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DAISY Foundation Sign Up Information

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4/24/2020

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Membership Emails

Below is a sample of the emails you can expect to receive when signed up to DAISY Foundation.

Your response to Evidence-Base...

Thank you. Your response to Evidence-Based Practice Grant Application Form has been saved.

You can resume this form at any time by going to https://www.tfaforms.com/forms/resume/4735536.

IMPORTANT: Your submission is considered incomplete until you resume it and press the submit button.

Raw Data Registration Structure Registration Form Text

Registration

First name

Last name

Title

Password

Home address

City

State

Country

Postcode

Password (confirm)

Please select...

Do you have additional Team Members/Investigators to add?

Please select...

How many team members/Investigators do you wish to add?

Please select...

Country:

Please select...

State:

Please select...

Provinces:

Please select...

Are you using a copyrighted tool or instrument that requires permission from the author, publisher, or organization, etc. who created it?

Please select...

If you are using a tool that requires permission, please confirm that you have permission now to use the tools you propose

Please select...

Budget

Timeline

Tools or instruments you are using

Interview formats, discussion guides, etc.

Consent Forms- if consent forms are required for IRB approval, they must be submitted with this application.

References (detail the sources of your assumptions and literature review)

Permission to use the tools or instruments

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 I

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

Your project is an Evidence-based Practice Project (EBP), not a Quality Improvement project (QI)

Your Purpose statement contains the patient population matching The DAISY Foundation's mission, clinical problem, evidence-based intervention or practice change and desired outcome.

Your Team includes staff nurses in project leadership roles, change agent(s) and an EBP expert as a mentor.

Your Background describes why this is a priority for patients/families and the organization.

Your Background describes a synthesis of the evidence establishing the need to address the clinical issue (e.g., cited prevalence of the clinical problem), the benefit of the intervention, and expected impact on process and outcome indicators. Evidence is cited that is current and comprehensive. If a practice guideline is part of the evidence synthesis you include a brief summary of the strengths and limitations as identified by your critique (e.g., using the AGREE Instrument - link to http://www.agreetrust

Your EBP Process Model provides direction for project development and planning. Commonly-used models include the Iowa Model, Johns Hopkins Model, or another model used in your organization.

Your Proposed change describes the procedure for the use of the evidence-based practice being introduced such that any nurse reader would be able to use the procedure as intended. Please see the sample EBP proposal for ideas when describing the desired practice, timing within patient encounters (e.g., week 4 of radiation therapy) and use of tools to engage patients and clinicians.

Your Implementation Plan describes a multi-faceted approach to engage clinicians and patients in use of the practice change. Do not limit implementation to education of clinicians, as additional implementation strategies will be needed. Consider a re-infusion plan along with a plan to promote initial adoption.

Your Process evaluation is included in the evaluation plan and describes the key process measures/indicators including a general definition (e.g., patient activity practices will be collected by interviewing patients to self-report the frequency and time spent walking, gardening, household chores, work, and other forms of physical activity over the past week), how data will be collected, planned data analysis and reporting. Examples of process measures include clinician knowledge, clinician feedback on impl

Your Outcome evaluation is included in the evaluation plan and describes the key outcome measures/indicators including a definition (e.g., patients will be asked to rate their fatigue on a 0-10 scale using Brief Fatigue Inventory (used with permission, The University of Texas MD Anderson Cancer Center, 1997), how data will be collected, planned data analysis and reporting. Examples of outcome measures include patient symptoms related to cancer or cancer treatment. Preliminary data may be helpful but is not

Your Attachments include ALL the tools to assist the clinician in engaging patients to participate in the practice change.

Your Attachments include ALL the tools used for data collection.

Your Attachments include all letters granting permission for use of tools.

Your Attachments includes a timeline that uses the format described above. It includes the steps of the EBP process following development of the tools supporting the practice change (i.e., Copying of patient materials, copying of data collection tools, staff training about practice change, core group work to promote adoption of the practice change, reinfusion plans, monitoring progress, data collection, data entry, data cleaning and analysis, Interim and Final Reports to The DAISY Foundation, etc.)

Your Attachments include a budget for materials and tools needed to engage patient in the practice change, train clinicians and complete the evaluation. You have used the format described above.

Your Attachments includes the letter of agreement with The DAISY Foundation, signed by you and your CNO or other administrative leader.

Your Attachments includes the list of references cited within the application.

Your Attachments include the CV of the applicant and EBP mentor. Acknowledgemnt By checking this box and submitting the online form, you agree to The DAISY Foundation collecting and storing your personal contact information. We may contact you if we have questions about your submission or to discuss next steps.� To learn more, please read our Privacy Policy.

Data Name	Data Type	Options
	Text Box
First name	Text Box
Last name	Text Box
Title	Text Box
Password	Text Box
Email	Text Box
Home address	Text Box
City	Text Box
State	Text Box
Country	Text Box
Postcode	Text Box
Password (confirm)	Text Box
	checklist
	button
	dropdown	Please select...
	dropdown	Please select...
Do you have additional Team Members/Investigators to add?	dropdown	Please select...
How many team members/Investigators do you wish to add?	dropdown	Please select...
Country:	dropdown	Please select...
State:	dropdown	Please select...
Provinces:	dropdown	Please select...
	dropdown	Please select...
	dropdown	Please select...
	dropdown	Please select...
	dropdown	Please select...
Are you using a copyrighted tool or instrument that requires permission from the author, publisher, or organization, etc. who created it?	dropdown	Please select...
If you are using a tool that requires permission, please confirm that you have permission now to use the tools you propose	dropdown	Please select...
	file
Budget	file
Timeline	file
Tools or instruments you are using	file
Interview formats, discussion guides, etc.	file
Consent Forms- if consent forms are required for IRB approval, they must be submitted with this application.	file
References (detail the sources of your assumptions and literature review)	file
	file
Permission to use the tools or instruments	file
	file
	file
	checklist	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 I
	checklist	Now that you have completed your proposal, please review it and check off each of the following requirements:
	checklist	Your project is an Evidence-based Practice Project (EBP), not a Quality Improvement project (QI)
	checklist	Your Purpose statement contains the patient population matching The DAISY Foundation's mission, clinical problem, evidence-based intervention or practice change and desired outcome.
	checklist	Your Team includes staff nurses in project leadership roles, change agent(s) and an EBP expert as a mentor.
	checklist	Your Background describes why this is a priority for patients/families and the organization.
	checklist	Your Background describes a synthesis of the evidence establishing the need to address the clinical issue (e.g., cited prevalence of the clinical problem), the benefit of the intervention, and expected impact on process and outcome indicators. Evidence is cited that is current and comprehensive. If a practice guideline is part of the evidence synthesis you include a brief summary of the strengths and limitations as identified by your critique (e.g., using the AGREE Instrument - link to http://www.agreetrust
	checklist	Your EBP Process Model provides direction for project development and planning. Commonly-used models include the Iowa Model, Johns Hopkins Model, or another model used in your organization.
	checklist	Your Proposed change describes the procedure for the use of the evidence-based practice being introduced such that any nurse reader would be able to use the procedure as intended. Please see the sample EBP proposal for ideas when describing the desired practice, timing within patient encounters (e.g., week 4 of radiation therapy) and use of tools to engage patients and clinicians.
	checklist	Your Implementation Plan describes a multi-faceted approach to engage clinicians and patients in use of the practice change. Do not limit implementation to education of clinicians, as additional implementation strategies will be needed. Consider a re-infusion plan along with a plan to promote initial adoption.
	checklist	Your Process evaluation is included in the evaluation plan and describes the key process measures/indicators including a general definition (e.g., patient activity practices will be collected by interviewing patients to self-report the frequency and time spent walking, gardening, household chores, work, and other forms of physical activity over the past week), how data will be collected, planned data analysis and reporting. Examples of process measures include clinician knowledge, clinician feedback on impl
	checklist	Your Outcome evaluation is included in the evaluation plan and describes the key outcome measures/indicators including a definition (e.g., patients will be asked to rate their fatigue on a 0-10 scale using Brief Fatigue Inventory (used with permission, The University of Texas MD Anderson Cancer Center, 1997), how data will be collected, planned data analysis and reporting. Examples of outcome measures include patient symptoms related to cancer or cancer treatment. Preliminary data may be helpful but is not
	checklist	Your Attachments include ALL the tools to assist the clinician in engaging patients to participate in the practice change.
	checklist	Your Attachments include ALL the tools used for data collection.
	checklist	Your Attachments include all letters granting permission for use of tools.
	checklist	Your Attachments includes a timeline that uses the format described above. It includes the steps of the EBP process following development of the tools supporting the practice change (i.e., Copying of patient materials, copying of data collection tools, staff training about practice change, core group work to promote adoption of the practice change, reinfusion plans, monitoring progress, data collection, data entry, data cleaning and analysis, Interim and Final Reports to The DAISY Foundation, etc.)
	checklist	Your Attachments include a budget for materials and tools needed to engage patient in the practice change, train clinicians and complete the evaluation. You have used the format described above.
	checklist	Your Attachments includes the letter of agreement with The DAISY Foundation, signed by you and your CNO or other administrative leader.
	checklist	Your Attachments includes the list of references cited within the application.
	checklist	Your Attachments include the CV of the applicant and EBP mentor. Acknowledgemnt By checking this box and submitting the online form, you agree to The DAISY Foundation collecting and storing your personal contact information. We may contact you if we have questions about your submission or to discuss next steps.� To learn more, please read our Privacy Policy.