Dartmouth Hitchcock Medical Center

Office of Professional Nursing

FORM FOR SCIENTIFIC REVIEW OF RESEARCH PROPOSALS

Project Titles: ______Investigator(s): ______Affiliation(s): ______

______The questions in Part A of this form are to be answered to the best of your knowledge. You do not need to seek out answers that you currently do not possess. This section is only meant to serve as a global feasibility review. A full administrative review will be done by appropriate nursing directors.

A. REVIEW FOR FEASIBILITY Comments

1. Are the required data and/or subjects available? ( )Yes ( ) No

2. Are the projected dates for data collection reasonable? ( )Yes ( ) No

3. Is the investigator qualified to conduct this study? ( )Yes ( ) No

4. Will the study compromise or interfere with patient care? ( )Yes ( ) No

5. Will the study compromise or interfere with present or projected research? ( )Yes ( ) No

6. Is the study consistent with the philosophy, objectives, and policies of the Department of Professional Nursing? ( )Yes ( ) No

7. Is the proposed study feasible at DHMC at this time? ( )Yes ( ) No

If there are major obstacles to feasibility, you may stop after completing Part A and return this form to the Nursing Research Coordinator. If there are no obstacles to feasibility, please complete Parts B & C.

B. SCIENTIFIC REVIEW

Comments/Suggested Changes

1. Research Problem: Is the problem relevant? Does the background statement give adequate rationale for study? Have appropriate variable been selected?

of 2 Comments/Suggested Changes

2. Sample: Is the method of sample selection appropriate? Are the subjects adequate in number and appropriate in type?

3. Procedure: Is the research design appropriate to the study? Are the procedures to be employed clinically sound? Are the tools/measurements appropriate; will they yield the desired data?

4. Risks/Benefits: Is the risk-benefit ratio acceptable? Are procedures for informed consent adequate?

5. Data Analysis: Is the data analysis plan adequate for the purpose of this study?

6. Overall Evaluation (Please rate this proposal on each of the following factors): Excellent Poor a. importance of the problem addressed 5 4 3 2 1

b. usefulness/applicability of results 5 4 3 2 1

c. overall scientific merit of study 5 4 3 2 1

C. APPROVAL

Please circle one response following each statement:

1. This study has sufficient scientific merit to warrant approval for its conduct within this hospital.

a. Yes b. No

2. My level of excitement and support for this project is:

a. very high b. moderately high c. neutral d. moderately low e. very low

Name of reviewer: ______Date: ______

Send completed review to Nursing Research Coordinator, Office of Professional Nursing.

Editor’s note: This form was taken from the book, Evidence-Based Practice in Nursing: A Guide to Successful Implementation. To find out more about the book and to order a copy visit http://www.hcmarketplace.com/prod- 3737.html.