Allison P Squires

Faculty

Prof. Allison P Squires headshot

Allison P Squires

FAAN PhD RN

Associate Professor
Director, Florence S. Downs PhD Program in Nursing Research and Theory Development

1 212 992 7074

433 First Avenue
Room 656
New York, NY 10010
United States

Accepting PhD students

Allison P Squires's additional information

Allison P Squires,  PhD, FAAN, RN, is an associate professor and director of the Florence S. Downs PhD Program in Nursing Research & Theory Development at NYU Rory Meyers College of Nursing. She was the 2019–2020 Distinguished Nurse Scholar in Residence for the National Academy of Medicine where she worked on the consensus study for the next Future of Nursing 2020–2030 report. An internationally recognized health services researcher, Prof. Squires has led or participated in studies covering 38 countries, with current active projects Mexico, Ghana, and the European Union. She is also leading the international arm of a COVID-19 study that examines how the global pandemic has affected clinical nursing practice on the frontlines. Domestically, her research focuses on improving immigrant and refugee health outcomes with a special interest in breaking down language barriers during the healthcare encounter.

Prof. Squires has consulted with the Migration Policy Institute and the World Bank on nursing and health workforce issues and produced several major policy analyses with their teams. A prolific writer, Squires has authored over 150 publications, including 100+ in peer-reviewed journals. She serves as an associate editor of the International Journal of Nursing Studies (the top- ranked nursing journal in the world), the research editor for the Journal of Nursing Regulation, and an Associate Editor for BMC Health Services Research.

Prior to entering academia full time, Squires worked as a staff nurse in solid organ transplant and as a staff educator for 11 years in the US healthcare system.

Prof. Squires completed her PhD at Yale University, MSN at Duquesne University, and BSN at the University of Pennsylvania. She completed a Post-Doctoral Fellowship in Health Outcomes Research at the University of Pennsylvania. In addition to her primary appointment at the College of Nursing, she holds affiliated faculty appointments with the Grossman School of Medicine, Center for Latin American Studies, and the Center for Drug Use and HIV Research at NYU.

She is currently accepting PhD students and/or post-doctoral fellows/associates with interests in the following areas: 1) global health, 2) migration & immigrant health, and 3) health services and workforce research.

Post-Doctoral Fellowship - University of Pennsylvania
PhD - Yale University
MSN - Duquesne University
BSN - University of Pennsylvania

Global
Immigrants
Gerontology
Health Services Research

Academy Health
American Nurses Association
Consortium of Universities for Global Health
Interdisciplinary Research Group on Nursing Issues (Academy Health)
National Council for Interpreting in Health Care
Sigma Theta Tau International

Faculty Honors Awards

Chair, New York Academy of Medicine (2021)
Co-Chair, American Academy of Nursing's Global Health Expert Panel (2021)
Co-Chair, American Academy of Nursing's Global Health Expert Panel (2020)
Chair, Interdisciplinary Research Group on Nursing Issues for Academy Health (2020)
Distinguished Nurse Scholar in Residence, National Academy of Medicine (2020)
Vice-Chair, Global Health and Health Care Interest Group for Academy Health (2020)
Chair, New York Academy of Medicine (2020)
Chair, New York Academy of Medicine (2019)
Co-Chair, American Academy of Nursing's Global Health Expert Panel (2019)
Chair, Interdisciplinary Research Group on Nursing Issues for Academy Health (2019)
Distinguished Nurse Scholar in Residence, National Academy of Medicine (2019)
Chair, Global Health and Health Care Interest Group for Academy Health (2019)
Vice-Chair, Global Health and Health Care Interest Group for Academy Health (2019)
Vice Chair, Interdisciplinary Research Group on Nursing Issues for Academy Health (2018)
Outstanding Scholarly Contribution to Gerontological Nursing Practice, International Journal for Older People Nursing (2018)
Chair, Global Health and Health Care Interest Group for Academy Health (2018)
Prose Award, “A New Era in Global Health” (W. Rosa, Ed.) (2018)
Fellow Ambassador to the Media, New York Academy of Medicine (2017)
Fellow, American Academy of Nursing (2015)
Distinguished Alumna, Duquesne University (2015)
Fellow, New York Academy of Medicine (2014)
Fellow, Yale World Fellows Program (2003)

Publications

Cultural adaptation of the Safety Attitudes Questionnaire - Short Form (SAQ-SF) in Poland

Malinowska-Lipien, I., Brzyski, P., Gabrys, T., Gniadek, A., Kozka, M., Kawalec, P., Brzostek, T., & Squires, A. (2021). PloS One, 16(2). 10.1371/journal.pone.0246340
Abstract
Abstract
Background It is essential to provide safe healthcare in complex, difficult, and quickly changing conditions. The quality of healthcare services directly influences the safety of both the patients and staff. Understanding healthcare staff attitudes toward safety in the healthcare delivery context is foundational for building a culture of safety. Aim of the work To adapt, via a structured translation methodology, the Safety Attitudes Questionnaire- Short Form (SAQ-SF), which assesses how employees of the health care sector perceive the safety climate in their workplace, to the Polish context. Methods Using a content validation approach to structure the translation process, we tested and psychometrically analysed the translated SAQ-SF. The sample comprised 322 employees of a district hospital (second referral level, which ensures 24/7 emergency care services) in Poland. Results The reliability of the sub-scales of the Polish version of the SAQ-SF ranged from 0.66 to 0.95. The discriminatory power of particular SAQ items ranged between 0.02 and 0.90. For 6 out of the 8 scale dimensions, the questions with the highest factor loadings were those measuring the same dimensions of the safety climate, according to the original scale. Conclusions The Polish version of the SAQ-SF (SAQ-SF-PL) meets the criteria of psychometric and functional validation as well as demonstrates good reliability as a measure of patient safety culture in the Polish context. The SAQ-SF-PL is an instrument that enable a valid and reliable assessment of patient safety climate in the Polish healthcare facilities and identify opportunities for improvement. International comparisons will also become easier.

Defining Telepresence as Experienced in Telehealth Encounters: A Dimensional Analysis

Groom, L. L., Brody, A. A., & Squires, A. P. (2021). Journal of Nursing Scholarship. 10.1111/jnu.12684
Abstract
Abstract
Purpose: Telehealth’s uptake has increased substantially in recent years, with an especially large jump in 2020 due to the emergence of COVID-19. This article provides background on and explores “telepresence” in healthcare literature. Telepresence strongly impacts the patient experience, but it is poorly defined in current research. The aim was to conceptually define telepresence using qualitative methods. Design: Dimensional analysis was used to analyze telepresence in clinical literature and create a clearer definition of telepresence as a concept. Multiple databases were searched for articles related to telepresence. Thirteen international articles related to telepresence were selected for analysis. Methods: Dimensional analysis allowed for multiple viewpoints to be explored within each distinct context and perspective. Findings: Twenty-five dimensions were discovered within the articles, which were synthesized to seven core dimensions of telepresence: connection, technological mediation, experienced realism, trust, being supportive, collaboration, and emotional consequence. Conclusions: Telepresence is highly impactful on the patient’s experience of telehealth care visits. The conceptual map produced by this dimensional analysis provides direction for clinicians to improve their ability to be present with patients during telehealth care. Potential implications include a starting point for future qualitative research, and the use of this dimensional analysis to inform clinical guidelines, improve clinician training, and assist in the development of new care models. Clinical Relevance: A telepresence definition brings clarity to an ill-defined concept. COVID-19 magnifies the need for a better understanding of telepresence, which allows clinicians to improve telehealth encounters.

Disparities in Breastfeeding Duration of New York City Latinx Mothers by Birth Region

Gerchow, L., Squires, A., & Jones, S. (2021). Breastfeeding Medicine. 10.1089/bfm.2021.0030
Abstract
Abstract
Background: Disparities in breastfeeding patterns by race and ethnicity in the United States have been documented, and Latinx ethnicity is often associated with higher rates of breastfeeding initiation and longer breastfeeding duration compared to other U.S. racial and ethnic groups. Despite marked differences in infant feeding practices in Latinx countries of origin, U.S. breastfeeding data are routinely presented with Latinx as a single category. Objective: To analyze breastfeeding duration of New York City Latinx mothers by birth region. Methods: Using data from the 2016 New York City Work and Family Leave Survey (WAFLS) surveying residents who gave birth in 2014, we conducted a survival analysis of breastfeeding duration in a sample of Latinx-identifying mothers (n = 271), who reported having ever breastfed their child. Kaplan-Meier survival curves for time to breastfeeding cessation were created for four birth regions (United States, Caribbean, Mexico/Central America, and South America) and compared using the log-rank test. Adjusted hazard ratios (AHRs) were calculated using Cox regression. Results: Survival curves and median breastfeeding duration were significantly different between the four regions. AHR models found that non-Caribbean birthplace was significantly associated with a lower risk of early breastfeeding cessation. Being partnered at the time of childbirth and neonate hospitalization of 6 days or longer was associated with a greater risk of earlier breastfeeding cessation. Conclusion: The significant differences reinforce the need to separate breastfeeding findings by birth region in the Latinx population. Within-group differences are lost in combined analyses and reinforce conclusions that Latinx mothers have optimal breastfeeding behaviors.

Disparities in chronic kidney disease-the state of the evidence

Clark-Cutaia, M. N., Rivera, E., Iroegbu, C., & Squires, A. (2021). Current Opinion in Nephrology and Hypertension, 30(2), 208-214. 10.1097/MNH.0000000000000688
Abstract
Abstract
Purpose of review The purpose of this review was to assess the prevalence of United States chronic kidney disease (CKD) health disparities, focusing on racial/ethnic groups, immigrants and refugees, sex or gender, and older adults. Recent findings There are major racial/ethnic disparities in CKD, with possible contributions from the social determinants of health, socioeconomics, and racial discrimination. Racial/ethnic minority patients experience faster progression to end-stage kidney disease (ESKD) and higher mortality predialysis, however, once on dialysis, appear to live longer. Similarly, men are quicker to progress to ESKD than women, with potential biological, behavioral, and measurement error factors. There is a lack of substantial evidence for intersex, nonbinary, or transgender patients. There are also strikingly few studies about US immigrants or older adults with CKD despite the fact that they are at high risk for CKD due to a variety of factors. Summary As providers and scientists, we must combat both conscious and unconscious biases, advocate for minority patient populations, and be inclusive and diverse in our treatment regimens and provision of care. We need to acknowledge that sufficient evidence exists to change treatment guidelines, and that more is required to support the diversity of our patient population.

Entrustable Professional Activities (EPAs) for Global Health

Steeb, D. R., Brock, T. P., Dascanio, S. A., Drain, P. K., Squires, A., Thumm, M., Tittle, R., & Haines, S. T. (2021). Academic Medicine : Journal of the Association of American Medical Colleges, 96(3), 402-408. 10.1097/ACM.0000000000003856
Abstract
Abstract
PURPOSE: As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings. METHOD: In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low- to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains. RESULTS: Twenty-two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability. CONCLUSIONS: EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions.

Graduate level health professions education: how do previous work experiences influence perspectives about interprofessional collaboration?

Squires, A., Miner, S., Greenberg, S. A., Adams, J., Kalet, A., & Cortes, T. (2021). Journal of Interprofessional Care, 35(2), 193-199. 10.1080/13561820.2020.1732888
Abstract
Abstract
Understanding how previous experiences with interprofessional education and collaboration inform health care provider perspectives is important for developing interprofessional interventions at the graduate level. The purpose of this study was to examine how previous work experiences of graduate level health professions students inform perspectives about interprofessional education and collaboration. Drawing from program evaluation data of two separate graduate level interprofessional education interventions based in primary care and home health care, we conducted a qualitative secondary data analysis of 75 interviews generated by focus groups and individual interviews with graduate students from 4 health professions cadres. Using directed content analysis, the team coded to capture descriptions of interprofessional education or collaboration generated from participants’ previous work experiences. Coding revealed 173 discrete descriptions related to previous experiences of interprofessional education or collaboration. Three themes were identified from the analysis that informed participant perspectives: Previous educational experiences (including work-based training); previous work experiences; and organizational factors and interprofessional collaboration. Experiences varied little between professions except when aspects of professional training created unique circumstances. The study reveals important differences between graduate and undergraduate learners in health professions programs that can inform interprofessional education and collaboration intervention design.

Infection Prevention and Control in Liberia 5 Years After Ebola: A Case Study

Ridge, L. J., Stimpfel, A. W., Klar, R. T., Dickson, V. V., & Squires, A. P. (2021). Workplace Health and Safety, 69(6), 242-251. 10.1177/2165079921998076
Abstract
Abstract
Background: Effective management of health emergencies is an important strategy to improve health worldwide. One way to manage health emergencies is to build and sustain national capacities. The Ebola epidemic of 2014 to 2015 resulted in greater infection prevention and control (IPC) capacity in Liberia, but few studies have investigated if and how that capacity was sustained. The purpose of this study was to examine the maintenance of IPC capacity in Liberia after Ebola. Methods: For this case study, data were collected via direct observation of nurse practice, semistructured interviews, and document collection. Data were collected in two counties in Liberia. Data were analyzed using directed content and general thematic analysis using codes generated from the safety capital theoretical framework, which describes an organization’s intangible occupational health resources. Findings: Thirty-seven nurses from 12 facilities participated. Ebola was a seminal event in the development of safety capital in Liberia, particularly regarding nurse knowledge of IPC and facilities’ investments in safety. The safety capital developed during Ebola is still being applied at the individual and organizational levels. Tangible resources, including personal protective equipment, however, have been depleted. Conclusions/Application to Practice: IPC capacity in Liberia had been sustained since Ebola but was threatened by under-investments in physical resources. Donor countries should prioritize sustained support, both financial and technical, in partnership with Liberian leaders. Occupational health nurses participating in disaster response should advocate for long-term investment by donor countries in personal protective equipment, access to water, and clinician training.

Kairos care in a Chronos world: Midwifery care as model of resistance and accountability in public health settings

Niles, M., Vedam, S., Witkoski Stimpfel, A., & Squires, A. (2021). Birth. 10.1111/birt.12565
Abstract
Abstract
Background: In the Unites States (US), pregnancy-related mortality is 2–4 times higher for black and indigenous women irrespective of income and education. The integration of midwifery as a fundamental component of standard maternity services has been shown to improve health outcomes and service user satisfaction, including among underserved and minoritized groups. Nonetheless, there remains limited uptake of this model in the United States. In this study, we examine a series of interdependent factors that shape how midwifery care operates in historically disenfranchised communities within the Unites States. Methods: Using data collected from in-depth, semi-structured interviews, the purpose of this study was to examine the ways midwives recount, describe, and understand the relationships that drive their work in a publicly funded urban health care setting serving minoritized communities. Using a qualitative exploratory research design, guided by critical feminist theory, twenty full-scope midwives working in a large public health care network participated. Data were thematically analyzed using Braun & Clarke's inductive thematic analysis to interpret data and inductively identify patterns in participants’ experiences. Findings: The overarching theme “Kairos care in a Chronos World” captures the process of providing health-promoting, individualized care in a system that centers measurement, efficiency, and pathology. Five subthemes support the central theme: (1) the politics of progress, (2) normalizing pathologies, (3) cherished connections, (4) protecting the experience, and (5) caring for the social body. Midwives used relationships to sustain their unique care model, despite the conflicting demands of dominant (and dominating) medical models. Conclusion: This study offers important insight into how midwives use a Kairos approach to maternity care to enhance quality and safety. In order to realize equitable access to optimal outcomes, health systems seeking to provide robust services to historically disenfranchised communities should consider integration of relationship-based strategies, including midwifery care.

Language barriers between nurses and patients: A scoping review

Gerchow, L., Burka, L. R., Miner, S., & Squires, A. (2021). Patient Education and Counseling, 104(3), 534-553. 10.1016/j.pec.2020.09.017
Abstract
Abstract
Objective: Global migration and linguistic diversity are at record highs, making healthcare language barriers more prevalent. Nurses, often the first contact with patients in the healthcare system, can improve outcomes including safety and satisfaction through how they manage language barriers. This review aimed to explore how research has examined the nursing workforce with respect to language barriers. Methods: A systematic scoping review of the literature was conducted using four databases. An iterative coding approach was used for data analysis. Study quality was appraised using the CASP checklists. Results: 48 studies representing 16 countries were included. Diverse healthcare settings were represented, with the inpatient setting most commonly studied. The majority of studies were qualitative. Coding produced 4 themes: (1) Interpreter Use/Misuse, (2) Barriers to and Facilitators of Quality Care, (3) Cultural Competence, and (4) Interventions. Conclusion: Generally, nurses noted like experiences and applied similar strategies regardless of setting, country, or language. Language barriers complicated care delivery while increasing stress and workload. Practice Implications: This review identified gaps which future research can investigate to better support nurses working through language barriers. Similarly, healthcare and government leaders have opportunities to enact policies which address bilingual proficiency, workload, and interpreter use.

Peer-Assisted Lifestyle (PAL) intervention: a protocol of a cluster-randomised controlled trial of a health-coaching intervention delivered by veteran peers to improve obesity treatment in primary care

Wittleder, S., Smith, S., Wang, B., Beasley, J. M., Orstad, S. L., Sweat, V., Squires, A., Wong, L., Fang, Y., Doebrich, P., Gutnick, D., Tenner, C., Sherman, S. E., & Jay, M. (2021). BMJ Open, 11(2), e043013. 10.1136/bmjopen-2020-043013
Abstract
Abstract
INTRODUCTION: Among US veterans, more than 78% have a body mass index (BMI) in the overweight (≥25 kg/m2) or obese range (≥30 kg/m2). Clinical guidelines recommend multicomponent lifestyle programmes to promote modest, clinically significant body mass (BM) loss. Primary care providers (PCPs) often lack time to counsel and refer patients to intensive programmes (≥6 sessions over 3 months). Using peer coaches to deliver obesity counselling in primary care may increase patient motivation, promote behavioural change and address the specific needs of veterans. We describe the rationale and design of a cluster-randomised controlled trial to test the efficacy of the Peer-Assisted Lifestyle (PAL) intervention compared with enhanced usual care (EUC) to improve BM loss, clinical and behavioural outcomes (aim 1); identify BM-loss predictors (aim 2); and increase PCP counselling (aim 3).METHODS AND ANALYSIS: We are recruiting 461 veterans aged 18-69 years with obesity or overweight with an obesity-associated condition under the care of a PCP at the Brooklyn campus of the Veterans Affairs NY Harbor Healthcare System. To deliver counselling, PAL uses in-person and telephone-based peer support, a tablet-delivered goal-setting tool and PCP training. Patients in the EUC arm receive non-tailored healthy living handouts. In-person data collection occurs at baseline, month 6 and month 12 for patients in both arms. Repeated measures modelling based on mixed models will compare mean BM loss (primary outcome) between study arms.ETHICS AND DISSEMINATION: The protocol has been approved by the Institutional Review Board and the Research and Development Committee at the VA NY Harbor Health Systems (#01607). We will disseminate the results via peer-reviewed publications, conference presentations and meetings with stakeholders.TRIAL REGISTRATION NUMBER: NCT03163264; Pre-results.