Name
Capella University
NURS-FPX4015 Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care
Prof. Name
Date
This Waiver and Consent Form establishes a voluntary agreement between ___________________ (“Participant”) and ___________________ (“Student”), a nursing student enrolled at Capella University. The purpose of this agreement is to formalize the Participant’s involvement as a simulated patient in a recorded health assessment activity conducted strictly for academic purposes. By signing this document, the Participant confirms that they understand the nature, procedures, and potential implications of participation. It is emphasized that participation is entirely voluntary, and the Participant retains the right to withdraw at any stage without facing any academic, legal, or personal consequences.
The waiver serves to clearly define the academic scope of the simulation while outlining how all recorded materials, collectively referred to as “Content,” will be used. The Content generated during this activity is intended exclusively for educational evaluation within the nursing curriculum.
More specifically, the Content will be utilized to support structured learning outcomes and competency development. It enables instructors to assess clinical skills, communication techniques, and professional behaviors demonstrated during the simulation. Additionally, the recorded material contributes to the completion of academic assignments such as SOAP (Subjective, Objective, Assessment, Plan) documentation and reflective analysis exercises.
Furthermore, the use of standardized simulation data ensures consistency and fairness in student evaluation. The Participant acknowledges that they will not have the opportunity to review, modify, or approve the Content before it is used academically. This policy is implemented to maintain academic integrity and align with established professional guidelines in nursing education (American Nurses Association [ANA], 2023).
The Participant grants permission for the creation and academic use of multiple forms of Content generated during the simulation. These elements are outlined below:
| Component | Description |
|---|---|
| Video Recording | Digital media capturing the Participant’s physical presence, voice, and actions during the simulation. |
| Verbal Statements | All spoken interactions, including answers, explanations, and communication exchanges. |
| Health-Related Information | Any information shared for simulation purposes that aligns with assessment objectives. |
All Content will be used strictly within the limits necessary to achieve educational goals. Unauthorized use beyond these parameters is not permitted.
No, this activity does not constitute real medical care. It is a simulated learning exercise designed for academic evaluation only. Participants will not receive diagnoses, treatments, or professional medical advice during the session.
No, Participants are not obligated to disclose actual personal medical histories. They may provide fictional, generalized, or scenario-based information. Only minimal demographic details, such as age or gender, may be required when relevant to the simulation. This approach protects confidentiality and adheres to ethical standards in nursing practice (ANA, 2023).
By agreeing to participate, the Participant provides Capella University with a non-revocable, royalty-free license to use the Content for academic purposes. This includes the right to reproduce, distribute, and share the material with faculty members, evaluators, and other authorized academic personnel. Additionally, the university may retain the Content as part of its official educational records.
The Participant agrees to waive several rights as part of this consent, including:
The right to review or approve the Content prior to its academic use.
The right to receive financial or material compensation for participation or Content usage.
The right to pursue legal claims related to the approved academic use of the Content.
All Content generated during the simulation is considered the intellectual property of Capella University. The institution maintains full authority over the storage, usage, distribution, and archival of the material for educational and evaluative purposes.
The Participant releases Capella University from any legal claims associated with:
The creation, editing, or academic use of the Content.
Alleged breaches of privacy or publicity rights.
Claims related to defamation, reputational harm, or similar concerns resulting from authorized use.
By signing this agreement, the Participant agrees to release Capella University, including its faculty, staff, students, contractors, and affiliated individuals, from any legal or financial liability connected to the development, use, or storage of the Content. This provision reflects standard risk management practices commonly applied in academic and clinical simulation environments.
This agreement is governed by the laws of the State of Minnesota. Any disputes or legal matters arising from this waiver will be resolved in the appropriate state or federal courts located within Minnesota.
By signing below, the Participant confirms the following:
They are at least 18 years of age.
They have read and fully understood all terms and conditions outlined in this document.
They voluntarily agree to participate under the specified guidelines.
| Role | Signature | Date | Printed Name |
|---|---|---|---|
| Student | ______________________ | 24-02-2025 | __________________ |
| Participant | ______________________ | 24-02-2025 | __________________ |
