Specifications

2
Patient Consent Form for study: Nurses’ Exposure to Nitrous Oxide
Langley Memorial Hospital, the Workers’ Compensation Board of BC
and McGill University are doing a research project concerning nurses’
exposure to nitrous oxide (laughing gas) during labour and delivery.
Signing of this from acts as consent for Charlotte Ferguson, McGill
Masters Student, to monitor the nurses during your delivery (only during
nitrous oxide use). Your privacy will be respected at all times.
Please consider being part of this study if you chose to use nitrous oxide
during your delivery.
Your participation in the study is voluntary and will be kept confidential.
If at any time you would like Charlotte to leave the delivery room –
please say so and she will leave immediately.
If you have any questions about the study please feel free to ask
Charlotte at any time.
Date: _____________________
Name: _________________________________________
Signature: ______________________________________