence: patient/family systems, nursing care models, etc. (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 or relevance of patient safety on clinical nursing practices 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 staffing 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.

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 oIDs 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. This project can be used as a guideline for assessing the adequacy or lack thereof of arrangements that affect CNS staffing. 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 care 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 utilization of better staffing to ensure that the patient population is well cared. The assumption is that there is a one to one correspondence between patient health outcomes and staffing requirements. 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 poor staffing on patient outcomes and the associated risks thereof. 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 utilize evidence-based practice to compare the conclusions in literature and the findings of this research. This project therefore is confirmatory in character since the goal is to discover how the organizational changes in nursing staffing 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.
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.

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:

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). In 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.

Begun, J.W., & Kaissi, A.A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management. Retrieved from:

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
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.

Moore, J. (2012). A personal insight into researcher positionality. Nurse Researcher 19(4) 11-14. Retrieved from

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.
To complete this research; adequate information will be gathered from the CNS as the key specialists directly involved with the issue and RNs. Theoretical information will also be gathered from journals, books, and other online sources to support the findings of this research. Data will be gathered to support this study and make a statistical analysis of the issue and how it impacts service delivery at the selected health facility. To gain insight into the influence of the organizational change in the nursing sector; the main interview will be carried out with a sample of CNS and RNs that will be selected randomly (Rowley, 2012).
The project will be guided by the objectives outlined above so as to make a clear flow and management of the issues be aIDressed. The major part of this project will relate to a gathering of adequate and accurate data through the interviews and a review of the relevant hospital records. The project will also be supported by personal views on the matter based on the results of the data collected. The data will be analyzed and the conclusion drawn thus making it easier for deductions to be made. Crucial data analysis tools will be used to ensure accuracy in interpretation of the data thus aIDing to the quality of the research (Kim, 2011). Data will finally be presented in various forms to make it easy to read. The various data presentation forms to be used include tables and charts.

Rowley, J. (2012). Conducting research interviews. Management Research Review, 35(3/4), 260-271.
Kim, Y. (2011). The pilot study in qualitative inquiry identifying issues and learning lessons for culturally competent research. Qualitative Social Work, 10(2), 190-206.

3.2 Results

Describe your program evaluation and dissemination of results plan.
Before conducting the research project, the data collection tools will be tested for suitability for this kind of study. A sample and closely related pre-test project will be conducted to verify the use of the data collection tools for this study. Also, the sample group to be interviewed will be notified about the matter as part of the preparations for the data collection tasks. A timeframe will be established in line with each objective to be achieved to ensure that every task is connected in its right time (Cardello et al., 2012). The established procedure will be communicated to the relevant people involved in the research to ensure that each member is aware of the tasks to be done in the project.

Cardello, A. V., Meiselman, H. L., Schutz, H. G., Craig, C., Given, Z., Lesher, L. L., & Eicher, S. (2012). Measuring emotional responses to foods and food names using questionnaires. Food Quality and Preference, 24(2), 243-250.
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.
The study uses qualitative research methods to gather data. Under the qualitative research methods, various data collection tools to be used include;
And Observation
Qualitative research methods will be appropriate for this study since it relates to gathering data on observable phenomena. Also, qualitative research is easy to conduct and gather data on both small and large study groups. It will also facilitate the collection of theoretical data that can be analyzed statistically hence play a great role in the accuracy of the results. Questionnaires will be used as the major data collection tool to facilitate the data collection process. Questionnaires will be prepared in line with the objectives of the research so as to aIDress every matter to be investigated. Also, the data to be collected through questionnaires will be compared with that gathered through observations and interviews. Surveys will also be used in the study to maximize on data collection and accuracy. Each of the data collection tools to be used will also be tested for its applicability in the research so as to ensure accuracy as well as how it meets the goals of the study. A validated survey instrument, the PVCT (Perceived Value of Certification Tool) survey tool, will be used to gather pertinent data. This is a Likert scale-based survey which consists of 18 questions associated to respondents’ opinions on the value of certification. The questions are grouped into two: intrinsic and extrinsic subsets. The decision to use PVCT is influenced in part by its high level of validity and reliability, which to a certain degree, makes the survey instrument a valuable asset for both academic and clinically-based research projects.
Questionnaires will be used to generate both statistical and theoretical data depending on the formulated questions. Both theoretical and numeric information in the questionnaires will play a big role in the final analysis
Interviews will also gather both numeric and theoretical data that will be determined by the nature of questions. Observation will also contribute to the study as a unique tool in the data collection process. Unlike the questionnaires and the interview, observation will be used to review the hospital records on the issue (Shi et al., 2010). Observation will also be used to review the hospital’s operations in relation to patient satisfaction and how staffing problems affect the operations.
The data gathered using questionnaires and interviews are also reliable as it contains first-hand information that can be used to make deductions on the matter. The interview session and observations will provide a chance to enquire on other matters that can be applied in the study (Rohde, Lewinsohn, & Seeley, 2014). Gathering of data through open ended questions will be most suitable with interviews, hence their adoption in the study.
The selected data collections tools are most suitable because of their accuracy and simplicity in data collection and they are also cost friendly.
The selected data collections tools will facilitate the analysis of the data at each stage thus ensuring accurate results in the final analysis. The accuracy of the data collected through qualitative methods will ensure that the research is reliable and covers the matter exhaustively. It will also be easy to interpret and present the data through graphs, charts and tables. Qualitative research methods are not limited to rigidly definable variables thus making it suitable for the study. A further assessment of how other factors contribute to the observed phenomena in the health facility will also be carried out. Each of the data groups will be analyzed separately and used to make stage by stage deductions (Keenan, van Teijlingen, & Pitchforth, 2015). It will also be easy to notice and correct errors in the data and thus making the qualitative methods more suitable for this study. The data will be analyzed and used to show how changes in nurse staffing affect service delivery and flow of operations in the health facility.

Keenan, K. F., van Teijlingen, E., & Pitchforth, E. (2015). The analysis of qualitative research data in family planning and reproductive health care. Journal of Family Planning and Reproductive Health Care, 31(1), 40- 43.
Rohde, P., Lewinsohn, P. M., & Seeley, J. R. (2014). Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. American Journal of Psychiatry. 45-59.
Shi, L., Liu, J., Koleva, Y., Fonseca, V., Kalsekar, A., & Pawaskar, M. (2010). Concordance of adherence measurement using self-reported adherence questionnaires and medication monitoring devices. Pharmacoeconomics, 28(12), 1097-1107.

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.
Since a validated survey instrument (the PVCT survey tool) will be used in the collection of pertinent data, there is no need to conduct pilot testing. This is in part due to the high validity and reliability of the survey instrument.
The quality of the questions developed will also be assessed to ensure they meet the required standards for a questionnaire. The respondents will also be assessed to how far they understand the issue being investigated to ensure they give proper answers during the main study.
There is though a need to perform pilot testing for the purpose of assessing the effectiveness of using interviews in the study. This can be done by carrying out sample interviews with a group of CNS. The sample interviews will have closely related questions and also reflect what is to be covered in the main research. Sample interviews will be useful in making necessary recommendations on what should be covered or rectified before the main study is conducted. The sample interviews will be conducted on a small group of respondents who represent the entire sample population to be interviewed.

3.5 Assumptions

Identify the key assumptions of the project; use citations to support their adoption.
The assumptions that this study will make are that there is a sufficient population that has been chosen to give credible responses as well as act as a measure that reflects the health care industry and the institution conducting the study. Secondly, the entire sample population is not biased, and the information they provide is their opinion and not hearsay. This means that they will be honest and by extension, the conclusions made in the study will reflect their sentiments and not predetermined results that the members of the organization may have imprinted on them either directly or indirectly. The study will also assume that the length of the study is an inherent limitation that will have a degree of effect on the quality and quantity of the data collected.

The participants will provide the most true and accurate data based on their opinions without the influence of any member of the organization.
The scenario being tested relating to the current state of nursing is the best representation of the organization’s medical state.
The data collected is a real representation of the matter thus making it a reliable sample for the situation of the health facility.
The data analysis tools selected did not affect the results thus making the data the most accurate in the study (LoBiondo-Wood, Haber, Berry, & Yost, 2013).

LoBiondo-Wood, G., Haber, J., Berry, C., & Yost, J. (2013). Study Guide for Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. New York: Elsevier Health Sciences.

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 aIDress any of the limitations identified.
One of the limitations of the research is the inability to cover a large population during the data collection process. The small population will give an accurate but minimal representation of the issue being investigated. It will be difficult to conclude that the data collected is a clear representation of the problem applicable to other facilities.
Also, the research uses few data collection and analysis methods thus limiting its diversity and coverage of the matter. The use of qualitative methods limits the research to various outcomes that could have been improved on if a combination of both qualitative and quantitative research methods were used (Heiervang, & Goodman, 2011).
One of the areas to be improved is the formulation of questionnaires to be used in the research project. The questions will be restructured to ensure they cover the issue exhaustively. More questions will also be aIDed and formulated to cover on relevant areas intended for investigation.

Heiervang, E., & Goodman, R. (2011). Advantages and limitations of web- based surveys: evidence from a child mental health survey. Social psychiatry and psychiatric epidemiology, 46(1), 69-76.

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.
The population to be used for the study will be made of clinical nurse specialists and RNs at the facility. The first group will be made of nurses in the facility and other medical practitioners. The study population will be divided into two groups, the groups will consist of the clinical nurse specialists and the other group will comprise RNs. The division will help in ensuring that each group receives relevant questions to their role regarding the issue being investigated (Keenan, van Teijlingen, & Pitchforth, 2015).
The inclusion criteria includes 2 years and above working experience as the facility. This is important as most of the data being collected will rely on the hospital’s history regarding turnover rate and performance. Another inclusion criteria is that the participant must be working as a CNS or an RN at the facility.
To come up with the right sample, the study will use non-probability sampling method. It is easy to select a group of participants to represent the entire population through non-probability method thus making it suitable for the study. It will also be easy to group the participants various demographics including age, gender, income level, and location setting. Under the non-probability sampling, the purposive strategy will be used to help select and group the sample population for the study.
In order to recruit the CNS and RN participants, the researcher will meet with the Director, unit managers and professional staff to provide them with all details to seek volunteers and gain informed consent for the participating study. Participation will be confidential and strictly voluntary. Once the volunteers have been identified an email will be sent out with availability to schedule accordingly.

Keenan, K. F., van Teijlingen, E., & Pitchforth, E. (2015). The analysis of qualitative research data in family planning and reproductive health care. Journal of Family Planning and Reproductive Health Care, 31(1), 40- 43.
Kim, Y. (2011). The pilot study in qualitative inquiry identifying issues and learning lessons for culturally competent research. Qualitative Social Work, 10(2), 190-206.
3.8 Sample Size

What is the expected sample size? Provide citations to support the sample size decision.
Considering the hospital’s population of 400 nurses, a sample calculation using the online monkey survey tool calculator shows that: a sample of 78 nurses should be used in the study (SurveyMonkey, n.d). This number was reached by using 400 as the total population at a 95% confidenc

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