ANGELES UNIVERSITY FOUNDATION

Angeles City

COLLEGE OF NURSING

NURSING RESEARCH 1 (NCM 111)

AY 2020-2021 (Summer)

INFORMED CONSENT FORM

Research Topic

“Student Nurse’s LMS Efficacy and Online Engagement as Predictors of Academic Performance in
Distance Learning Program.” (Pg1, Par1)

Purpose and Conduct of the Study

The sudden outbreak of the novel coronavirus and being declared a global pandemic by the
World Health Organization demanded a dramatic change in how education is delivered worldwide.
Learning a student’s self-efficacy in using learning management system (LMS) and online
engagement will enable instructors to design or remodel the instructional design to one that
customizes the learning process for students and develop more effective learning strategies, while
employing the maximal use of technology in an online or distance learning environment. In this end,
the research will like to establish if a student’s LMS self-efficacy and online engagement influenced
their academic performance during the online classes held in the summer term. The study will
include all student nurses enrolled during the summer term of A.Y. 2019-2020. (Pg1, Par2)

Nurse of Involvement

You will answer an online survey tool that relates to your LMS self-efficacy and online
engagement. This will be floated as a google form link in the CON-Student Portal in Canvas. The
LMS Self-Efficacy Scale (LMS SES) measures your confidence with LMS use. It consists of 4
subtopics, namely: 1) Accessing information -items 1 to 8; 2) Posting information -items 9 to 12; 3)
File management -items 13-15; and 4) Advanced features -items 16 to 24. You will rate the items on
a four-point Likert scale ranging from 1 (not confident) to 4 (very confident). The Online Community
and Engagement Scale (OCES) measures three types of student interactions in an online
community, namely: 1) Student-to-instructor engagement; 2) Student-to-student engagement; and
3) Student-to-course content engagement. You will rate the items on a five-point Likert scale
ranging from 1 (strongly disagree) to 5 (strongly agree). (Pg1, Par3)

Type of Data

Additionally, you will be asked to supplement information about your age, gender, student
number, and year level. You will affirm a message that you have read the terms, the nature of the
research, and the extent of involvement in the study. (Pg1; Par4)
Risk and Inconvenience

There is no serious risk involved in participating in this study. Personal information will only
include your age, gender, student number, and year level. Gathering of the participant’s student
number and year level will be for the sole purpose of gathering information regarding their academic
performance during the Summer Term, 2019-2020. The researchers assure you that all pertinent
data will be kept in strict confidentiality and will be utilized exclusively for the purpose of the
research. The survey tools will be attached as a google form link in the CON-Student Portal in
Canvas. Completion of the survey tools will take about 20-30 minutes and can be accomplished
using a digital instrument of your choosing (e.g. mobile phone, laptop). There is no expected conflict
of interest to arise from conducting the study. Furthermore, the participation in the study is voluntary
and that you have the inviolable right to withdraw from the study at any time, regardless of the
reason. (Pg2, Par1)

Possible Benefits of the Study

The participants of this study will become aware of their LMS self-efficacy and degree of
online engagement in a distant learning system. Self-efficacy is based primarily on reflection and
interpretation of past performance. A students’ awareness of their self-efficacy and online
engagement creates a more humanized approach to the learning process allowing the students, his
peers, and the instructor to structure an online learning environment that is dynamic, interesting,
creative, and interactive; thus, an engaged learning process. (Pg2, Par2)

Accessibility to Results

Participants can obtain access to the findings of the study upon submission of a request to
the authors. The results can also be accessed when the study is presented in a poster, oral
presentation from research conferences, or if the research study will be published. (Pg2, Par3)

Impact on the Community

The pedagogical shift is a new phase for reimagining education – a challenge both for the
students and the instructors. The use of technological advancements to restructure the learning
design in order to make it a more flexible learning program for students to meet learning outcomes,
in turn, academic success, is a task called for by this shift. Enabling students to be engaged
learners, while achieving confidence in the use of various online learning modalities, balancing their
time between online classes and personal life at home, is yet another bearing in the educational
community. Knowing the students’ viewpoint on this will allow instructors to remodel the
instructional design to one that customizes the learning process for students. The results of the
study will be shared with the Dean and level coordinators in the college to aid in constructing and
remodeling the learning materials, modalities, and techniques. (Pg2, Par4)

Right to Withdraw

This study will involve a survey, therefore the occurrence of either injury or illness as a result
of your participation is very unlikely. This is entirely a voluntary participation on your part. You can
withdraw your participation anytime from this study, if you deemed it necessary. (Pg2, Par5)
Ethics Clearance

The study will be subjected to peer-review from the Ethics Review Board of Angeles
University Foundation. It will also undergo institutional Ethics Review Board if deemed necessary.
This is done prior to pursuance of data collection. (Pg3, Par1)

Contact Person

If you have any questions regarding the study, please contact the first author, Ms. Sarah S. Nares,
RN, MN via email: nares.sarah@auf.edu.ph (Pg3, Par2)

If you have further concerns or matter to discuss regarding the study, you can also contact

Dr. Bella G. Panlilio

Chair, Ethics Review Committee

Angeles University Foundation

Email: bpanlilio@yahoo.com

Tel.: (045) 625-2888 Local: 1764

Mobile: 0923 736 5527 (Pg3, Par3)

Voluntariness Consent

Your participation in this research study is completely voluntary. You have an option to refuse in
participating and have an option to withdraw from the study anytime without any obligations. (Pg3,
Par4)

Confidentiality Pledge

Your identity in this study and the data you will provide will be treated as confidential. (Pg3, Par5)

CONSENT FORM

I hereby confirm that I have read the above information and all questions that I have raised were
properly answered and addressed to my contentment. I clearly understand the nature of the study. I
understand that my involvement in this project is entirely voluntary and that I have the freedom to
decline or withdraw anytime. I therefore agree to participate in this study. (Pg3, Par6)

__________________ _______________________ ______________

Name of Respondent Signature of Respondent Date

STATEMENT OF THE RESEARCHER

I, the undersigned, have read out and explained properly to the respondents all the necessary
information pertaining to this study. I hereby certify to the best of my ability that the participant
clearly understood the nature, corresponding risk in participating, and benefits of the study. I
confirm that the respondent was given the opportunity to ask questions and clarify any issues
related to the study and that all questions and issues raised were all answered correctly and
appropriately to the best of my knowledge. I further confirm that the respondent was not forced into
the provision of consent and that the aforementioned permission was given voluntarily. (Pg4, Par1)

__________________ _______________ ________________

Name of Researcher Signature Date

Researchers:

Sarah S. Nares

Alfredo G. Feliciano

Angela P. Apostol

Rolando L. Lopez

Jennie C. Junio

Anna Lyn M. Paano

 ANGELES UNIVERSITY FOUNDATION
Angeles City
Center for Research and Development

Informed Consent Assessment Form 1

Protocol Number:

Type of Research:

Study Protocol Title:

Principal Investigator:

Study Protocol Submission Date:

To be filled out by PI REVIEWER‘S

COMMENTS
Essential Elements Indicate if the Page and

(as applicable to the study) ICF has the paragraph

specified where
element

assessment point is found

(please

highlight the

paragraph)

YES N/A

1. Statement that the study Page 1,

involves research Paragraph
2

2. Statement describing
the purpose of the Page 1,
Study paragraph
2
3. Study-related treatments and
probability for

random assignment

4. Study procedures including all

invasive

Procedures

5. Responsibilities of the Page 1,

participant Paragraph
3

6. Expected duration of
participation in the
Study

7. Approximate number of
participants in the study

8. Study aspects that are

experimental

9. Foreseeable risks to
participant/embryo/
fetus/nursing infant;
including pain, discomfort,
or inconvenience
associated with
 participation including risks
to spouse or partner;

10. Risks from allowable use of a

placebo (as applicable)

11. Reasonably expected

benefits; or absence of direct Page 2,
benefit to participants, as Paragraph
applicable 2

12. Expected benefits to the

community or society, or Page 2,
contributions to scientific Paragraph
knowledge 4

13. Description of post-study access

to the study

product or intervention that

has been proven safe and
effective

14. Alternative procedures

or treatment available to
the participant

15. Compensation or
insurance or treatment
entitlements of the
participant in case of
study-related injury
1
Adapted from: PHREB Guidelines
16. Anticipated payment, if any,
to the participant in the
course of the study; whether
money or other forms of
material

goods, and if so, the kind and

amount

17. Compensation (or no plans of

compensation) for the
participant or the participant’s
family or dependents in case
of disability or death

resulting from study-related injuries

18. Anticipated expenses, if

any, to the participant in
the course of the study

19. A statement that participation

is voluntary and that Page 2,
participant may withdraw Paragraph
anytime 5
without penalty or loss of benefit to
which the participant is entitled
20. A statement that the study
monitor(s), auditor(s), the Page 3,
AUF-ERC and regulatory Paragraph
authorities will be granted 3
direct access to
participant’s medical
records for purposes ONLY
of verification of clinical trial

procedures and data

21. A statement that the records Page 3,

identifying the participant will Paragraph
be kept confidential and will not 5
be made publicly available, to
the extent permitted by law;
and that the identity of the
participant will remain
confidential in the event the
study results are published;
including limitations to the
investigator’s

ability to guarantee confidentiality

22. Description of policy regarding

the use of genetic tests and
familial genetic information,
and the precautions in place
to prevent disclosure of
results to immediate
family relative or to others without
the consent of the participant
23. Possible direct or secondary use of

participant’s medical records and

biological specimens were taken in
the course of clinical care or the
course of this study

24. Plans to destroy collected

biological specimen at the
end of the study; if not,
details about storage
(duration, type of storage
facility, location, access
information) and possible
future use; affirming
participant’s right to refuse
future use, refuse storage, or
have the materials destroyed

25. Plans to develop commercial

products from biological
specimens and whether the
participant will receive
monetarily or

other benefits from such

development

26. A statement that the participant or Page 2,

Paragraph
participant’s legally acceptable 3
a representative will be informed
on time if information becomes
available
 that may be relevant to the
willingness of the participant to
continue to participation

27. A statement describing access of Page 2,

participant to Paragraph
3
the result of the study

28. A statement describing the

extent of participant’s right to
access his/her records (or lack
thereof vis à vis pending
request for

approval of no or partial disclosure)

29. Foreseeable circumstances and

reasons

under which participation in the

study may be terminated

30. Sponsor, institutional affiliation

of the investigators, and
nature and sources of funds

31. A statement whether the

investigator is serving only as
an investigator or as both
investigator and the
participant’s healthcare
provider
 32. Person(s) to contact in the study Page 3,
team for further information Paragraph
regarding the study and whom 2
to contact in the event of
study-related injury

33. A statement that the Ethics Page 3,

Review Committee Panel has Paragraph
approved the study, and maybe 3
reached through the following
contact for information
regarding rights of study

participants, including grievances

and complaints:

Name of
ERC
Chair
Address:
Email:
Tel:
Mobile:

RECOMMENDED ACTION APPROVALm MINOR

MODIFICATIONS (to be reviewed by the chair) MAJOR
MODIFICATIONS DISAPPROVAL

JUSTIFICATION FOR RECOMMENDATION

 Signature Name
<Title, Name, Surname>

PRIMARY REVIEWER

Date:

<dd/mm/yyyy>

Signature Name

<Title, Name, Surname>

PANEL SECRETARY

Date:

<dd/mm/yyyy>

PANEL CHAIR Signature Name

Date: <Title, Name, Surname>

<dd/mm/yyyy>