Capella NURS FPX 4015 Assessment 1

Capella NURS FPX 4015 Assessment 1

Name

Capella University

NURS-FPX4015 Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care

Prof. Name

Date

Waiver and Consent Form

This Waiver and Consent Form establishes the voluntary agreement of ___________________ (“Participant”) to act as a simulated patient in a recorded health assessment conducted by ___________________ (“Student”), who is enrolled in a nursing program at Capella University. By signing this document, the Participant acknowledges a clear understanding of the purpose, procedures, and implications of their involvement in this academic activity. Participation is entirely voluntary, and the Participant may withdraw at any point without penalty or adverse consequences.

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Purpose of the Waiver

What is the purpose of this waiver?

The primary purpose of this waiver is to define the academic nature of the activity while clarifying how any recorded materials and related data (collectively referred to as “Content”) will be utilized. The Content generated during this exercise is intended exclusively for educational use within the nursing curriculum and is aligned with competency-based learning objectives.

Specifically, the collected materials will be used to support the following academic functions:

Purpose	Description
Clinical Skill Demonstration	Enables evaluation of nursing competencies such as communication, assessment techniques, and clinical reasoning.
Coursework Completion	Supports assignments, including the development of SOAP (Subjective, Objective, Assessment, Plan) notes.
Educational Analysis	Provides structured data for reflective learning, faculty feedback, and performance improvement.

The Participant understands that they will not be given an opportunity to review, modify, or approve the Content prior to its academic use. This approach ensures fairness, standardization, and integrity in student assessment, consistent with professional nursing education guidelines (American Nurses Association [ANA], 2023).

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Content Authorization

What constitutes “Content” under this agreement?

Under this agreement, “Content” refers to all materials generated during the simulation that contribute to the academic evaluation process. The Participant consents to the creation and use of the following components:

Component	Description
Video Recordings	Digital footage capturing the Participant’s physical presence, facial expressions, voice, and interactions.
Verbal Communication	All spoken responses, explanations, and interactions during the simulation exercise.
Health-Related Data	Information shared for educational purposes that aligns with assessment objectives, whether real or simulated.

All Content usage is strictly limited to educational purposes necessary to meet the objectives of the nursing assessment. Any use outside these defined academic parameters is strictly prohibited.

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Disclosures

Is this activity considered medical care?

No, this activity does not constitute medical care. It is a structured educational simulation designed solely for instructional and evaluative purposes. Participants should understand that no clinical diagnosis, treatment, or medical advice will be provided during the session.

Is real medical history required?

No, Participants are not required to disclose actual medical history. They may provide fictional, generalized, or scenario-based information, except for minimal demographic details (such as age or gender) if necessary for realism. This ensures confidentiality and aligns with ethical standards in nursing education (ANA, 2023).

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Voluntary Consent and Authorized Use

What rights are granted to Capella University?

By consenting to participate, the Participant grants Capella University a non-revocable, perpetual, and royalty-free license to:

• Use, reproduce, and distribute the Content for academic purposes.
• Share the Content with faculty, evaluators, and relevant academic personnel.
• Retain the Content as part of institutional and educational records.

What rights are waived?

The Participant agrees to relinquish the following rights:

Waived Right	Explanation
Review Rights	No opportunity to review or approve Content prior to use.
Compensation	No entitlement to financial or material compensation.
Legal Claims	No legal action for authorized academic use of Content.

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Rights and Ownership

Who owns the recorded material?

All Content produced during the simulation is the exclusive intellectual property of Capella University. The institution retains full rights to store, use, reproduce, and distribute the material for current and future academic purposes.

What claims are released?

The Participant releases Capella University from any claims associated with:

• Creation, editing, or academic use of Content.
• Alleged violations of privacy or publicity rights.
• Claims related to defamation or reputational harm arising from authorized use.

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Waiver and Release of Liability

The Participant formally releases Capella University, including its faculty, staff, students, contractors, and affiliates, from any legal or financial liability related to the creation, storage, or academic use of the Content. This clause reflects established risk management practices commonly applied in educational and clinical simulation environments to ensure institutional and participant protection.

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Governing Law and Venue

Which laws govern this agreement?

This agreement is governed by the laws of the State of Minnesota. Any disputes arising from this waiver will be addressed within the appropriate state or federal courts located in Minnesota.

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NURS FPX 4015 Assessment 1 Waiver and Consent Form

Consent Confirmation

By signing below, the Participant affirms that:

• They are at least 18 years of age.
• They have read and fully understood the contents of this document.
• They voluntarily agree to participate under the stated terms and conditions.

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Capella NURS FPX 4015 Assessment 1

Role	Signature	Date	Printed Name
Student	________________________	24-02-2025	____________________
Participant	________________________	24-02-2025	____________________

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References

American Nurses Association. (2023). Code of ethics for nurses with interpretive statements. American Nurses Association Publishing.

Capella University. (2024). Guidelines for simulation-based learning and assessment in nursing education. Capella University Academic Resources.