SCHOOL OF NURSING
Telefax No.: (074) 442-3071 Website: [Link] E-mail Address: ub@[Link]
Informed Consent
“Experiences of A Primary Caregiver with A Relative Undergoing Hemodialysis”
Introduction
The BSN students who are enrolled in Research 2 are conducting a study entitled
“Experiences of A Primary Caregiver with A Relative Undergoing Hemodialysis”. We are
going to give you information and invite you to be part of this research. You do not have
to decide today whether or not you will not participate in the research. Before you decide,
you can talk to anyone you feel comfortable with about the research. This consent form
may contain words that you do not understand. Please ask me t stop as we go through the
information and I will take time to explain. If you have questions later, you can ask them
of me or of another researcher.
Purpose of the Research
The purpose of this research is to gain an understanding of the experiences of
parents and we want to find ways to enhance the homecare management after hemodialysis.
May we request a brief moment of your time to take part in this study? We believe that you
can help us by telling us what are your experiences in taking care of your child. We want
to know about the different health practices rendered because this knowledge might help
us to learn how to formulate a proper guideline for homecare management.
Type of Research Intervention and Duration
This research will involve your participation in an interview that will take about 30
minutes to one hour of your time with follow-up interview until the saturation point has
been met.
Participant Selection
You are being invited to take part in this research because we feel that your experience as
a parent can contribute much to our understanding and knowledge of local health practices.
SCHOOL OF NURSING
Telefax No.: (074) 442-3071 Website: [Link] E-mail Address: ub@[Link]
Voluntary Participation
Your participation in this research is entirely voluntary. It is your choice whether
to participate or not. If you choose not to participate all the services you receive at this
study will continue and nothing will change.
Procedures
We are asking you to help us learn more about the lived experiences that you
encounter. We are inviting you to take part in this research project. If you accept, you will
be asked to participate in an interview with the researchers. During the interview, I or
another interviewer will sit down with you in a comfortable place. If it is better for you,
the interview will take place at your home. If you do not wish to answer any of the questions
during the interview, you may say so and the interviewer will move on to the next question.
No one else but the interviewer will be present unless you would like someone else to be
there. The information recorded is confidential and no one else except the researchers will
access to the information documented during the interview.
The entire discussion will be tape recorded but no one will be identified by name
on the tape. The tape will be kept in a secure area, accessible only to those involved in this
study. The tape will be destroyed after the research has been completed.
Duration
The research takes place over three months in total. During that time, we will visit
you three times at one-month interval and each interview will last for about 30 minutes to
one hour.
Risks
If the discussion is on sensitive and personal issues, example of text could be
something like “We are asking you to share with us some very personal and confidential
information, and you may feel uncomfortable talking about the topics. Then you do not
have to answer any questions or take part in the discussion/interview/survey if you don’t
wish to do so, and that is also fine. You do not have to give us any reason for nor responding
to any question, or for refusing to take part in the interview.”
SCHOOL OF NURSING
Telefax No.: (074) 442-3071 Website: [Link] E-mail Address: ub@[Link]
Benefits
There will be no direct benefit to you, but your participation is likely to help us find
out more about your lived experiences on homecare management.
Reimbursements
You will not be provided any incentives to take part in the research. However, we
will give you money for your travel expenses (if applicable).
Confidentiality
We will not be sharing information about you to anyone outside of the research
team. The information that we collect from this research project will be kept private. Any
information about you will have a number on it instead of your name. Only the researchers
will know what your number is and we will lock that information up with a lock and key.
It will not be shared with or given to anyone except the researchers and their adviser.
Sharing the Result
Nothing that you tell us today will be shared with anybody outside the research
team, and nothing will be attributed to you by name. The knowledge that we get from this
research will be shared with you before it is made widely available to the public. So each
participant will receive a summary of the results.
Right to Refuse or Withdraw
You do not have to take part in this research if you do not wish to do so, and
choosing to participate will not affect your job or job-related evaluation in any way. You
may stop participating in the interview at any time that you wish without your job being
affected. I will give you an opportunity at the end of the interview to review your remarks
and you can ask to modify or remove portions of those. If you do not agree with my notes
or if I did not understand you correctly.
SCHOOL OF NURSING
Telefax No.: (074) 442-3071 Website: [Link] E-mail Address: ub@[Link]
Who to Contact
If you have nay questions, you can ask them now or later. If you wish to ask
questions later, you may contact any of the following: Arlene C. De Vera, #9 Micael St.
Lower Engineer’s Hill Baguio City, Benguet 2600/ 09151351020/
lene.deve1020@[Link]. This proposal has been reviewed and approved by the
Research and Development Center which is a committee whose task it is to make sure that
research participants are protected from harm.
SCHOOL OF NURSING
Telefax No.: (074) 442-3071 Website: [Link] E-mail Address: ub@[Link]
CERTIFICATE OF CONSENT
I have been invited to participate in research about “Experiences of A Primary
Caregiver with A Relative Undergoing Hemodialysis”. 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 questions 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)
Statement by the Researcher/Person Taking Consent
I have accurately read out the information sheet to the potential participant, and to
the best of my ability made sure that the participant understands that the following will be
done:
1. Providing confidentiality and anonymity;
2. Providing a summary of the interview and assuring that the data collected is
accurate and correct.
I confirm that the participant was given an opportunity to ask questions about the
study and all the questions asked by the participants have been answered correctly and to
the best of my ability. Thus, I confirm that the individual has not been coerced into giving
consent, and the consent has been given freely and voluntarily.
A copy of this ICF has been provided to the participant.
Print name of Researcher: ________________________________
Signature of the Researcher: ______________________________
Date: __________/___________/___________
(Day/Month/Year)
