ADULT CONSENT FORM

Time Customs and Sleep in American Indian Shift Workers

WHAT ARE THE POTENTIAL BENEFITS TO YOU?

A potential benefit of participating in this study is that you may be more aware of your activity/rest habits.

WHAT ARE THE POTENTIAL BENEFITS TO SOCIETY?

The findings of this study may advance our knowledge about activity/rest patterns in American Indian/Alaskan Native and White, non Hispanic licensed nurses and contribute new information to the body of existing research. The findings about sleepiness and sleep disturbances will increase societies’ knowledge. Social time customs data and its relationship to sleep disturbances and sleepiness will provide direction for future research.

WHAT ARE YOUR FINANCIAL OBLIGATIONS?

There are no financial obligations to participation in this study.

WHAT COMPENSATION WILL YOU RECEIVE FOR PARTICIPATING?

Phase 1: You will receive a ten dollar ($10.00) gift certificate. After submitting the completed web-base survey, you must email your name and mailing address to the principal investigator. The gift certificate will be mailed within 5-days of receiving the email.
Phase 2: You will receive $50.00 compensation for participating in the five-day research study. After data collection is complete and equipment is returned, you will receive an additional gift certificate valued at $25.00 to a nationally recognized company. Should you decided to withdraw from the study before it is completed, you will receive $10.00 for each day that you did participate.

WHAT SHOULD YOU DO IN CASE OF AN EMERGENCY?

If you have a research related injury or problem, you should immediately contact one of the personnel listed at the end of this consent form.

HOW WILL YOUR CONFIDENTIALITY BE PROTECTED?

You have rights regarding the privacy of your medical information collected prior to and in the course of this research. This medical information, called “protected health information” (PHI), includes demographic information, the results of physical exams, blood tests, x-rays and other diagnostic and medical procedures, as well as your medical history. You have the right to limit the use of sharing of your PHI, and you have the right to see your medical records and know who else is seeing them.
By signing this consent form, you are allowing the research team to have access to your PHI. The research team includes the investigators listed on this consent form and other personnel involved in this specific study at UNMC/NHS.