PHN Residency: Resident Consent Form  

You are invited to participate in a study evaluating the effectiveness of the Public Health Nurse Residency Program. By completing this study, we hope to learn about the effectiveness of the public health residency program and use the information to improve the program for future users.

Purpose

You were selected as a possible participant in this study because you participated in the  Public Health Nurse Residency Program.  The evaluation is designed to obtain information on your perception of the effectiveness of the program and your rating of other factors that could be impacted by the program.  Your completion of evaluation instrument is implied consent.

 Procedures/Risks and Benefits

In addition to completing the 3-month feedback form, you will be asked to provide feedback at 6 months and 12 months.  It will take approximately 10 minutes to complete each evaluation. No benefits accrue to you for completing the study, but your responses will be used to make improvements to the public health residency program which will benefit future users.  There are very limited risks to this study which may include anxiety from completing the evaluation instruments.

 Confidentiality/Voluntary Nature of the Study

No identifying information will be collected in this study, any information that is obtained in connection with this study will remain confidential and will not be disclosed. The records of this study will be kept private. In any publication or presentations, we will not include any information that will make it possible to identify individual participants.

Your decision whether to participate in this study will not affect your ability to participate in the Public Health Nurse Residency program or affect your current or future relations with the College of Saint Benedict/Saint John’s University or the researchers. If you decide to participate, you are free to discontinue participation at any time without affecting these relationships.

 Contacts and Questions

Please feel free to ask questions regarding this study. You may contact Dr. Rachelle Larsen, principal investigator, if you have additional questions at [email protected].

Any questions about your rights may be directed to Dr. Ellen Block, Chair of the CSB/SJU Institutional Review Board by e-mail at [email protected].

By completing the study instruments you are consenting to paritipate in this study.

Thank you

Dr. Rachelle Larsen    Mary Zelenak             Karen Jorgensen-Royce      Julia Ashley     Alex Smith