Consent Form

You are being asked to participate in a research study conducted by Christine Plett and Jessica Marks, nursing students at DePaul University under the supervision of adviser Dr. Barbara Harris and Dr. Young-Me Lee from the Nursing Department at DePaul University. This research project is a requirement of DePaul University’s nursing masters program.
The focus of our research is looking at nurse’s perceptions of interventions to maximize patient care with individuals who experience sundowning. This survey should take approximately 10-15 minutes to complete. We are looking for nurses who know what sundowning and are an individual who has worked with patients experiencing sundowning in an acute care setting. If you agree to be a part of this study, you will be asked to fill out a 15 question survey on a secure link at Quickdata.com.
All responses will be kept anonymous. You can choose not to participate in this study or withdraw at any time. There will be no negative consequences if you decide not to participate or if you change your mind once you begin. If you decide to stop once you begin, your answers will not be recorded. You can withdraw your participation at any time prior to submitting your survey. If you change your mind later while answering the survey, you may simply exit the survey.
If you have any questions or would like a copy of the research paper please feel free to contact Christine Plett at cplett711@hotmail.com, Jessica Marks at jlmarks@mail.bradley.edu, or our research advisors Barbara Harris (bharri14@depaul.edu) and Dr. Young-Me Lee (ylee23@depaul.edu) from the Nursing Department at DePaul University. Please include “sundowning survey” in the subject line. If you have questions about your rights as a research subject you may contact Susan Loess-Perez, DePaul University’s Director of Research Protections at 312-362-7593 or by email at sloesspe@depaul.edu
Thank you for your time,
Christine Plett & Jessica Marks


By submitting to this form, I agree that I have a general idea as to what sundowning is and have worked with patients experiencing sundowning in acute care settings. I also agree that the data used in this survey may be used to create awareness of nurse’s perceptions of interventions when dealing with sundowning. My name or identity will never be linked with my answers to this survey.
Do you consent to this statement and wish to continue? *
Yes
No

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