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

Accepting PhD students

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Professional overview

Allison Squires is the 2019-2020 Distinguished Nurse Scholar in Residence for the National Academy of Medicine where she is working on the consensus study for the next Future of Nursing 2020-2030 report. She 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 healthcare 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. 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 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, 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

Chair, Nursing Section, New York Academy of Medicine (201920202021)
Co-Chair for the American Academy of Nursing's Global Health Expert Panel (201920202021)
Distinguished Nurse Scholar in Residence, National Academy of Medicine (20192020)
Vice-Chair, Global Health and Health Care Interest Group for Academy Health (2019-2020) (20192020)
Chair, Interdisciplinary Research Group on Nursing Issues for Academy Health (20192020)
Chair, Global Health and Health Care Interest Group for Academy Health (20182019)
Vice Chair, Interdisciplinary Research Group on Nursing Issues for Academy Health (2018)
Prose Award, Honorable Mention, for contributions to “A New Era in Global Health” (W. Rosa, Ed.) (2018)
Outstanding Scholarly Contribution to Gerontological Nursing Practice, International Journal for Older People Nursing (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)

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

Assessing geriatric capacity building needs in public hospitals in Mexico

Squires, A., Caceres, B., Bub, L., & Negrete Redondo, M. I. (2019). International Journal of Older People Nursing. 10.1111/opn.12262
Abstract
AIMS To conduct a needs assessment of public hospitals in Mexico to determine workforce specific capacity building needs in the care of older people. BACKGROUND The older population in Mexico is growing rapidly. The healthcare system and workforce may not be prepared to handle the needs of older people, especially those with chronic illnesses who are also disadvantaged socioeconomically. Determining workforce and system needs is important to strategically develop capacity. METHODS A needs assessment using a pragmatic qualitative approach structured this study. Semi-structured interviews and focus groups were conducted with healthcare professionals at five public hospitals in Mexico. Directed content analysis techniques analysed the data. RESULTS Ninety-two healthcare professionals participated in the study. Three themes emerged, including geriatric service delivery, social changes and human resources for health. Participants reported a lack of gerontology knowledge and related clinical skills deficits to provide care for hospitalised elders and expressed emotional distress related to the lack of resources in their institutions. All healthcare professionals expressed strong concern at the social toll the ageing population had on families. The support of government organisations emerged as a facilitator for adoption of geriatric care principles. CONCLUSIONS This qualitative study uncovered important data to inform the implementation of quality improvement and capacity building models for older people care in Mexico. There appears to be strong potential for a culturally appropriate translation of high-income country older people care models within the Mexican healthcare context. IMPLICATIONS FOR PRACTICE Findings suggests there is a need to increase geriatric capacity building among helathcare professionals in Mexico. This will be an important step in improving care for hospitalised older people.

Assessing geriatric capacity building needs in public hospitals in Mexico

Squires, A., Caceres, B., Bub, L., & Negrete Redondo, M. I. (2019). International Journal of Older People Nursing, 14(4). 10.1111/opn.12262
Abstract
Aims: To conduct a needs assessment of public hospitals in Mexico to determine workforce specific capacity building needs in the care of older people. Background: The older population in Mexico is growing rapidly. The healthcare system and workforce may not be prepared to handle the needs of older people, especially those with chronic illnesses who are also disadvantaged socioeconomically. Determining workforce and system needs is important to strategically develop capacity. Methods: A needs assessment using a pragmatic qualitative approach structured this study. Semi-structured interviews and focus groups were conducted with healthcare professionals at five public hospitals in Mexico. Directed content analysis techniques analysed the data. Results: Ninety-two healthcare professionals participated in the study. Three themes emerged, including geriatric service delivery, social changes and human resources for health. Participants reported a lack of gerontology knowledge and related clinical skills deficits to provide care for hospitalised elders and expressed emotional distress related to the lack of resources in their institutions. All healthcare professionals expressed strong concern at the social toll the ageing population had on families. The support of government organisations emerged as a facilitator for adoption of geriatric care principles. Conclusions: This qualitative study uncovered important data to inform the implementation of quality improvement and capacity building models for older people care in Mexico. There appears to be strong potential for a culturally appropriate translation of high-income country older people care models within the Mexican healthcare context. Implications for practice: Findings suggests there is a need to increase geriatric capacity building among helathcare professionals in Mexico. This will be an important step in improving care for hospitalised older people.

Content Validation of the Arabic Translation of the Practice Environment Scale of the Nursing Work Index-Revised

Ambani, Z., Al-Hamdan, Z., Al-Touby, S., Ghanim, A., Al Jarameez, F., & Squires, A. (2019). Journal of Nursing Measurement, 27(2), 234-246. 10.1891/1061-3749.27.2.234
Abstract
BACKGROUND AND PURPOSE: There is no reliable and valid version of the Practice Environment Scale of the Nursing Work Index-Revised (PES-NWI-R) in Arabic. The purpose of this study was to describe the systematic instrument translation and validation of the PES-NWI-R. METHODS: Using the Content Validity Indexing-based approach, 32 expert nurses from four countries in the Eastern Mediterranean Region (Jordan, Oman, Saudi Arabia, and United Arab Emirates) participated in the validation of this translation. RESULTS: The content validity index score of the overall scale was excellent (0.87 for the relevancy, and 0.95 for the quality of Arabic translation). CONCLUSION: Our study supported the content validity of the Arabic version of the instrument which provided the first valid Arabic translation of the instrument.

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.

Dysbiosis of the Gut Microbiome: A Concept Analysis

Perez, N. B., Dorsen, C., & Squires, A. (2019). Journal of Holistic Nursing : Official Journal of the American Holistic Nurses’ Association, 898010119879527. 10.1177/0898010119879527
Abstract
Background:Gut microbes influence the development several chronic conditions marking them as targets for holistic care, prevention strategies, and potential treatments. Microbiome studies are relatively new to health research and present unfamiliar terms to clinicians and researchers. "Dysbiosis" often refers to an alteration in the gut microbiome, but conceptual clarification is rarely provided. Purpose: The purpose of this study is to refine a conceptual definition of dysbiosis based on a review of nursing literature. Method: A Rodgerian approach to concept analysis was used. CINAHL, PubMed, and Web of Science were queried using "dysbiosis" through December 2018. Each article was analyzed with regard to the antecedents, attributes, and consequences of dysbiosis. Essential elements were tabulated and compared across studies to determine recurring themes and notable outliers. Findings: Analysis revealed several important antecedences, attributes, and consequences of dysbiosis. The findings also elucidated notable gaps and highlighted the co-evolving nature of the proposed definition with advances in microbiome research. Conclusion: This article adds a proposed definition of dysbiosis, offering a contribution of conceptual clarity upon which to enhance dialogue and build research. The definition emphasizes risk factors and consequences of dysbiosis as implications for holistic nursing practice.

Dysbiosis of the Gut Microbiome: A Concept Analysis

Perez, N. B., Dorsen, C., & Squires, A. (2019). Journal of Holistic Nursing. 10.1177/0898010119879527

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

Home health care services to persons with dementia and language preference

Ma, C., Herrmann, L., Miner, S., Stimpfel, A. W., & Squires, A. (2019). Geriatric Nursing. 10.1016/j.gerinurse.2019.08.016
Abstract
Despite the rapid increase in the number of persons with dementia (PWD) receiving home health care (HHC), little is known of HHC services patterns to PWD of varied backgrounds, including language preference other than English. Analyzing data of 12,043 PWD from an urban home health agency, we found on average PWD received 2.48 skilled visits or 1.88-hour skilled care and 5.81 aide visits or 24.13-hour aide care weekly. Approximately 63% of the skilled visits were from nurses. More non-English preferred PWD received aide visits, compared to English preferred PWD (44% vs. 36%). The type and intensity of HHC services were associated with language preference; when stratified by insurance, non-English preference was still significantly associated with more HHC aide care. Our study indicated that HHC services (both type and amount) varied by language preference and insurance type as an indicator of access disparities was a significant contributor to the observed differences.

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 Stimpfel, A. (2019). International Journal of Nursing Studies, 99. 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.