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Middle Georgia State University (MGA)

Graduate School of Nursing

Informed Consent


Title: Awareness Assessment of Chiari Malformation for the Advance Practice Registered Nurses in Georgia


Principal Investigator: Antwan Baker


 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 study about Chiari Malformation awareness. The purpose of the study is to assess the awareness of Chiari Malformation among APRNs in Georgia. The survey is designed to assess APRNs awareness of signs and symptoms of Chiari Malformation. A total of 20-50 or more participants will be recruited for the survey. Participation will require about 2 minutes of your time.


II. Procedures:
If you decide to participate, there will be a 10-question survey given along with 5 demographic questions. Once the survey is completed, the study will require no more of your time. The study is limited to Georgia’s UAPRN members. The study will be conducted electronically, and research data collection will start April 15, 2019 and end April 20, 2019. Participants will not require any interactions with other participants used in the 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 will give the investigator increased knowledge about the APRNs awareness of Chiari Malformation.


V. Voluntary Participation and Withdrawal:

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


VI. Confidentiality:

We will keep your records private to the extent allowed by law. Dr. Veela Hughes and Antwan Baker 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 might point to 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 Antwan Baker at Antwan.Baker1@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 at irb@mga.edu if you want to talk to someone who is not part of the study team. You can talk about questions, concerns, offer input, obtain information, or suggestions about the study. You can also call the IRB chair if you have questions or concerns about your rights in this study.

VIII. Copy of Consent Form to Subject:
You can print a copy of this form for your records.

If you agree to participate in this research, please continue with the survey.


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