IRB AND CONSENT FORM

INFORMED CONSENT FOR PARTICIPATION IN A DNP PROJECT

Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay

Project Title: A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Project Manager: Mary Jane Evangelista

Project Location: Bryn Mawr Nursing Home

What is the purpose of this project?

The DNP project aims to determine the impact of motivational interviewing and technology on medication adherence among inpatient schizophrenia patients.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay

What will I be asked to do if I choose to be in this project?

The project will take place over 10 weeks. You will be asked to provide informed consent that shows that you understand the project’s purpose, benefits, and risks at the beginning of the project (week 1). You will also be asked to complete a self-reported questionnaire (Brief Medication Questionnaire) at the beginning of the project (week 1) and the end of the study (week 8). Lastly, you will be asked to communicate your concerns about the medication by taking weekly phone calls and attend weekly in-person meetings with the project manager for motivational interviewing at the Bryn Mawr Nursing Home for eight weeks.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

How much time will I be asked to devote to this project?

You will be asked to spend around an hour to complete the pre-implementation self-reported questionnaire (Brief Medication Questionnaire) and an hour and a half to complete the post-implementation questionnaire (Brief Medication Questionnaire). Each phone call will take about 10 minutes, while the in-person meeting will take 1 hour.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

What are the possible risks or discomforts that I might experience?

There are no possible risks or discomforts you might experience with the project.

What are the possible benefits for me or others?

You may learn to have better maintenance of medication adherence and achieve positive health outcomes.

What alternatives are available?

There are no alternatives for this project.

Do I have to participate?

No, you do not have to participate, participation is voluntary.

What will happen if I do not participate?

There will be no consequences if you choose not to participate in the project.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

What will happen if I leave the project?

There are no consequences if you leave the project.

Will it cost me anything to participate?

There is no cost for you to participate.

Will I get paid anything if I participate?

You will not be paid anything for participating in the project.

How will my confidentiality and privacy rights be protected?

Your confidentiality will be upheld. No participant-identifying information will be utilized on the questionnaires or for data collection.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

In this project:

  • Identifiable private information or specimens (private information or specimens that can be traced back to you) will be collected:

Yes                         No

If yes:

  • Identifiable private information or specimens may be used for future quality improvement projects without gaining further permission:(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Yes                         No

  • Identifiable private information or specimens may be used for future quality improvement projects, but only with your permission:

Yes             No

  • Identifiable private information or specimens will not be used for future quality improvement projects:

Yes             No

Who do I contact for any questions about this project?

You will contact me, Mary Jane Evangelista. My phone number is 312-912-3444, and my email address is [email protected]

Is there anything else I need to know?

No, nothing at this time.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

What are my rights?

  • If you choose to be in this project, you have the right to be treated with respect, including respect for your decision to stop being in the project.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
  • You are free to stop being in the project at any time.
  • Choosing not to be in this project or to stop being in this project will not result in any penalty to you or loss of benefits to which you are otherwise entitled.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
  • You will be given any information that either the project manager or the IRB reasonably believes is important to your choice about whether or not to be in this project.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
  • We will make every effort to keep the information obtained as part of this project confidential. However, information about abuse or neglect may be required to be reported to the appropriate local or state agency per applicable law.
  • If you want to speak with someone not directly involved in this project or have questions about your rights as a participant, contact the DNP Program Dean at [email protected].

The following project has been reviewed by the Chamberlain College of Nursing and prescreened as a practice-change/ quality improvement project in collaboration with the Chamberlain University Institutional Review Board.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

(If Applicable)

I give permission for photographs or videotapes of me to be used in this project:

 __________ (initials)

I DO NOT give permission for photographs or videotapes of me to be used in this project:

___________ (initials)

I have read this form, and the project has been explained to me. I have been given the opportunity to ask questions, and my questions have been answered. If I have additional questions, I have been told whom to contact. I agree to participate in the project described above and will receive a copy of this consent form after I sign it.(Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

______________________                            ___________________________

Signature of Participant                      Date 

Revised 2/14/2022

Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay

Reference

https://www.ncbi.nlm.nih.gov/