NURS FPX 4015 Assessment 1

NURS FPX 4015 Assessment 1 Waiver and Consent Form

Name

Capella university

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

Prof. Name

Date

Institution Information

Institution: Capella University Course: NURS4015 or NURS-FPX4015

Participant Agreement

I, ___________________ (“Participant”), willingly consent to act as a mock patient for a health assessment video demonstration conducted by ___________________ (“Student”), who is currently enrolled as a nursing student at Capella University.

By agreeing to participate, I acknowledge and accept the terms outlined below. This agreement is made in recognition of its educational intent and the valuable role it serves in the Student’s professional development.

Purpose of Participation

The purpose of this activity is strictly educational. The recorded content will only be used for academic training and evaluation. This includes, but is not limited to:

• Demonstrating nursing health assessment techniques and skills for academic grading.
• Completing a comprehensive examination with a SOAP note (subjective, objective, assessment, and plan) as outlined in the course curriculum.
• Providing simulated health information for practice in clinical decision-making assignments.

I acknowledge that I waive the right to review or approve the final recorded content before it is used by Capella University.

Content Description

The term “Content” refers to the video recording created during the assessment and all information provided for the simulation. This may include:

• My image, appearance, voice, and likeness as recorded.
• Health-related data collected by the Student to complete the SOAP note.
• Verbal responses or hypothetical health information shared during the assessment.

I understand that the Content will be restricted to educational purposes only and handled within the Capella University academic framework.

Disclosures

The simulation does not represent professional medical care or actual health advice. Both the Student and the Participant are not required to reveal real health history or personal identifiers. Information provided can be hypothetical, except for certain vital signs or readings that may naturally reflect the Participant’s actual health status.

Voluntary Consent and Use

I voluntarily grant Capella University full rights to use the Content for academic purposes. This includes the authority to:

• Display, reproduce, and distribute the Content to course faculty and relevant staff.
• Evaluate the Student’s performance in health assessment practices.

I waive my right to:

1. Inspect or approve the Content prior to its academic use.
2. Claim damages, financial compensation, or protection against modifications, alterations, or reproductions of the Content.

Rights and Ownership

I acknowledge that Capella University holds complete ownership of the Content. Once recorded, it becomes the property of the institution. By signing this form, I release Capella University from:

• Any future claims regarding the Content, including issues related to privacy, publicity, or reputation.
• Any harm, losses, or expenses that may arise as a result of the use of the Content.

Waiver and Release

I hereby waive and release all legal claims against Capella University, its employees, students, contractors, and representatives. This includes freedom from liability related to the recording, storage, distribution, or academic use of the Content.

Governing Law

This agreement will be governed under the laws of the State of Minnesota. Any disputes related to this waiver will be resolved exclusively in state or federal courts located in Minnesota.

NURS FPX 4015 Assessment 1

Waiver and Consent Form

By signing below, I affirm that I am at least 18 years of age and fully understand the terms of this consent.

Agreement Table

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.

Capella University. (2023). NURS-FPX4015: Nursing course materials. Capella University.

NURS FPX 4015 Assessment 1 Waiver and Consent Form

Minnesota Legislature. (2024). Minnesota statutes: Health records and privacy laws. https://www.revisor.mn.gov