University of the East

Ramon Magsaysay Memorial Medical Center, Inc

#64 Barangay Doña Imelda Aurora Boulevard Quezon City 1113
Telephone No. 713-33-09; 715-08-61

Patient Information and Informed Consent Form

You are being invited to participate voluntarily in the study entitled “Learning
Simulated Mammography in Lecturio and the Satisfaction and Self-Confidence of
First-Year Nursing Students From UERMMMCI” under the supervision of Dr. Janelle
Castro MSN, RN, PhD and professor Chonalyn Macorol MSN, ENT, RN

Before you agree to join this study, you need to know the risks and benefits so
you can make an informed decision. This process is known as “informed consent.” This
consent form tells you about the study that you may wish to join. Please read the
information carefully and discuss it with anyone you want. This may include a friend or a
relative. If you have questions please ask the principal investigator or study staff to
answer them.

The objective of this study is to determine the correlation between learning

mammography stimulation in Lecturio and the satisfaction as well as self-confidence of
first year nursing students from UERMMMCI. The initial number of study participants is
thirty (30).

To help researchers to ensure that the study results are accurate and study
participants are representative of the population being studied. You are being invited to
participate in this study because of the following inclusion criteria:

Inclusion Criteria:

1. Enrolled in Bachelor of Science and Nursing (BSN) at the University of the East
Ramon Magsaysay Memorial Medical Center Inc. (UERMMMCI)
2. First year Nursing Students
3. Students from sections A, B, C, D, E and F for first-year
 4. Experienced using Lecturio

You can also partake in this study if you failed to fulfill the following exclusion criteria:
Exclusion Criteria:
1. Attended vocational courses closely related to nursing, such as Midwifery,
Healthcare Services II or Nursing Aide Training in TESDA, etc.
2. 2nd to 4th-year nursing students
3. Students who have a history of disciplinary action related to clinical practice.

The duration of your participation in this study will be from June 2023. In this
study, you will complete the Student Satisfaction and Self-Confidence in Learning
questionnaire—an instrument that may take up to no more than 13 to 15 minutes . The
data collection shall be done virtually with the supervision or support of the researchers
this June.

Your responsibilities as a study subject include:

a. Know the start and end dates of your participation in the study
b. Keep a personal copy of your informed consent form
c. Read and sign the informed consent for prior to participating in the study
d. Report any and all unanticipated problems to the principal investigator and
researchers

The principal investigator may remove you from this study for any justified reason
according to the protocol. Examples of such reasons are the following:
a. Participants who could not completely answer the questionnaire (Google Form)
sent to the participants would be excluded from the study. For this reason, the data
collected from the participants would be lacking, causing a problem in identifying
the results using the statistical treatment.
b. Participants who have taken a leave of absence or have been absent for more than
2 consecutive days during the data collection period.
 You may withdraw your consent from participation in this study at any time. It is
important that you inform the principal investigator in writing. The principal investigator
will continue to retain and use any research results that have already been collected for
the study evaluation. No further study-related activities will take place. The choice to
withdraw from research participation will have no repercussions.

Risk of study participation would be the inconvenience associated with

participating in this study since time is needed in the completion of the Student
Satisfaction and Self-Confidence in Learning questionnaire. Participating in this study
will pose no actual direct benefit to you.

There will be no monetary costs to you for participating in this study since any
expenses in such an evaluation is not expected. You will not be paid for participating in
this research.

This study would benefit nursing schools or other related institutions to know
whether there is a correlation between learning respiratory stimulation in Lecturio as
well as the satisfaction and self-confidence of first-year nursing students from
UERMMMCI.

Unless required by law, your name will not be disclosed outside the research
clinic. Your name will be available only to the following people or agencies: the principal
investigator and staff; authorized representatives of the principal investigator; ethics
committees and health authority inspectors. While participating in this study, the
principal investigator will replace your name with a special code that identifies you. Your
participation in this study is voluntary and you may cancel this consent at any time and
without any penalty, reason, or loss of benefit. If you do so, your participation in the
study will end and the study staff will stop collecting information from you.

You have the right to review your study information and request changes to the
study information if it is not correct. However, please note that during the study, access to
study information may be limited if it weakens the integrity of the research. You may
have access to the study information held by the principal investigator at the end of the
study. You can call or ask questions anytime regarding this study.

The contact person for further information or for consultation on diverse events is
Synaira Anne I. Fodra, 09617514060, group leader.

This study has been approved for implementation by the Research Institute for
Health Sciences Ethics Review Committee. If you have questions related to your rights
as a research subject, please contact:

Research Institute for Health Sciences ERC Panel Chair: Maria Milagros U. Magat, MD,
MEM.

Address: 2/F JMC Bldg. Aurora Blvd. Quezon City

Email: research@uerm.edu.ph

Telephone No.: +63 2 7161843

Cellphone No: 09258528048

I have read this document/had its contents explained to me. I understand the
purpose of this study and what will happen to me in this study. I do freely give my
consent to join in this study, as described to me in this document. I understand that I will
receive a copy of this document as signed below. By signing this consent form, I
authorize the use, access, and sharing of my personal medical information as described in
the section “Confidentiality and Authorization to collect, use and disclose Personal
Medical Information”. This consent is valid unless and until I revoke it.

Kirk V. Espinar 06/25/2023

Printed Name Over Signature of Date

the Participant
 June 25, 2023
Janela E. Ayapana Signature Date

June 25, 2023

Anika Janlin G. Borce Signature Date

June 25, 2023

Synaira Anne I. Fodra Signature Date

June 25,2023
Alecsa Gabriele V. Jimenez Signature Date

June 25, 2023

Andrea S. Ramos Signature Date
 Informed Consent

I, (full name) Kirk V. Espinar a (year level) Level 1 nursing student from
(section) N1A agree to take part in the study: “Learning Simulated
Mammography in Lecturio and the Satisfaction and Self-Confidence of First-Year
Nursing Students From UERMMMCI”. I confirm that I have had time to read carefully
and understand the subject information sheet provided for this study.
● I confirm that I have had the opportunity to discuss the study and ask questions
and I am satisfied with the answers and explanation that I have been provided.
● I give permission for my medical records to be reviewed by the investigators.
● I understand that my participation is voluntary and I am free to withdraw at any
time without giving any reason and without my medical care or legal rights being
affected.
● I agree that my anonymous personal data may be transferred and processed
worldwide under the responsibility of the Sponsor and submitted to the Bureau of
Food and Drug where the drug may be considered for registration and marketing.
● I agree to take part in this study.
● I agree that my personal/family doctor can be informed of my participation in the
study.
● I understand that I will receive a copy of this document as signed below. By
signing this consent form,
● This consent is valid unless and until I revoke it.

Kirk V. Espinar 06/25/2023

Name and Signature
of the Participant Date

Synaira Anne I. Fodra June 25, 2023

Name and Signature of the
Principal Investigator Date