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.
