Manuel S.

Enverga University Foundation

Informed Consent for Participation in a Research

year nursing students who are in their higher year at college’s school that have nursing course

in the Quezon province, and who we are inviting to participate in a research study entitled “A

Closer Look at the Factors Predictive of Student’s Success in Studying in the Nursing Program”.

Part I: Information Sheet

Introduction

We are Ms. Clea O. Caparros and Mr. Lemuel M. Guevarra BSN, a student of Manuel S.

Enverga University Foundation, Lucena City. We are currently undertaking dissertation on “A

Closer Look at the Factors Predictive of Student’s Success in Studying in the Nursing Program”.

May we invite you to be part of this research. Kindly read and answer the questions and adhere

to the terms and conditions regarding your participation in this study.

Purpose of the research

The research study aims to determine the factors predictive of student success in

studying in the nursing program. The researcher assumes that understanding these factors will

contribute to the improvement of strategies aimed at increasing the throughput rates in the

nursing program.
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

Type of Research Instrument

This research study will involve the participation of the 2nd year 3rd year, 4th nursing

students by answering a questionnaire composed of two parts: 1) Demographic profile of the

respondents; and 2) self-assessment regarding on the factors of student’s success in studying in

the nursing program.

Participant Selections

The respondents of the study will be the 2nd year 3rd year, 4th year nursing students who

are in their higher year during the conduct of this study. The research was conducted at college’s

school that have nursing course in the Quezon Province.

Voluntary Participation

The nursing students are invited to take part in this study and their participation will be

entirely voluntary and according to your free-will. It is their choice whether to participate or not.

The choice that they will make will have no bearing to any aspects of the personal and

professional life. They may change their mind later and withdraw their participation even if you

agreed earlier.

Procedures, Protocol, and Description of the Process

Initially, the researcher will conduct a short introduction with regards to the research

study. The study procedures will be discussed thoroughly, the duration of the study, as well as

the risks and benefits of the study. Afterwards, questions will be entertained in connection with

the study for the purpose of clarification. Thereafter, they will be asked to accomplish and sign

the consent form if they are willing to participate in the study in the absence of coercion or threat.
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

If they will voluntarily sign the consent and participate in the study, they will be asked to

accomplish the questionnaire.

Duration

This research study will take place from October 2019 until December 2019.

Accomplishing the instrument will only require at least 20 minutes of their time.

Risks

The research instrument will be asking the respondents to share some personal

information and their self-assessment on their global health competencies. They do not have to

answer any questions in the instrument if you don’t wish to do so, and that is also fine. They do

not have to give any reason for not responding to any question.

Benefits

The benefits for participating in our study will include the opportunity to express their

self-assessment on the factors of student’s success in studying in the nursing program.

Reimbursements

They will not be provided any incentive for taking part in this research. However, they

will be given a token of appreciation as an expression of gratefulness for being participative in

the entire duration of the study.

Confidentiality

All information that will be provided in this research study will be kept confidential and

will be used only for the conduct of the research. All information will stay put on the researcher

and no other people will have an access on it except the researcher’s adviser, and unless it will
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

be required for publication. In case publication will be required, it will be brought to their

knowledge and awareness and their approval for publication will be sought. All the information

will have a number instead of their name and only the researcher will know what their number

is and it will be locked with a lock and key.

Sharing the Results

Results of the study will be explained to you and a copy of the study may be given to the

participants when requested. Thus, in case publication will be required, it will be brought to their

knowledge and awareness and their approval for publication will be sought. However,

confidential information will not be shared.

Right to Refuse

Nursing students may not participate in this research if they do not feel comfortable to

do so and refusing to participate will not affect any aspect of their personal and professional life.

They will still enjoy and have the benefits and privileges that they have despite of not partaking

in this study. They may also withdraw their participation in this research study in any phase or

any time that they feel like uncomfortable without losing any of their benefits and privileges.

Who to Contact

If you have any questions, you can ask us now or feel free to contact us at

09772744597/ 09950290928 or e-mail us at [email protected] /

[email protected] and rest assured that all your concerns will be addressed the best

way we can.
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

This proposal has been reviewed and approved by Manuel S. Enverga University

Foundation Research Ethics Review Committee, which is a committee whose task is to make

sure that research participants are protected from harm. If you wish to find more about MSEUF

Research ERC, you may contact __________________________________________.

Part II: Certificate of Consent

I have been invited to participate in the research on “A Closer look at the factors

predictive in student success in studying in the nursing program”. Likewise, I have read and

understand the foregoing information thus; it was read and explained to us by Ms. Clea O.

Caparros/ Mr. Lemuel M. Guevarra to the level of my understanding. I had the opportunity to

ask questions about this study and all questions I had asked has been answered to my satisfaction.

Therefore, I consent voluntarily to be a participant in this study.

Printed Name and Signature of Participant: __________________________

Printed Name and Signature of Witness: _____________________________

Date: ________________________

Thumb Print of the Participant:

Statement by the Researcher/ Person taking the Consent

I have accurately read out the information sheet to the potential respondent, and to the

best of my ability made sure that the respondent understands that the following will be done:

1. Orientation about the research process

2. Informed Consent signing

3. Answering the questionnaire

I corroborate that the respondent was given an opportunity to ask questions about the

study, and all questions asked by the respondent have been answered correctly to the best of my

ability. I also confirm that the individual has not been coerced upon giving consent, and the

consent has been given freely and voluntarily. Thus, a copy of this informed consent form has

been provided to the respondent.

Printed Name and Signature of the Researcher/Person taking the Consent:

_______________________

Date: ___________________________