Continuing Education Course Planning Form Information Sheet

Information/Instructions: Please Read Carefully

Processing may take up to 30 days. Please plan accordingly.

CPPN will not advertise nor take registrations for any educational activity until planning form is completely processed.

Course Requirements

When planning form is completed, submit to cppn@health.ucdavis.edu

All components of the (1) planning form, (2) course agenda, and (3) all biographical/conflict of interest forms for presenters and planning committee members are required to be submitted to start processing.

CPPN will not publish nor take registration for a course until the planning form has been endorsed.

Continuing Education (CE) contact hours are provided for a three-year period. To offer the same course after that date, the coordinator must submit a new CE planning form.

If ANCC Course Credit Desired

To be considered for ANCC credit, your course must meet the following criteria:

ANCC credit cannot be awarded if a CPPN Nurse Planner is not involved from the beginning. To initiate the process, please contact cppn@health.ucdavis.edu to discuss.

Content must be beyond the basics of general nursing information.

Cannot be a skills day or unit-based class.

All ANCC required information must be included in planning form.

If PT/PTA Continuing Education Course Credit Desired

To be considered for PT/PTA credit, your course must meet the following criteria:

Topics and subject matter must be pertinent to the practice of physical therapy. Questions about subject matter can be directed to PMREducation@health.ucdavis.edu.

All instructors must submit a CV or resume.

A bibliography is required with at least 5 peer-reviewed journal articles published within the last 5 years.

Courses with a hands-on lab component cannot exceed a student to instructor ratio of 16:1.

Simulation Training

A CPPN Course utilizing the Center for Simulation and Education Enhancement and the Center for Health and Technology (CHT) should be coordinated through CPPN.

Course Content

The content of all CE courses must be relevant to the practice of registered nursing.

Course offerings must be at least 60 minutes (1 hour) in length.

Credit cannot be offered for completing part of a course.

Blended Learning or e-Learning must have expiration dates for the enduring or online materials.

All CE courses that contain any direct patient care component must include curriculum on implicit bias CPPN cannot provide CE credit for courses that fail to meet this requirement.

Two Levels of CPPN Support

CPPN-based courses, which means that the class is on the CPPN website and open to all (internal and/or external) who wish to attend. CPPN handles the registration, evaluation, printing of course materials (if received 10 days prior to the class), questions concerning, etc. CPPN personnel will be on hand to open and close the class, supply AV equipment, and support as needed.

Note: For all CPPN-based courses, there is a base deposit of $25 for UCDH employees and a fee per hour charged for non-employees. Registration costs vary depending on length, catering needs, honorariums, etc. This is determined by CPPN.

Unit-based courses, which means opened to only a select group/unit of staff only to attend, and no pre-registration nor deposit required. CPPN supplies in advance blank rosters and evaluation forms only.

Course Fees

Course fees are dependent on multiple factors and are thus at the discretion of CPPN.

All CPPN courses have a minimum of a $25 deposit for UCDH employees.

If non-UCDH employee, there is a fee for all contact hours awarded.

Return entire form and direct questions to: cppn@health.ucdavis.edu

Title of Activity: Click or tap here to enter text.
TO BE COMPLETED BY CPPN
Date received: Click here to enter a date.	Consent to provide course date: Click here to enter a date.	Renewal date: (3 years from consent to provide course) Click here to enter a date.
Course Code: Click here to enter text.
Contact Hours: Click here to enter text.
Type: ☐ CPPN Course ☐ Unit-Based Course
Planning form reviewed and meets BRN regulatory criteria. CPPN Consent to provide course: Click here to enter text.
Planning form reviewed and meets ANCC regulatory criteria. CPPN Nurse Planner Consent to provide course: Click here to enter text.
ANCC Course CPPN Nurse Planner: Click here to enter text.	CPPN Coordinator: Click here to enter text.

CPPN Nurse Planner and Analyst Notes:

Gap Analysis

Required for ANCC Courses

Suggested for all courses. For more information on Gap Analysis, including definitions and examples, see informational worksheet at end of planning form

Identify the professional practice gap by clearly describing both the desired state and the current state of practice, supported by validating evidence
Desired State (or best practice)	Current State (current practice, target audience)	Data that Validates Professional Practice Gap and Current State (gap is the difference between desired and current state)
After identifying the professional practice gap, determine the underlying reason for the gap. Is it due to something learners do not know (knowledge deficit), do not know how to do (skill deficit), or are not able to perform effectively in practice (practice deficit)? Once the underlying educational need is identified—whether it pertains to knowledge, skill, and/or practice—complete the corresponding columns related to that type of educational need. The backwards planning process (also known as backwards design) is a helpful framework for aligning all elements of the educational activity. This includes determining educational need, identifying relevant competencies, developing measurable learning outcomes, selecting appropriate assessment methods, and choosing active learning strategies that directly address the professional practice gap before developing content.
Underlying Educational Need (Identified by the professional practice gap--knowledge, skills, and/or practice. Select the need identified by the gap)	Competency (Established professional competencies that align with the practice gap and educational need. Source must be cited)	Learning Outcomes (Specific, measurable, and attainable statements that describe expected changes in learners. Must align with the practice gap, educational need, and competency)	Assessment Methods (Used to measure change in knowledge, skill, and/or practice. Must align with the practice gap, educational need, and learning outcomes. Each outcome requires a corresponding assessment method)	Active Learning Strategies (Strategies that actively engage learners and promote meaningful learning. Must align with the underlying educational need.)
☐ Knowledge Describe the knowledge need:
☐ Skill Describe the skill need:
☐ Practice Describe the practice need:
Use the information from your completed gap analysis to fill out the corresponding sections of the planning form. Ensure the professional practice gap, educational need (knowledge, skill, and/or practice), competencies and supporting evidence are clearly and consistently reflected throughout the planning document.

Continuing Education Course Planning Form

Course Code: (entered by CPPN)
Submitter’s Contact Information
Submitted By (Name, Degree, Credentials, Title): Click here to enter text.
Department: Click here to enter text.
Telephone: Click here to enter text.	UCDH email address: Click here to enter text.
ANCC – CPPN Nurse Planner: Click here to enter text.
CPPN Course Coordinator: Click here to enter text.
Location: Click here to enter text.
Maximum # participants for Activity: Click here to enter number.
Activity Type: (Choose one that applies) ☐ Provider-directed, provider-paced: Live (in-person or webinar) Initial Date of live activity: Click here to enter a date. Additional Dates: Click here to enter text. ☐ Provider-directed, learner-paced: Enduring material (i.e.; e-course or journal review) Start date of enduring material: Click here to enter a date. Review/expiration date of enduring material (maximum: 3 years after creation): Click here to enter a date. ☐ Blended activity Date(s) of enduring materials (e.g. prework): Click here to enter a date. Date of live portion of activity: Click here to enter a date. Review/expiration date of enduring material (maximum: 3 years after creation): Click here to enter a date.
Course Start Time: Click here to enter text.	Course End Time: Click here to enter text.
Brief Course Description for website posting. Include attendance requirements, need to wear scrubs/work attire, prerequisites, etc.: Click or tap here to enter text.
Professional Practice Gap: (required for ANCC courses) Identified Professional Practice Gap: (What learning need are you fulfilling?) Data/Evidence to validate the Professional Practice Gap (check all methods/types of data that apply): ☐ 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, law, and health care ☐ Direct observation ☐ Other—Describe: Click here to enter text. Educational need that underlies the Professional Practice Gap (e.g., knowledge, skill, and/or practice) ☐ Gap in Knowledge ☐ Gap in Skills ☐ Gap in Practice
Audience Description of Target Audience (RNs, Adv Pract. RNs, MDs, Resp Ther., etc.): Click here to enter text.
Registration opened to:	☐ Open to all who match target audience	☐ UC Davis Employee only	☐Unit (Group), specify:
Level of CPPN support requested: Review “Two Levels of CPPN Support” on page 2 of form	☐ CPPN-based course	☐ Unit-based course
PT/PTA course credit is desired:
Review required criteria on page 1.	☐ PT/PTA Course credit desired (content will be reviewed for approval)
Learning Outcomes: (required for ANCC courses) Desired learning outcome(s) for activity: Click or tap here to enter text.
Description of Assessment Method Evidence that changes in knowledge, skills, and/or practices of target audience was assessed:
Short-term assessment options: Knowledge-Based Methods: ☐ Active participation in learning activity ☐ Intent to change practice (not acceptable for ANCC) ☐ Polling or audience response ☐ Post-test/quiz ☐ Self-report ☐ Verbal response or discussion ☐ Other – Describe: Click here to enter text.	Skill-Based Methods: ☐ Active participation in learning activity ☐ Case study analysis ☐ Computer-based simulation scenarios ☐ Essay demonstrating application of knowledge and skill ☐ Intent to change practice (not acceptable for ANCC) ☐ Return demonstration ☐ Role-play ☐ Simulation ☐ Other – Describe: Click here to enter text.	Practice-Based Methods: ☐ Intent to change practice (not acceptable for ANCC) ☐ Observation of performance ☐ Other – Describe: Click here to enter text.
Long-term assessment options: Knowledge-Based Methods: ☐ Follow-up post-test/quiz ☐ Knowledge retention survey ☐ Other – Describe: Click here to enter text.	Skill-Based Methods: ☐ Annual skills validation ☐ Competency-based review ☐ Portfolio ☐ Other – Describe: Click here to enter text.	Practice-Based Methods: ☐ Change in quality outcome measure ☐ Observation of performance ☐ Return on Investment (ROI) ☐ Self-reported change in practice ☐ Other – Describe: Click here to enter text.
Implicit Bias Inclusion into Content (REQUIRED): For more information on IMPLICIT BIAS, see informational sheet at end of planning form Select from list how this course will meet the BRN requirement of including curriculum on implicit bias into all courses that contain any direct patient care component. At least one box must be selected AND description provided. ☐ Course does NOT contain any direct patient care component (i.e., solely leadership, research, etc.) ☐ Provides examples of how implicit bias affects perceptions and treatment decisions of healthcare providers, leading to health outcome disparities. Describe: Click here to enter text. ☐ Provides strategies to address how unintended biases in decision-making may contribute to healthcare disparities (by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identify, sexual orientation, age, socioeconomic status, or other characteristics. Describe: Click here to enter text.
Active Learning Strategies Select the learner engagement strategies that will be employed:
Knowledge-Based Strategies: ☐ Blended Learning ☐ Case Study Analysis ☐ Concept mapping ☐ Discussion ☐ Flipped Classroom ☐ Gamification ☐ Interactive Polling ☐ Jigsaw Discussions ☐ Self-learning Module ☐ Self-Quizzing ☐ Socratic Questioning ☐ Storytelling/Narrative ☐ Think-Pair Exercises ☐ Other – Describe: Click or tap here to enter text.	Skill-Based Strategies: ☐ Blended Learning ☐ Case Study Analysis ☐ Demonstration/Return Demonstration ☐ Flipped Classroom ☐ Gamification ☐ Group Work ☐ Jigsaw Discussions ☐ Problem-Based Learning ☐ Role Play ☐ Simulation ☐ Skills Stations ☐ Tabletop Exercises ☐ Think-Pair Exercises ☐ Other – Describe: Click or tap here to enter text.	Practice-Based Strategies: ☐ Blended Learning ☐ Case Study Analysis ☐ Flipped Classroom ☐ Group Work ☐ Guided Reflection ☐ Jigsaw Discussions ☐ Problem-Based Learning ☐ Role Play ☐ Simulation ☐ Skills Stations ☐ Tabletop Exercises ☐ Think-Pair Exercises ☐ Other – Describe: Click or tap here to enter text.
Criteria for Awarding Contact Hours Criteria for awarding contact hours for live and enduring material activities include: ☒ No contact hours awarded if late to activity as described in course description; must attend all sessions (required) ☐ Successful completion of a post-test (attendee must score Click here to enter text.% or higher) ☐ Successful completion of a return demonstration ☐ Successful completion of required eLearning (i.e.; Pre-Study) (attendee must score Click here to enter text.% or higher) ☐ Other - Describe: Click here to enter text.

List of Individuals in a Position to Control Content
Complete the table below for each person in a position to control content of the educational activity (e.g., nurse planners, planning committee members, speakers/presenters, and content reviewers). For each individual, include name, credentials, educational degree(s), and role in the activity. Each person must submit a complete Biographical and Conflict of Interest form that validates their expertise to fulfill their respective role (annually for ongoing courses). Required for ANCC courses: There must be one Nurse Planner from CPPN who is knowledgeable of the nursing continuing professional development processes and is responsible for adherence to ANCC criteria. The individuals who fill the roles of Nurse Planner must be identified. Required for PT/PTA courses: A CV or resume is required for each instructor which reflects their relevant experience and expertise qualifying them to teach the subject matter. Every person on list must complete a Biographical and Conflict of Interest (COI) form.
Name of individual and credentials (i.e., John Smith, MSN, RN, CCRN)	Individual’s role in activity Nurse Planner, Planning Committee, Content Reviewer, Presenter, Content Expert	Planning committee member? (Yes/No)	Name of commercial interest	Nature of relationship to the commercial interest (i.e., speaker bureau, stockholder, CEO, etc.)	COI form completed

Educational Design

Educational Planning Table
Content (Topics) Provide a short outline of the content/topic presented. Content needs to be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view. Include reference/resources used to develop content (may be as additional reference sheet)	Learning Objectives Minimum of 2, Maximum of 5, learning objectives for content. Objectives highlight the topics that will be discussed during the presentation. Use Bloom’s Taxonomy to write objectives (i.e., describe, discuss, apply, analyze, evaluate, examine, etc.).	Time Frame in minutes Must match provided course agenda	Presenter List presenter(s) name, credentials, degrees for each topic/content area. Each presenter must submit a COI/Bio form	Learning Strategies List the learning strategies for each topic or content area. Include active learner engagement strategies.
Right click on last row to insert additional rows below as needed

References (Required for ANCC courses: content must be based on best available current evidence to foster achievement of desired outcomes)
Please list all references below or attach a separate reference sheet. Cite sources using APA format. External links must be cited using the appropriate citation style and should not be provided as standalone URLs. Please note that the inclusion of an expert speaker does not replace the requirement for published, peer-reviewed references to support the educational content.
References (Required for PT/PTA courses)
Please list all references below or attach a separate reference sheet. At least five peer-reviewed journal articles published within the last five years are required.

Standards for Integrity and Independence

Standards for Integrity and Independence: (required for ANCC courses) Accredited education must present learners with only accurate, balanced, scientifically justified recommendations and protect learners from promotion, marketing, and commercial bias. With this in mind, please answer the questions below. If any pre-selected options are modified, please provide an explanation in the designated section. At least one box must be selected for each question AND description provided if applicable. Commercial Bias and Marketing Yes No ☒ ☐ All decisions related to the planning, faulty selection, delivery, and evaluation of accredited education were made without any influence or involvement from the owners and employees of an ineligible company. ☒ ☐ This education is free of marketing or sales of products or services. Faculty will not actively promote or sell products or services that serve their professional or financial interests during the accredited education. ☒ ☐ Names and contact information of learners will not be shared with any ineligible company or its agents without the explicit consent of the individual learner. If “No” was selected for #1, 2, or 3 above, provide a detailed explanation: Click here to enter text. Commercial Support Yes No ☐ ☒ Does this activity receive commercial support? This includes financial commercial support (i.e. monetary, grant, donation, or scholarship) and/or in-kind commercial support (i.e. materials, space, or other nonmonetary resources or services from an ineligible company). If “Yes” was selected for #4 above, provide the fully executed commercial support agreement. Include evidence of the disclosures to learners of commercial support: Click here to enter text. Ancillary Activities Yes No ☐ ☒ Does this activity have ancillary activities (i.e. exhibits from ineligible companies) offered in conjunction with the accredited continuing education? If “Yes” was selected for #5 above, ensure that all marketing materials related to this activity—including any advertising or promotions by or on behalf of ineligible companies—are included as an attachment to this document. Additionally, provide evidence that clearly demonstrates the accredited educational activity is separated, by space and/or time, from any non-accredited ancillary activities: Click here to enter text.

Course General Information Sheet

This form is required to be given to attendees prior to the start of any educational activity

Requirements for completion of this program

Participant must sign in on official roster and be present for content presentation.

C.E. credit will not be awarded for this program session if the participant is more than:

5 minutes late for a course of 4 hours or less in duration or

20 minutes late for a course of more than 4 hours in duration

Specific requirements for individual course:

Pre-requisite activities (if applicable): Click or tap here to enter text.

Enduring activity expiration date (if applicable): Click or tap here to enter text.

Conflict of interest

Conflict of interest can exist when an individual has an opportunity to affect nursing continuing professional development content in relation to an ineligible company (previously termed commercial interest) in which they have a relevant financial relationship.

Unless indicated below, all planners and presenters associated with this program no relevant financial relationships with ineligible companies with relation to the content of this program.

Off label use

This educational activity does not include any unannounced information about off label use of a product for a purpose other than that for which it was approved by the Food and Drug Administration (FDA).

Potential Conflict of Interest & Financial Relationship Notification to Course Attendees (select one and describe as needed)

☐	There are no relevant financial relationships with ineligible companies (previously termed commercial interests) to disclose among planners, faculty, and everyone in control of content.

☐	Relevant financial relationships exist and are disclosed to learners below, including the names of individuals with relevant relationships, names of ineligible companies (previously termed commercial interests), the nature of relationships, and a statement that all relationships have been mitigated.

Click or tap here to enter text.

Professional Practice Gap Analysis Tool

A gap analysis is a valuable tool during the beginning of an educational plan to take you from “I think I know what the problem is” to planning relevant professional development activities targeted to specifically address a clearly established professional practice gap, resulting in measurable outcomes. Analyzing a professional practice gap determines the gap between a current and desired state, underlying educational need(s), relevant competencies, and activities needed to close the identified gap.

Steps to assist in completing the Professional Gap Analysis:
Step 1	Determine the Desired State, the best practice, or where you want to be. The desired state is the level that activity planners would like the learners to achieve due to the educational activity. Where do we want to be? What should learners know, be able to do, or demonstrate after participating in the activity?
Step 2	Describe the Current State, which is the current level of practice of the target audience. What is happening in practice right now? What are learners currently doing—or not doing—that reflects a gap in knowledge, skill or practice?
Step 3	Summarize the Data that Validates the Professional Practice Gap, or the difference between the current and desired state. Planners should use evidence to validate and support the need for an educational activity. This evidence needs to be objective and not assumptions. This may include surveying stakeholders, reviewing quality data, direct observation, evaluations of other activities, trends in healthcare or literature, change in practice, etc. There should be analysis and not just data sources nor solely stating there is a “need” or “request” for the activity. Now ask: What is underlying reason causing the gap? Is knowledge missing? Is a skill not being performed correctly? Is there a practice issue? What pieces are missing in the target audience?
Step 4	The missing piece is the Underlying Educational Need to bridge between the current and desired state. Why do the learners need the education? The underlying need could be due to knowledge (don’t know), skill (don’t know how to do), and/or practice (not able to show or do in practice). This should align with the professional practice gap, evidence, competency(ies) and learning outcome(s).
Step 5	Identify established Professional Competencies that align with the identified progressional practice gap, underlying educational needs (knowledge, skill, or practice).These competencies help ensure that the education being designed is grounded in recognized standards. What competency best supports what the learner needs to know, do, or demonstrate to close the gap. The competency needs to align with the educational need and supports measurable learning outcomes. Include the professional source that developed the competency(ies). A key resource is the Blaisdell Medical Library that provides access to a wide range of professional scope and standards of practice, organization guidelines, and competency frameworks.
Step 6	Develop Learning Outcomes that are specific, measurable, and attainable, written as a quantitative statement. What should the learner know, show, and/or be able to do at the end of the activity? This should be aligned to the current state, underlying educational need, competency, and assessment method. For instance, if the underlying need is knowledge, the outcome should be related to measuring a change in the learner’s knowledge.
Step 7	Describe the Assessment Method, or how the activity’s outcome will be measured, including how evaluation data will be obtained and analyzed. This should be aligned with the professional practice gap, underlying need, competency, and learning outcome(s). This can include short-term and/or long-term methods. For instance, you can use post-tests or discussion to assess knowledge; return demonstrations or case study analysis can assess skill; and simulation, observation in practice, or quality measure tracking can assess practice.
Step 8	Identify the appropriate Active Learning Strategies to promote learning and actively engage learners in educational activities. These strategies go beyond passive engagement to promote a deeper cognitive and behavior engagement. The active learning strategies need to align with the underlying educational need. For instance, if the underlying need is knowledge, the selected active learning strategies should be designed to facilitate the acquisition and application of that knowledge.

Note: See the next page for an example of the Professional Practice Gap Analysis Tool

Title of Activity: Example

Identify the professional practice gap by clearly describing both the desired state and the current state of practice, supported by validating evidence
Desired State (or best practice)	Current State (current practice, target audience)	Data that Validates Professional Practice Gap and Current State (gap is the difference between desired and current state)
Staff nurses promptly recognize signs of patient deterioration and effectively escalate care using structured communication tools (e.g., SBAR), leading to timely activation of rapid response teams and improved patient outcomes.	Staff nurses inconsistently recognize or respond to clinical deterioration, leading to delays in escalation of care and avoidable patient harm events such as unplanned ICU transfers or code blues.	Performance Metrics: A retrospective chart review revealed that only 54% of rapid response team activations on medical-surgical units were initiated by bedside nurses, with the remainder coming from charge nurses or physicians after delays in escalation. Incident Reports: Over a 3-month period, 12 incident reports cited missed or delayed recognition of deterioration in patients with abnormal vital signs prior to code blue events. Survey Results: In a recent internal survey of 75 medical-surgical RNs, 68% reported low confidence in using SBAR to escalate concerns to providers, and **62% stated they were unsure when to activate the rapid response team.
After identifying the professional practice gap, determine the underlying reason for the gap. Is it due to something learners do not know (knowledge deficit), do not know how to do (skill deficit), or are not able to perform effectively in practice (practice deficit)? Once the underlying educational need is identified—whether it pertains to knowledge, skill, and/or practice—complete the corresponding columns related to that type of educational need. The backwards planning process (also known as backwards design) is a helpful framework for aligning all elements of the educational activity. This includes determining educational need, identifying relevant competencies, developing measurable learning outcomes, selecting appropriate assessment methods, and choosing active learning strategies that directly address the professional practice gap before developing content.
Underlying Educational Need (Identified by the professional practice gap--knowledge, skills, and/or practice. Select the need identified by the gap)	Competency (Established professional competencies that align with the practice gap and educational need. Source must be cited)	Learning Outcomes (Specific, measurable, and attainable statements that describe expected changes in learners. Must align with the practice gap, educational need, and competency)	Assessment Methods (Used to measure change in knowledge, skill, and/or practice. Must align with the practice gap, educational need, and learning outcomes. Each outcome requires a corresponding assessment method)	Active Learning Strategies (Strategies that actively engage learners and promote meaningful learning. Must align with the underlying educational need.)
☒ Knowledge Describe the knowledge need: Staff nurses on inpatient adult medical-surgical units demonstrate a knowledge deficit in recognizing early signs of patient deterioration.	Competency Statement: Analyzes assessment data to identify patterns, trends, and situations that impact the person's health and wellness. Source: American Nurses’ Association. (2021). Nursing : scope and standards of practice (Fourth Edition edition). American Nurses Association Location: ANA Nursing: Scope and Standards of Practice, Standard 1 – Assessment	By the end of the activity, 90% of participants will accurately identify at least three early clinical indicators of patient deterioration from a provided case scenario.	Formative: Participants will review and analyze case studies and complete a short knowledge quiz identifying key deterioration indicators (e.g., abnormal vital signs, mental status changes, lab trends).	Discussion Case Study Analysis Socratic Questioning Quizzing
☒ Skill Describe the skill need: Staff nurses exhibit a skill deficit in effectively communicating changes in patient condition using structured tools such as SBAR.	Competency Statement: Communicates changes in person's condition to the interprofessional team. Source: American Nurses’ Association. (2021). Nursing : scope and standards of practice (Fourth Edition edition). American Nurses Association. Location: ANA Nursing: Scope and Standards of Practice, Standard 1 – Assessment	By the end of the activity, 90% of participants will accurately identify and report changes in patient condition using the SBAR tool in a simulated scenario.	Formative: Participants will demonstrate appropriate use of the SBAR tool and ability to escalate concerns in response to changes in patient condition.	Simulation
☐ Practice Describe the practice need:	N/A	N/A	N/a	N/A
Use the information from your completed gap analysis to fill out the corresponding sections of the planning form. Ensure the professional practice gap, educational need (knowledge, skill, and/or practice), competencies and supporting evidence are clearly and consistently reflected throughout the planning document.

BRN Requirements: Implicit Bias Inclusion into Content

All CE courses that contain any direct patient care component must include curriculum on implicit bias (“implicit bias” is defined as the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, that exist and often contribute to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, and other characteristics that contribute to health disparities). CPPN cannot provide CE credit for courses that fail to meet this requirement. Courses with a direct patient care component must address at least one, or a combination, of the following:

Examples of how implicit bias affects perceptions and treatment decisions of licensees, leading to disparities in health outcomes.

Strategies to address how unintended biases in decision-making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or other characteristics.

Course content related to direct patient care can include but is not limited to: patient education strategies; therapeutic interpersonal relationship skills with patients/clients; certification/recertification skills (e.g., advanced life support, audiology, etc.); skills courses (stoma care, etc.); advanced courses on any type of patient monitoring equipment (fetal, cardiac, respiratory, etc.); cultural and ethnic diversity; foreign languages (conversational) and sign language; and courses in any specialty area of nursing practice including occupational health nursing, school nursing, office nursing, etc.

Content related to indirect patient care can include but is not limited to: nursing administration or management, nursing education, or nursing research; statistics; quality assurance; legal aspects of nursing; assertiveness; teaching multi-ethnic students and staff; retention of nurses in the health care delivery system, including cross training; current trends in nursing and health care; publishing for professional journals or books; and instructor courses in CPR, basic life support (BLS), and advanced life support (ALS).

Course content may include basic and advanced courses in the physical, social and behavioral sciences, and advanced nursing in general or specialty areas.

Examples of acceptable courses include advanced nursing theory, pathophysiology, or planning form of content areas related to specialized nursing; i.e. ACLS, chemotherapy, recent scientific knowledge, direct patient care such as; patient education strategies, certification/re-certification skills, cultural aspects, or indirect patient care such as; nursing administration, publishing for professional journals or books, current trends in nursing care, and legal aspects of nursing

Examples of non-acceptable courses include CPR, orientation programs, equipment in-services, basic nursing skills or review of basic nursing care procedures courses focusing on self-improvement (i.e., self-awareness, yoga, weight loss, etc.), economic courses geared for personal financial gain (i.e., preparing resumes, job interviewing techniques, etc.), and courses for the lay public (i.e., parenting courses, etc.).

Title of Activity: Click here to enter text.
Completed by CPPN	Explanation of planning form requirements – please direct any questions to cppn@health.ucdavis.edu
Title of Activity: Should be specific to content; if course is part of a series should be differentiated by day (i.e., Day 1, Day 2, Part 1, Part 2., Pediatric Critical Care Day 1).
Location, Maximum Number of Participants, Course Start/End Time: Should be specific. This is what CPPN will post on the website and learning management system for course advertisement and participant communication.
Brief Course Description for website posting: This is what CPPN will post on the website for course advertisement. If there are any prerequisites or attendance requirements, please state clearly.
Professional Practice Gap Analysis: Should be complete for all courses (required for those requesting ANCC credit). Information concerning how and why course came about, the underlying educational gap (knowledge, skills, and/or practice), competency statements including the professional source, learning outcome statements, assessment methods, and active learning strategies to which the course is aligned.
Audience: Who the course is targeted towards, and any restrictions on that audience (i.e., only from NICU, only RNs, only UC Davis employees, etc.). Indicate level of CPPN support requested.
Learning Outcomes: What is the purpose of the learning, what outcome measures will be affected, or skill enhanced. Should be specific, measurable, attainable, aligned to practice gap, relevant, and time bound. Should reflect PCS or UCD Health strategic goals (i.e., the learners will increase their practice of post-cardiac catheterization patient care). Include quantitative statement. Quantitative Statement example: After the learning activity has initiated, there will be a decrease in length of stay for post-cardiac catheterization patients by at least 10% within 12 months.
Assessment Methods: Indicate what type of evaluation, short- and/or long-term, that will reflect the change in knowledge, skills, and/or practice of the learner.
Implicit Bias Inclusion into Content: All CE courses that contain any direct patient care component must include curriculum on implicit bias. Select and describe how this course will meet this BRN requirement (i.e., does not contain any direct patient care component, will provide examples of how implicit bias affects perceptions and treatment decisions of licensees, leading to disparities in health outcomes, and/or will provide strategies to address how unintended biases in decision-making may contribute to healthcare disparities (by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identify, sexual orientation, age, socioeconomic status, or other characteristics).
Active Learning Strategies: List strategies you plan to use to engage learners.
Criteria for Awarding Contact Hours: List any criteria beyond attending the class in full.
Conflict of Interest: All persons in a position to control the content of the educational activity are required to complete the Biographical and Conflict of Interest Form. Planning forms will not be processed until all forms are completed and attached to planning form.
Educational Design: Content/Topics – What information will be covered by presenter? Include references either with content or on separate reference sheets. Objectives – Written as to what the learner should be able to do, not what the speaker is going to talk about. “At the end of this session the learner will be able to…” (Understand is not an acceptable learning objective). Each 60 minutes of content should have minimum of 2 and maximum of 5 learning objectives. Use Bloom’s Taxonomy to assist you with writing learning objectives. If you need assistance with writing your objectives, contact: cppn@health.ucdavis.edu Time Frame – Amount of time in minutes to present topic: 60. Not specific clock time 0800-0900. Specific times should be reflected in the class agenda. Presenter/Speaker – Name, Credentials, and Title of person(s) presenting Learner Strategies – How is the information going to be presented? Lecture only, Demonstration, Case Study Discussion, Group brainstorming, etc. Including learner engagement strategies is a best practice and will positively affect the activity and resulting knowledge, skills, practice change(s).
Standards for Integrity and Independence: Should be complete for all courses (required for those requesting ANCC credit). Respond to questions regarding commercial bias, marketing, commercial support, and ancillary activities. Provide additional requested information based on responses if applicable.