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Appendix F Informed Consent Form

This document is an Informed Consent Form for a research study conducted by the College of Nursing at Our Lady of Fatima University. It outlines the purpose of the research, participant selection, voluntary participation, risks, benefits, confidentiality, and the right to refuse or withdraw from the study. Participants are encouraged to ask questions and will receive a summary of the results while their personal information will remain confidential.

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30 views3 pages

Appendix F Informed Consent Form

This document is an Informed Consent Form for a research study conducted by the College of Nursing at Our Lady of Fatima University. It outlines the purpose of the research, participant selection, voluntary participation, risks, benefits, confidentiality, and the right to refuse or withdraw from the study. Participants are encouraged to ask questions and will receive a summary of the results while their personal information will remain confidential.

Uploaded by

Citrus Jay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Appendix F: Informed Consent Form

Our Lady of Fatima University


Quezon City Campus
College of Nursing

Informed Consent Form for _____________________

This informed consent form is for the ______________________________

(Name of Principal Investigator)- Principal Investigator

Our Lady of Fatima University QC

“TITLE OF THE RESEARCH STUDY”

This Informed Consent Form has two parts:

• Information Sheet (to share information about the study with you)
• Certificate of Consent (for signatures if you choose to participate)

You will be given a copy of the full Informed Consent Form

Part 1: Information Sheet

Introduction:

I am (Name of Principal Investigator), the principal investigator of our research under the College of
Nursing in Our Lady of Fatima University, Quezon City. I and my group members are working on (Title
of Research Study). We are going to give you information and humbly invite you to be part of our research.
You do not have to decide immediately whether you will participate in the research or not. You can talk
with someone or ask us about the research in such a way that you will be comfortable before deciding to
accept our invitation. This consent may also contain words that you can’t fully understand but you can reach
us out and let us explain further the sections that may be unclear to you. If you have a question later, you
are free to ask me, the other members, or another researcher.

Purpose of the research: _______________________________________________________

Type of Research Intervention: __________________________________________________

Participant Selection

Due to your academic affiliation and concerns about the research topic variables, we invite you to take
part and share your personal health information as _______________. We believe that you can provide
further understanding and intellect to help us gather our research findings.

Voluntary Participation

It is up to you whether you participate in this study or not. But if you choose not to answer or participate,
there will be no changes and it will not affect your academic performance or ratings. You have the right
to change your mind and refuse the participation.
Procedures (Data Collection Procedures)

A.

B.

Duration

(Discuss the duration of the study)

Risks

We are asking you to share with us some very personal information about _____________ and you may
feel uncomfortable talking about some topics. You can refuse to answer and ask to move on to the next
question if you do not want to answer and we will not ask why. As with any other circumstances, there
could be a risk that some of the personal or confidential information will be shared accidentally, and we do
not wish for this to happen. And as we respect your personal life, information about your identity will not
be revealed to the public. Again, you do not have to answer the questions you feel are too personal or that
make you uncomfortable.

Benefit

The research may be beneficial to you because of your significance to the research project and your
participation will be greatly appreciated and will help us affirm _______________________.

Reimbursements

Participants are greatly appreciated and valued. They will receive something as a token of appreciation and
participation in answering our survey form.

Confidentiality

The survey will be accessible only_________. Your personal information, opinion, or answer to our
questions will not be given or shared outside of our research group. The information that we will gather
will be kept private. All information about you will be labeled with a number or a code instead of your
name. Only the researchers will know what your information is and will keep that with our principles and
ethics.

Sharing the Results

The compiled results will not be shared with anybody outside our research group, and nothing will be
attached or affiliated to your name to protect you. The information we gather for the research will be shared
with you and soon, to the nursing students and community before it will be accessible to all. After getting
the results, all the participants will obtain a summary of the results. The result will be published long after
the research is done, and numerous interested individuals may learn from the research; which may also be
used for future research.

Right to Refuse or Withdraw


It is not necessary to participate in this study if you don’t want to, and it will not affect your academic-
related evaluations. You have a right to refuse to answer the online survey form if you wish to. We will
allow you to review all the remarks that were noted that you have been given at the end of the interview
and you can ask to remove some portions of them.

Who to Contact

If you have any questions regarding the research or procedure, you can ask them now or later. Here are
the following contacts you may ask:

· Name of Principal Investigator / Location Address/ Contact No./ Fatima Gmail


Name of Research Members / Location Address/ Contact No./ Fatima Gmail
……………………as follows for other research members………………………….

This proposal has been reviewed and approved by the RDIC, which is a committee whose task it is to
make sure that research participants are protected from harm. If you wish to find out more about
RDIC, contact the researchers above to assist you.

You can ask me any more questions about any part of the research study if you wish to. Do you have any
questions?

Part II: Certificate of Consent

I have been invited to participate in this research (Title of Research Study)

I have read the foregoing information, or it has been read to me. I have had the opportunity to ask
questions about it and any queries I have been asked have been answered to my satisfaction. I consent
voluntarily to be a participant in this study.

Print Name of Participant_______________________

Signature of Participant ________________________

Date____________________

(Day/month/year)

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