- Professional overview
Dr. Squires' research focuses on health workforce capacity building with a specific interest in improving immigrant health outcomes and for those with a language barrier between patients and providers. She has in-depth expertise on migration and health as well as nursing workforce development. An experienced global health researcher, she has worked in 30 countries to date and has regional expertise in Latin America. 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. Her current funded studies are examining the challenges of health workforce capacity building to meet the demand for geriatric services and studying the impact of language concordant encounters between nurses and patients receiving home care. A prolific writer, Dr. Squires has authored over 100 papers including 58 in peer reviewed journals. 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.
Bachelor of Science in Nursing with a minor in Latin American Studies, 1995, University of Pennsylvania;Master of Science in Nursing - Education, 1999, Duquesne University; Post-Masters Certificate in Nursing Administration, 2000, Villanova University;Doctor of Philosophy, 2007, Yale University; Post-Doctoral Fellowship, Center for Health Outcomes Research, 2007-2009, University of Pennsylvania .
Home careImmigrantsNursing workforcePolicyGlobalResearch methods
- Professional membership
Academy Health;American Nurses AssociationAmerican Academy of Nursing; National Council for Interpreting in Health CareSigma Theta Tau International Honor Society for Nursing;
Examining the influence of country-level and health system factors on nursing and physician personnel production.Squires, A., Uyei, S. J., Beltrán-Sánchez, H., & Jones, S. A. (2016). Human resources for health, 14, 48, 10.1186/s12960-016-0145-4
A key component to achieving good patient outcomes is having the right type and number of healthcare professionals with the right resources. Lack of investment in infrastructure required for producing and retaining adequate numbers of health professionals is one reason, and contextual factors related to socioeconomic development may further explain the trend. Therefore, this study sought to explore the relationships between country-level contextual factors and healthcare human resource production (defined as worker-to-population ratio) across 184 countries.
Exploring longitudinal shifts in international nurse migration to the United States between 2003 and 2013 through a random effects panel data analysis.Squires, A., Ojemeni, M. T., & Jones, S. (2016). Human resources for health, 14, 21, 10.1186/s12960-016-0118-7
No study has examined the longitudinal trends in National Council Licensure Exam for Registered Nurse (NCLEX-RN) applicants and pass rates among internationally-educated nurses (IENs) seeking to work in the United States, nor has any analysis explored the impact of specific events on these trends, including changes to the NCLEX-RN exam, the role of the economic crisis, or the passing of the WHO Code on the International Recruitment of Health Personnel. This study seeks to understand the impact of the three aforementioned factors that may be influencing current and future IEN recruitment patterns in the United States.
Research lessons from implementing a national nursing workforce study.Brzostek, T., Brzyski, P., Kózka, M., Squires, A., Przewoźniak, L., Cisek, M., … Ogarek, M. (2015). International nursing review, 62, 412-20, 10.1111/inr.12191
National nursing workforce studies are important for evidence-based policymaking to improve nursing human resources globally. Survey instrument translation and contextual adaptation along with level of experience of the research team are key factors that will influence study implementation and results in countries new to health workforce studies.
The Economics of Health Professional Education and Careers: Insights from a Literature ReviewMcPake, B., Squires, A., Agya, M., & Araujo, E. (2015). 10.1596/978-1-4648-0616-2
Bayesian Multilevel MIMIC Modeling for Studying Measurement Invariance in Cross-group Comparisons.Bruyneel, L., Li, B., Squires, A., Spotbeen, S., Meuleman, B., Lesaffre, E., & Sermeus, W. (2014). Medical care, 10.1097/MLR.0000000000000164
Recent methodological advancements should catalyze the evaluation of measurement invariance across groups, which is required for conducting meaningful cross-group comparisons.
In our country tortilla doesn't make us fat: cultural factors influencing lifestyle goal-setting for overweight and obese Urban, Latina patients.Jay, M., Gutnick, D., Squires, A., Tagliaferro, B., Gerchow, L., Savarimuthu, S., … Kalet, A. (2014). Journal of health care for the poor and underserved, 25, 1603-22, 10.1353/hpu.2014.0165
Obesity disproportionately affects Latina adults, and goal-setting is a technique often used to promote lifestyle behavior change and weight loss. To explore the meanings and dimensions of goal-setting in immigrant Latinas, we conducted four focus groups arranged by language ability and country of origin in an urban, public, primary care clinic. We used a narrative analytic approach to identify the following themes: the immigrant experience, family dynamics, and health care. Support was a common sub-theme that threaded throughout, with participants relying on the immigrant community, family, and the health care system to support their goals. Participants derived satisfaction from setting and achieving goals and emphasized personal willpower as crucial for success. These findings should inform future research on how goal-setting can be used to foster lifestyle behavior change and illustrate the importance of exploring the needs of Latino sub-groups in order to improve lifestyle behaviors in diverse Latino populations.
Methodological considerations when translating "burnout"Squires, A., Finlayson, C., Gerchow, L., Cimiotti, J. P., Matthews, A., Schwendimann, R., … Sermeus, W. (2014). Burnout research, 1, 59-68, 10.1016/j.burn.2014.07.001
No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout.
Validation of the Spanish verison of the practice environment scale of the Nursing Work Index in the Colombian context.Cardona-Alzate, L. C., Arango-Bayer, G. L., & Squires, A. (2014). Hispanic Healthcare International, 12(1), 34–42,
A systematic survey instrument translation process for multi-country, comparative health workforce studies.Squires, A., Aiken, L. H., van den Heede, K., Sermeus, W., Bruyneel, L., Lindqvist, R., … Matthews, A. (2013). International journal of nursing studies, 50, 264-73, 10.1016/j.ijnurstu.2012.02.015
As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems.
Content validity of the Spanish version of the Practice Environment Scale of the Nursing Work Index.Orts-Cortés, M. I., Moreno-Casbas, T., Squires, A., Fuentelsaz-Gallego, C., Maciá-Soler, L., González-María, E., & (2013). Applied nursing research : ANR, 26, e5-9, 10.1016/j.apnr.2013.08.006
The objective of this study is to evaluate the content validity of the Iberian Spanish version of the questionnaire The Practice Environment Scale of the Nursing Work Index (PES-NWI) by using the Content Validity Indexing (CVI).
Strengthening health systems in North and Central America: What role for migrationSquires, A., & Beltrán Sánchez, H. (2013).
A qualitative study of the work environments of Mexican nurses.Squires, A., & Juárez, A. (2012). International journal of nursing studies, 49, 793-802, 10.1016/j.ijnurstu.2012.02.001
Studies of the nursing work environment are increasingly common in developed countries, but few exist in developing countries. Because of resource differences between the two contexts, researchers need to clarify what aspects of the work environments are similar and different.
Becoming a Promotora: A Transformative Process for Female Community Health WorkersSquires, A., & O'Brien, M.J. (2012). Hispanic Journal of Behavioral Sciences, 34, 457-473, 10.1177/0739986312445567
Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries.Squires, A., Bruyneel, L., Aiken, L. H., Van den Heede, K., Brzostek, T., Busse, R., … Sermeus, W. (2012). International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua, 24, 470-5, 10.1093/intqhc/mzs040
To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts.
A pilot study of a systematic method for translating patient satisfaction questionnaires.Liu, K., Squires, A., & You, L. M. (2011). Journal of advanced nursing, 67, 1012-21, 10.1111/j.1365-2648.2010.05569.x
This paper is a report of a descriptive comparative pilot study of use of a method that simultaneously tests the content validity and quality of translation of English-to-Chinese translations of two patient satisfaction questionnaires: the La Monica-Oberst Patient Satisfaction Scale and Hospital Consumer Assessment of Healthcare Providers and Systems.
Exploring the links between macro-level contextual factors and their influence on nursing workforce composition.Squires, A., & Beltrán-Sánchez, H. (2011). Policy, politics & nursing practice, 12, 215-23, 10.1177/1527154411431326
Research that links macro-level socioeconomic development variables to health care human resources workforce composition is scarce at best. The purpose of this study was to explore the links between nonnursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro-level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries.
The North American Free Trade Agreement (NAFTA) and Mexican nursing.Squires, A. (2011). Health policy and planning, 26, 124-32, 10.1093/heapol/czq024
In the context of nurse migration, experts view trade agreements as either vehicles for facilitating migration or as contributing to brain-drain phenomena. Using a case study design, this study explored the effects of the North American Free Trade Agreement (NAFTA) on the development of Mexican nursing. Drawing results from a general thematic analysis of 48 interviews with Mexican nurses and 410 primary and secondary sources, findings show that NAFTA changed the relationship between the State and Mexican nursing. The changed relationship improved the infrastructure capable of producing and monitoring nursing human resources in Mexico. It did not lead to the mass migration of Mexican nurses to the United States and Canada. At the same time, the economic instability provoked by the peso crisis of 1995 slowed the implementation of planned advances. Subsequent neoliberal reforms decreased nurses' security as workers by minimizing access to full-time positions with benefits, and decreased wages. This article discusses the linkages of these events and the effects on Mexican nurses and the development of the profession. The findings have implications for nursing human resources policy-making and trade in services.
Health system reconstruction: Perspectives of Iraqi physicians.Squires, A., Sindi, A., & Fennie, K. (2010). Global public health, 5, 561-77, 10.1080/17441690903473246
In conflict or post-conflict situations, health system reconstruction becomes a critical component of ensuring stability. The purpose of this study was to determine the priorities for health system reconstruction among Iraqi physicians residing in the northern region of the country. A convenience sample of practicing male and female physicians residing in the Kurdish region completed a 13-item survey about health system reconstruction. A total of 1001 practitioners completed the survey with gender breakdown of 29% female and 71% male, all working in different specialty areas. Significant differences between the providers based on gender (p=0.001), specialty (p=0.001) and geographic location (p=0.004) were found to affect the responses of the participants. This study demonstrates that input from healthcare professionals is important for health system reconstruction, but that gender, geography and medical specialty make the process complex.
Methodological challenges in cross-language qualitative research: a research review.Squires, A. (2009). International journal of nursing studies, 46, 277-87, 10.1016/j.ijnurstu.2008.08.006
Cross-language qualitative research occurs when a language barrier is present between researchers and participants. The language barrier is frequently mediated through the use of a translator or interpreter. The purpose of this analysis of cross-language qualitative research was threefold: (1) review the methods literature addressing cross-language research; (2) synthesize the methodological recommendations from the literature into a list of criteria that could evaluate how researchers methodologically managed translators and interpreters in their qualitative studies; (3) test these criteria on published cross-language qualitative studies.
Predicting nursing human resources: an exploratory study.Squires, A., & Beltrán-Sánchez, H. (2009). Policy, politics & nursing practice, 10, 101-9, 10.1177/1527154409339395
The nurse-to-population ratio (NPOP) is a standard indicator used to indicate a country's health care human resources capacity for responding to its disease burden. This study sought to explore if socioeconomic development indicators could predict the NPOP in a country. Mexico served as the case example for this exploratory study, with the final five variables selected based on findings from a qualitative study analyzing the development of nursing human resources in the country. Multiple linear regression showed that two variables proved significant predictors of the NPOP and the model itself explained 70% of the variance (r( 2) = .7; p = .0000). The findings have multiple implications for nursing human resources policy in Mexico and at a global level as governments attempt to build human capital to respond to population health needs.
Role development of community health workers: an examination of selection and training processes in the intervention literature.O'Brien, M. J., Squires, A. P., Bixby, R. A., & Larson, S. C. (2009). American journal of preventive medicine, 37, S262-9, 10.1016/j.amepre.2009.08.011
Research evaluating community health worker (CHW) programs inherently involves these natural community leaders in the research process, and often represents community-based participatory research (CBPR). Interpreting the results of CHW intervention studies and replicating their findings requires knowledge of how CHWs are selected and trained.
Ethical behaviours in clinical practice among Mexican health care workers.Valdez-Martínez, E., Lavielle, P., Bedolla, M., & Squires, A. (2008). Nursing ethics, 15, 729-44, 10.1177/0969733008095384
The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as ;dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional-patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care.
Language barriers and qualitative nursing research: methodological considerations.Squires, A. (2008). International nursing review, 55, 265-73, 10.1111/j.1466-7657.2008.00652.x
This review of the literature synthesizes methodological recommendations for the use of translators and interpreters in cross-language qualitative research.
Latina food patterns in the United States: a qualitative metasynthesis.Gerchow, L., Tagliaferro, B., Squires, A., Nicholson, J., Savarimuthu, S. M., Gutnick, D., & Jay, M. Nursing research, 63, 182-93, 10.1097/NNR.0000000000000030
Obesity disproportionately affects Latinas living in the United States, and cultural food patterns contribute to this health concern.
Reconstructing a health system and a profession: priorities of Iraqi nurses in the Kurdish region.Squires, A., Sindi, A., & Fennie, K. ANS. Advances in nursing science, 29, 55-68,
To evaluate nurses' priorities for health system reconstruction and professional development in Iraq, a survey of 744 Iraqi nurses was conducted, with the research process managed via the Internet. Seven definite priorities emerged along with significant differences in priorities related to years of experience, age, speciality area of nursing practice, gender, level of education, and geographic location of practice. Results indicate that nurses should be included in health system reconstruction processes and that support for the development of the nursing profession should be included in the plan for overall reconstruction.