A Multiple Methods Study to Understand Hospital Nurses Practices Accessing Language Services to Address Language Preference Associated Health Inequities

New York University, New York NY

Investigators

Abstract

Project Abstract Background & Significance: Approximately 20% of US households do not speak English at home based on the most recent census data. These persons may have limited English proficiency at a level that affects their ability to communicate during a healthcare encounter. Across the lifespan, research has demonstrated that when hospitalized, compared to English speakers people with limited English proficiency have worse and inequitable outcomes. These include higher rates of adverse events, higher rates of harm from adverse events, increased risk for hospital readmission from any point after discharge, delays getting surgery, and longer lengths of stay. Because all of these outcomes are sensitive to hospital nursing practices, hospital-based nurses have the potential to improve these outcomes. Previous research by the study’s team, however, has demonstrated that research has not examined how to optimize hospital nurses’ work with persons with limited English proficiency. Purpose: This formative multiple methods research study will generate detailed data about hospital nurses’ practices accessing language access services and help enhance our understanding of where practice associated inequities may occur. Setting: The proposed study will take place in the New York University Langone Health System—a four hospital urban-suburban system serving a linguistically diverse population. Methods: A narrative qualitative analysis will explore how hospital-based nurses describe their approaches to surveillance with LEP patients. Using purposive and stratified sampling approaches, we will recruit nurses who practice in diverse settings (e.g. ICU, medical-surgical, obstetrics, emergency department, pediatrics, psychiatry, and perioperative) to participate in semi-structured interviews for a total sample of n=94 (range of 22-32 participants/hospital). Simultaneously, using standardized approaches we will develop, pilot test, and psychometrically evaluate an instrument designed to measure nurses’ practices accessing and implementing language services in hospital settings. The goal of the instrument is to assess nurses’ clinical practices with limited English proficiency persons to identify opportunities for practice improvement interventions that can improve their outcomes. Implications: Overall, the study will produce the foundational data needed for the next phase of the work: 1) Development of an organizational intervention to improve nursing practice with LEP patients and 2) the ability to link self-reported practices to patient electronic health record data to study the practice-outcome link. The study addresses the research priorities of the National Institute for Nursing Research in the areas of health equity, the social determinants of health, and systems and models of care.