Allison P Squires, PhD, FAAN, RN, is an associate professor at NYU Rory Meyers College of Nursing. She is the 2019–2020 Distinguished Nurse Scholar in Residence for the National Academy of Medicine, 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 in the Czech Republic, Mexico, and Uganda. 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.
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 academic editor of 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.
Squires completed her PhD at Yale University, MSN at Duquesne University, and BSN at the University of Pennsylvania. She completed a Post-Doctoral Fellowship at the University of Pennsylvania.
Squires 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.
Post-Doctoral Fellowship - University of PennsylvaniaPhD - Yale UniversityMSN - Duquesne UniversityBSN - University of Pennsylvania
Honors and awards
Chair, New York Academy of Medicine (201920202021)Co-Chair, 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 (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, “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)
Academy HealthAmerican Nurses AssociationConsortium of Universities for Global HealthInterdisciplinary Research Group on Nursing Issues (Academy Health)National Council for Interpreting in Health CareSigma Theta Tau International
Regulación de la enfermería en México: actores, procesos y resultadosAbstractThis paper aims to analyze the regulatory structure of nursing in Mexico through its legislation and perspectives of participant stakeholders. A case study was undertaken using qualitative and quantitative data sources, as well as from the review of official documents. The analysis included data from the sources according to the four realms proposed by the Moran & Wood (1993) model. The more advanced realm was the market entry since the state regulates entry through a license of practice. The regulation of competition is weak, showing very reduced areas of autonomous practice. The labor market is offering a wide variety of entry options with clear signs of deterioration. The dominant payment mechanism is salary, showing a structure that incorporates a component that does not impact on pensions at the end of the labor cycle. The regulation of nursing is a component of its professionalization, and as such, it is understood as a multidimensional consolidating process, particularly realms related to the regulation of competition, market structure, and payment mechanisms, in which nursing representatives should play a more active role in the future.
Assessing geriatric capacity building needs in public hospitals in MexicoAbstractAims: 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-RevisedAbstractBACKGROUND 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 PatientsAbstractAccording 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
The Experience of Being Aware of Disease Status in Women with Recurrent Ovarian Cancer: A Phenomenological StudyAbstractBACKGROUND: 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.
Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: A qualitative studyAbstractLynch, H. M., Green, A. S., Clarke Nanyonga, R., Gadikota-Klumpers, D. D., Squires, A., Schwartz, J. I., & Heller, D. J. (2019). International Journal for Equity in Health, 18(1). 10.1186/s12939-019-1109-9Background: Hypertension is the leading risk factor for mortality worldwide and is more common in sub-Saharan Africa than any other region. Work to date confirms that a lack of human and material resources for healthcare access contributes to this gap. The ways in which patients' knowledge and attitudes toward hypertension determine their engagement with and adherence to available care, however, remains unclear. Methods: We conducted an exploratory, qualitative descriptive study to assess awareness, knowledge, and attitudes towards hypertension and its management at a large private hospital in Kampala. We interviewed 64 participants (29 with hypertension and 34 without, 1 excluded) in English. General thematic analysis using the Integrated Conceptual Health Literacy Model was used to iteratively generate themes and categories. Results: We identified three main themes: Timing of Hypertension Diagnosis, Aiming for Health Literacy, and the Influence of Knowledge on Behavior. Most participants with hypertension learned of their condition incidentally, speaking to the lack of awareness of hypertension as an asymptomatic condition. Drove nearly all participants to desire more information. However, many struggled to translate knowledge into self-management behaviors due to incomplete information and conflicting desires of participants regarding lifestyle and treatment. Conclusions: Internal patient factors had a substantial impact on adherence, calling attention to the need for educational interventions. Systemic barriers such as cost still existed even for those with insurance and need to be recognized by treating providers.
Health translators and interpreters in national healthcare systems
Home health care services to persons with dementia and language preferenceAbstractDespite 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 dataAbstractBackgroundIncreasingly, 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.