Individual Activity Application

Instructions

1. Submit the Individual Activity Applicant Eligibility Verification Form.
2. Complete the Individual Activity Application.
3. Applications must be submitted with payment at the end of this form.
4. Your application will be assigned for review and you will receive an email from the Program Director notifying you of the timeline of the review process and next steps.
5. If you have questions or need assistance with this process, please email
nurseplanners@chietaphi.org.

6. If a commercial interest is involved, then please also complete the Commerical Support Agreement and upload to this form.

 

Application Fees:
Individual Activity Application fees can be found here. Application fees are for the review of the individual activity and are non-refundable once the application has been submitted.

Note: Applications will not be reviewed until fees are received.

 

Helpful Tips:
• If your activity is intended to build upon the educational and experiential bases of the professional RN for the enhancement of practice, education, administration, research, or theory development, to improve the health of the public and RN’s pursuit of their professional career goals, then it is considered continuing nursing education.
• Review the resources and process for completing an Individual Activity Application.
• Review the Individual Activity Application Frequently Asked Questions (FAQs) Resource.
• The Nurse Planner’s role is to guide the planning process and ensure adherence to ANCC Educational Design Criteria.
• This application should guide the planning of your educational activity. You will find it much easier to complete the application if it is used to facilitate the development of your activity rather than completing it after you plan the activity.
• If providing an enduring activity or repurposing a live activity as enduring, the
planning team will need to demonstrate an appropriate learning outcome, evaluation method, learner engagement strategies, and disclosures that align with the method of delivery.
• If you are advertising this activity prior to approval, you may use the following statement on your marketing materials: "This activity has been submitted to Chi Eta Phi Sorority, Inc. (R) for approval to award contact hours. Chi Eta Phi Sorority, Inc.® is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation."
• Once approved, your activity may be provided as many times as you choose during the two-year approval period as long as you do not make significant changes to the activity.

 

Basic Activity Information

Number of hours to be awarded: If the educational activity is longer than 3 hours, a copy of the agenda must be attached.

• The agenda must specify the time allocations to provide evidence to support the number of contact hours that can be awarded.

Nurse Planner Contact Information for this Activity

The Nurse Planner must be a registered nurse who holds a current, unrestricted nursing license (or international equivalent) AND holds a baccalaureate degree or higher in nursing (or international equivalent) AND must be actively involved in planning, implementing and evaluating this NCPD educational activity. The nurse planner is accountable for all information provided in the application.

The ANCC Accredited Approval Unit will use the email address provided for the Nurse Planner for all communication regarding the status of this application.

Individuals in Control of Content:
A planning team must consist of a minimum of two individuals. Please identify the Nurse Planner and the Content Expert. If the Nurse Planner is also the Content Expert, there must be at least one additional planning team member. The Nurse Planner is responsible for adherence to the ANCC criteria. There should be only one individual designated as the Nurse Planner, but there may be additional nurses and non-nurses on the planning team. Please identify all planning team members and include credentials.

• Provide a list of all individuals in control of content.

• Credentials must be included along with the names of the individuals, including education and licensure (i.e. MSN, RN, CCRN).

• The list must include ALL individuals with the ability to control content, whether they are members of the planning committee or not.

Identification, Mitigation, and Disclosure of Financial Relationships

 

We adhere to the Standards for Integrity and Independence in Accredited Continuing Education. These standards ensure that approved educational activities are high quality, evidence based, and free of industry bias and marketing. As a part of this process, if your activity is clinical in nature, you will be required to assess all individuals in a position to control the content for relevant financial relationships that may influence their role. Please follow the steps below and refer to the Standards for Integrity and Independence in Accredited Continuing Education for guidance in identification, mitigation, and disclosure of financial relationships with ineligible companies.

Prevent Commercial Bias and Marketing in Accredited Continuing Education
Accredited continuing education must protect learners from commercial bias and marketing (Standard 2 Standards for Integrity and Independence in Accredited Continuing Education)

1. The provider must ensure that all decisions related to planning, faculty selection, delivery, and evaluation of accredited education are made without any influence or involvement from the owners and employees of an ineligible company.
2. Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.
3. The provider must not share the names or contact information of learners with any ineligible company or its agents without the explicit consent of the individual learner.

Ancillary Activities-(Standard 5 Standards for Integrity and Independence in Accredited Continuing Education, if applicable) le for ensuring that education is separate from marketing by ineligible companies—including advertising, sales, exhibits, and promotion—and from nonaccredited education offered in conjunction with accredited continuing education. Standard 5 applies only when there is marketing by ineligible companies or nonaccredited education associated with the accredited continuing education.

Step 2: Collect Information about All Financial Relationships with Ineligible Companies* for ALL individuals in a position to control content (planners, presenters, faculty, authors, and/or content reviewers). Provide evidence that financial relationship data has been collected and analyzed by the Nurse Planner and/or Program Director for all individuals in a position to control content, including the planning team, by attaching a copy of the completed Financial Disclosure Form(s), assessment email, or other evidence demonstrating the process used to assess for relevant financial relationships with ineligible companies within the past 24 months. Must demonstrate that you defined what an ineligible organization is and assessed for relationships in the past 24 months. Access the financial disclosure form here, complete, and upload for all individuals in a position to control content.

Step 3: Determine if there is a relevant financial relationship with an ineligible company within the last 24 months and document on the table below.

Financial relationships are relevant if all of the following three conditions are met for the individual who will control content of the
education:
1. A financial relationship, in any amount, exists between the person in control of content and an ineligible company.
2. The financial relationship existed during the past 24 months.
3. The content of the education is related to the products of an ineligible company with whom the person has a financial relationship.

• If there are not relevant financial relationships, mitigation is not required and you may proceed to Step 5.
• If there are relevant financial relationships, mitigation is required and you should proceed to Step 4.
• Owners/employees from ineligible companies must be excluded from planning, presenting or any role that has control of
  content, unless one of these three exceptions is met:
  • When the content of the activity is not related to the business lines or products of their employer/company.
  • When the content of the approved activity is limited to basic science research, such as pre-clinical research and drug discovery, or the methodologies of research, and they do not make care recommendations.
  • When they are participating as technicians to teach the safe and proper use of medical devices, and do not recommend whether or when a device is used.

Step 4: Mitigate relevant financial relationships. Describe the steps taken to mitigate the risk of undue influence in planning and/or providing the activity. This should be described in the table below. Examples of mitigation strategies include:

• Divesting the financial relationship
• Recusal from controlling aspects of planning and content with which there is a financial relationship
• Peer review of planning decisions by persons without relevant financial relationships
• Peer review of content by persons without relevant financial relationships
• Attest that clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering
  to evidence-based practice guidelines)

Step 5: Disclosure to Learners prior to the start of the activity. Develop and attach a sample of the required disclosures in
section M.

• If there are no relevant financial relationships, disclose to learners: There are no relevant financial relationships with ineligible companies for those with the ability to control the content of this activity.
• If there are relevant financial relationships, disclose to learners the individual, their role, the ineligible organization, the nature of the relationship, and that it has been mitigated: Dr. John Doe, faculty for this educational event, has received a research grant from ABC pharmaceuticals. The relevant financial relationship listed for this individual has been mitigated and there are no other relevant financial relationships with ineligible companies for those with the ability to control the content of this activity.

Identification, Mitigation, and Disclosure of Financial Relationships Documentation Table

 

This table must be complete for all individuals in a position to control content.

Educational Design Criteria

B. Provide a brief summary of the evidence that supports the problem/opportunity/issue (identified in A) exists for your target audience. Provide an analysis of the evidence that demonstrates the problem exists. What data supports the need for this educational activity? How is the evidence (e.g. data, trends in literature) informing you that a gap exists for the target audience?
This should not be a description of the content of the activity. Stating that there is a “need” or a “request” for the activity is not adequate.

Please note: the evidence stated must indicate how do you know they do not know.

Examples of types of evidence to validate the need for the activity:

• Survey data from stakeholders, target audience members, subject matter experts or similar
• Input from stakeholders such as learners, managers, or subject matter experts
• Evidence from quality studies and/or performance improvement activities to identify opportunities for improvement.
• Evaluation data from previous education activities
• Trends in literature
• Direct observation

E. What is the measureable learning outcome for the learner at the end of this activity?

• What do you want the learner to know, or be able to do, or apply in practice,
  after participating in the activity and how will you know if you are successful?
• The measurable learning outcome must tie to the professional practice gap and the underlying educational need. If the underlying need is knowledge, the outcome should be related to measuring a change in the learner’s knowledge, etc.
• The measurable learning outcome is not a list of objectives.
• The measurable learning outcome must align with the type of activity provided.
• The learning outcome needs to be written in measurable terms and should include the outcome and the metric that the outcome is measured by.

 

Examples: 100% of participants will demonstrate knowledge of basic arrhythmia interpretation by passing a post-test with a score of 80% or higher.; 75% of learners will identify 1 piece of knowledge related to patient engagement that they will use to change or enhance their practice.; 75% of participants will demonstrate skill with de- escalation through participation in a simulation.

F. Please describe your Evaluation Method. How will you evaluate if the learner has
gained knowledge, is able to implement a skill, or will apply what has been learned to practice?

• Your evaluation should determine if the learning outcome identified in E. has been achieved at the level of identified educational need (knowledge, skill, or practice).
• Evaluation can be conducted in various ways, including through observation of participants in engagement strategies throughout the program, post-test, performance in a simulation or other skill demonstration, end of program discussion, verbal or written response to specific questions, etc. A form is not required.
• The evaluation method must align with the type of activity provided.
• The description of the evaluation method should discuss how the evaluation data is obtained and analyzed and should clearly describe the data being collected. For example, do not simply state that an end of program discussion will be completed but share what types of questions will be asked.
• Asking learners to rate a list of objectives on a scale of 1-5 is not measuring their knowledge.

G. Description of evidence-based content with supporting references or resources: description of the evidence-based content and supporting references. 

• Description of the evidence-based content can be presented in any format including an educational planning table, a timed outline,  an abstract, and itemized agenda, or narrative response.

For conferences or activities longer than 3 hours, an abstract can include a description of how the overall content facilitates learner achievement of the expected outcome for the conference, detailed information about individual sessions and individual session outcomes is not required.

How did you determine the amount of contact hours to be awarded?

• This may include time allotted on agenda/outline, complexity of content, historical data, pilot study, Mergener Formula, etc.)
• The number of contact hours awarded for an activity needs to be logical and defensible.
• Breaks and non-educational activities are not included in the calculation of contact hours.
• 1 contact hour=60 minutes
• Contact hours may be rounded up or down to the nearest quarter hour (i.e. if the calculation is 1.19 contact hours, it may be rounded up to 1.25 contact hours)

H. Please provide current and evidence-based resources that will support the
development of the content of this educational activity.

• Best practice is to use references and resources that have been published with the last 5-7 years.
• If a content expert will be a resource, please also ensure there is another evidence-based resource to support the content.
• It is not required that references be provided in APA format, however references should include adequate detail to ensure the reference can be located (i.e. List the authors, specific title, dates of publication, page number, link). Solely providing a website link is insufficient.
• It is not required to provide an exhaustive list of all content resources.

I. Please describe the learner engagement strategies that will be used to actively
involve the participant in the activity.

• This section is about learner engagement strategies and not teaching methods.
• Examples of engagement strategies include discussion, reflection, Q&A, skills practice, case studies, role play/simulations, gaming etc. PowerPoint and lecture are not engagement strategies. Learners will have the opportunity to engage in question/answer dialogue about the information, will take a 5-question quiz to assess their knowledge, and will participate in patient teaching role-playing to assure that they are teaching current and current information.
• Please ensure you have engagement strategies appropriate for the type of activity.
• If the live activity is repurposed as an On-Demand/Enduring activity, the planning team will need to identify engagement strategies for both types of activities.

J. Criteria for Awarding Contact Hours

Determine what the learner must do or achieve in order to receive contact hours for the activity. Clearly outline what is expected. The criteria for awarding contact hours should relate to the learning outcome(s) and be enforceable for the activity. Criteria identified must match the educational disclosure provided to learners in Section M. Check all that apply:

K. Will this activity be Jointly Provided?

Joint Providership is when two or more organizations plan, develop, and implement an educational activity together. You may not jointly provide an educational activity with an ineligible organization.

L. Will Commercial Support be provided for this activity? Commercial Support is financial or in-kind support from ineligible companies. If you choose to accept commercial support you are responsible for ensuring that the education remains independent of the ineligible company and that the support does not result in commercial bias or influence in the education.

M. Educational Disclosures

 

• Learners must receive required educational disclosures prior to the start of the educational activity.
  Educational disclosures can be provided via printed materials (ex. agenda), verbally, via presentation slide, registration email, etc.
• Two sets of educational disclosures are required if the live activity is repurposed as an OnDemand/Enduring Activity.
• You are required to attach a sample copy of educational disclosure(s) that will be provided to the learner in this activity file.

 

Required educational disclosures:

• Individual Activity Approval Statement: This nursing continuing professional development activity was approved by Chi Eta Phi Sorority, Inc.®, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
• Criteria for successful completion in order to receive contact hours: The criteria disclosed should be congruent with the criteria documented in Section J.
  • Example: Criteria for successful completion includes attendance at the entire event and completion of post-test with a score of 80% or higher.
• Presence or absence of relevant financial relationships for all individuals in a positionto control content.
  • If the content is non-clinical, no financial disclosure should be made.
  • If a relevant financial relationship is present, the disclosure must include:
    • The names of individuals with relevant financial relationships
    • The names of the ineligible companies with which they have a relationship
    • The nature of the financial relationships
    • A statement that all relevant financial relationships have been mitigated. The mitigation steps do not need to be outlined.
    • Example: Dr. John Doe, faculty for this educational event, has received a research grant from ABC pharmaceuticals. The relevant financial relationship listed for this individual has been mitigated and there are no other relevant financial relationships with ineligible companies for those with the ability to control the content of this activity.
  • If no relevant financial relationships were identified, the disclosure should inform the learners that no relevant financial relationships with ineligible companies were identified.
    • Example: There are no relevant financial relationships with ineligiblecompanies for those with the ability to control the content of this activity.

Commercial Support (If applicable)

• If the educational activity received commercial support, there must be a disclosure to learners of the names of the ineligible companies that gave the support and the nature of the support.
• No logos, trade names, or product group messages for the organization can be provided in the disclosure.
• Example: ABC Pharmaceuticals has provided an unrestricted educational grant for this conference.

Expiration date must be disclosed if on-demand/enduring materials

• Example: Nursing contact hours will be awarded for completion of this activity until December, 31, 20XX.

Joint providership (If applicable)

• If the activity is jointly provided, there should be a statement that demonstrates that two or more groups were involved in the planning and development of the activity.
• Example: This activity is being jointly provided by [Insert Individual Activity Applicant Name] and [insert Joint Provider Organization’s name].

N. Certificate/Documentation of Completion

To be provided by the National Second Vice-President:

The certificate must include:

• Title and date of the educational activity
• Name and address of the provider of the educational activity (web address is acceptable)
• Number of contact hours awarded
• Individual Activity Approval Statement: This nursing continuing professional development activity was approved by an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
• Space for participant’s name

O. Post Activity Recordkeeping and Reporting:

• Recordkeeping: You are required to maintain secure and confidential records of this activity for a minimum of 6 years from the date of delivery. This includes: the application file, evaluation summation, and a record/roster of all participants with the amount of contact hours awarded to each participant.
• Reporting: Chi Eta Phi Sorority, Inc.® requests submission of a Summative Evaluation of your activity within 30 days of the activity or by January 15th for on-demand/enduring activities.
  Please submit this to nurseplanners@chietaphi.org. The Summative Evaluation should be an analysis of the evaluation data and include:
  
  • You will also be asked to report the total number of individuals participating in the activity, the total number of RNs who participated in the activity, the amount of commercial support received, and intent to repeat the activity.
  • Patterns or trends noted in evaluation comments (if applicable):
  • Narrative Summary of How This Activity Advanced Professional Development
  • Strengths of the Activity
  • Opportunities for Improvement in Planning/Delivery
    • How Lessons Learned Will Be Used to Improve Future Activities
    • Evidence Supporting the Achievement of Outcomes