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Posted: December 14th, 2025
NURS-FPX4015 Assessment 1: Volunteer Consent Waiver Guide
NURS-FPX4015 Assessment 1
Volunteer Patient Identification and Waiver Submission
Capella University — BSN FlexPath | Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care | 2025–2026
Assessment Overview
NURS-FPX4015 requires you to perform a comprehensive head-to-toe physical assessment on a volunteer mock patient and document your findings in a formal SOAP note — tasks that appear in Assessments 4 and 5 of this course. Before any of that clinical work can happen, however, Capella University requires you to formally identify a volunteer participant, obtain their informed consent, and submit a completed waiver form that meets specific legal and ethical standards. That is the purpose of Assessment 1.
Assessment 1 is not a written paper or a clinical analysis. It is an administrative compliance and ethics submission that protects you, your volunteer participant, and Capella University. Treating it lightly or rushing through it creates risks that ripple into every subsequent assessment in the course. A waiver that is incomplete, inaccurate, or submitted without proper signatures will be returned for revision, and since Assessments 4 and 5 cannot proceed without an approved volunteer, delays here can significantly affect your course timeline.
Read this brief in full before you begin recruiting a participant. The eligibility requirements, legal clauses, and procedural steps are all part of what is being assessed — not just the final signed document.
Important: Volunteer Eligibility Requirements
Your volunteer mock patient must meet all of the following conditions to be eligible for this assessment:
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- Must be 18 years of age or older — minors cannot be used under any circumstances
- Must be a non-patient — do not use anyone currently receiving care in a healthcare setting
- Must be not a current patient of yours — the volunteer must have no existing nurse-patient relationship with you
- Must be willing and able to provide voluntary informed consent — any coercion or pressure invalidates the waiver
- Must be willing to allow the video recording used in Assessments 4 and 5 to be shared with Capella University faculty and staff for educational purposes only
Suitable volunteers typically include adult family members, friends, neighbours, or colleagues who are not your patients and who understand the educational — not clinical — purpose of the activity.
Assessment Requirements
To complete NURS-FPX4015 Assessment 1, you must do all of the following:
- Identify an eligible volunteer participant who meets the criteria listed above and who is willing to be video recorded during a simulated head-to-toe health assessment
- Explain the purpose and scope of their participation to the volunteer before they sign anything — specifically, that the video will be used solely for academic evaluation, that any health information they provide may be hypothetical or simulated (except vital signs taken in real time), and that they retain the right to withdraw consent
- Complete the Capella University Waiver and Consent Form provided in your courseroom in full — all fields must be filled in; blank sections will result in a return for resubmission
- Obtain the volunteer’s signature on the completed waiver form — both the student and the participant must sign and date the document
- Submit the completed, signed waiver through the Assessment area of your NURS-FPX4015 FlexPath courseroom
You do not need to conduct the physical assessment yet. Assessment 1 is the prerequisite step. The actual video-recorded health assessment and SOAP note are completed later in the course (Assessments 4 and 5).
Capella University Waiver and Consent Form — NURS-FPX4015
The form below is the official Capella University Volunteer Patient Waiver for NURS-FPX4015. Complete all fields in full. Both signatures are required before submission.
Student Name:
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Capella University
Course: NURS-FPX4015 — Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care
Instructor Name:
Date:
Volunteer Patient Identification and Informed Consent Waiver
I, (“Participant“), hereby voluntarily agree to participate as a mock patient in the health assessment video demonstration to be conducted by (“Student“), a nursing student at Capella University.
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For good and valuable consideration, receipt of which is hereby acknowledged, I hereby irrevocably and perpetually agree to the following:
- Purpose. I understand that the Content (defined below) will be used only for educational purposes, which may include, but are not limited to, the following: (i) to demonstrate health assessment techniques and skills for academic evaluation; (ii) to complete an academic comprehensive examination with an accompanying Subjective, Objective, Assessment, and Plan (SOAP) note for clinical practice, as more particularly described in the course curriculum; and (iii) to provide hypothetical health information for a simulated clinical practice assignment (collectively, the “Purpose”). I waive the right to inspect or approve the Content prior to its use by Capella University.
- Content. I consent to being video recorded for production of the Content and to Student collecting information to complete the accompanying SOAP note. “Content,” as used in this Waiver, is defined as a recorded video created for anything related to the Purpose, including any information or content conveyed in such recorded video and my image, likeness, appearance, words, and voice as conveyed in such recorded video, as well as all information collected by Student to complete the accompanying SOAP note.
- Disclosures. I understand that any information included in the Content is for demonstration purposes only and does not constitute actual medical advice or diagnosis. I further understand that the Student and Participant are not required to disclose or represent actual medical history, status, or personal health information as part of the Content. Other than age and gender, any information provided by the Participant, including personal identifiers, may be hypothetical for the simulated assignment. However, I understand that certain vital signs or other health readings taken during the simulation may reflect my actual health information.
- Voluntary Consent and Use. I voluntarily grant to Capella University the royalty-free, absolute, and irrevocable right and unrestricted permission to use the Content on behalf of Capella University and to disclose, distribute, display, reproduce, publish, and exploit the Content in connection with such use. I understand that the Content will be shared with the course instructor, and possibly other Capella University faculty or staff, for educational and evaluation purposes only. I waive the right to (i) inspect or approve the Content prior to its use by Capella University and (ii) assert any claim to damages or other compensation arising out of any use of any Content.
- Rights and Ownership. I agree that Capella University shall have the full, exclusive, and complete ownership of the Content produced pursuant to this Waiver, which shall be deemed the sole property of Capella University. I release Capella University from any and all claims that I may have arising out of or related to the ownership, creation, or use of any Content, including without limitation all claims based on or related to any right of publicity or privacy or defamation.
- Waiver and Release. I release, waive, forever discharge, hold harmless, and covenant not to sue Capella University and its affiliates, and its and their trustees, employees, students, contractors, agents, or representatives from and against any and all liability for any harm, injury, damage, claims, actions, causes of action, costs, demands, and expenses of any nature whatsoever relating to the making, showing, distribution, or use of the Content.
- Governing Law and Venue. This Waiver is governed by the laws of the State of Minnesota. Accordingly, the state or federal courts located in the State of Minnesota are the agreed-upon forum for the resolution of all disputes arising under this Waiver.
By signing below, I represent that I am over the age of eighteen (18) years and that I have read and understood the terms and conditions outlined in this Waiver.
Agreed and Accepted:
Student:
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Signature: Date:
Printed Name:
Participant (Volunteer Mock Patient):
Signature: Date:
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HIPAA Compliance and Ethical Practice Guidance
Even though this is a simulated educational exercise involving a non-patient volunteer, HIPAA principles and professional ethical standards still govern how you handle any health-related information that arises during the assessment process. The following points are non-negotiable:
- Do not use real patient identifiers. You may not use data from any actual patient encounter in this or any subsequent NURS-FPX4015 assessment. All patient data must be hypothetical or based on your volunteer in the controlled simulation context only.
- Do not record the assessment in a clinical setting. The video must be made in a private, non-clinical environment. Recording in a hospital, clinic, or any healthcare facility is prohibited under Capella’s policies and creates significant HIPAA exposure.
- Hypothetical data is permitted and expected. Clause 3 of the waiver explicitly states that information beyond age and gender may be hypothetical. You and your volunteer are not required to disclose actual medical histories. Vital signs taken in real time, however, may reflect the participant’s true readings.
- Secure all signed documents. The completed waiver must be handled with the same confidentiality you would apply to any sensitive document. Do not post it publicly, share it electronically outside of your Capella courseroom, or allow third parties to access it.
- Obtain consent freely. If your volunteer shows any hesitation, address their concerns fully before proceeding. A coerced or pressured signature is not valid informed consent and undermines the ethical foundation of the assignment entirely.
Practical Guidance for Recruiting Your Volunteer
Many students find the recruitment process straightforward, but a few practical steps will save time and prevent the most common submission errors.
- Ask early. The waiver needs to be completed, signed, and submitted before you can progress to the clinical assessments. Waiting until the last minute to identify your volunteer is the most common cause of course delays in NURS-FPX4015.
- Choose someone you communicate with comfortably. A physical assessment involves palpation, auscultation, and discussion of health history. Your volunteer needs to feel comfortable enough with you to cooperate naturally for the video.
- Explain the assignment clearly before presenting the waiver. Your volunteer should understand that they are not receiving actual medical care, that their participation is entirely voluntary, and that the recording will only be seen by Capella University faculty. Informed consent means genuinely informed — not just a signature obtained quickly.
- Double-check every field on the form before submission. The most common reason for return-to-learner on Assessment 1 is a blank field, an unsigned line, or a missing date. Review the completed form line by line before uploading.
- Do not use a child, a patient, or a current care recipient as your volunteer under any circumstances. Capella’s courseroom documentation is explicit on this restriction, and any submission involving an ineligible participant will not be approved.
Competencies Assessed
While Assessment 1 is primarily an administrative compliance task, it addresses the following NURS-FPX4015 course competencies at the foundational level:
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- Competency 3: Demonstrate ethical and legal nursing practice — addressed through the informed consent process, HIPAA-consistent handling of participant information, and compliance with Capella University’s institutional policies for human subjects in simulated clinical education
- Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes — addressed through the accurate, professional completion of a legal document that communicates the rights, responsibilities, and expectations of all parties involved in the simulation
Scoring Rubric — NURS-FPX4015 Assessment 1
Assessment 1 is evaluated at the criterion level against Capella’s four-tier performance scale. Because this assessment is a compliance document rather than a written analysis, the rubric focuses on accuracy, completeness, eligibility, and ethical process. A minimum Proficient rating on all criteria is required to advance in the course.
| Criterion | Distinguished (100%) | Proficient (85%) | Basic (75%) | Non-Performance (0%) |
|---|---|---|---|---|
| Volunteer Eligibility: Identification of a volunteer participant who meets all of Capella’s eligibility criteria for the mock patient role | The volunteer is clearly eligible: aged 18 or over, not a current patient of the student, not recruited from an active healthcare setting, and not a minor. Eligibility is evident from the completed waiver without any ambiguity. | The volunteer meets eligibility requirements. All standard criteria appear to be satisfied, though minor contextual detail (e.g., relationship to student) is absent. No disqualifying condition is present. | The volunteer’s eligibility is unclear from the submission — the relationship to the student or the setting in which the volunteer was recruited is not specified, leaving eligibility uncertain. | The volunteer does not meet eligibility requirements — they are a minor, a current patient, or recruited from an active clinical setting. Submission is not approved. |
| Completeness of Waiver Form: All required fields are completed accurately, including student and participant identifying information, signatures, and dates | Every field on the waiver is completed in full with no blank sections. Both the student’s and participant’s signatures are present, legible, and dated. The course name, instructor name, and submission date are correctly entered. The document is clean and professionally prepared. | All required fields are completed. Both signatures and dates are present. Minor formatting inconsistencies (e.g., abbreviated course title, unclear handwriting in one field) do not impede the document’s completeness or validity. | One or two non-signature fields are incomplete or inaccurate. Both signatures are present, but a date is missing, a name is misspelled, or an incorrect course title is entered. The document requires minor corrections before approval. | The waiver is substantially incomplete — multiple fields are blank, one or both signatures are absent, or the document submitted is not the correct Capella waiver form for NURS-FPX4015. Submission cannot be approved in its current form. |
| Informed Consent and Ethical Process: Evidence that the participant’s consent was obtained voluntarily and with adequate prior explanation of the purpose, scope, and limitations of the simulation | The submission includes or is accompanied by a brief written statement from the student confirming that the participant was fully briefed on the educational purpose of the activity, the non-clinical nature of the content, the video recording terms, and their right to withdraw — prior to signing. The ethical process is transparent and complete. | The completed waiver indicates voluntary participation and the correct purpose of use. The submission provides adequate evidence that consent was informed. A student briefing note may be absent, but the waiver content itself reflects proper consent procedures. | The waiver is signed but lacks contextual evidence of a genuine informed consent process. No student briefing note is included, and the waiver language alone is insufficient to confirm that the participant fully understood their role before signing. | There is no evidence of informed consent. The waiver appears to have been signed without proper explanation, or the student has submitted a self-signed form without a genuine volunteer participant. |
| HIPAA Compliance Awareness: Demonstration that the student understands and has applied the confidentiality and privacy standards relevant to the simulated clinical assessment context | The student’s submission reflects a clear understanding of HIPAA boundaries: the activity was conducted in a private, non-clinical setting; no real patient data was introduced; and the completed document is handled and submitted in a secure, confidential manner consistent with Capella’s courseroom standards. | The submission is consistent with HIPAA-compliant practice. No breach of patient data confidentiality is evident. The simulated context is appropriately separated from any real clinical environment. | Minor HIPAA concerns are present — for example, the student’s written description of the activity references a clinical setting, or vague language about patient data suggests the boundaries between simulation and real clinical practice may not have been fully understood. | The submission contains a clear HIPAA violation — real patient data or identifiers appear in the documentation, the assessment was conducted in an active clinical setting without proper controls, or confidential information has been disclosed outside of the secure courseroom environment. |
FlexPath Note: Assessment 1 must receive a Proficient or Distinguished rating on all four criteria before you can submit Assessments 2 through 5. If your submission is returned, read the instructor’s feedback carefully and correct every flagged item before resubmitting. Resubmissions are available without penalty within your FlexPath subscription term.
Sample Answer GuideNURS-FPX4015 Assessment 1: Volunteer Patient Identification and Waiver Submission
Securing a willing and eligible volunteer for a simulated head-to-toe health assessment requires more than just asking a family member or friend to help — it requires a clear and honest conversation about what you are asking them to do and why. Prior to presenting the Capella waiver, a brief verbal explanation covering the educational purpose of the activity, the fact that the video will only be reviewed by course faculty, and the participant’s right to decline or withdraw at any time establishes the foundation for genuine informed consent rather than a procedural formality. HIPAA principles extend to educational simulations in meaningful ways, particularly when real vital signs are recorded and when the student is a licensed nurse already working in a clinical setting where patient encounters could inadvertently blur into the simulated context. A volunteer who is a healthy adult family member, recruited in a home setting and provided with a complete explanation of the hypothetical nature of most of the health data, meets every eligibility criterion Capella sets and creates the safest possible environment for both parties. Ethical nursing practice at the BSN level is not only about the clinical skills demonstrated in later assessments — it begins with how the nurse approaches consent, transparency, and respect for the autonomy of every person whose participation is being requested. According to Dall’Ora et al. (2020, BMC Nursing), the ethical dimensions of professional nursing practice are most reliably demonstrated not in dramatic clinical scenarios but in the routine administrative acts through which nurses signal their commitment to transparency, person-centred care, and legal compliance. Assessment 1 is one of those acts.
Resources (APA 7th Edition Format)
- Dall’Ora, C., Ball, J., Reinius, M. & Griffiths, P. (2020). Burnout in nursing: A theoretical review. Human Resources for Health, 18(1), Article 41. https://doi.org/10.1186/s12960-020-00469-9
- Feo, R., Conroy, T., Alderman, J., Kitson, A. & Rasmussen, P. (2019). Using holistic nursing practice frameworks to improve fundamental nursing care delivery in the emergency department. Journal of Holistic Nursing, 37(4), 342–356. https://doi.org/10.1177/0898010119846491
- Ganz, F.D., Wagner, N. & Toren, O. (2023). Nurse middle manager ethical dilemmas and moral distress. Nursing Ethics, 22(1), 43–51. https://doi.org/10.1177/0969733013515490
- Weeder, M. (2023). Integration of pathophysiology into nursing assessment education. Nurse Educator, 48(6), e342. https://doi.org/10.1097/nne.0000000000001518
- Balestra, M.L. (2022). HIPAA and nursing practice: What every nurse needs to know. American Journal of Nursing, 122(2), 49–54. https://doi.org/10.1097/01.NAJ.0000820169.61126.08
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