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Montana Nurses
Association
Provider Newsletter: April, 2015
Practice Issue: The Question of Bias
In the March newsletter, we talked about conflict of interest – what it is, why it’s important, and how
you manage it. We addressed the fact that regulators, payers, patients, and others depend on us to
practice according to best-available evidence, not based on what we’ve learned from someone who
wants us to use his or her company’s medication, product, or device. We identified how you determine
whether a conflict of interest exists, what steps you take to resolve the conflict prior to the educational
activity, and how you provide transparency to learners.
Let’s switch gears now and talk about bias. While bias is also important in maintaining content integrity,
it doesn’t carry the same risk as conflict of interest, because there’s no patient-related product that is at
stake. Bias is defined by ANCC as “the tendency or inclination to cause partiality, favoritism, or
influence” (accreditation manual, 2013). Just like with conflict of interest, bias may be present in any
one with the ability to control an educational activity.
How do you assess for bias? Frankly, this is harder than assessing for conflict of interest, because we
have clear definitions and a developed algorithm to follow for conflict of interest. Bias is much “looser”.
On a planning committee, watch for a member who doesn’t want to engage in conversation about a
particular approach to care or who is so passionate about what she believes to be “right” that she is not
listening to other options. These behaviors indicate bias and have the ability to negatively influence how
the activity is planned. Among presenters or authors, watch for people who seem to have their own
“agenda” and want to dictate their plan rather than listening to your needs assessment, gap analysis,
and desired outcome data. While biographical data forms do not explicitly address bias, you might be
able to pick up some “clues” from the section where the person describes his/her expertise in the topic.
Is he an author of books on the subject? Has she conducted research about the effectiveness of the
treatment that is going to be discussed in the class? Has he had a bad (or good) personal experience
with a hospital, agency, or other organization that will influence how he will talk about a health care
issue?
How do you address bias? Two ways – be proactive when possible; be reactive when necessary. First,
take a proactive approach. When convening a planning committee, you can specifically ask people if
they have any perspectives, experiences, or feelings that would negatively impact their ability to be
objective participants in planning the activity. If anyone does, talk with that person about whether or
Montana Nurses Association is accredited as an approver of continuing nursing education by the
American Nurses Credentialing Center’s Commission on Accreditation.
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not he/she will be able to set aside that personal perspective. If not, that person should not continue to
be engaged in the committee’s work. For prospective speakers or authors, ask the same question. You
can also be very direct in communicating with both planners and presenters by saying, “It is important
that this educational activity be developed and presented based on best-available evidence, not on any
one particular viewpoint. Bias will not be tolerated”. You can use the resolution steps that were
discussed with conflict resolution – all of those would also be applicable in addressing bias. One
common strategy is to have the speaker sign an agreement stating that there would be no bias in the
presentation. Reviewing the references and resources is also helpful. Has the person cited references
other than his own? Is there a balance of different viewpoints or perspectives represented among the
references? You can ask to see the person’s slides or handouts in advance – check to be sure the
content is balanced, free of promotion or influencing comments, and free from logos or “sales pitches”
for products, services, or organizations.
Example: A home care company is invited to come into the hospital to do a class for hospital discharge
planners and case managers about successful strategies for transition from hospital to home and how to
avoid readmissions to the hospital. Sounds good on the surface. In light of changes in today’s healthcare
environment, it makes sense that hospitals and home care agencies would be wanting to collaborate in
achieving the stated goals. Here’s the question – does the home care company truly want to have a
collaborative working relationship with the hospital, or is the planned education a ploy to increase the
visibility of this agency, with the underlying aim of increasing referrals? Thoughtful conversation
between the nurse planner at the hospital and the representative from the home care company will
help to assure that the presentation stays on target and that the session doesn’t become an “ad” for the
company. Reviewing slides and handouts to check for logos or other promotion would be a prudent
action on the part of the nurse planner.
The bottom line – you have an obligation to assure that educational activities are based on best
available evidence and are designed from a sound educational perspective to achieve the desired
outcome for your learners. Prevention of bias during the planning and presentation of the activity will
help you achieve this goal.
Questions? Please let me know how I can help.
Best Practice Sharing – Documenting Needs
Assessment Evidence
This sample was submitted to MNA by the Montana Department of Public Health and Human Services
Asthma Control Program as they were planning for the 2015 Big Sky Pulmonary Conference. We
received permission to share this excellent example with you. Notice key factors: there is objective
evidence presented from credible sources, state-wide data is corroborated by members of the planning
committee in relation to the target audience for this activity, the needs assessment lays the foundation
Montana Nurses Association is accredited as an approver of continuing nursing education by the
American Nurses Credentialing Center’s Commission on Accreditation.
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for determining the desired outcome, and references are provided to guide not only the needs
assessment but also the development of relevant content for the activity.
Montana is a rural state with less than one million residents and only 6.4 persons per square
mile. (5) Because of Montana’s rural nature, there are few specialists in the area of pulmonary
medicine. Most patients with pulmonary concerns in Montana see primary care physicians or
allied health professionals who may or may not be trained in the most updated evidenced based
guidelines for pulmonary care or abreast of the latest research in this area of medicine. The lack
of quality care for pulmonary patients is evidenced by findings from the MT Behavioral Risk
Factor Surveillance System Asthma Call-back Survey. From 2006-2008, a representative
sample of adults with asthma in MT reported receiving asthma care far below the standard of
the Expert Panel Report-3 (EPR-3) Clinical Guidelines of Asthma. For instance, only 25%
reported ever receiving an Asthma Action Plan, a document that the EPR-3 Guidelines
recommend that all patients with asthma receive. (6) Additionally, only 40% reported ever being
advised to change something in their environment to control their asthma, though the guidelines
recommend that all patients receive this type of self-management education. (6) The lack of
asthma self-management education provision is evident even in patients with uncontrolled
asthma who report frequent trips to the emergency department or visits to their primary care
physician. Frazier et al, in their discussion of the MT Asthma Call Back Survey data in an article
published in the Journal of Asthma and Allergy Educators conclude, “It is particularly striking
that even after controlling for demographics and socioeconomic status, adults with uncontrolled
asthma are no more likely to report receiving an asthma action plan or being taught to recognize
the early signs of an asthma attack than are those with well controlled asthma despite having
much more frequent contact with health care providers and the health care system.” (6) Though
the most robust data on pulmonary care in Montana is related to asthma, it is easy to see the
gaps in practice likely extend to all patients with pulmonary illness in the state, particularly those
that have more complicated, rare and serious forms of respiratory disease like cystic fibrosis
and pulmonary hemorrhage.
During the medical planning committee meetings for the Big Sky Pulmonary Conference, the
difficulty with the gaps in practice, including the lack of specialty care and the need for training
on evidenced based guidelines were discussed repeatedly. Discussions with these healthcare
providers, who are all currently practicing in Montana, and the evaluation responses from the
2014 conference, reinforced the need to have continuing education sessions focused on
evidenced-based guideline implementation at the primary care level. These discussions are
reflected in the attached planning committee meeting notes. The planning committee
corroborated what the public health data showed-namely that Montana providers, especially the
primary care providers who administer most of the care to pulmonary patients in the state, need
training on the evidenced based guidelines and emerging research on pulmonary care to remain
abreast on how to best care for these patients.
References:
1) Montana Behavioral Risk Factor Surveillance System, 2009.
Montana Nurses Association is accredited as an approver of continuing nursing education by the
American Nurses Credentialing Center’s Commission on Accreditation.
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2) “The Health Impact of uncontrolled Asthma” Montana Asthma Control Program Quarterly
Surveillance Report, January-March 2010.
3) “Chronic Lower Respiratory Disease and Tobacco Use.” Montana Asthma Control Program
Quarterly Surveillance Report, July-September 2010.
4) Data request from Montana Hospital Discharge Data System Epidemiologist. Received
11/16/2010.
5) US Census Bureau, American Community Survey. Accessed 1/18/08.
www.factfinder.census.gov
6) J. Frazier, K. Loveland, T. Harwell and S. Helgerson. “Missed Opportunities to Provide Selfmanagement Education to Patients With Uncontrolled Asthma in a Rural State.” Journal of
Asthma and Allergy Educators. Published online 4 October 2010.
National Nurses Week
National Nurses Week is May 6-12, 2015. The theme this year is “Ethical Practice; Quality Care”. This
theme coincides with ANA’s release of the 2015 edition of the Code of Ethics for Nurses. Have you
thought about activities you could offer in your organizations to recognize your nurses? This is a
wonderful opportunity for your provider unit to be a very visible presence in contributing to the way we
celebrate and value nurses and nursing.
At MNA, we are offering a complimentary webinar, “Ethics to Guide Our Care”, for all nurses. To
accommodate various schedules, the webinar will be provided 4 different times on May 11. While there
is no cost for members to participate, registration is required. Please refer to the MNA web site
(www.mtnurses.org) for information.
Provider Update Logistics
Register Now!
Provider updates will be coming soon. Thanks to all of you who have already registered! Registration
information is available on the MNA web site. Here is some information that will help in your planning:
ALASKA:
Location of Event: May 7th will be in the East Auditorium--(lower level) Providence Alaska
Medical Center, 3200 Providence Drive, Anchorage, Alaska 99508.
Montana Nurses Association is accredited as an approver of continuing nursing education by the
American Nurses Credentialing Center’s Commission on Accreditation.
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May 8th will be in the West Auditorium--(Lower Level) Providence Alaska Medical
Center, 3200 Providence Drive, Anchorage, Alaska 99508 There is free visitor parking in
the front of the hospital or in parking garage on the east end of the facility. If
participants enter through the main entrance of the hospital and either take the stairs
or the D elevator to the basement, the East and West Auditoriums are to the left of the
stairs.
Dates of Event: May 7 (individual activity focus) and May 8 (approved provider unit
focus)
Nearby Hotels: Spring Hill Suites, 1-907-751-6300; Embassy Suites, 844-891-0996; Best
Best Western Golden Lion Hotel, 907-561-1522
Other: - a light breakfast and lunch will be provided each day
MONTANA:
Location of Event: Green Meadow Country Club, 2720 Country Club Ave., Helena, MT
Date of Event: May 14
Nearby Hotels: Baymont Inn & Suites, 844-850-7956; Elkhorn Mt. Inn, 406-442-6625;
Fairfield Inn, 406-449-9944
Other – a light breakfast and lunch will be provided
Availability of Webinars on ONA web site
The fall, 2014 webinar series, “Documenting Evidence of Success in your Provider Unit”, is now available
in independent study format from the Ohio Nurses Association
(https://ce4nurses.org/courses/approved-provider-education/). This series was jointly provided by the
Ohio Nurses Association and the Montana Nurses Association. Speakers were Zandra Ohri from Ohio for
session 1 and Pam Dickerson from Montana for sessions 2, 3, and 4. Each webinar focused on one area
of the provider application – organizational overview, structural capacity, educational design process,
and quality outcomes. If your approved provider application is due in the next 6-9 months and you did
not participate in the “live” webinars, you would find them exceedingly valuable in writing to the criteria
in your application.
In addition to these webinars, tapes of the previous sets of webinars (“Nurse Planner” series of 3
webinars and “Quest for Quality” series of 3 webinars) are also available for your access. Each webinar is
$12, and contact hours are available for all of them. If you have questions, feel free to contact Pam
(pam@mtnurses.org) or Zandra (zohri@ohnurses.org).
Montana Nurses Association is accredited as an approver of continuing nursing education by the
American Nurses Credentialing Center’s Commission on Accreditation.
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Upcoming Activities
May 7 - 8, 2015 – Alaska Provider Update - Anchorage
May 14, 2015 – Montana Provider Update – Helena
September 30 – October 2, 2015 – Montana Nurses Association 103rd Convention – Helena
MNA Independent Study Library Available Online @ www.mtnurses.org
Also, please note that previous provider-unit specific webinars in the Quality Outcomes, Nurse Planner,
or Documenting the Evidence series jointly provided by the Ohio Nurses Association and MNA are
available as independent studies. Please contact Kathy at Kathy@mtnurses.org for more information.
No May Newsletter
Please note that there will not be a May newsletter, since many of us will be together in person at the
Provider Update sessions. For those of you unable to attend one of the Provider Updates, please contact
me if you have questions or would like me to address a specific issue for your approved provider unit.
Contact Information
Pam Dickerson, PhD, RN-BC, FAAN, Director of Continuing Education
pam@mtnurses.org
1-406-465-9126
Kathy Schaefer, BA, Continuing Education Specialist
kathy@mtnurses.org
1-406-442-6710
Mary Thomas, BA, RN, OCN
mary@mtnurses.org
1-406-442-6710
Montana Nurses Association is accredited as an approver of continuing nursing education by the
American Nurses Credentialing Center’s Commission on Accreditation.