Association of the Nurse Work Environment and Disparities in 7-Day Readmissions Among Hospitalized Patients With Limited English Proficiency / Kathy Sara Sliwinski.

Format:

Book

Thesis/Dissertation

Author/Creator:

Sliwinski, Kathy Sara, author.

Contributor:

University of Pennsylvania. Nursing, degree granting institution.

Language:

English

Subjects (All):

Nursing.

Biostatistics.

Bioinformatics.

Nursing--Penn dissertations.

Penn dissertations--Nursing.

Local Subjects:

Nursing.

Biostatistics.

Bioinformatics.

Nursing--Penn dissertations.

Penn dissertations--Nursing.

Physical Description:

1 online resource (129 pages)

Contained In:

Dissertations Abstracts International 85-12B.

Place of Publication:

[Philadelphia, Pennsylvania] : University of Pennsylvania, 2022.

Ann Arbor : ProQuest Dissertations & Theses, 2024

Language Note:

English

Summary:

Decades of research demonstrate hospitalized patients with limited English proficiency (LEP) experience poorer outcomes compared to English proficient individuals. Research on LEP patient outcomes is often limited to single-hospital systems and little is known about how to improve care delivery and narrow outcomes disparities beyond the use of individually targeted interventions such as using medical interpreter services. Though medical interpreters are the gold standard, they are not uniformly used in all hospitals, perhaps because nurses in some hospitals lack the adequate time and resources to acquire and utilize interpreter services. This study examined the association between hospital nurse work environments and disparities in 7-day readmissions between patients with and without LEP. A substantial body of literature has shown hospital nursing resources such as more favorable nurse work environments to be associated with improved patient outcomes and particularly advantageous for racial and ethnic minoritized individuals. This study evaluated (1) whether and to what extent the hospital nurse work environment attenuates disparities in 7-day readmissions between patients with and without LEP and (2) whether 7-day readmissions for LEP patients are associated with the LEP volume of the hospital and whether and to what extent the effect of hospital LEP volume on 7-day readmissions for LEP patients is conditional on the nurse work environment. This study used three linked data sources from patients, nurses, and hospitals in New Jersey in 2016: 1) New Jersey Discharge Data Collection System, 2) RN4CAST data, and 3) American Hospital Association Annual Survey data. Sequential multivariable logistic regression models were performed. LEP patients have higher odds of 7-day readmission compared to non-LEP patients, even after accounting for patient and hospital characteristics. The nurse work environment moderated the effect of LEP status on the odds of a 7-day readmission, such that mixed/better nurse work environments were particularly beneficial for LEP patients with respect to lower odds of readmission. Higher hospital LEP volume was associated with higher odds of readmission for LEP patients; however, this relationship was only statistically significant in hospitals with poor nurse work environments. The study results demonstrate a link between better nurse work environments and more favorable readmission outcomes for all patients, but with an even greater benefit among LEP patients. Hospitals committed to delivering equitable health care can look to improving nurses' working conditions as an intervention to reduce health outcomes disparities.

Notes:

Source: Dissertations Abstracts International, Volume: 85-12, Section: B.

Advisors: Lasater, Karen B.; Committee members: Squires, Allison P.; McHugh, Matthew D.

Department: Nursing.

Ph.D. University of Pennsylvania 2024.

Local Notes:

School code: 0175

ISBN:

9798382830315

Access Restriction:

Restricted for use by site license.