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TEXAS NURSES ASSOCIATION8501 North Mopac Expressway, Suite 400, Austin, Texas 78759-8396

Phone: (512) 452-0645 Fax: (512) 323-5379 E-mail: cne@texasnurses.orgWeb site: www.texasnurses.org

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Individual Activity Application Guidelines and Criteria_________________________________________________________________________________

An education activity is a planned organized effort, either Provider-Directed, Learner-Paced or Blended aimed at accomplishing learning outcomes. An activity, once approved, may be presented once or be presented multiple times over a two-year period as long as the content remains current. A Provider-Directed activity is one where the provider controls all aspects of the learning. A Learner-Paced activity is an activity where the learner determines the pace at which the learner engages in the learning activity. A Blended Activity is an activity that combines aspects of the Provider-Directed and the Learner-Paced activity.

The individual activity organization is defined as an individual, organization, or part of an organization that submits a continuing nursing education (CNE) activity for approval to an Accredited Approver – in this case, the Texas Nurses Association (TNA). The individual activity organization must have a clearly defined process for assessing a nursing learning need which becomes the basis for planning, implementing, and evaluating the CNE activity which adheres to adult learning principles, professional education standards, and ethics.

Prior to completing this application read all activity guidelines and criteria completely. All eligibility documentation requirements must be met prior to approval of the activity. Information presented within this application is the minimum required to meet the Texas Nurses Association (TNA) and the American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA) criteria for continuing nursing education. In addition, the objectives and content must meet the definition of and criteria for continuing nursing education as established by the Texas Board of Nursing (BON). The definition is found in the Texas Administrative Code, TITLE 22 EXAMINING BOARDS, PART 11 TEXAS BOARD OF NURSING, CHAPTER 216 CONTINUING COMPETENCY, Rule 216.1 Definitions, (9) Continuing Education (CE). It reads as follows: “Programs beyond the basic nursing preparation that are designed to promote and enrich knowledge, improve skills and develop attitudes for the enhancement of nursing practice, thus improving health care to the public.”

Criteria for what is not CNE can be found in Rule 216.6 – “Activities which are not acceptable as Continuing Education”:

The following activities do not meet continuing education requirements for licensure renewal.1- Basic Life Support (BLS) or cardiopulmonary resuscitation (CPR) courses.2- Inservice programs. Programs sponsored by the employing agency to provide specific information

about the work setting and orientation or other programs which address the institution’s philosophy, policies and procedures; on-the-job training; basic cardiopulmonary resuscitation; and equipment demonstration are not acceptable for CE credit.

3- Nursing refresher courses. Programs designed to update knowledge or current nursing theory and clinical practice, which consist of a didactic and clinical component to ensure entry level competencies into professional practice are not accepted for CE credit.

4- Orientation programs. A program designed to introduce employees to the philosophy, goals, policies, procedures, role expectations and physical facilities of a specific work place are not acceptable for CE credit.

5- Courses which focus upon self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, and yoga.

6- Economic courses for financial gain, e.g., investments, retirement, preparing resumes, and techniques for job interview.

7- Courses which focus on person appearance in nursing.8- Liberal art courses in music, art, philosophy, and others when unrelated to patient/client care.9- Courses designed for lay people.

FAQs: You are also encouraged to review the FAQ section of the CNE page of the TNA website for additional information and helpful hints.

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Fee schedule … $100.00 administrative fee plus $10.00 per contact hour or fraction thereof.

0.5 - 1.0 contact hour $ 110.00 1.1 - 2.0 contact hours $ 120.00 2.1 - 3.0 contact hours $ 130.00 3.1 - 4.0 contact hours. $ 140.00 etc.

Continue to add $10.00 per portion of a contact hour up to a maximum of $500.00. When calculating the review fee, round the number of contact hours up to the next whole number. Refer to website for complete fee schedule.

Review fees are non-refundable.

For a complete Individual Activity Fee Schedule, see FAQ #5.

Upon receipt of Individual Activity application you will be invoiced by TNA.

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INDIVIDUAL ACTIVITY APPLICATION GUIDELINES AND CRITERIA

Instructions:

Applications will be submitted electronically in either Word or PDF format and are to be received at TNA no less than 60 calendar days for a “large activity” (see “Eligibility Assessment”) or 45 calendar days prior to the date of the first presentation. Attach your Individual Activity Application, as one continuous file, to an email and send to: CNE@texasnurses.org. The Nurse Planner will receive an email from a TNA CNE program staff member upon receipt by staff.

Complete the application in full and submit necessary supplemental material as required. Do not leave any area blank. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

The entire application must be typed, in English and on the most current form. Each page of the application must be numbered in sequence from beginning to end starting with the Title Page being number one (1). It is highly encouraged that you establish a process for proofreading looking for typographical errors, grammatical errors, etc. in your application prior to forwarding it to TNA.

Please note: If the Nurse Peer Reviewers request revisions or corrections, you must submit the additional materials within the timeframe the Nurse Peer Reviewer gives you in the request. The Nurse Peer Reviewers must have sufficient time to review the revised materials before the date of first presentation. If you change the date of the activity, it does NOT change the review time of 45 days. Failure to complete and submit requested revisions to the Nurse Peer Review team member within the requested time frame will result in the application being returned to TNA for further action.Do not submit the instruction pages with this application. These pages are for reference and assistance in completing the application only. Sample forms at the end of the application are for your use. If used, sample forms should be adapted to your organization/activity prior to submission.

The following checklist is for your use prior to submission.___ Completed Individual Activity Application

___ Signature on the “Statement of Understanding”

___ Conflict of Interest Disclosure forms for all planning committee members and presenters/ authors/content reviewers

___ Documentation of Disclosures Provided to Activity Participants

___ Copy of the Activity Evaluation Tool

___ Copy of the Certificate of Successful Completion

___ Copy of any advertising materials/promotional materials, i.e., flyer, brochure, copy of electronic flyer___ Copy of Commercial Support Agreement(s), if applicable

___ Copy of Joint Provider Agreement(s), if applicable

___ For Learner-Paced on-line activities include “print screens” of your disclosure tool (your disclosure to participants), your certificate of successful completion, and your evaluation tool.

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TITLE PAGE This information is to assist you in completing the application. Do not submit these instructional pages with this application.

ORGANIZATION NAME: Clearly identify the name of the organization, agency, or individual that will be responsible for providing the activity and maintaining records for six (6) years. The organization name must remain constant throughout the application especially on the Certificate of Successful Completion.

ORGANIZATION ADDRESS: This is the address that all correspondence regarding the disposition of the activity will be directed to. It should be the organization address, but if it is not, please identify who it belongs to. An email address is acceptable.

IDENTIFY ORGANIZATION TYPE: As part of the organization’s eligibility assessment, check the organization type that best describes your organization type.

DEMOGRAPHIC DATA:

TITLE OF ACTIVITY: The title of the activity should reflect the activity’s content and “CNE-ness”. "Catchy" titles that do not accurately reflect the content and nursing focus of the activity and the use of abbreviations may bring the activity into question. This title should correspond with the title on the Education Documentation Form, promotional materials, and Certificate of Successful Completion.

DATE OF FIRST PRESENTATION: Provide the anticipated date of the first scheduled presentation. If you are unsure of the specific date, then provide a projected date. Remember that we need 45 days to review your application. Sixty (60) days if it is a large activity. “TBD” or similar phrases are not acceptable.

HAS THIS ACTIVITY BEEN APPROVED BY TNA IN THE PAST? This question must be responded to by all seeking approval of an activity for CNE. Answer “Yes” ONLY if the submission you are making has no major changes to the objectives or content from the last submission. Always use the most current submission CNE ID#, NOT the original CNE ID#.

LOCATION OF ACTIVITY: The location of the activity should be specific to the date listed above. If multiple locations have been determined, you may list all locations and dates. A location is not required if this is a Learner-Paced activity. Location should address city and state. If the activity is a webinar, you can include “webinar” in this section.

ACTIVITY TYPE: As previously defined, a Provider-Directed (PD) activity is one where the provider of the activity controls all aspects of the learning. Examples include workshops, seminars, lecture series and distance learning such as teleconferences or webinars. Learner-Paced (LP) activities are ones where the learner determines the pace at which the learner engages in the learning activity. Examples include articles in journals and online modules. By their nature, LP activities are considered to be enduring materials – “a non-live activity that endures over time” (“2015 ANCC Primary Accreditation Approver Application Manual,” 2015, p. 55).

Start date: Is the launch/release date for the LP activity.Expiration date: Is the date two (2) years/24 months from the approval date.

A Blended Activity (BA) combines aspects of a PD and a LP into one CNE activity.

NUMBER OF CONTACT HOURS REQUESTED: For Provider-Directed activities, the number of contact hours requested should correspond with the time frames listed on the Education Documentation Form. For Learner-Paced activities, the number of contact hours requested should be based on a pilot study or some other defensible method to determine the number of contact hours to be awarded. If your activity will be web-based, be sure to list the URL (website address). For a Blended Activity, the contact hours are based on combining contact hours calculated for the LP portion and the PD portion of the activity.

ACTIVITY OFFERINGS: Indicate if this is activity will be offered one-time or will be offered multiple times.

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NURSE PLANNER: The Nurse Planner must have a valid, current, unencumbered RN license, a minimum of a baccalaureate or higher degree in nursing and past experience in CNE. The Nurse Planner is responsible for assessing needs, planning, implementation and evaluation of the activity. The Nurse Planner is ultimately responsible and accountable for the individual activity and its application. It is the Nurse Planner who the Nurse Peer Review team will contact regarding questions about the activity and/or application. Be sure to include both the Nurse Planner’s degrees (from an academic setting) and credentials (from a regulatory or certifying agencies). The Nurse Planner is responsible for the activity throughout the life of the activity. TNA will validate the Nurse Planner’s RN license status.

ALTERNATE CONTACT PERSON: The alternate contact person should be the individual who can be contacted for clarification or any questions regarding the application if the Nurse Planner is unavailable. This person should be a member of the planning committee who can address or clarify issues. Indicate a telephone number, and e-mail address for the alternate contact person.

ARE YOU PURSUING OTHER ACCREDITATION/APPROVAL FOR THIS ACTIVITY: This question will help the Nurse Peer Review team to better understand the focus of your activity.

ELIGIBILITY ASSESSMENT:

Is your organization a commercial interest? A “Commercial Interest” is defined as an entity either producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients, or that is owned or controlled by an entity that produces, markets, resells or distributes health care goods or services consumed by or used on patients. If you are, you MAY NOT submit an individual activity application. Contact TNA for further instructions.

Is this activity Continuing Nursing Education (CNE) for the Registered Nurse as defined/outlined by the Texas Board of Nursing? Refer to the Texas Board of Nursing’s rule/chapter 216. CNE is defined by ANCC as a planned, organized learning experience designed to improve the knowledge, skills, and practice of Registered Nurses. It should enhance nursing practice, theory development, research, and administration. It should be generalizable and evidence-based/best practice. The outcome should be to improve the health and well being of the public while supporting the Registered Nurse’s pursuit of continued competency and life-long learning. If this activity is not CNE, please DO NOT complete and submit this individual activity application.

It is imperative that the “Individual Activity Application Guidelines and Criteria” and the ANCC “Content Integrity Standards” be read in their entirety prior to beginning the application process.

LARGE ACTIVITY APPLICATIONS: Please Note: For Large Activity Applications – Does your activity meet one of the following:

1. Is it multi-disciplinary?2. Is it greater than two (2) days in length?3. Does it have multiple presenters?4. Are there multiple breakout sessions?5. Is it a national conference?

These types of activities present a special challenge to both the individual activity organization and the Nurse Peer Review team responsible for assuring that the activity meets ANCC/TNA criteria. These applications tend to be several hundred pages in length and complex with respect to content, Conflict of Interest Disclosure forms and awarding of contact hours. In an effort to facilitate the application and review process, the following is now required –

1. The Nurse Planner must have a pre-application/submission discussion with the TNA CNE Program Manager. This discussion should take place early in the activity development process, not at the end.

2. The activity application must be submitted at least 60 days prior to the date of first presentation. This is to allow sufficient time for the review process to be completed and, if necessary, provide time for any revisions or additional information that may be needed.

Please be aware that failure to comply with these requirements may impact the processing and review of the activity application thus delaying the awarding of contact hours in a timely manner. The CNE Program Manager may be contacted at llerma@texasnurses.org for questions or for the pre-application discussion.

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STATEMENT OF UNDERSTANDING: Signature of the Nurse Planner indicates the individual activity orga-nization’s commitment to providing accurate information; coordinating the entire CNE activity process; main-taining the CNE files/records for six (6) years; adhering to all local, regional, state, and federal regulations; and meeting its legal and ethical obligations. Applications received without this signature will not be pro-cessed.

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Activity Application

A. Description of the Professional Practice Gap

This section asks the question – What are you seeing in practice? – that may be causing a problem in practice, that can be addressed by education. What are learners doing – or not doing – that they should or should not be doing? Is there an opportunity for improvement? What is the current state of nursing practice? NOTE: A professional practice gap may exist for Registered Nurses regardless of the practice setting – clinical practice, administration, education, research, etc. When identifying the professional practice gap keep in mind the definition of and criteria for CNE as outlined by the Texas Board of Nursing (Rule 216). The professional practice gap drives the CNE activity.

B. Evidence to Validate the Professional Practice Gap

1. Identify the methods or types of data the Nurse Planner used to validate the existence of the above described professional practice gap. What is the evidence that supports that things could or should be different?

2. Once the Nurse Planner has identified the source of the evidence, briefly describe what the evidence says that validates the professional practice gap exists. NOTE: At this point, take the time to thoroughly analyze the situation. Ask yourself: Is this a situation that can be addressed through education? Or is it more a system/compliance/environmental issue? Take the time to determine if education is the appropriate strategy to address the situation.

C. Description of Target Audience

The target audience for any continuing nursing education activity approved by TNA is always the Registered Nurse (RN). In this section, indicate what type of Registered Nurse will be the focus for this activity. This section should describe who your learner/participant is – who is this activity designed for specifically. Not the “who might come” but the “who (based on the validated professional practice gap) needs to come.” “Specialty” is not limited to specialty organizations. Specialty is the area of practice the RN for whom this activity is designed works.

D. Educational Need that Underlies the Professional Practice Gap

Identify the gap(s) for the intended target audience that this CNE activity will address based on the professional practice gap. Be realistic.

E. Description of the Desired State - Learning Outcome

In this section, based on analysis of the above situation, the Nurse Planner can identify where the Registered Nurse should be – the desired state – as a result of the CNE activity. The learning outcome should describe what the Registered Nurse should know, do, or perform in practice after the professional gap has been narrowed or closed. Be realistic. The desired state then sets the stage for identifying the measurable evidence – the evaluation method – to be used to assess the effectiveness of the activity in closing the professional practice gap.

Are you wanting: an improvement in professional practice behaviors, which would lead to an improvement in nursing practice? High quality care based that is evidence-based, best practice? Better leadership skills? Enhanced critical thinking? Enhanced patient outcomes based on improved nursing care delivery and competency? Why are you providing this activity?

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F. Description of the Outcome Measure

The outcome measure should be a statement that is learner focused and describes what the learner will be able to observably demonstrate as a result of participating in the CNE activity. Example: If the identified gap is in knowledge, then the outcome statement might reflect knowledge acquisition through passing a post-test. The outcome measures should match what you check in Section O.

G. Area of Impact

As professional continuing education continues to transition to a focus on quality, CNE must be able to identify how continuing education is contributing to quality. Indicate in what area this activity will impact quality.

H. Qualified Planners/Presenter(s)/Author(s)/Content Reviewer(s)

The planning committee must consist of a minimum of two (2) people. Both planning committee roles – Nurse Planner and Content Expert – must be accounted for. A person may play more than one role on the planning committee as long as they meet the qualifications for those roles. The planning committee pulls together those responsible for planning the education activity in an effort to meet the identified learning outcome.

The Nurse Planner must hold a baccalaureate or higher degree in nursing. The Nurse Planner is ultimately responsible and accountable for this activity – for the assessing of the need, planning, implementing and evaluating the activity. He/she should have CNE background/experience, know the definition of and criteria for continuing nursing education in the State of Texas, and be familiar with educational design and adult learning principles. 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 education activity. If the Nurse Planner has an actual or potential conflict of interest, he or she must be recused from the role as Nurse Planner for this CNE activity. The Nurse Planner may not sign his or her Conflict of Interest Disclosure.

The Content Expert provides input to the planning committee on available resources to fill the learning outcome. This individual has qualifications that demonstrate education, knowledge, and experience in the selected subject matter of the activity.

Although the Nurse Planner and Content Expert fulfill the major roles of the planning committee, others may be involved to make the planning committee more well-rounded or to meet the two (2) people minimum if the same person is fulfilling the Nurse Planner and Content Expert roles. These additional members can be included as “Others Participating on Planning Committee.” They may be Target Audience Representatives, additional Content Experts, or other necessary individuals for the planning committee. If this activity is designed for Advanced Practice Registered Nurses (APRNs), an APRN should be on the planning committee. A planning committee member may not be a content reviewer or an employee of a commercial interest. “Planning committee member” is not a planning committee role. Note: While Biographical Data Forms (BDFs) are no longer required from planning committee members, it is the responsibility of the Nurse Planner and the Content Expert to ensure that planning committee members are qualified to fulfill the roles they play on the planning committee.

A completed, signed, and countersigned by the Nurse Planner Conflict of Interest Disclosure form must accompany this application for each member on the planning committee. The Nurse Planner may not review, resolve, and sign his/her own Conflict of Interest Disclosure form. A member of the planning committee must review, resolve, and sign – in the appropriate box – the Conflict of Interest Disclosure form for the Nurse Planner. This section only needs to be completed on the Conflict of Interest Disclosure form for the Nurse Planners. If the Nurse Planner has a relationship with a commercial interest organization that is relevant to the content of this education activity, the Nurse Planner must be recused from this education activity. All others should be left blank. Indicate the page numbers within the application where the Conflict of Interest Disclosure form can be found. Electronic Signatures are acceptable. (See FAQs for more details on the use of electronic signatures.)

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List each presenter for Provider-Directed activities or author for Learner-Paced activities from column K of the Education Documentation Form (EDF).

Also list any content reviewers that were involved in the activity development. A content reviewer is defined as “an individual selected to evaluate an education activity (or portion of an educational activity)….for quality of content, bias, and any other aspects of the activity that may require evaluation.” (2015 Approver Manual, p. 54). The content reviewer is a third party outside of the planning committee. They may not have been active in the planning of the activity. Therefore, they may not be a member of the planning committee or a presenter/author. A content reviewer is not required if the Nurse Planner and/or planning committee can make determinations related to the content integrity and/or bias.

Be sure to include a completed copy of the person’s Conflict of Interest Disclosure form for each person listed in this section. Indicate the page numbers within the application where the Conflict of Interest Disclosure form can be found. Place them at the back of the application. [ Note: Although Biographical Data Forms (BDFs) are no longer a required element in the Individual Activity Application, it still remains the Nurse Planner’s responsibility – in conjunction with the Content Expert – to ensure the activity’s presenter(s)/author(s) are indeed qualified for their roles as presenter(s) and author(s) – and content reviewer(s). Provide a brief description of the person’s qualifications. While work experience is commendable, it is not the sole determinant of expertise. ]

No member of the planning committee or presenter/author/content reviewer can be an employee of a commercial interest.

Conflict of Interest Guidelines

The potential for conflicts of interest exists when an individual has the ability to control or influence the con-tent 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 education 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 be recused from the role as Nurse Planner for this CNE activity.

A “commercial interest”, as defined by ANCC/TNA, is any entity producing, marketing, reselling, or distribut-ing health care goods or services consumed by, or used on patients, or that is owned or controlled by an en-tity that produces, markets, resells or distributes health care goods or services consumed by or used on pa-tients.

An organization is NOT a commercial interest organization if it is a: Blood bank Constituent Member Association Diagnostic laboratory Federal Nursing Services Group medical practice Government organization Health insurance provider Hospital (for-profit and not-for-profit) Liability insurance provider National nurses organizations based outside the United States Nursing home (for-profit and not-for-profit) Rehabilitation center (for-profit and not-for-profit) Specialty Nursing Organization Single-focused non-commercial interest organization devoted to offering CNE

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The Nurse Planner is responsible for ensuring that all individuals who have the ability to control or influence the content of an education activity disclose all relevant relationships** with any commercial interest, includ-ing but not limited to members of the planning committee, presenter, authors and/or content reviewers. Rel-evant 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 learners prior to the start of the education activity.

** Relevant relationships, as defined by ANCC/TNA, are relationships with a commercial interest if the prod-ucts or services of the commercial interest are related to the content of the education activity.

Relationships with any commercial interest of the individual’s spouse/partner may be relevant rela-tionships and must be reported, evaluated, and resolved.

Evidence of a relevant relationship with a commercial interest may include but is not limited to re-ceiving 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 con-tractor relationships, other contractual relationships, consulting, speaking, teaching, membership on an advisory committee or review panel, board membership, and other activities from which remu-neration is received or expected from the commercial interest.

Conflict of Interest Disclosure statements shall be obtained from all planners, presenter/authors and content reviewers to identify and resolve any potentially biasing financial relationships on the part of those who have an impact on the content of an education activity. A conflict of interest does not preclude a person from par-ticipating in the activity. It just needs to be evaluated and resolved appropriately. A person refusing to com-plete a Conflict of Interest Disclosure form will be recused from the activity. Conflict of Interest Disclosure must be signed on a per activity basis. Encourage planning committee members and presenters/authors and content reviewers to read the disclosure form carefully. All Conflict of Interest Disclosure forms must be signed by the planner/presenter/author/content reviewers disclosing. If original, faxed, or electronic signa-tures are not available and a font/print signature is used, be sure to maintain the documentation that sup-ports that signature. The Nurse Planner is responsible for reviewing the forms and evaluating whether any planner/presenter/author/content reviewer has a relationship with a commercial interest organization. For each planner/presenter/author/content reviewer, the Nurse Planner must evaluate the following: That there is –

No relevant relationship with a commercial interest exists. No resolution required. Relevant relationship with a commercial interest exists. The relevant relationship with the commer-

cial interest is evaluated by the Nurse Planner and determined not to be pertinent to the content of the education activity. No resolution required. (Documentation should reflect rationale for content not pertinent).

Relevant relationship with a commercial interest exists. The relevant relationship with the commer-cial interest is evaluated by the Nurse Planner and determined to be pertinent to the content of the education activity. Resolution is required.

Additionally, please note: Employees of commercial interest organizations are not permitted to serve as planners, presen-

ters, authors and/or content reviewers if the content of the educational activity is related to the prod-ucts or services of the commercial interest organization.

Employees of commercial interest organizations are permitted to serve as planners, presenters, authors and/or content reviewers if the content of the educational activity is NOT related to the prod-ucts of the commercial interest organization.

Individuals who have non-employee relationships with commercial interest organizations are per-mitted to serve as planners, presenters, authors and/or content reviewers as long as the individual activity organization has implemented a mechanism to identify, resolve and disclose the relation-ship.

1. If conflicts of interest have been identified, they need to be resolved by the Nurse Planner. Methods to resolve conflicts of interest or potential bias include:

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a) Conflict was discussed with the individual.b) Revised the role of the individual with conflict of interest so that the relationship is no longer relevant

to the education activity.c) Not awarding contact hours for a portion or all of the educational activity. d) Undertaking review of the educational activity by the Nurse Planner and/or a member of the

planning committee to evaluate for balance in presentation, evidence-based content or other indicator of integrity and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the activity.

e) Undertaking review of the educational activity by a content reviewer to evaluate for balance in presentation, evidence-based content or other indicators of integrity, and absence in bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation.

f) Undertaking review of the educational activity by a content reviewer to evaluate for 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.

g) Other

Describe:

The Nurse Planner signs the Conflict of Interest Disclosure form indicating that he/she has reviewed the form and has determined that there are no relevant conflicts of interest or, if there are, how they have been resolved.

The Nurse Planner for the activity may not review, resolve, or sign his/her own Conflict of Interest Disclosure form. This process should be completed by another member of the planning committee. This person should sign in the section on the Conflict of Interest Disclosure form designated for this purpose. On all other Conflict of Interest Disclosure forms this section should be left blank.

2. If in reviewing the Conflict of Interest Disclosure forms, the Nurse Planner and/or planning committee suspect that there might be a conflict of interest and/or potential bias for a presenter/author/content reviewer that was not self-reported, it must be identified and addressed.

ABOUT THE EDUCATION DOCUMENTATION FORM (EDF)

The Education Documentation Form (EDF) may be adapted to an organization’s word processing package – either landscape or portrait - or the form may be reproduced and the information typed directly on the form. This is a four-column table. Information submitted in other formats will not be reviewed . Refer to the top of the EDF for instructions on what columns to complete depending on the type of activity that is being developed.

TITLE: The title should match – verbatim – the title listed on your title page. If your activity has multiple presentations, you may opt to use the presentation title. (When your activity has multiple presentations, develop one (1) Education Documentation Form per presentation, and include an agenda.)

LEARNING OUTCOME: Pull the Learning Outcome from section E – verbatim.

I. Content

Outline or summarize the content to be presented that addresses the learning outcome. The content area column must include definitive, detailed information. The selection of content must focus on the learning needs of the Registered Nurse, their characteristics, and information meaningful to their nursing practice. Content must meet the Texas Board of Nursing’s definition of and criteria for continuing nursing education. Content is the information the learner needs in order to meet learning outcome. It should be evidence-based or based on the best available evidence. Content integrity of the activity is maintained by ensuring that:

Actual or potential conflicts of interest are resolved. There is independence from any organization providing in kind or financial support for the activity. The activity is presented free of any promotional activity – promotion and education must be kept

separate.

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The information presented is objective, current, and supported by the best available evidence.

J. Time Frame - for Provider-Directed activities only

State the time needed to complete each topic or content area. Do not indicate time in time-lapse format, i.e., 0930-1030, but in minutes, i.e., 60 minutes. This facilitates the calculation into contact hours and reduces errors. It is not necessary to include the time for “breaks” or “lunch” on the form as they cannot be counted into the contact hours received by the Registered Nurse.

Pharmacology Hours: If the CNE activity is being planned specifically for APRNs with prescriptive authority and the content specifically addresses pharmacotherapeutics, the Nurse Planner needs to delineate the exact amount of time dedicated to pharmacotherapeutics in column J of the Education Documentation Form. This will allow the number of contact hours to be calculated accurately. The Certificate of Successful Completion would then include the total number of contact hours to be awarded and the number of pharm hours – 8.0 contact hours including 2.0 pharmacotherapeutic contact hours.

Evaluation Time: Evaluation is considered part of the learning process and should be included in the calculation of contact hours. List the number of minutes that will be allotted for evaluation. List the evaluation method(s) – written tool, post-test, Q & A, etc. – that will be used. This should be congruent with section P-1 of the application. If you consider the evaluation to be included within the presentation time, indicate such on the Education Documentation Form with the following, or a similar statement: “Evaluation time is included in presentation time.” Don’t forget to list the evaluation method(s).

K. Presenter/Author

State the name of the person presenting the content. When the same person is teaching the entire activity, it is allowed to state “Presenter for entire activity” after the person’s name rather than listing the same person over and over again. If, however, you know the activity will be offered more than once with multiple presenters, list all potential presenters with an “or” in between their names and include the appropriate paperwork documentation for each. [Note: Many qualified people can teach nurses, but only a nurse can teach nursing.]

L. Teaching Methods/Learner Engagement Strategies

This column is divided into two (2) sections:

Teaching Methods: The teaching methods are the strategies that will be used by the presenter in a Provider-Directed activity by which the content will be provided to the learners and should reflect adult learning principles.

Learner Engagement Strategies: As part of the activity development, the Nurse Planner/Planning Committee in conjunction with the activity’s presenter/author needs to identify ways to actively engage learners in the educational activity. Adult learners do not always respond to the lecture method. A combination of strategies will provide opportunities for active participation and learning.

Be sure your time frame aligns with the strategies you use (i.e.: small group sessions don’t usually take only 10 minutes). Instructional strategies should be congruent with the content being presented and the learning outcome(s).

Reference List : References are the resources that were used to develop the presentation(s) within the activity. Identify what evidence-based, valid, reliable sources were used to develop the content for this CNE activity. Please use an approved reference format (APA, MLA, etc) which includes the date of the reference. List the references starting with the most recent date. The recommendation is to list 3 to 5 references per hour of content. For multiple-presenter activities, include a separate reference list with each separate Education Documentation Form (EDF). Websites should be listed in their correct format and provide enough information that the Nurse Peer Review team could quickly search for the site for its relevance to the presentation.

Case Studies/Case Scenarios: If using case studies and/or case scenarios as an instructional strategy –

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Include a brief description of each case study/case scenario in the content column (column I) of the EDF.

Time frames should be reflective of the increased amount of time needed to adequately discuss/analyze a case study/case scenario.

Learner engagement strategies should list case study/case scenario, discussion, question and answer, and any other appropriate instructional strategy.

M. Successful Completion

Successful completion may be achieved by a variety of methods; i.e. attendance at the entire event; completion/submission of the CNE activity evaluation form; post-testing; return demonstration; etc. Criteria for successful completion are determined by the planning committee and should be based on the learning outcome. The listed options provide some flexibility for the planning committee if needed in some cases.

N. Awarding Contact Hours

Specify the number of contact hours being requested. Contact hours must be determined in a logical defensible manner, consistent with the content, instructional strategies and the target audience. The appropriate measure of credit is the 60-minute contact hour. A contact hour is 60 minutes of an organized learning activity that is either a didactic or clinical experience or independent study. Welcome, introductions, breaks and viewing of exhibits are not included in the calculation of contact hours. Evaluation is considered part of the learning activity. Education activities may also be conducted “asynchronously” with contact hours awarded at the conclusion of the activity. Contact hours may not be awarded retroactively/retrospectively except in the case of a pilot study. There is no minimum to the number of contact hours that can be awarded. The Nurse Planner for a large conference or an activity with breakout sessions may be asked to calculate the total number of contact hours requested and the maximum number of contact hours that an attendee can be awarded.

For Provider-Directed activities, add the total number of minutes listed in column J of the Education Documentation Form and divide the sum by 60. The result is the total number of contact hours for the activity. Rounding is not allowed. (e.g. 2.76 or 2.7 not 2.8)

For Learner-Paced activities, provide a detailed explanation of the rationale used to determine the number of contact hours to be awarded. Pilot-testing is a method commonly used to determine the number of contact hours to be awarded for a Learner-Paced activity. Show evidence (math calculation) of how the contact hours were determined. If you require more information on pilot-testing or use of word count formulas, please contact the TNA CNE Program Manager. Rounding is not allowed.

For Blended Activities, once the number of contact hours has been determined for the Provider-Directed portion and the Learner-Paced portion of the activity, add the contact hours together to calculate the total number of contact hours to be awarded. Rounding is not allowed.

Remember, evaluation is considered part of the learning activity. It should be indicated on the Education Documentation Form and included in the calculation of the contact hours.

O. Evaluation/Outcome Measure

The focus of this section is two-fold: evaluation of the learning outcome and evaluation of the overall activity.

1. Evaluation of the learning outcome: The primary focus of this section is the learner, i.e., did the activity impact the learner? What methods will be used-either short-term or long-term – to evaluate a change in knowledge, skill, and/or practice based on the learning outcome? (Tie this section back to section F of the activity application).

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2. Evaluation of the overall activity: The focus of these tools is to provide the planning committee feedback regarding the overall activity itself. This evaluation is required prior to the issuance of certificates of successful completion. A process that provides anonymity of the person completing the evaluation tool is highly encouraged.

The evaluation component of continuing nursing education should reflect the circular nature of the educational design process. Planning begins with identifying a measurable outcome for the learner and is completed in the evaluation of the learner to determine if the outcome has been met. An evaluation is not a subjective feeling that the learner has about enjoying the event. An effective evaluation determines if the learner gained the knowledge, skill or ability that was identified during the planning process.

1. The planning committee must identify the learning outcome method(s) of evaluation that will be used. Clearly defined methods for evaluating the learner should be determined by the type of outcome identified in the learning outcome. Various tools are available such as post-tests, case studies, and skill performance. Evaluation can be short-term and/or long-term again depending on the purpose and anticipated outcomes of the activity. The evaluation method should also tie to the gap that is being narrowed or closed – knowledge, skill, and/or practice.

2. Additionally, an evaluation of the overall activity is required.

Provider-Directed evaluations must include the following five criteria: 1. Effectiveness of each presenter in using the teaching/learning strategies2. Was the learning outcome met?3. Outcomes measurement assessment4. Perceived bias during a presentation5. Additional learning needs

Learner-Paced evaluations must include the following six criteria: 1. Effectiveness of teaching/learning resource(s) in meeting the learning outcome2. Was the learning outcome met?3. Time required of the learner to complete the activity4. Outcomes measurement assessment5. Perceived bias during the presentation6. Additional learning needs

Blended activity evaluations consist of a Provider-Directed evaluation for the Provider-Directed portion of the activity and a Learner-Paced evaluation for the Learner-Paced portion of the activity.

Additional questions may be included on the evaluation tool. The elements listed above are required.

Include a copy of the evaluation tool with your application.

3. Following the activity, the results of the evaluation – the summative evaluation - must be shared with the planning committee. The results may help determine the success of the activity or identify problem areas and determine whether the CNE activity should be offered again or revised. For activities offered multiple times, the Nurse Planner must determine a time frame in which the activity’s evaluation data is compiled and reviewed. Mandated criteria have been pre-selected. Check any additional criteria that apply to this activity.

P. Promotional Materials

1. Promotional materials are defined as any medium used to promote/advertise your education activity. They include, but are not limited to, brochures, in-house flyers and calendars, save-the-date cards, emails, and websites. The following statement, and the following statement only, must

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be included and displayed prominently on this CNE activity’s promotional materials prior to approval:

2. “This activity has been submitted to the Texas Nurses Association for approval to award contact hours. Texas Nurses Association – Approver is accredited with distinction as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.”

Once the CNE activity application is approved, a replacement statement to be used on all promotional materials will be included in your approval letter from TNA.

A copy of all promotional materials must be included with the CNE activity application. The promotional materials may be either a mock-up or the final materials. Individual activity organizations are encourage to NOT post the number of contact hours

awarded for the activity until the activity is actually approved.

3. If this activity is joint provided, the following statement must be included on all promotional materials:

This CNE activity is being jointly provided by _____________________________________(the Individual Activity organization)

collaboratively with ________________________________________________.(list of joint providers)

Q. Documentation of Successful Completion

Written verification of successful completion is given to each learner that reflects the following:

a. Organization name and address, including street, city, state, and zip code.b. CNE Activity ID Number – provided by TNA upon approval.c. Name of participant. d. Number of contact hours awarded.e. Title of the activity.f. Day, month and year of the activity presentation, (or completion date if Learner-Paced).g. Location of activity presentation (delete if Learner-Paced).h. Correct TNA approval statement:

This continuing nursing education activity was approved by the Texas Nurses Association – Approver, an accredited approver with distinction, by the American Nurses Credentialing Center’s Commission on Accreditation.

A copy of the proposed certificate of successful completion – the one you will actually be distributing to attendees/participants - must accompany this application.

R. Commercial Support

Promotion and education must be kept separate.

A commercial interest is defined by ANCC/TNA as any entity either producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients or an entity that is owned or controlled by an entity that produces, markets, re-sells or distributes health care goods or services consumed by, or used on, patients. Exceptions are made for non-profit or government organizations and non-health care related companies.

Therefore, the following are exempt from the ANCC/TNA definition of a commercial interest:a. Blood banksb. Constituent Member Associationsc. Diagnostic laboratoriesd. Federal Nursing Services

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e. Group medical practicesf. Government organizationsg. Health insurance providersh. Hospitals (for-profit and not-for-profit)i. Liability insurance providersj. National nurses organizations based outside the United Statesk. Nursing homes (for-profit and not-for-profit)l. Rehabilitation centers (for-profit and not-for-profit)m. Specialty Nursing Organizationsn. Single-focused organization(s) devoted to offering CNE

Commercial support is financial, or in-kind, contributions given by a commercial interest which is used to pay all or part of the costs of a CNE activity.

Based on the above information, determine if your CNE activity is receiving commercial support. If “no”, check “no” and move on to section S. If “yes,” attach the completed signed agreement.

o A provider of commercial support may not be on the planning committee, be a joint provider of the CNE activity, or the provider of the CNE activity.

o If commercial support is provided for a CNE activity, an employee from the organization providing commercial support may not be a presenter nor can they sit on the planning committee.

It is the responsibility of the Nurse Planner and the planning committee to ensure the CNE activity’s content integrity is maintained. ANCC/TNA requires that:

o Funds from a commercial support source should be in the form of an educational grant to the individual activity organization and must be acknowledged in printed materials and brochures.

o Arrangements for commercial support exhibits will not influence the planning of or interfere with the presentation of education activities.

o Learners will be made aware of the nature of all commercial support related to an education activity.

o Education activities are distinguished as separate from endorsement of commercial products. When commercial products are displayed, learners will be advised that approval of the CNE activity refers only to its continuing education activities and does not imply the CNE provider’s, ANCC COA or TNA endorsement of any commercial products.

o Education activities that present research conducted by commercial companies will be designed and presented with scientific objectivity and without bias.

o A signed, written agreement is accepted between the individual activity organization and the commercial supporter.

o The individual activity organization adheres to the ANCC “Content Integrity Standards for Industry Support of Continuing Nursing Educational Activities” at all times. These standards are posted on the TNA website.

The Nurse Planner is responsible for ensuring that bias does not occur in the planning of the CNE activity or the actual presentation. Bias, as defined by ANCC/TNA, is the “tendency or inclination to cause partiality, favoritism, or influence” (“2015 ANCC Primary Accreditation Approver Application Manual,” 2015, p. 53). Appropriate precautions must be taken to prevent bias in educational content (i.e. no logos on the power point slides; no promotional materials in the room,) and to resolve conflicts.

A commercial supporter who wishes to display his/her merchandise at the activity must agree to the posting of a statement indicating that such display of merchandise or the giving of free advertising/ promotion materials (pens, notepads, etc. with company logos) does not constitute endorsement by the individual activity organization, American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA) or of the Texas Nurses Association (TNA).

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If this activity received commercial support, a copy of the signed “Commercial Support Agreement” must ac-company this application. Commercial supporters must be listed on the promotional materials and disclosure to participants tool.

S. Disclosures Provided to Activity Participants

Learners must receive disclosure of required items prior to the start of an education activity. For Provider-Di-rected (PD) activities, disclosures must be made to the learner prior to initiation of the educational content. For Learner-Paced (LP) activities, disclosure must be visible to the learner prior to the start of the educational content. Required disclosures may not occur or be located at the end of an education activity. Evidence of the disclosures to the learner must be retained in the activity file. Acceptable formats include a listing on the promotional materials, a handout, or an AV slide.

Disclosures that are always required include:

Notice of Requirements for Successful Completion of the education activity: Prior to the start of an education activity, learners must be informed of the learning outcome(s) of the education activity and the criteria used to determine successful completion.

Presence or absence of conflicts of Interest for planners, presenters, authors and content reviewers: Any influencing relationships, or lack thereof, of planners, presenters, authors, or content reviewers in relation to the education activity. Must disclose:

a. Name of individualb. Name of commercial interestc. Nature of relationship the individual has with the commercial interest

Disclosures required, only if applicable include:

Commercial Support – Learners must be informed if a commercial interest has provided financial or in-kind support for the education activity.

Joint Provider Statement – Learners must be clearly informed when there is a joint provider relationship who the approved organization – the Provider – is and who the joint providers are. The Provider is the organization awarding the contact hours and is responsible for adherence to ANCC/TNA criteria.

Expiration Date for Awarding Contact Hours – Learners must be informed of an expiration date for Learner-Paced activities, documenting how long contact hours will be awarded. This date must be visible to the learner prior to the start of the educational content.

A copy of the Disclosure to Participants must accompany this activity application.

T. Joint Providership

This section and the appropriate form are completed if there is joint providership. Joint providership is defined as the planning, developing, and implementing of an education activity by two (2) or more organizations. When education activities are joint provided, the identified provider is responsible for ensuring adherence to all ANCC/TNA criteria. PLEASE NOTE: If you are using this activity as one (1) of the three (3) required activities in preparation for applying to become an Approved Provider, this activity may not be joint provided. A joint providing organization(s) may not be a commercial interest. The individual activity organization’s Nurse Planner must be on the planning committee from the beginning; involved in all aspects of activity assessing, planning, implementing, and evaluating; and responsible for ensuring adherence to all ANCC/TNA criteria. Decision making responsibility may be shared collaboratively between the individual activity organization and the joint providing organization(s), however, final responsibility rests with the individual activity organization when awarding contact hours.

Note: As the CNE Provider of this educational activity, the following items are your responsibility: Determining the educational appropriateness of the content Selecting planners, presenters, authors and content reviewers Awarding of contact hours Recordkeeping procedures Developing evaluation methods

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Managing any commercial support Ensuring the individual activity organization is prominently displayed on all promotional

materials and certificates of successful completion. Ensuring the Joint Provider Statement is included on all promotional materials and

disclosure methods.If the activity is not being joint provided, check “no” and move on to section U. If the activity is being joint provided, check “yes” and complete the grid indicating who the joint providing organizations are and contact the TNA CNE Program Manager for additional information.

U. Record Keeping and Storage SystemRecords must be maintained by the individual activity organization in an easily accessible, confidential man-ner for six (6) years.

1. The Nurse Planner’s initials indicate his/her commitment to maintain the following: Title and location (if live) of activity Type of activity format: Provider-Directed/Learner-Paced/Blended Date of live activity presented or, for ongoing enduring activities, date first offered and subsequent re-

view dates Description of the target audience Description of the professional practice gap and its validation Description of the learning outcome Names and titles of activity planners Role held by each Planning Committee member (must include identification of the Nurse Planner

and Content Expert(s)) Names and titles of activity presenters, authors, and/or content reviewers Conflict of interest disclosure statements from planners Resolution of conflict of interest for planners, if applicable Conflict of interest disclosure statements from presenters, authors, and/or content reviewers Resolution of conflict of interest for presenters, authors, and/or content reviewers Outcome measure Evidence of gap in knowledge, skill, and/or practice for the target audience Content of activity: An Educational Documentation Form (EDF) with its associated Reference List Instructional strategies used Criteria for judging successful completion Number of contact hours awarded for activity, including method of calculation (Activity provider must

keep a record of the number of contact hours awarded to each participant. Learner data must be kept safe and secure.)

Template of evaluation tool(s) used Marketing and promotional materials Means of ensuring content integrity in the presence of commercial support (if applicable) Commercial Support Agreement(s) with signature and date and associated policy (if applicable) Joint Provider Agreement(s), if applicable Evidence of disclosing to the learner:

o Learning outcome statement and criteria for successful completiono Presence or absence of conflicts of interest for all members of the planning committee, pre-

senters, authors, and content reviewerso Commercial support (if applicable)o Expiration date (Learner-Paced materials only)o Joint Providership statement (if applicable)

Documentation of successful completion (Certificate of Successful Completion) must include:a. Name and address of CNE provider (web address acceptable)b. CNE activity ID# under the name of the providerc. Name of participantd. Number of contact hours awarded to participante. Title of activityf. Day, month and year of activity presentation (or completion date if Learner-Paced)

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g. Locationh. Correct TNA approval statement

Summative evaluation

2. Include the location – organization and address – where the records are filed and stored.

Activity application complete on : The person responsible for completing the activity application should sign and date the activity application in this section. If that person is not the activity’s identified Nurse Planner, the Nurse Planner needs to sign and date the activity application verifying it has reviewed prior to submission.

1. The Nurse Planner is responsible for ensuring that the evaluations are summarized into a single document – the summative evaluation - and that the document is retained as part of the activity file for six (6) years.

2. The Nurse Planner commits to reviewing with the planning committee the summative evaluation(s) to assess the education activity is effectiveness and to identify how results may be used to guide future education activities.

3. The Nurse Planner commits to submitting CNE activity data to TNA as outlined in their approval letter

Sample forms:Included with the application are samples of all the forms required for this application for your use. They meet the minimum criteria requirements. Format may be changed but the content must be met.

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