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Application Details

Projected Dates of Project:  We realize that you may not have precise dates at this time.  Your best guess will suffice.

Principal Investigator Information:

Additional Team Members/Investigators
If there are additional people on your team please add them below- you may list up to 5 total

Additional Team Member/Investigator #1

Additional Team Member/Investigator #2

Additional Team Member/Investigator #3

Additional Team Member/Investigator #4

Additional Team Member/Investigator #5

Your Current Institution Information:

Institutional Official

Institutional Official (IO) Contact Information:

Payment Information:

Mentor Information
We strongly encourage our applicants to have mentors for their work, especially if you are not a highly experienced researcher. Hopefully a mentor will be available in your own institution or a nearby college/school of nursing.

Mentor: If you have a project mentor, please enter their information below:

IRB Information:

Please complete the following proposal. Please number your references throughout. (For example, “Cholesterol is comprised of two values(3)”. Then, please use APA format and detail your corresponding references on an attachment. (For example, Smith and Jones, 2012.)


NOTE ABOVE: Be as specific as you can.

Include the Population (i.e., patient/family), clinical Problem, evidence-based Intervention for the practice change and desired Outcome.


    • Describe the current issue (i.e., clinical condition, social services, or community need) that you propose to change and cite appropriate evidence. Preliminary data or a community assessment may be included.
    • Who is the target audience? (e.g. what group of patients/family will be the focus of the project?)
    • Describe why this is a priority for this population (i.e., 1) report the established needs of the community as assessed by the Community Benefits Office, 2) prevalence of the issue, and 3) describe the link between the social/service/economic opportunity to the evidence-based intervention).
    • Describe how this project will benefit patients/families affected by SDOH(s), in keeping with DAISY Foundation’s stated goal.
    • Cite and summarize evidence (e.g., patient focused data establishing a need, practice guidelines and more recently published research and research supporting the practice change) to support the need for a change, and also cite evidence to support the expected benefit of the initiative you are proposing.
    • Upload a list of references as an attachment to the application. (Uploading is explained below.)

    Proposed Change


      • List step-by-step how the change will be implemented. Please see the sample EBP proposal for ideas when describing the desired practice. Implementation should include a description of the strategies (see below) that will promote adoption of the evidence-based intervention, not project management activities (e.g., building rapport, garner community leader support, arranging meetings).  
      • Describe timing within encounters and use of resources/tools to engage patients, families and clinicians.
      • When will you evaluate the outcomes of the change?
      • This description should be detailed enough that the reviewer could independently replicate development of evidence-based intervention for your project.
      • The tools of the practice change must be ready to use and attached.


      Implementation Plan

        • Outline and use a phased implementation plan. A phased approach to implementation that prepares clinicians, assisting them with adoption of the EBP and re-infusion is required. One resource to provide direction is: Cullen, L. & Adams, S. (2012). Planning for Implementation of Evidence-Based Practice. Journal of Nursing Administration 42(4), 222-230.
        • Include a multi-faceted approach to implementation with specific implementation strategies (e.g., build expertise among local change champions, training build skill competence, delivery of accessible resources/tools).
        • Education can be included but must not be the only implementation strategy.
        • This description should be detailed enough that the reviewer could independently replicate implementation of your project.

        NOTE ABOVE

        Outcome measures include 1) what process data will be collected (e.g., hemoglobin A1c testing, improved access to services, feasibility of use of the evidence-based intervention), 2) what outcome data will be collected (e.g., hemoglobin A1c <7% for diabetics, consumer reported change in symptom, quality of life) 3) a definition (e.g., patients will report their quality of life using the Veterans RAND 12-Item Health Survey (VR-12) (used with permission, The RAND Corporation, 2017), 4) how data will be collected (e.g., hard copy of questionnaire), 5) planned data analysis, and 5) reporting.

        Evaluation Plan

        NOTE ABOVE:

        Describe in detail how you will evaluate the outcomes of your initiative. Be as specific as possible on what your outcome measures are.

        • Include a brief description of the sample size and identification of the usual care group representing the current status and the EBP or practice change group. Include a brief description of the sample and sample size for clinicians, and patients or the community participating.
        • Process measures include clinician knowledge (e.g., knowledge of community resources for nutritional support, resources supporting access the healthy food, points for nutritional guidance), clinician feedback on implementation with resources/tools, clinical practices used by clinicians (e.g., frequency of providing nutritional education), patient knowledge or patient health behaviors (e.g., where to access healthy foods, recipes and cooking habits).
        • The process measures include 1) a general definition (e.g., patient health activities will be collected by interviewing patients to obtain their self-reported frequency and time spent walking, gardening, doing household chores, work, and other forms of physical activity over the past week), 2) how data will be collected (e.g., patient interview), 3) planned data analysis (e.g., percent change in physical activity, paired t-test) and 4) reporting (e.g., report to local community council, school committee).
        • Evaluation includes process measures (e.g., how you evaluated actually use of the evidence-based interventions) and outcome measures/endpoints in this section (e.g., pre -post evaluation of clinical symptoms)
        • Preliminary data may be helpful but is not required.
        • This description should be detailed enough that the reviewer could independently replicate evaluation of your project.

        Clinical Nurse Engagement

        NOTE ABOVE

        • Describe in detail how clinical/staff nurses will be involved in this project. E.g. in conceptualization, data collection, analysis, reporting. This is a very important component of your proposal.

        Detail your proposed step-by-step timeline, following this example. Your plan should not exceed 12 months.

        Study Timeframe

        Your Timeline:

        Create a spreadsheet identical to the one above to present your project’s timeline. Include additional steps from the EBP process model you identified previously as guiding this project work.  Please upload your timeline at the end of this application.

        Proposed Budget

        Funds are available for direct expenses only. Institutional overhead may not be included. Provide budget using the following chart and describe/provide justification for how you will use the grant funding to support your project (e.g., cost for reproduction of booklets - 500 booklets @ $2/booklet = $1000).


        Your Budget:

        Create a spreadsheet identical to the one above to present your project’s budget.  Please upload your budget below.


        DOCUMENTATION – Upload the documents listed below.

        Letter of Agreement

        Please copy and paste this onto your institution’s letterhead.  Fill in the blanks, print it out and sign it. Your Chief Nursing Officer or other Senior Administrator's signature is also required as an indication of her/his support of your work. 

        Then scan it into your computer, and upload with this application.  Your application is not complete without this document.

        Letter of Agreement:

        I, __________________________________________, Team Leader/Project Leader/Principal Investigator of the  project entitled _________________________________________________, commit the following to The DAISY Foundation in return for funding I request of $____________:


        • That funds will be used only for direct expenses as detailed in the budget provided in my application
        • That I will inform The DAISY Foundation of the actual start date of this project
        • That a check for any unused funds will be sent to The DAISY Foundation within 90 days of the project’s completion
        • That I will communicate in writing to The DAISY Foundation if my project is terminated before completion
        • That an interim report will be submitted 6 months after funding and a final report submitted within 90 days of the project’s completion. These reports will be submitted through The DAISY Foundation website.
        • That the report of my project may be posted on The DAISY Foundation website, if the Foundation chooses to do so.
        • That the DAISY Foundation is permitted to use my name/those of my team members and institution and the title and summary of my project in their marketing materials to help promote the grant program.
        • That I will submit my EBP project to the Virginia Henderson Library of Sigma Theta Tau International within 30 days of filing my final report with The DAISY Foundation.
        • That I will credit funding from The DAISY Foundation upon publication/presentation of this research, using the authorized DAISY Foundation logo to be provided by The Foundation.
        • That The DAISY Foundation may not be held liable for any risk to the subjects of this project.


        Signed ________________________________________                           Date_________________________





        I fully support __________________________________, Principal Investigator of the EBP project entitled ___________________________________________________ in her/his implementation of this project.


        Furthermore, I attest to the fact that nurse clinicians/staff nurses will be involved in this work, as described in the application.







        Application Checklist
        Now that you have completed your proposal, please review it and check off each of the following requirements:


        Please allow a few minutes for the form to process. If the form becomes stuck on "please wait" or you are not re-directed to another page after you hit submit, please email Christina Johnson at ChristinaJohnson@DAISYFoundation.org to confirm we have received your submission. Thank you!