Informed Consent Form Template: Sepsis Research

Introduction

You are invited to participate in a research project been conducted by a researcher from the University. NAME RN BSN a graduate nursing student, is conducting research to determine the value of sepsis prevention within a hospital setting by educating nurses on implementing bundles from sepsis campaigns.

Description of the Project:

The purpose of this study intends to examine whether or not a sepsis prevention program within a hospital setting will increase nurses’ awareness of sepsis identification. Participants will be asked to fill out a survey that will qualify their eligibility to participate in the study. Upon acceptance, each participant will sit for a pre-test and a post-test, with some participants sitting for a 20-minute lecture and exercises. The research will be conducted within the hospital setting in a private room and should take approximately one hour. All participants are expected to partake in all routine classroom activities, including the preliminary survey, the pre and post-tests, the lecture, and learning activities. The results will be culminated and analyzed to assess the effectiveness of the sepsis bundle in correctly identifying at-risk patients in developing, and informing them about sepsis.

Benefits and Risks of This Study:

The benefits to the participants are increased knowledge in sepsis vulnerability identification, added training and experience, and gained skills that can enhance the participants’ career. There are no known risks associated with this study at this time (please see the Confidentiality section below for measures taken to protect your identity).

Confidentiality:

Confidentiality in this study is protected and ensured. The researcher will take measures to protect the identity of all participants. No identifying information will be present on the pre-tests and post-tests. Only codes will be used to identify the documents by department and control versus the experimental group. No names will be gathered or documented for the research. The documents will be kept under lock and key in a double-locked drawer for five years, after which the documents will be shredded. Any and all results of the individual responses will be seen by the researcher only, and the researcher will report the information as an aggregate number representing the group and not any individual scores that could identify the participant in any way.

Voluntary Participation and Withdrawal:

All participation in this study is voluntary. Participants are expected to participate fully in all classroom activities and instruction: sitting for lectures, surveys, pre-tests, and post-tests, participation in learning exercises. Participants may withdraw from participation at any time from non-regular classroom instruction and will not be penalized for non-participation. Participants may also reserve the right to have their individual results excluded from the final report.

Questions, Rights, and Complaints: Provide information about how participants or their legal guardians can contact you as the researcher. Provide a name, phone number, and email address. YOU FILL THIS OUT. Participants and legal guardians have a right to the results of the study.

Consent Statement:

In signing this informed consent you are choosing to voluntarily consent to be part of this study.