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

Detecting Disparities in Medication Management Among Limited English Proficient and English Proficient Home Health Patients

Miner, S. M., Squires, A. P., Ma, C., McDonald, M. V., & Jones, S. A. (2019). Home Health Care Management and Practice. 10.1177/1084822319865546
Abstract
According to the U.S. census Bureau, close to 20% of the U.S. population speaks a language other than English at home. Home health care (HHC) patients who speak English less than very well or have limited English proficiency (LEP) are at an increased risk for medication mismanagement and serious health consequences. The purpose of this study was to examine if there were differences in medication management between English-speaking patients and patients with LEP receiving HHC services. Data for this cross-sectional observation study were collected from 2010 to 2014. Medication management was measured by two items in the Centers for Medicare and Medicaid Services–mandated Outcomes Assessment Information Set (OASIS). All patients in the database who were taking medications and had a valid admission and discharge assessment from HHC were included in the analysis. Inverse probability of treatment weighting (IPTW) with a marginal structural model was used to address potential imbalances in observed patient characteristics when estimating the effect of having LEP or being an English-speaking HHC patient on changes in medication management over the course of a HHC episode. Estimates from marginal structural model with inverse probability weighting indicate that being LEP was associated with less improvement in medication management and increased likelihood of getting worse over the course of a HHC episode. This study is one of the first to demonstrate that patients with LEP experience disparities in medication management when compared to English-speaking patients in HHC.

The Experience of Being Aware of Disease Status in Women with Recurrent Ovarian Cancer: A Phenomenological Study

Finlayson, C. S., Fu, M., Squires, A., Applebaum, A., Van Cleave, J., O’Cearbhaill, R., & DeRosa, A. P. (2019). Journal of Palliative Medicine, 22(4), 377-384. 10.1089/jpm.2018.0127
Abstract
BACKGROUND: Awareness of disease status has been identified as a factor in the treatment decision-making process. Women with recurrent ovarian cancer are facing the challenge of making treatment decisions throughout the disease trajectory. It is not understood how women with ovarian cancer perceive their disease and subsequently make treatment decisions. PURPOSE: The purpose of this phenomenological study was to understand the lived experience of women with recurrent ovarian cancer, how they understood their disease and made their treatment decisions. METHODS: A qualitative design with a descriptive phenomenological method was used to conduct 2 in-depth interviews with 12 women (n = 24 interviews). Each interview was ∼60 minutes and was digitally recorded and professionally transcribed. Data collection focused on patients' understanding of their disease and how patients participated in treatment decisions. A modified version of Colaizzi's method of phenomenological reduction guided data analysis. RESULTS: Three themes emerged to describe the phenomenon of being aware of disease status: (1) perceiving recurrent ovarian cancer as a chronic illness, (2) perceived inability to make treatment decisions, and (3) enduring emotional distress. CONCLUSIONS AND IMPLICATIONS: This study revealed how 12 women conceptualized recurrent ovarian cancer as a chronic disease and their perceived inability to make treatment decisions because of lack of information and professional qualifications, resulting in enduring emotional distress. Future research should replicate the study to confirm the persistence of the themes for racially, ethnically, and religiously diverse patient samples and to improve understanding of awareness of disease status and decision-making processes of patients.

Health translators and interpreters in national healthcare systems

Squires, A. (2019). 10.4324/9781351000390

How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data

Squires, A., Miner, S., Liang, E., Lor, M., Ma, C., & Witkoski, A. (2019). International Journal of Nursing Studies. 10.1016/j.ijnurstu.2019.103394
Abstract
BackgroundIncreasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting.ObjectivesTo explore home health care professionals’ perspectives about how workload changes from managing language barriers influence quality and safety in home health care.DesignA qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data.SettingA large urban home health care agency located on the East Coast of the United States.ParticipantsThirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist].ResultsA total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety.ConclusionsHome health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient’s language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models.

Integrating Health Care Interpreters Into Simulation Education

Latimer, B., Robertiello, G., & Squires, A. (2019). Clinical Simulation in Nursing, 32, 20-26. 10.1016/j.ecns.2019.04.001
Abstract
Patients with limited English proficiency skills are accessing health care services more frequently around the world. Language barriers increase patient vulnerability for adverse events, and health care interpreters may mitigate this risk. Nursing education regarding the effective and appropriate use of health care interpreters has been limited. Interpreters are natural partners for nurses as a strategy to bridge language barriers with patients and could be integrated more regularly into nursing education using clinical simulation strategies. This article offers an overview of the different types of interpreters in health care, proposes recommendations for integrating them into simulation education, and provides a case example to illustrate implementation.

A needs assessment of geriatric capacity building in public hospitals in Mexico

Squires, A., Caceres, B., Negrete, M., Bub, L., & Giraldo Rodríguez, L. (2019). International Journal of Older People Nursing.

Policy update - Section 1557 of the Affordable Care Act: Strengthening language access rights for patients with limited English proficiency

Squires, A., & Youdelman, M. (2019). Journal of Nursing Regulation, 10(1), 65-67.

Provider Perspectives of Medication Complexity in Home Health Care: A Qualitative Secondary Data Analysis

Squires, A., Ridge, L., Miner, S., McDonald, M. V., Greenberg, S. A., & Cortes, T. (2019). Medical Care Research and Review. 10.1177/1077558719828942
Abstract
A primary service provided by home care is medication management. Issues with medication management at home place older adults at high risk for hospital admission, readmission, and adverse events. This study sought to understand medication management challenges from the home care provider perspective. A qualitative secondary data analysis approach was used to analyze program evaluation interview data from an interprofessional educational intervention study designed to decrease medication complexity in older urban adults receiving home care. Directed and summative content analysis approaches were used to analyze data from 90 clinician and student participants. Medication safety issues along with provider–provider communication problems were central themes with medication complexity. Fragmented care coordination contributed to medication management complexity. Patient-, provider-, and system-level factors influencing medication complexity and management were identified as contributing to both communication and coordination challenges.

Strategies for overcoming language barriers in research

Squires, A., Sadarangani, T., & Jones, S. (2019). Journal of Advanced Nursing. 10.1111/jan.14007
Abstract
Aim: This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier. Design: Discussion paper. Data Sources: Research methods papers addressing cross-language research issues published between 2000–2017. Implications for Nursing: Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into “big data” systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. Conclusion: Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable, and valid cross-language research. Impact: This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The recommendations generated here have the potential to have an impact on the health and well-being of migrants around the world.

“She wears red lipstick” – A study of the public image of nursing in Georgia

Squires, A., Ojemeni, M. T., Olson, E., & Uchaneishvili, M. (2019). Nursing Inquiry. 10.1111/nin.12295