Living a Good Life…At the End of Life

2014NHPCA Annual Conference

CALL FOR PRESENTATIONS

The Nebraska Hospice and Palliative Care Associationis seeking presentation proposals for the 2014NHPCA Annual Conference. The conference will be held April 15-16, 2014,at the Embassy Suites Hotel in Lincoln, Neb.

The conference will address the educational needs of all levels of hospice staff as well as a broader community of physicians, nurses, social workers, nursing facility and assisted living administrators and staff, VA staff, hospital staff, and others from Nebraska and surrounding states.

We are seeking presentationsthat have innovative and informative messages. Interest areas include but are not limited to:

  • Disease-Specific Information
  • Pain Management and other symptom control
  • Care plan development
  • Quality Improvement
  • Team relationships
  • Cultural and Religious Diversity
  • Alternative therapies
  • Bereavement and Grief
  • Volunteer Management
  • Veteran Issues
  • Patient Education techniques
  • Palliative Care
  • Ethical Issues
  • Hospice-Nursing Facility Collaboration
  • Spiritual Care

Questions can be directed to September Stone at 402-435-3551 or by email to .

Please share copies of this Call for Presentations with anyone you think would be interested.

The proposal application must be submitted by Oct.31, 2013

to be considered for the 2014 NHPCA Annual Conference

THE SELECTION PROCESS:

Proposals for presentations must be submitted by Oct. 31, 2013.TheNHPCA Annual Conference Committee will review all proposals. Proposals will be selected and individuals will be notified the week of Nov. 11, 2013.

Presenter Responsibilities – the presenter must:

  • Comply with submission deadlines
  • Complete all documentation–Presentation Submission Form, Session Description, Bibliography, Biographical and Conflict of Interest Form for each speaker
  • Develop a handout and submit a copy electronically to NHPCA no later than March 15, 2014
  • Agree to have presentation handouts posted on NHPCA website for attendees to print off

CALL FOR PRESENTATION SUBMISSION REQUIREMENTS:

To submit a presentation proposal for consideration, send the following to r fax to 402-475-6289 by Oct. 31, 2013:

1. Presentation Submission Form (page 3)

2. Session description for publication in the conference program (page 4)

3. Bibliography with a minimum of three (3) sources (page 4)

4. Biographical and Conflict of Interest Form for each speaker (pages 5-8)

All sessions are 60-90 minutes in length

In order for your presentation to be considered, the NHPCAAnnual Conference Committee will need the following information. You must use the enclosed Presentation Submission Form to submit the following:

1. Objectives:The objectives are what you hope participants will learn from your presentation. All presentations need to have at least three objectives and they must be measureable. Avoid general terms such as know, understand, internalize and appreciate. Use descriptive terms such as explain, classify, diagram, diagnose, develop, apply, implement, translate, formulate, solveand evaluate.

2. Content:The content of the presentation must be stated by objective. Thus, objective 1 will have content 1, etc.

3. Teaching method for each objective:The teaching method can be the same for the entire presentation (methods such as lecture, discussion, case studies, etc. arecommon).

2014Annual Conference Presentation Submission Form

Submit to: or fax to 402-475-6289

Deadline: October 31, 2013

TITLE:

PREFERRED PRESENTATION DATE: April 15, 2014 April 16, 2014 No preference

PRIMARY PRESENTER:

CO-PRESENTER:

At least 3 objectives are required and they must be measurable

Objectives / Content Outline / Time Frame / Presenter / Teaching Methods
List at least three objectives for your presentation.
The participant will be able to: / Listthe content (topics) for each objective / List the time it will take to address each objective / List the name of the presenter for each objective / Provide teaching methods for each objective, i.e., lecture, discussion, case studies, PowerPoint, question/answer, etc.
Objective 1: / Content 1 (must relate to objective 1): / Objective is
minutes in length / Presenter: / Teaching methods for objective 1:
Objective 2: / Content 2 (must relate to objective 2): / Objective is
minutes in length / Presenter: / Teaching methods for objective 2:
Objective 3: / Content 3 (must relate to objective 3): / Objective is
minutes in length / Presenter: / Teaching methods for objective 3:

Session description (100 words or less): Be sure the description provides the reader with a clear understanding of the session. The description may incorporate the proposed objectives and/or content, or may be a narrative description.

“The purpose of this activity is to enable the learner to…”

Bibliography: List the evidence-based references used for developing this presentation. Include at least three sources (examples include: journal articles, books, and websites)

1.

2.

3.

**Complete Sections 1, 3, 4, and 6**

Biographical and Conflict of Interest Form

2014 Criteria

Title of Educational Activity: 2014 Nebraska Hospice and Palliative Care Association (NHPCA) Annual Conference – Living a Good Life…At the End of Life

Education Activity Date: April 15-16, 2014

Role in Educational Activity: (Check all that apply) Planning Committee Member

Faculty/Presenter/Author

Content Reviewer

Other – Describe:

Section 1: Demographic Data

Name with Credentials/Degrees:

If RN, Nursing Degree(s): AD Diploma BSN Masters Doctorate

Address:

Phone Number: Email Address:

Position/Title:

Facility:

Section 2: Expertise - Planning Committee Member

If a planning committee member, select area of expertise specific to the educational activity listed above:

Nurse Planner (responsible for ensuring adherence to ANCC Accreditation criteria)

Content Expert

Other

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 Provider Unit 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 Provider Unit may request additional documentation.)

______

______

______

Section 4: Conflict of Interest

The 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 (see figure 6). 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 ineligiblefor accreditation.

An organization is NOT a Commercial Interest Organization* if it is:

  • 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.
  • Liability insurance providers
  • Health insurance providers
  • Group medical practices
  • Acute care hospitals (for profit and not for profit)
  • Rehabilitation centers (for profit and not for profit)
  • Nursing homes (for profit and not for profit)
  • Blood banks
  • Diagnostic laboratories

(*Reference: Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, August 2007 ( - 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?

Yes No

If yes, complete the table below for all actual, potential or perceived conflicts of interest**:

Check all
that apply / Category / Description
Salary
Royalty
Stock
Speakers Bureau
Consultant
Other

** 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: Conflict Resolution (to be completed by Nurse Planner)

  1. Procedures used to resolve conflict of interest or potential bias if applicable for this activity:

(Check all that apply)

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:

Section 6: Statement of Understanding

An “X” in the box 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.

Electronic Signature (Required) Date: ______

______

Completed By: Name and Credentials

Nurse Planner Signature(* If form is for the activity Nurse Planner, an individual other than the Nurse Planner must review and sign)

An “X” in the box below serves as the electronic signature of the Nurse Planner reviewing the content of this Biographical/Conflict of Interest Form.

Electronic Signature (Required)

______

Completed By: Name and CredentialsDate

1