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 ACTION RESEARCH TEMPLATE (SMART) FORM
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 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 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
http://www.chofsa.org/

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 addressed.
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.

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. 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.
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/KeynotesofNote/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). 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.

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