APPLICATION FORM FOR RESEARCH ETHICAL APPROVAL

This application is for research ethical approval only.

Please indicate your program

./ Bachelor of Nursing Science with Hons.

/
/ Master of Nursing
1
/ Doctor of Nursing
/
/
SECTION
\ A APPLICANT INFORMATION
\
1. / Student’s Name : SITI ROHAIZA BINTI SUBAKIN
/
/ Matric No. : 820810016500001

Contact No. : 013-3339486

Email : SITIROHAIZA@OUM.EDU.MY

Learning Centre : OUM JOHOR BAHRU

Supervisor’s Name :PUAN MANICKAVALLI

Contact No. :0129865287

Email manicka8@hotmail.com

Project Title: FACTORS INFLUENCING JOB STRESS AMONG PERIOPERATIVE

NURSES IN AN OPERATION THEATRE, JOHOR GOVERNMENT HOSPITAL.

Softcopy of the application form must be submitted with the research proposal to the secretariat
of the Research Ethical Committee.

1
SECTION B TO BE COMPLETED BY SUPERVISOR

Supervisor Checklist : Please place a tick () in the “Proposal” Column to indicate
compliance of each item stated below.

Dimension Proposal

Title /

Background to the study /

Statement of the Problem /

Research Objectives and Questions (hypotheses) /

Significance of the study /

Operational definition of terms /

Literature Review /

Methodology /

Ethical considerations /

Data Collection Tools (e.g. Questionnaire or Interview script) /

Adequate presentation, style, and language,references (APA Format) /

I certify that the student is ready for his/her ethical approval.

Comment/ Suggestion:
Make problem statement stronger.
Name of Supervisor : Manicka Valli A/P Ramahsendran

Supervisor’s Signature : Manicka Valli

Date : 11.9.2022

2
SECTION C REVIEWER RECOMMENDATIONS FOR IMPROVEMENT

Please tick (√ ) either Major or Minor.

Dimension Criteria Minor Major

 The title is clear and focused and reflects the need OK
Title of the study incorporating adequate information
(e.g. variables, subjects & research setting).
OK
Background to  Background information is relevant and clear.
the study and OK
 The problem statement is well articulated, clear,
Statement of
focused, precise and relevant. Contents
the Problem
supported/justified by theory and/or evidence.
OK
Research  Research Objectives & Questions/hypotheses are
Objectives and focused, clearly related to the problem.
Questions  The research objectives, questions and/or research
(hypotheses) hypotheses are well aligned.

Literature  Adequacy, clear, current, well developed, well Adequate

Review written and organised
Appropriate
research
design, please
add more
 Appropriate research design and methods. sample
 Justifications for the use of the methodology More
Methodology provided. explanation on
 Instrument used is appropriate your
(e.g Questionnaire/Interview script) Questionnaire,
Is there any
scoring?
Data analysisno
information.
 Well written and complete description of ethical Please
consideration. improve on
APA, -
 Ethical consideration following guidelines.
Ethical should not
- Letter of permission – Authority (Hospital / OUM
Considerations have any
/ other organisation)
number.
- Participants
 Confidentiality assurance / informed consent

Reviewer comment/suggestion:

Please improve according to the above feedback

...................................................................................................................................................................

Signature of Reviewer : AiniAhmad

Name of the Reviewer : AP Dr Aini Ahmad

Date : 03/11/2022

3
SECTION D VERIFIED BY CHAIRPERSON

RESULT FOR ETHICAL APPROVAL APPLICATION

(Tick one box only)

Approved with minor correction

 [Can proceed to data collection.]

Not approved with major correction

[Revise proposal & seek guidance from supervisor before resubmit for approval.]

Comment(s):

.......Kindly proceed.

Chairperson’s Signature : ........

Chairperson : .......YEE BIT LIAN................................................

Date : .....08/11/2022........................................................