2013 Biographical Data & Conflict of Interest Form

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TNA & TASN Joint Convention
The Many Dimensions of Nursing
October 18-20, 2013
Embassy Suites Hotel & Conference Center
Murfreesboro, Tennessee
CALL FOR ABSTRACTS
We invite you to submit an abstract to be considered for oral or poster presentation at the 2013 TNA &
TASN Joint Convention, The Many Dimensions of Nursing, in Murfreesboro, Tennessee. The focus/content
of your abstract should relate to one of the following themes:
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Leadership
Policy Development
Spiritual Caregiving
Patient Education
Care Coordination
Mentorship
Advocacy
Clinical Best Practices
Research
Innovative care models
If you have an innovative project or topic that does not quite fit into any of these categories, please
submit, as a few innovative presentations outside those boundaries will be considered.
ABSTRACT SUBMISSION DEADLINE:
June 17, 2013
ABSTRACT CLASSIFICATION
Abstracts may be submitted for oral presentation or poster presentation.
ABSTRACT SUBMISSION GUIDELINES
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Abstracts must be submitted utilizing the forms contained in this call for submissions. Any
submissions not utilizing this format or containing incomplete information will be
disqualified.
Abstracts must be submitted electronically via e-mail to bmartin@tnaonline.org
Abstracts must be no more than 250 words in length.
Abstracts should include a description of the problem addressed, objectives, methods/procedures,
findings and recommendations for practice/research.
Abstracts must be submitted in MS Word format using a 12 point font and be single spaced.
Faxed or mailed hard copy abstracts will not be accepted.
Abstracts must be accompanied by a completed Educational Design Form, as well as Biographical
Data & Conflict of Interest Form for each presenter/author.
TIMELINE
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Abstract submissions must be received by 4:30 p.m. CST, on June 17, 2013.
Email confirmations will be sent within 24 hours of your submission. If you do not receive a
confirmation, please contact Barbara Martin at bmartin@tnaonline.org A panel of judges will review
the abstracts and applicants will be notified of their acceptance or denial by July 16, 2013
All presenters must register to attend the conference.
ACCEPTED ORAL PRESENTATIONS
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Oral presentations will be of 60 minutes duration, including introduction and questions and
answers.
Oral presentations must be free of commercial bias.
All presenters are responsible for any expenses incurred in preparing, presenting and transporting
their presentation.
Oral presentations will be presented in the afternoon on Saturday, October 19, 2013.
ACCEPTED POSTER PRESENTATIONS
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Posters will be displayed throughout the convention in the House of Delegates. Poster set up is
5pm-9pm Friday October 18, 2013. All poster abstracts accepted will be published in the
conference proceedings. On Saturday, October 20 the poster session will be a “round robin” with
each presenter given 2-3 minutes to introduce their poster after which, attendees can visit the
posters for in depth discussion.
Poster presentations must be free of commercial bias.
Posters are to be of a size and material which can be displayed easily on a standard floor easel.
You must mount your poster on a board if it will not stand-alone on one standard easel.
Poster presenters will assume all costs related to the poster.
Poster presenters are responsible for displaying and dismantling their posters at the designated
time, as well as attending the posters during the open sessions.
All presenters are responsible for any expenses incurred in preparing, presenting and transporting
their poster presentations.
Application for Presentation
Please return the following 3 pages to:
bmartin@tnaonline.org
Please consider my application for:
____ Oral Presentation
____ Poster Presentation
____ Both
Presenter: (Primary presenter to be contacted with questions)
Name
Degree(s)
Organization
Address
City
State
Zip Code
Phone
Email
Speaking Experience (how often do you make public presentations, largest audience you have presented to)
Co-Presenter: (if applicable)
Name
Degree(s)
Organization
Address
City
State
Zip Code
Phone
Email
Speaking Experience (how often do you make public presentations, largest audience you have presented to)
Title of presentation:
Abstract: Description as you would like it to appear on the web and in the conference program. Please describe your
session in 250 words or less (including what you will present, how, and what participants will do):
2013 Biographical Data & Conflict of Interest Form
Presenter
Name
Credentials
Address
Daytime Telephone:
Email Address:
Present Position (Title) & Employer
Presenter: Describe your expertise in this topic:
Conflict of Interest Statement
ANCC defines a "conflict of interest" as when an individual has an opportunity to affect CNE content with products or services from a commercial
interest with which he/she has a financial relationship. Having an interest in an organization does not prevent a speaker from making a
presentation, but the audience must be informed of this relationship prior to the start of the activity and any potential conflict must be
resolved. In order to ensure balance, independence, objectivity and scientific rigor at all programs, the planners and faculty must
make full disclosure indicating whether the planner, faculty or content specialist and/or his/her immediate family members have any
relationships with sources of commercial support, e.g. pharmaceutical companies, biomedical device manufacturers and/or
corporations whose products or services are related to pertinent therapeutic areas. All planners, faculty and content specialists
participating in CE activities must disclose to the audience information listed below.
A.
Is there a potential conflict of interest?
Yes
No
Relationship
Name of Commercial Company(ies)
Research Support
Speakers’ Bureau
Consultant
Shareholder
Large Gift(s)
Other Support
If yes, list company(ies) with relationship:
B.
If there is conflict of interest, how has it been resolved?
1. Have discussed this conflict with individual who is now aware of and agrees to our policy.
2. Presenter has signed a statement that says s/he will present information fairly and without bias.
3. RN with minimum of BSN or designee will monitor session to ensure conflict does not arise.
4. Other: Describe:
C.
Discussion of off-labeled uses:
Yes
No
If yes, you must disclose this information during your presentation. How will you do this?
1. Verbal statement during the presentation.
2. Information provided on handouts.
3. Information provide in audiovisuals (slides, overhead, PowerPoint, etc.)
4. Other: Describe:
All information disclosed must be shared with the audience either on the program handouts, advertising and/or audiovisual presentation.
Signature:
Date:
EDUCATION DESIGN FORM
INSTRUCTIONS: This form must be used to provide Objectives, Content, Time Frames, Presenters and Teaching Strategies.
Title of Poster/Presentation
Objectives
Content (Topics)
Time Frame
List educational objectives in measurable learner
outcomes; e.g. describe, list, identify. Objectives must
be consistent with the purpose. The participant will:
List each topic area to be covered & provide a description of
the content to be presented in sufficient detail to determine
consistency with objectives & appropriate time allotted.
Provide a time frame
for each topic or
content area, e.g. 60
minutes.
Presenter
List the presenter
for each topic or
content area.
Teaching Method
List the teaching method(s) used by each
presenter for each topic/content area; e.g.
lecture, Q & A, demonstration.
Revised 1/07
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