Research Grant Application Form

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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







Payment Information:











Institutional Official: If there is an Institutional Official (IO), who should receive copies of funding approval and report requests, please complete the information below.






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. Use the APA format for references, citing the author and publication year in parentheses. (For example, Smith and Jones, 2012.) Then detail your references on an attachment.


To determine the number of words you are using, type in a Word document first and use word count.  Then copy/paste into the form below.

Abstract


Significance/ Background

NOTE ABOVE:

Briefly describe the background of your proposal, including:

  • A critical evaluation of the existing body of knowledge about the problem.
  • Identify the importance of this study by relating it to existing knowledge.
  • Summarize how the proposed research addresses the priorities of the J. Patrick Barnes Grant program.
  • Include a list of references as an attachment (upload explained below).
Specific Aims and/or Hypothesis

NOTE ABOVE

Your aims or hypothesis should be specific (Example: Less strong: we want to determine if a patient/family education program works.  Stronger: Determine if there is an improvement in patient/family satisfaction with discharge education after implementation of a computer-based medication education program).
Methods

NOTE ABOVE
    • Detail the methods you will use for the research.
    • Identify your sample (characteristics, sample size, provide power analysis as appropriate to justify your sample size). Explain the difficulty or ease you believe you'll have recruiting your sample and why you feel this way.
    • Specify the protocols and instruments you will use. If you are using a particular instrument, provide a copy as an attachment. As appropriate, provide information on the psychometric properties of the instrument you are proposing to use. Please be sure you have already obtained permission to use your tools so that this study is ready to implement once your IRB has approved it and we have agreed to fund it.
    • Describe outcome variables in detail.
    • Describe your proposed data analysis plan.
    • Please explain how you will maintain confidentiality.



    Clinical Nurse Engagement

    NOTE ABOVE

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

    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).  If the funding level offered by The DAISY Foundation is not adequate for your project, please email bonniebarnes@DAISYFoundation.org to discuss.

    budget


    Your Budget:

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

    Documentation

    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 study
    • 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 study 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 study in their marketing materials to help promote the grant program.
    • That I will submit my study 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 study.

     

    Signed ________________________________________                           Date_________________________

     

     

     FOR YOUR CHIEF NURSING OFFICER OR OTHER SENIOR ADMINISTRATOR:

     

    I fully support __________________________________, Principal Investigator of the study 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.

     

    Signed__________________________________________________

     

    Title____________________________________________________

     

    Date___________________________________________________

    Acknowledgemnt

    Contact Information