Barriers to Alcohol Screening Survey: Informed consent

                                                                Middle Georgia State University (MGA)
                                                                         Graduate School of Nursing
                                                                                  Informed Consent

 

Title: Perceived Barriers to Routine Screenings for Alcohol Abuse

 

Principal Investigator: Jasmine Franklin

 

 Are you 18 years of age or older? Yes or No (If “No”, you need a different form; please see the principal investigator)

 

I. Purpose:
You are invited to participate in a research study. The purpose of the study is to investigate perceived barriers to the utilization of alcohol screening tools by APRNs in the state of Georgia. You are invited to participate because you are an APRN. Participation will require 10 minutes of your time.

 

You are being asked on a voluntarily basis to participate in research for this study. This research will help to identify barriers to alcohol screenings and increase clinician’s awareness and consistency of alcohol screening tools in the primary and acute care setting. This study will not involve patients.  

 

II. Procedures:
If you decide to participate, you will answer 15 multiple choice questions. Once questions are completed this study will require no more of your time. This study is limited to Georgia’s UAPRN members. This study will be conducted electronically. Research data collection will start February 2019 and end March 2019. Participants will not require any interactions with other participants used in this study.

 

III. Risks:

In this study, you will not have any more risks than you would in a normal day.

 

IV. Benefits:
Participation in this study may or may not benefit you personally. Overall, we hope to gain information about barriers to alcohol screenings from the providers view point.

 

V. Voluntary Participation and Withdrawal:

Participation in research is voluntary. Participation is not a requirement. If you decide to be in the study and change your mind, you have the right to drop out at any time. You may stop participating at any time.

 

VI. Confidentiality:

We will keep your records private to the extent allowed by law. Dr. Keri Wilbur and Jasmine Franklin will have access to the information you provide. Information may also be shared with those who make sure the study is done correctly (MGA Institutional Review Board and the Office for Human Research Protection (OHRP). We will use a study number rather than your name on study records. The information you provide will be stored in a password protected computer. Your name and other facts that may identify you will not appear when we present this study or publish its results. The findings will be summarized and reported in group form. You will not be identified personally.

 

VII. Contact Persons:

Contact Jasmine Franklin at Jasmine.Franklin@mga.edu if you have questions, concerns, or complaints about this study. You can also call if you think you have been harmed by the study. Contact the chair of the Middle Georgia State University IRB at IRB@mga.edu if you would like to speak to s

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* 1. 1.      Age

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* 2. Gender

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* 3. Number of years as an APRN?

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* 4. Race

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* 5. Area of Practice

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* 6. What is the highest level of education you have completed?

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* 7. I am motivated to discuss alcohol with my patients?

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* 8. I feel that alcohol abuse contributes to comorbidities in my patient’s health:

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* 9. I feel alcohol screening is important to my patient’s plan of care?

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* 10. I feel that screening my patient for alcohol abuse lessens the amount of hospital visits:

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* 11. Do you use alcohol screening tools (CAGE, AUDIT, SBIRT, etc) on every patient encounter?

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* 12. I provide interventions to patient’s that screen positive?

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* 13. I provide medications to patient’s that screen positive for alcohol abuse:

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* 14. Alcohol screenings are a public health problem:

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* 15. Please select any barriers that contribute to alcohol screenings in your healthcare setting (select all that apply)?

0 of 15 answered
 

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