Informed Consent

Heather M. Palmer


Dear Academy of Medical-Surgical Nurses,

My name is Heather Palmer, and I am a PhD Nursing student at the Van Loan School of Graduate and Professional Studies at Endicott College in Beverly, Massachusetts. I am conducting a study through which I hope to measure the perceived confidence level of nurses caring for patients using an insulin pump during an acute care hospitalization. In this study I plan to ask nurses who work in an acute inpatient hospital setting to fill out a demographic data sheet and complete a self-efficacy survey.

The survey, Self Efficacy in Nurses Caring for Patients Using an Insulin Pump in the Inpatient Setting, was designed by myself. This survey has been tested for content validity and reliability. These 9 survey items represent a general knowledge of insulin pump therapy and should take approximately 15 minutes to complete. Participation is voluntary; refusal to participate will involve no penalty whatsoever. To give your consent to participate in this study please complete the demographic data sheet and self-efficacy survey. If you do not wish to participate in the study please exit your screen now. You will not receive compensations to participate in this study.

This study will be conducted by me with oversight from my faculty sponsor, Kelly Fisher, PhD., RN and faculty advisors, Emily G. Smith, DNP RN and Mike Diehl, Ph.D. Only my faculty sponsor, advisors, and I will have access to the data to ensure your confidentiality. The results of this test will in no way have any effect on your employment. If you at any time have questions or comments related to this study, or would like more information, you may contact me or my faculty sponsor, who may be reached at 978-232-2328 or

Thank you very much for your time and consideration. I greatly appreciate your willingness to make this study possible!


Heather M. Palmer