Inform Consent

ANNEXURE IV
PARTICIPANT INFORMATION SHEET AND CONSENT FORM

Dear participant,
I am M.Sc Nursing student of PDM Subharti Nursing College Meerut, as the part of our
curriculum study program; we are doing research on “A study to assess the effectiveness of
planned nursing intervention regarding ‘warm chain' in terms of knowledge and practice
among staff nurses working in obstetrical and neonatal units in selected hospitals at
Meerut.”
The information given by you will be used for the research purposes and for quality
improvement and will be kept confidential.
You are free not to participate in the study or to withdraw from the
study at any time. If you choose not to participate or to withdraw from the
study, you will not be harmed by any means. If you have any further
questions please contact Mrs. Pinky (Lecturer O.B.G Dept., PDM Subharti
Nursing College, Meerut)
The successful completion of the study largely depends on your active
co-operation and participation.
Thanking you,
Yours sincerely,
CONSENT FORM
The content of the provided information sheet has been read carefully
by me & I have fully understood it. The nature and purpose of the study and
its potential risks/ benefits, and other relevant details of the study have been
explained to me in detail. I affirm that I have the opportunity to ask
questions. I understand that my participation is voluntary and that I am free
to withdraw at any time, without giving any reason and without my legal
rights being affected.
I

……………………………………………………..

here

with

give

consent

for

participation knowing that all the information provided by me will be treated

with confidentiality.
Date:
Signature of participant
Place:
1) Witness 1
Name
Designation
Place

2) Witness
Name
Designation
Place