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Call for AbstractsDue by November 21, 2014
Conference Objectives:
1. Appraise Public Health Nursing’s Role in the Integration of Primary Care and Population Health
2. Explain Best Public Health Practices in Chronic Disease Management
3. Apply Best Practices in Low Resource Environments
4. Describe the role of public health partnerships in assuring effective public health services.
Who should consider submitting an application? Nurses, educators, public health professionals, policy makers, innovators, researchers, clinicians/practitioners, administrators and students/residents.
Applications will be selected by the Association of Public Health Nurses (APHN) based on the content of this application and its relevance to the continuing education and professional development needs of public health nurses. One person may submit multiple abstracts. The presenter(s) is not required to be a nurse or a member of APHN.
ApplicationUse the following checklist as a guide to providing a complete application: (Refer to page numbers listed).
___ Presentation/Activity Title___ Lead presenter/author name and credentials___ Additional presenter/author name(s) and credentials___ Presentation type and requests
80 Years – A Salute to Public Health Nursing,Building on Our Past and Partnering to Shape
Our Future
May 3-6, 2015
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___ Short description of presentation___ Abstract___ Lead presenter/author electronic signature___ Activity (presentation) planning table and references ___ Presenter biographical and conflict of interest disclosure form (all presenter/author(s) must
complete and sign and this must be included together with application by November 21, 2014).
Requirements:
Only complete, electronic applications submitted in Word format (doc, docx) will be reviewed. NO PDFs or other formats are allowed without permission. Applications should be in Times New Roman 12 point font. Please use only standard abbreviations and spell out the words on first use, followed by the abbreviation in parentheses. All numbers, except those that start a sentence, should be in digits.
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Type responses for items 1-8:
1. Title of proposed presentation/activity (65 characters or less):
2. Lead presenter/author first and last name and credentials:
3. Other presenter(s)/author(s) first and last name(s) and credentials:
4. Presentation type and requests:
Please place an “x” next to all that apply:
___ Oral presentation (including time for questions and answers at the end)___30 minutes ___45 minutes ___60 minutes ___other (specify length in
minutes:_____)
___ Request a microphone, podium, laptop and projector (presenter will be required to send their final presentation electronically by March 31, 2015 to [email protected]).
___ Request to show a video or video clip (must be sent electronically to Bobbie D. Bagley by March 31, 2015).
___ Panel discussion (all panelists must be listed in this application as presenters/authors and complete the required forms). Number of chairs and equipment needed:
___ Oral presentation with only a microphone and podium (if you do not require a laptop or projector for your presentation).
___ Poster presentation. Indicate size of poster (height x length) in inches:_____ height x _____length (maximum size is 36” high x 48” long)
___ Other type of activity or presentation (please describe):
___ Other requirements or assistance requested:
5. Write a short description (up to 50 words) of your presentation that will appeal to attendees. If your presentation is selected, this information may appear in the conference program (subject to APHN edits). This applies to all presentations, including oral and poster.
6. Abstract (for all presentations, including oral and poster) in 300 words or less: Background of topic Purpose or aim of the presentation Summary of the content (include results or findings, if applicable), that will be
presented Significance and implications for public health nurses
7. Complete the Activity Planning Table and include it with this application.
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8. Electronic Signature: The Lead Presenter/Author must type their name and the date. This serves as the electronic signature and signifies the intent to comply with all requirements of the Association of Public Health Nurses and of New Hampshire Nurses Association for continuing education requirements.
____An “X” here serves as the electronic signature of the Lead Presenter/Author submitting this application.
Typed Full Name of Lead Presenter/Author: Date:Credentials:Email address:Cell phone and alternate daytime phone:
Send this completed application and all presenter/author forms to Bobbie D. Bagley at: [email protected] no later than November 21, 2014. Please send only ONE email with the application and forms in Microsoft Word formal. PDF or other formats may be rejected.
APHN will notify the lead presenter at the email address provided about the status of this application by December 15, 2014. Presenters may be required to complete additional paperwork or forms for continuing education purposes.
All presenters will be assigned a time to present and will be required to report in person at the APHN conference presenter check-in area at least 1 hour prior to their assigned presentation time. Poster presenters will be provided instructions about the time and details of the poster session.
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Activity Planning Table and ReferencesInstructions for completion:
A. Complete the planning table and references and submit them along with this application. The information in the planning table may be edited by the APHN conference planners to meet ANCC guidelines. You will be sent a final version.
B. Educational Objectives: Use the Example Table (next page) and ANCC’s Revision of Blooms Taxonomy of Objectives
when writing objectives.
Write 2-3 specific objectives for the learning activity in the planning table. You may be asked to provide additional objectives, depending upon the length of your presentation.
Each objective should have one measurable action verb and should specify what the learner will know or do once the objective has been completed (the outcome of attaining the objective). Example: Learner will be able to list 3 public health nursing interventions in a systems approach to chronic disease prevention or control.
C. Quality of Content and Time Frames:
On the Table, list the content for each objective. See the Example Table. The content must:
o Be congruent with purpose and objectives.o Include specific details of what will be taught to achieve those objectives.o Reflect the intent of the objectives.o Be numbered consistently with the related objective, and appear next to the objective.o Be evidence-based or based on the best available evidence.
List the time in minutes for each part of the presentation/activity.
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Complete the following Planning Table for your presentation: OBJECTIVES CONTENT (Topics) TIME in
MINUTES
PRESENTER TEACHING METHODS
List learner’s objectives in behavioral terms (see example table and list of approved verbs): “Learner will be able to:”
Provide an outline of the content for each objective. Be specific, give bullets of covered content- no justifications of need
State the time frame for each objective
List the Presenter/Faculty for each objective.
Describe the teaching methods, strategies, materials & resources for each objective
Provide 2-3 objectives (or more, for longer presentations).
1.
2.
3.
References: Indicate each type of reference and list all references next to each type you have indicated (APA style is preferred http://www.apastyle.org/learn/tutorials/basics-tutorial.aspx )
___ Organization/web sites: (Organization must use current available evidence within past 5-7 years as resource for readers, may be published on unpublished content; examples: Agency for Healthcare Research and Quality, Centers for Disease Control, National Institutes of Health).
___ Peer reviewed journal (most should be within the last 5-7 years):
___ Clinical guidelines (like those listed at: www.guidelines.gov):
___ Expert resource (may include individual, organization, educational institution, book article or website):
___ Textbook reference:
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Example Planning Table (notice that there are multiple presenters for this 30 minute activity in this example):
OBJECTIVES CONTENT (Topics) TIME in MINUTE
S
PRESENTER TEACHING METHODS
List learner’s objectives in behavioral terms: “Learner will be able to:”
Provide an outline of the content for each objective. Be specific, give bullets of covered content- no justifications of need
State the time frame for each objective
List the Faculty for each objective.
Describe the teaching methods, strategies, materials & resources for each objective
1. Identify the most common microbial pathogens in health care facility cultures
2. Describe common microbial pathogens causing hospital acquired infections
1. Site specific cultures and organisms typically seen (urine, sputum, blood, wound, and sterile body sites)
2. Gram Positives (staph, strep, etc.); gram negatives (E.coli, etc.); misc.
15 minutes
15 minutes
Thomas Smith, RN
Gina Cody, MS, MPH, RN
Slide presentation, lecture
Slide presentation, lecture, Q & A
ANCC’s revision of Blooms Taxonomy of Objectives: Use verbs from the list below. DO NOT use “understand” or “learn” or the title of the categories below. Do not use the title of the category (for example, “remember”) as your verb.
Category:Remember
Category:Understand
Category:Apply
Category:Analyze
Category:Evaluate
Category:Create
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definerepeatrecordlistrecallnamerelate
translaterestatediscussdescriberecognizeexplainexpressidentify
interpretapplyemployusedemonstratedramatizepracticeillustrateoperateschedule
distinguishanalyzedifferentiateappraisecalculateexperimenttestcomparecontrastcriticizediagraminspect
composeplanproposedesignformulatearrangeassemblecollectconstructcreateset uporganizemanage
judgeappraiseevaluateratecomparevaluerevisescoreselectchooseassessestimatemeasure
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Note: Time spent evaluating the learning activity may be included in the total time when calculating contact hours.
Total Minutes Click here to enter text. divided by 60 = Click here to enter text. contact hour(s)
Completed By Name and Credentials Click here to enter a date.Completed By: Name and Credentials Date
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Southern NH AHECEducational Planning Table – Live
Title of Activity: “80 Years- A Salute to Public Health Nursing, Building on Our Past and Partnering to Shape Our Future.” Identified Gap(s): Click here to enter text.
Description of current state: Click here to enter text.
Description of desired/achievable state: Click here to enter text
Gap to be addressed by this activity: Knowledge Skills Practice Other: Describe
Purpose: (write as an outcome statement, e.g. "The purpose of this activity is to enable the learner to…..Click here to enter text.”
OBJECTIVESCONTENT
(Topics)TIME
FRAME PRESENTER TEACHING METHODS
List learner’s objectives in
behavioral terms
Provide an outline of the content for each
objective. It must be more than a restatement
of the objective.
State the time
frame for each
objective
List the Faculty for each
objective.
Describe the teaching methods, strategies,
materials & resources for
each objective1. Click here to enter
text.
Click here to enter text. Click here to enter text.
Click here to enter text.
Click here to enter text.
2. Click here to enter text.
Click here to enter text. Click here to enter text.
Click here to enter text.
Click here to enter text.
3.Click here to enter text.
Click here to enter text. Click here to enter text.
Click here to enter text.
Click here to enter text.
List the evidence-based references used for developing this educational activity: Click here to enter text.
Southern NH AHECBiographical and Conflict of Interest Form
Title of Educational Activity: “80 Years- A Salute to Public Health Nursing, Building on Our Past and Partnering to Shape Our Future.” Educational Activity Date: May 3-6, 2015
Role in Educational Activity: (Check all that apply) Nurse Planner
Content Expert Faculty/Presenter/Author Content Reviewer Other: Planning Committee
Section 1: Demographic DataName with Credentials/Degrees: Name with CredentialsIf RN, Nursing Degree(s): AD Diploma BSN Masters Doctorate
Address: AddressPhone Number: Email Address: Email AddressCurrent Employer and Position/Title: Current Employer and Position/Title
Section 2: Expertise - Planning CommitteeIf a planning committee member, select area of expertise specific to the educational activity listed above:
Other If Other: Explain Here
Please describe expertise and years of training specific to the educational activity listed above. (If the description of expertise does not provide adequate information, the Nurse Planner may request additional documentation.)
Section 3: Expertise - Presenter/Faculty/Author/Content Reviewer
An "X" on this line identifies the expertise information the same as listed above.
Please describe expertise and years of training specific to the educational activity listed above. (If the description of expertise does not provide adequate information, the Nurse Planner may request additional documentation.)
Describe Here
Section 4: Conflict of InterestThe potential for conflicts of interest exists when an individual has the ability to control or influence the
content of an educational activity and has a financial relationship with a commercial interest,* the products or services of which are pertinent to the content of the educational activity. The Nurse Planner is responsible for evaluating the presence or absence of conflicts of interest and resolving any identified actual or potential conflicts of interest during the planning and implementation phases of an educational activity. If the Nurse Planner has an actual or potential conflict of interest, he or she should recuse himself or herself from the role as Nurse Planner for the educational activity. *Commercial interest, as defined by ANCC, is any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients, or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by or used on patients.
Commercial Interest Organizations are ineligible for accreditation.
An organization is NOT a Commercial Interest Organization* if it is:
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A government entity; A non-profit (503(c)) organization; A provider of clinical services directly to patients, including but not limited to hospitals, health care
agencies and independent health care practitioners; An entity the sole purpose of which is to improve or support the delivery of health care to patients,
including but not limited to providers or developers of electronic health information systems, database systems, and quality improvement systems;
A non-healthcare related entity whose primary mission is not producing, marketing or selling or distributing health care goods or services consumed by or used on patients.
A liability insurance provider; A health insurance provider; A group medical practice; An acute care hospital (for profit and not for profit); A rehabilitation center (for profit and not for profit); A nursing home (for profit and not for profit); A blood bank; or A diagnostic laboratory.
(*Reference: Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, August 2007 (www.accme.org) - ANCC’s definition is intended to ensure compliance with Food and Drug Administration Guidance on Industry-Supported Scientific and Educational Activities and consistency with the ACCME definition)
All individuals who have the ability to control or influence the content of an educational activity must disclose all relevant relationships** with any commercial interest, including but not limited to members of the Planning Committee, speakers, presenters, authors, and/or content reviewers. Relevant relationships must be disclosed to the learners during the time when the relationship is in effect and for 12 months afterward. All information disclosed must be shared with the participants/learners prior to the start of the educational activity.
**Relevant relationships, as defined by ANCC, are relationships with a commercial interest if the products or services of the commercial interest are related to the content of the educational activity.
Relationships with any commercial interest of the individual’s spouse/partner may be relevant relationships and must be reported, evaluated, and resolved.
Evidence of a relevant relationship with a commercial interest may include but is not limited to receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (stock and stock options, excluding diversified mutual funds), grants, contracts, or other financial benefit directly or indirectly from the commercial interest.
Financial benefits may be associated with employment, management positions, independent contractor relationships, other contractual relationships, consulting, speaking, teaching, membership on an advisory committee or review panel, board membership, and other activities from which remuneration is received or expected from the commercial interest.
Is there an actual, potential or perceived conflict of interest for yourself or spouse/partner? Choose an item.
If yes, please complete the table below for all actual, potential or perceived conflicts of interest**:
Check all that apply
Category Description
Salary Click here to enter text.
Royalty Click here to enter text.
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Stock Click here to enter text.
Speakers Bureau Click here to enter text.
Consultant Click here to enter text.
Other Click here to enter text.* *All conflicts of interest, including potential ones, must be resolved prior to the planning,
implementation, or evaluation of the continuing nursing education activity.
Section 5: Statement of UnderstandingCompletion of the line below serves as the electronic signature of the individual completing this
Biographical/Conflict of Interest Form and attests to the accuracy of the information given above.
Type Signature Here: Name and Credentials Typed Signature: Name and Credentials (Required) Date
Section 6: Conflict Resolution (to be completed by Nurse Planner)
Procedures used to resolve conflict of interest or potential bias if applicable for this activity:
Not applicable since no conflict of interest. Removed individual with conflict of interest from participating in all parts of the educational activity. Revised the role of the individual with conflict of interest so that the relationship is no longer relevant to the
educational activity. Not awarding contact hours for a portion or all of the educational activity. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,
balance in presentation, evidence-based content or other indicators of integrity, and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation.
Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicators of integrity, and absence of bias, AND reviewing participant feedback to evaluate for commercial bias in the activity.
Other - Describe: Click here to enter text.
Nurse Planner Signature (*If form is for the activity Nurse Planner, an individual other than the Nurse Planner must review and sign).
Completion of the line below serves as the electronic signature of the Nurse Planner reviewing the content of this Biographical/Conflict of Interest Form.
AHEC to sign here
_______________________________________________________________________ Typed or Electronic Signature: Name and Credentials (Required) Date
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