The 29thAnnual Convention of the

Texas & New Mexico Hospice Organization

And the Annual Meeting of the

Texas Academy of Palliative Medicine

La Fonda Hotel, Santa Fe, NM

March 16-18, 2012

CALL FOR PRESENTATIONS

Deadline: Friday, October 14, 2011

Texas & New Mexico Hospice Organization

P.O. Box 1525, Austin, TX 78767

¨ 1-800-580-9270 ¨ (512) 454-1247 ¨ FAX (512) 454-1248 ¨

ABOUT T&NMHO

The Texas Hospice Organization, established in 1982, fully merged with the New Mexico Hospice Organization in 1998. T&NMHO seeks to support its members by offering educational activities, fostering communication and ensuring quality of care through standards and guidelines.

ABOUT TAPM

Texas Academy of Palliative Medicine (TAPM) is the professional organization of Texas physicians who have an interest in hospice and palliative care.

THE 2011ANNUAL CONFERENCE

We are excited to announce that we will be holding our Annual Convention at the La Fonda Hotel at Santa Fe, NM onMarch 16-18, 2012 and we would like to invite you to join us in our celebration of our 31st Conference. We are expecting over 500 professionals in attendanceagain this year.

PROPOSED TOPICS

Participants are invited to respond to this year's Call for Presentations with a wide range of proposals. Emphasis is placed both on skills-based teaching workshops, clinical research and interdisciplinary team and health systems-related issues affecting hospice care and End-of-Life issues.

Innovative approaches to hospice care for all terminally ill people are encouraged and welcomed. Interdisciplinary team proposals and joint presentations by more than one hospice are acceptable.

CONTENT AREAS

To balance the program, we are suggesting that presentations be in the following areas:

  • Clinical/Psychosocial: Involving all aspects of patient/family care
  • Program Development: Implementation of hospice programs
  • Management: Administration of hospice programs

RECORDING

Unless the presenter specifically marks “disagree” on the Permission to Tape portions of the application, the submission of a proposal for the conference will serve as permission to record the presentation and the subsequent sale of the recordings and use of the presentations for on-line training.

PRESENTATION LEVELS

Applicants must select an accurate knowledge level for their intended audience.

•Beginning: For people with a basic knowledge in a subject area

• Intermediate: For those having a working knowledge in an area

• Advanced: Presenter and audience both are knowledgeable and able to discuss the subject matter thoroughly

•General: Relevant to all participants

Specifying levels assists participants in their selections and improves the presenter’s evaluations.

PRESENTATION FORMATS

Workshops are scheduled for 60 minute sessions. Proposals must be submitted according to the recommended format, including CEU information. Only those proposals, which include all requested items in computer typed format, will be considered. (All items on the checklist must be included.)

DEADLINE

Proposals will be accepted by On-line submission, mail, fax or email until 5 p.m., October 14, 2011. Proposals received after that date and time may not be considered.

SCREENING AND NOTIFICATION

A panel of health professionals representative of an interdisciplinary team will screen the proposals. Presenters selected will be notified of acceptance by email not later than January 30, 2012.

REGISTRATION FEES

A $100.00 reduction of conference registration fees will be granted to the two primary presenters in each session. (All other presenters in that session will be authorized a $50 reduction in fees.) All communications regarding the proposed session will be directed to the primary presenter.

WHAT TO INCLUDE IN PROPOSALS

To submit a proposal, complete and mail, fax or email a typed copy (of the following items to the: Texas & New Mexico Hospice Organization, P.O. Box 1525, Austin, TX 78767 FAX (512) 454-1248. To be considered, proposals must be typed and include all of the following items:

  • A title of the presentation that does not exceed ten (10) words or 54 characters. (Longer titles will be edited, if accepted.) The title should inform the reader of the subject matter.
  • A brief description of the presentation (not to exceed 25 words or 150 characters) for inclusion in the registration brochure.
  • An abstract of the teaching workshop or original research presentation, neatly typed within the space provided on the application form. (See example: Addendum A)
  • A Biographical Data Form with date of April 2010 in right hand corner.
  • A hand signedPresenterConflictDisclosure Declaration
  • A Summary Bio of no more than 150 words.
  • A fully completed application, Education Documentation Form, including PURPOSE of the presentation, with 2 - 4 objectives, etc., and Check List. PURPOSE should indicate how the health care professional will use the information in his/her practice anddoes not use the word ‘understand’.
  • Copies of the handouts to be provided at the conference.

TEXAS & NEW MEXICO HOSPICE ORGANIZATION

2012 ANNUAL MEETING AND CONFERENCE

PRESENTATION PROPOSAL APPLICATION

Title of Presentation:

Name of Primary Presenter:

Job Title:

Name of Organization:

Your Mailing Address (Street/PO Box):

City:State:Zip:

Your Telephone: (Home): (Work):

(FAX): Email:

Other Presenter(s) Name(s): Job Title(s):

Write 1-3 sentences that describe your presentation(this will go on the brochure and all printed material):

Intended Audiences: Nurses / Volunteers
Physicians / Home Health Aides
Chaplains / Office/Clerical
Social Workers / Administrators
Counselors / Others
Bereavement / All
/ Type of Presentation / Audience Level
Workshop / Beginning
Research / Intermediate
Advanced
General

AV Needs: Each room will be set up with podium, microphone, laptop, LCD projector and projector screen.Please list any additional AV needs you have? ______

Please mail, email or fax this completed application, by October 14, 2011, to Brandie Baker at: TX & NM Hospice Organization, P.O. Box 1525, Austin, TX 78767, r Fax to: (512) 454-1248.

CONSENT TO TAPE PRESENTATION: AGREE DISAGREE

SIGNATURE: ______DATE: ______

BIOGRAPHICAL DATA FORM FOR ACTIVITIES

Instructions: Use this format to provide documentation of an individual’s expertise as a planning committee member or as faculty (content specialist) for this activity.Submitted information must not be more than 2 pages. Do not attach any additional material.

Check which role you are fulfilling:

Nurse Planner

Target Audience Representative

Faculty

Content Specialist

Other______(explain)

Name and Degrees
Preferred Contact Address:
Number and Street:
City, State and Zip Code:
Preferred Contact Telephone:
FAX:
E-mail Address:

Present Position:

(Employer, job title)

Education (include basic preparation through highest degree held) Reminder: A degree is awarded from an academic setting; a license is issued by a regulatory agency.

Institution (Name, Major AreaYear Degree

Degree City, State) of Study Awarded

1.

2.

3.

4.

Biographical Data

Use the space below to briefly describe your professional experience as it relates to your role, as indicated above, in this continuing nursing education activity: (add additional areas as needed that relate to this role.) Based on the role(s) checked above, complete the appropriate following statement:

  • As Nurse Planner, I have education or experience in the field of education or adult learning and knowledge related to ANCC/TNA criteria through:
  • As Target Audience Representative, I represent the target audience by:
  • As Faculty and or Content Specialist, I have content expertise in this topic by:
  • Other: As ______, my professional experience as it relates to this continuing nursing education activity is:

Texas and New Mexico Hospice OrganizationTexas Academy of Palliative Medicine

Conflict of Interest Disclosure

As an approved provider by the Texas Nurses Association, it is the policy of Texas and New Mexico Hospice Organization to ensure balance, independence, objectivity and scientific rigor in all of its continuing nursing education activities. All planning committee members and presenters/content specialists/authors participating in a Texas and New Mexico Hospice Organization activity must disclose to Texas and New Mexico Hospice Organization any financial relationships that they or an immediate family member may have with any commercial interest in any amount occurring within the past 12 months that create a conflict of interest. An “immediate family member” is defined as someone with whom you have a relationship involving the sharing of income or assets.

The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to inform Texas and New Mexico Hospice Organization of any financial relationships so that conflicts can be resolved prior to the activity.

Name/degree(s):

For all disclosures, complete each section, sign and date the last page. Please spell out all acronyms.

I or an immediate family member have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the following categories:

  1. Employment

No, I do not have an employment relationship with a commercial interest to disclose.

Yes, I have an employment relationship with

  1. Board of Directors/Other Leadership Position

No, I do not have a leadership position with a commercial interest to disclose.

Yes, I have a leadership relationship with

  1. Research Funding

No, I do not have research funding from a commercial interest to disclose.

Yes, I receive research funding from

  1. Paid Consultant or Member of an Advisory Board or Review Panel

No, I do not have a consultant or advisory position to disclose.

Yes, I have a consultant or advisory board relationship with

  1. Speaker’s Bureau

No, I am not on a speaker’s bureau for a commercial interest.

Yes, I am on the speaker’s bureau(s) for

6. Major Stock or Investment Holder

No, I do not have major stock or investment holdings to disclose.

Yes, I have stock holdings with

7. Other Remuneration

No, I do not have other compensation to disclose.

Yes (please list relationship and company name)

______

FDA Approved Drug and Devices Assurance Statement

Texas and New Mexico Hospice Organization is required by the TNA and ANCC COA guidelines to instruct you that any discussions regarding the utilization of FDA approved drugs or devices must be within approved regulations. If you discuss the utilization of FDA drugs or devices that are outside approved regulations (off-label or investigational uses), you must clearly delineate this for your audience.

Signature of Person Disclosing: Date: ______

FDA Approved Drug and Devices Assurance Statement

Texas and New Mexico Hospice Organization is required by the TNA and ANCC COA guidelines to instruct you that any discussions regarding the utilization of FDA approved drugs or devices must be within approved regulations. If you discuss the utilization of FDA drugs or devices that are outside approved regulations (off-label or investigational uses), you must clearly delineate this for your audience.

Signature of Faculty Disclosing: ______Date: ______

Please be sure that both signatures are completed.

For Texas and New Mexico Hospice Organization RN Nurse Planner use Only:

Resolution of potential conflicts:

No relevant relationship(s) to resolveProvided talking points/outline

Restricted presentation to clinical data Data, slides added or removed

Reassigned faculty’s lecture/topicReviewed content – free of commercial bias

Notes: ______

Signature of RN Nurse Planner: ______Date: ______

Nancy Ritts, MSN, RN

Glossary of Terms for Conflict of Interest Disclosure form

Commercial Interest
ANCC defines an entity that has a “commercial interest” as any proprietary entity producing health care goods or services, with the exception of non-profit or government organizations.

Conflict of Interest
ANCC defines a “conflict of interest” as when an individual has an opportunity to affect CNE content with products or services from a commercial interest with which he/she has a financial relationship.
ANCC considers “opportunity to affect CNE content” to include content about specific agents/devices, but not necessarily about the class of agents/devices, and not necessarily content about the whole disease class in which those agents/devices are used.

Financial relationships
ANCC defines “financial relationships” as those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options, or other ownership interest, excluding diversified mutual finds), or other financial benefit. Financial relationships can also include ‘contracted research’ where the institution gets the grant and manages the funds and the individual is the principal or named investigator on the grant. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ANCC considers relationships of the person involved in the CNE activity to include financial relationships of a family member.

Off label
Using products for a purpose other than that for which it was approved by the Food and Drug Administration (FDA).

Relevant financial relationships
ANCC considers financial relationships in any amount occurring within the past 12 months as “relevant” in terms of creating a conflict of interest.

Role(s): Employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities (please specify).

What was received: Salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.

EDUCATION DOCUMENTATION FORM

This format is required. Instructions for presenter-directed activities: Use this five-column format to provide documentation of Educational Criteria: C. Objectives, D. Content, E. Time Frames, F. Presenters/Content Specialists, and G. Teaching Learning Strategies to show that the activity supports the purpose/goal(s).

For self-directed activities: Utilize a three-column format that includes objectives, content and teaching strategies.

Title of Activity:

Purpose:

C. Objectives / D. Content (Topics) / E. Time Frame / F.Presenter/ CONTENT Specialist / G. Teaching/ Learning Strategies
List the learner objectives in behavioral/measurable outcomes for evaluation. / Do not put sentences here. Include single words and short phrases only that describe the detailed content for the objective to which it refers. / Provide a time frame in minutes for each objective/ topic or content area for presenter directed activities. / List the presenter for each objective/topic or content area in presenter directed activities. / List the teaching strategies utilized by each presenter for each objective, topic or content area – such as resources, materials, delivery methods.

This format (as directed by ANCC) may be adapted to an organization’s own word-processing package and printed in landscape or portrait format, or the form may be reproduced and the information typed directly on the form.

Behavioral Objectives Verb List

In order to comply with the guidelines set forth by our credentialing agency, the following list of measurable verbs are to be used in the development of your behavioral objectives.

KNOWLEDGE / COMPREHENSION / APPLICATION / ANALYSIS / SYNTHESIS / EVALUATION
Define / Choose / Apply / Compare / Develop / Assess
Identify / Describe / Develop / Contrast / Organize / Appraise
List / Explain / Compare / Appraise / Design / Judge
Name / Select / Assess / Evaluate / Classify / Validate
Recognize / Detail / Use / Distinguish / Organize / Discuss
Recall / Demonstrate / Relate / Select / Modify / Critique

The following verbs are not acceptable:

Understand / Review / Teach
Expand / Enlighten / Instruct
Increase / Enhance / Become aware

PLEASE NOTE: Purpose/Objectives: DO NOT use the word ‘understand’ in your Purpose or Objectives.
OFFERING DOCUMENTATION FORM--EXAMPLE

Title of Offering: "Why Hospice?"

Description of the offering: A compassionate presentation of the history, philosophy, and concepts of hospice care; its importance as part of the continuum of care in the treatment of terminally ill patients.

Purpose: The health care professional will apply hospice care with compassion when the value of hospice for terminally ill patients and families is recognized.

Objectives / Content / Time Frame / Faculty / Teaching Methods
List objectives in measurable/behavioral terms. / List the content area to be covered and
provide a description or outline of the content. / State the time frame for the content. (In minutes) / List the faculty person or presenter for each content area. / List the teaching method(s) used for each.
1. Recognize the significance of the Hospice Movement. / 1. The Hospice Movement
a. History of the Hospice Movement
1) Biblical times - weary and ill travelers
2) St. Christopher's in England
3) Hospice in USA - 1972
4) Hospice in the '90s
b. Significance of the Hospice Movement
1) Maximizes the quality of life
2) Nuclear element of care
3) Holistic clinical approach
4) Ethical principles of autonomy
5) Provides a template to accept dying as a natural process / 15 minutes / Dr. Josefina Magno / Discussion
Lecture
Handouts

Total Minutes: + 50 = (Please deduct coffee and lunch breaks from total time.) (EXAMPLE)

Call to Presentations Application Check-List

Required Information Needed / Completed / Enclosed / Comments
1. / Biographical Data Form
2. / Brief Bio of 150 words or less
3. / Presenter Disclosure Declaration
4. / Consent to tape workshop noted
5. / Typed Proposal Application
a. Type of application
b. Audience education level
c. Target audience
d. Teaching methods
e. Audio-visual needs noted
6. / Typed Education Offering Outline Form
a. Objectives (3 or 4) (see attached Behavioral Object Verb List)
b. Content outline/Purpose
c. Time Frame
d. Format (Lecture, Discussion, PowerPoint, Handouts)
7. / Handouts to be used. Please email handouts to (T&NMHO needs a copy for CEU approval purposes and to make handouts by Feb.20, 2012. If you can not meet this deadline we ask that you bring 60 copies of handouts for the participants.