Capella 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

A Waiver and Consent Form documents a participant’s voluntary agreement to take part as a simulated patient in a recorded nursing health assessment. The form explains the educational purpose of the recording, what information may be collected, how the content may be used, and the participant’s rights and responsibilities. Because the activity is part of a nursing education assignment, it is intended for academic simulation rather than actual medical care.

Purpose of the Waiver and Consent Form

The primary purpose of this waiver is to establish informed consent before a nursing student records a simulated health assessment. It confirms that the participant understands why the recording is being created and how the resulting materials may be used for educational purposes.

The participant, ___________________ (“Participant”), voluntarily agrees to participate as a simulated patient in a recorded health assessment demonstration conducted by ___________________ (“Student”), a nursing learner enrolled at Capella University.

The recorded materials and related information, collectively referred to as “Content,” are intended for academic and instructional purposes within the nursing program.

Capella 4015 Assessment 1

The Content may be used to:

• Demonstrate and evaluate nursing health assessment skills.
• Support completion of required coursework.
• Provide information needed to prepare a SOAP (Subjective, Objective, Assessment, Plan) note.
• Support simulation-based learning activities and skills evaluation.

The participant understands that the Content may be used for the stated academic purposes without being submitted to the participant for review, modification, or approval beforehand.

What Is Included in the Recorded Content?

For purposes of this agreement, “Content” includes information and materials collected or created during the simulated assessment that are reasonably necessary to complete the academic activity.

Content Component	Description
Video Recording	A digital recording that may capture the participant’s image, voice, likeness, or physical presentation during the simulation.
Verbal Statements	Spoken responses, explanations, questions, and other dialogue provided during the assessment.
Health-Related Information	Information used as part of the simulated health assessment and educational exercise.

The Content should be limited to information reasonably necessary for the nursing assignment and its learning objectives.

Is the Health Assessment Actual Medical Care?

No. The recorded activity is an educational simulation, not a clinical encounter in which the participant receives medical care. Participation does not create a provider-patient relationship and should not be interpreted as medical advice, diagnosis, treatment, or professional healthcare evaluation.

The purpose of the exercise is to allow the nursing student to demonstrate assessment and documentation skills in an academic setting.

Does the Participant Need to Provide Real Medical History?

No. The participant does not need to disclose an actual medical history or confidential personal health information for this educational activity.

Except for basic information such as age and gender, which may be represented accurately when appropriate, other case details may be fictional, simulated, or adapted to meet the learning objectives. Using simulated information can help students practice assessment and documentation skills while limiting unnecessary disclosure of private health information.

Nursing education also emphasizes ethical practice, confidentiality, privacy, and respect for individuals participating in educational activities (American Nurses Association [ANA], 2023).

Voluntary Consent and Authorized Use

Participation is voluntary. By signing the waiver, the participant confirms that they understand the purpose of the activity and agree to the authorized academic use of the Content.

Subject to the terms of the agreement, the participant grants Capella University a perpetual, royalty-free license to use the Content for the purposes described in the form, including the right to:

• Use, reproduce, distribute, publish, and display the Content.
• Share the Content with faculty, instructors, staff, or evaluators involved in academic review.
• Retain the Content as part of institutional educational records.

What Rights Does the Participant Waive?

Under the agreement, the participant waives certain rights associated with the authorized academic use of the Content. These include the right to review or approve the Content before its academic use and the right to receive financial compensation associated with its creation or authorized educational use.

The agreement also includes a release concerning claims for damages arising from authorized academic use of the Content.

Rights and Ownership of the Content

The agreement states that Content created under its terms remains the intellectual property of Capella University. The university retains rights associated with storing, maintaining, and using the Content for the purposes authorized by the agreement.

The participant also releases the university from certain claims associated with the authorized creation, modification, storage, or distribution of the Content, including claims involving privacy, publicity rights, defamation, or reputational harm.

Waiver and Release of Liability

The participant releases Capella University and its trustees, faculty, employees, students, contractors, and affiliated representatives from liability, claims, or expenses that may arise in connection with the production, storage, or authorized academic use of the Content.

This provision is intended to address potential liability associated with participation in a recorded educational simulation.

Governing Law and Venue

The waiver states that the agreement is governed by the laws of the State of Minnesota. Any dispute arising under the agreement is to be addressed in the appropriate state or federal courts located in Minnesota, as specified by the agreement.

Because waiver and consent forms can have legal consequences, participants should carefully review the actual document and seek appropriate legal guidance if they have questions about their rights or obligations.

Participant Consent Confirmation

By signing the form, the participant confirms that they:

• Are at least 18 years of age.
• Have reviewed and understood the provisions of the agreement.
• Voluntarily agree to participate under the stated terms.
• Understand the educational purpose of the recorded simulation.

Signature and Agreement Details

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

Key Takeaways About the NURS FPX 4015 Waiver and Consent Form

The NURS FPX 4015 Assessment 1 waiver is designed to document consent for participation in a recorded simulated nursing assessment. The participant agrees to the creation and academic use of specified Content and acknowledges that the activity is educational rather than medical care.

The form also addresses the handling of health-related information, authorized use of recordings, ownership and licensing, liability, governing law, and participant consent. Students and participants should read the actual waiver carefully because the specific terms of an institutional form control how the agreement applies.