A Multiple Methods Study of Nurses' Practices with and Access to Communication Services in Hospital Settings - PROJECT SUMMARY Background & Significance: Approximately 30 million Americans will face a communication challenge during a hospitalization because English is not their first language, or they communicate via sign language. When hospitalized, these patients often experience poorer health outcomes, including increased adverse events, higher readmission rates, and longer lengths of stay. Since many of these outcomes are sensitive to hospital nursing practices, nurses are in a unique position to improve their care; however, little research has focused on how to optimize nurses' interactions with these patients. Purpose: This formative, multiple-methods study will generate detailed data on hospital nurses' practices in accessing language services. This will enhance our understanding of where communication barriers occur and how they impact care. Setting: The study will be conducted within the New York University Langone Health System, a four-hospital urban-suburban system serving a linguistically varied patient population. Methods: We will use a narrative qualitative analysis to explore how hospital nurses describe their approaches to patient monitoring and care for those with communication challenges. Using purposive and stratified sampling, we will recruit nurses from diverse settings (e.g., ICU, medical-surgical, obstetrics, emergency department, pediatrics, psychiatry, and perioperative) to participate in semi-structured interviews. Our goal is a total sample of 94 participants (22-32 per hospital). Concurrently, we will develop, pilot-test, and psychometrically evaluate a new instrument designed to measure nurses' practices in accessing and implementing language services. The goal of this instrument is to assess clinical practices to identify opportunities for targeted interventions to improve patient outcomes. Implications: This study will produce the foundational data needed for the next phase of our work: 1) developing an organizational intervention to improve nursing practices with patients who have unique communication needs, and 2) linking self-reported practices to electronic health record data to study the practice-outcome relationship. The study addresses the research priorities of the National Institute for Nursing Research by focusing on improving systems and models of care.
