Faculty

Prof. Allison P Squires headshot

Allison P Squires

FAAN PhD RN

Associate Professor

1 212 992 7074

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

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Professional overview

Dr. Squires is a global health workforce capacity-building researcher with a special interest in improving immigrant and refugee health outcomes. To date, she has led or participated in studies covering 34 countries, with current active projects taking place in Mexico, Uganda, and the Czech Republic. Her methods expertise lies in cross-language research, both qualitative and quantitative. She recently completed an Agency for Health Care Research and Quality funded R01 level study that examined how language barriers affect home health care outcomes. That study was the first to find how a patient’s language preference affects their risk for adverse outcomes and how organizations respond to mitigate those risks. Dr. 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, Dr. Squires has authored over 150 publications including 100 in peer-reviewed journals. She serves as an Associate Editor for the International Journal of Nursing Studies (the top-ranked nursing journal in the world), the Research Editor for the Journal of Nursing Regulation, and as an Academic Editor for PLoS One. Prior to entering academia full time, Dr. Squires worked as a staff nurse in solid organ transplant and as a staff educator for 11 years in the US healthcare system. 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 research.

Education

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

Honors and awards

Fellow, Yale World Fellows Program (2003)
Fellow, New York Academy of Medicine (2014)
Distinguished Alumna, Duquesne University (2015)
Fellow, American Academy of Nursing (2015)
Fellow Ambassador to the Media, New York Academy of Medicine (2017)
Outstanding Scholarly Contribution to Gerontological Nursing Practice, International Journal for Older People Nursing (2018)
Prose Award, Honorable Mention, for contributions to “A New Era in Global Health” (W. Rosa, Ed.) (2018)
Chair, Global Health and Health Care Interest Group for Academy Health (2018)
Vice Chair, Interdisciplinary Research Group on Nursing Interests for Academy Health (2018)
Co-Chair for the American Academy of Nursing's Global Health Expert Panel (20192020)

Specialties

Global
Immigrants
Gerontology

Professional membership

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

Publications

Publications

Geriatric Interdisciplinary Team Training 2.0: A collaborative team-based approach to delivering care

Giuliante, M. M., Greenberg, S. A., McDonald, M. V., Squires, A., Moore, R., & Cortes, T. A. (2018). Journal of Interprofessional Care, 1-5. 10.1080/13561820.2018.1457630
Abstract
Interprofessional collaborative education and practice has become a cornerstone of optimal person-centered management in the current complex health care climate. This is especially important when working with older adults, many with multiple chronic conditions and challenging health care needs. This paper describes a feasibility study of the Geriatric Interdisciplinary Team Training 2.0 (GITT 2.0) program focused on providing interprofessional care to complex and frail older adults with multiple chronic conditions. A concurrent triangulation mixed-methods design facilitated program implementation and evaluation. Over three years (2013-2016), 65 graduate students from nursing, midwifery, social work, and pharmacy participated along with 25 preceptors. Participants were surveyed on their attitudes toward interprofessional collaboration pre and post-intervention and participated in focus groups. While attitudes toward interprofessional collaboration did not change quantitatively, focus groups revealed changes in language and enhanced perspectives of participants. Based on the evaluation data, the GITT 2.0 Toolkit was refined for use in interprofessional education and practice activities related to quality initiatives.

The meaning of “capacity building” for the nurse workforce in sub-Saharan Africa: An integrative review

Ridge, L. J., Klar, R., Stimpfel, A., & Squires, A. (2018). International Journal of Nursing Studies, 86, 151-161. 10.1016/j.ijnurstu.2018.04.019
Abstract
Background: “Capacity building” is an international development strategy which receives billions of dollars of investment annually and is utilized by major development agencies globally. However, there is a lack of consensus around what “capacity building” or even “capacity” itself, means. Nurses are the frequent target of capacity building programming in sub-Saharan Africa as they provide the majority of healthcare in that region. Objectives: This study explored how “capacity” was conceptualized and operationalized by capacity building practitioners working in sub-Saharan Africa to develop its nursing workforce, and to assess Hilderband and Grindle's (1996) “Dimensions of Capacity” model was for fit with “capacity's” definition in the field. Design: An integrative review of the literature using systematic search criteria. Data sources searched included: PubMed, the Cumulative Index for Nursing and Allied Health Literature Plus, the Excerpt Medica Database, and Web of Science. Review methods: This review utilized conventional content analysis to assess how capacity building practitioners working in sub-Saharan Africa utilize the term “capacity” in the nursing context. Content analysis was conducted separately for how capacity building practitioners described “capacity” versus how their programs operationalized it. Identified themes were then assessed for fit with Hilderband and Grindle's (1996) “Dimensions of Capacity” model. Results: Analysis showed primary themes for conceptualization of capacity building of nurses by practitioners included: human resources for health, particularly pre- and post- nursing licensure training, and human (nursing) resource retention. Other themes included: management, health expenditure, and physical resources. There are several commonly used metrics for human resources for health, and a few for health expenditures, but none for management or physical resources. Overlapping themes of operationalization include: number of healthcare workers, post-licensure training, and physical resources. The Hilderband and Grindle (1996) model was a strong fit with how capacity is defined by practitioners working on nursing workforce issues in sub-Saharan Africa. If overall significant differences between conceptualization and operationalization emerged, as the reader I want to know what these differences were. Conclusions: This review indicates there is significant informal consensus on the definition of “capacity” and that the Hilderbrand and Grindle (1996) framework is a good representation of that consensus. This framework could be utilized by capacity building practitioners and researchers as those groups plan, execute, and evaluate nursing capacity building programming.

Un Estudio Piloto del Clima Laboral de las Enfermeras Mexicanas: A Pilot Study of Mexican Nurses’ Work Environments

Squires, A., Fletcher, J., Hidalgo, H. C., & Nigenda, G. (2018). Hispanic Health Care International, 16(3), 145-157. 10.1177/1540415318804481
Abstract
Introduction: We conducted a pilot study to examine the work environments of Mexican nurses using an internationally comparable instrument. Methods: We used the Spanish version of the Practice Environment Scale of the Nurses Work Index for the cross-sectional pilot study. Using both online and paper-based data collection methods, we recruited Mexican nurses from five sites around the country to participate. The study took place betwen 2011 and 2013. Principal component analysis analyzed the reliability and validity of the instrument in the Mexican context. Results: The Mexican Spanish translation of the instrument produced five factors which differed from the original factor loadings. Nonetheless, the instrument proved capable of differentiating problematic from non-problematic areas of the work environments of Mexican nurses. Conclusions: The Mexican Spanish verison of the instrument can be successfully used to evaluate nurses’ work environments in Mexican hospitals.

A post-master's advanced certificate in gerontology for NPs

Greenberg, S. A., Squires, A., Adams, J., Altshuler, L., Oh, S. Y., Blachman, N. L., & Cortes, T. A. (2017). Nurse Practitioner, 42(9), 18-23. 10.1097/01.NPR.0000521992.53558.73
Abstract
This article describes an innovative post-master's advanced certificate in gerontology program developed by the Hartford Institute for Geriatric Nursing at the New York University Rory Meyers College of Nursing. The program provides advanced practice registered nurses geriatric content to meet eligibility criteria for the Adult-Gerontology Primary Care NP certification exam and develops interprofessional care providers to care for complex older adults.

Validating the health literacy promotion practices assessment instrument

Squires, A., Yin, H. S., Jones, S., Greenberg, S. A., Moore, R., & Cortes, T. (2017). Health Literacy Research and Practice, 1(4), E239-46. 10.3928/24748307-20171030-01

Does bioelectrical impedance analysis provide a reliable diagnosis of secondary lymphedema in breast cancer patients?

Nahum, J. L., & Squires, A. (2014). Journal of Clinical Outcomes Management, 21(2), 55-58.

Does exercise help reduce cancer-related fatigue?

Wright, F., & Squires, A. (2014). Journal of Clinical Outcomes Management, 21(4), 155-156.

Frailty as a predictive factor in geriatric trauma patient outcomes

Sadarangani, T., & Squires, A. (2014). Journal of Clinical Outcomes Management, 21(9), 396-397.
Abstract
Objective. To evaluate the usefulness of the Frailty Index (FI) as a prognostic indicator of adverse outcomes in geriatric trauma patients,. Design. Prospective cohort study. Setting and participants. Geriatric (aged 65 and over) trauma patients admitted to inpatient units at a Level 1 trauma center in Arizona were enrolled. Patients were excluded if they were intubated/nonresponsive with no family members present or transferred from another institution (eg, skilled nursing facility). The following categories of data were collected: (a) patient demographics, (b) type and mechanism of injury, (c) vital signs (eg, Glasgow coma scale score, systolic blood pressure, heart rate, body temperature), (d) need for operative intervention, (e) in-hospital complications, (f) hospital and intensive care unit (ICU) lengths of stay, and (g) discharge disposition. Patients or, in the case of nonresponsive patients, their closest relative, responded to the 50-item Frailty Index questionnaire, which includes questions regarding age, comorbid conditions, medications, activities of daily living (ADLs), social activities, mood, and nutrition. FI score ranges from 0 (non-frail) to 1 (frail), with an FI of 0.25 or more indicative of frailty based on established guidelines. Patients were categorized as frail or non-frail according to their FI scores and were followed during the course of their hospitalization. Main outcome measure. The primary outcome measure was in-hospital complications. In-hospital complications included myocardial infarction, cardiopulmonary arrest, pneumonia, pulmonary embolism, sepsis, urinary tract infection, deep venous thrombosis, disseminated intravascular coagulation, renal insufficiency, and reoperation. The secondary outcome measure was adverse discharge disposition, which was defined as death during the course of hospitalization or discharge to a skilled nursing facility. Main results. The sample consisted of 250 patients with a mean age of 77.9 years. Among these, 44.0% were considered frail. Patients with frailty were more likely to have a higher Injury Severity Score (P = 0.04) and a higher mean FI (P = 0.01) than those without frailty. There were no statistically significant differences with respect to age (P = 0.21), mechanism of injury (P = 0.09), systolic blood pressure (P = 0.30), or Glasgow Coma Scale score (P = 0.91) between the groups. Patients with frailty were more likely to develop in-hospital complications (37.3% vs 21.4%, P = 0.001) than those without frailty. Among these complications, pneumonia and urinary tract infection were the most common. There were no differences in the rate of reoperation (P = 0.54) between the 2 groups. An FI of 0.25 or higher was associated with the development of in-hospital complications (P = 0.001) even after adjusting for age, systolic blood pressure, heart rate, and Injury Severity Score. Frail patients had longer hospital length of stay (P = 0.01) and ICU length of stay (P = 0.01), and were more likely to have adverse discharge disposition (37.3% vs. 12.9%, P = 0.001). All patients who died during the course of hospitalization (n = 5) were considered frail. Frailty was also found to be a predictor of adverse discharge disposition (P = 0.001) after adjustment for age, male sex, Injury Severity Score, and mechanism of injury. Conclusion. The FI is effective in identifying geriatric trauma patients, who are vulnerable to poor health outcomes.

Use of HbA1c in the diagnosis of diabetes in adolescents

Nahum, J. L., & Squires, A. (2014). Journal of Clinical Outcomes Management, 21(7), 298-299.
Abstract
Objective. To examine the screening practices of family practitioners (FPs) and pediatricians for type 2 diabetes (T2D) in adolescents. Design. Cross-sectional study. Setting and participants. The researchers randomly sampled 700 pediatricians and 700 FPs who participated in direct patient care using the American Medical Association Physician Masterfile using a mail survey. Exclusion criteria included providers who were residents, hospital staff, retirees, or employed by federally owned medical facilities, certified with a subspecialty, or over age 70. Main outcome measures. Providers were given a hypothetical case of an obese, female, teenaged patient with concurrent associated risk factors for T2D (family history of T2D, minority race, signs of insulin resistance) and asked what initial screening tests they would order. Respondents were then informed of the updated American Diabetes Association (ADA) guidelines that added hemoglobin A1c as a screening test to diagnose diabetes. The survey then asked if knowing this change in recommendation has changed or will change their screening practices in adolescents. Main results. 1400 surveys were mailed. After 2 were excluded due to mailing issues, 52% of providers provided responses. Of these, 129 providers reported that they did not care for adolescents (age 10-17), resulting in 604 providers in the final sample, 398 pediatricians and 335 FPs. The vast majority (92%) said they would screen the hypothetical case for diabetes, with most initially ordering a fasting test (fasting plasma glucose or 2-hour glucose tolerance test) (63%) or A1c test (58%). Of the 58% who planned to order HbA1c, only 35% ordered it in combination with a fasting test. HbA1c was significantly more likely to be ordered by pediatricians than by FPs (P = 0.001). After being presented with the new guidelines, 84% said then would now order HbA1c, a 27% increase. Conclusion. In response to information about the new guidelines, providers were more likely to order A1c as part of initial testing. Due to the lower test performance in children and increased cost of the test, the use of HbA1c without fasting tests may result in missed diagnosis of T2D in adolescents as well as increased health care costs.