After a hospitalization, home healthcare enables patients to recover where they feel most comfortable: in their homes. Nurses visit patients to provide care to keep them at home, given that hospital readmissions cost the U.S. healthcare system more than $41 billion each year.
A new study finds that for people with limited ability to communicate in English, having the same home health nurse across visits significantly decreases hospital readmissions, regardless of whether the patient and nurse speak the same language. The findings, published in the journal Medical Care, can inform how home health agencies staff the care of patients with limited English proficiency by having the same provider throughout a patient’s care.
“While having both the continuity of the same nurse across multiple visits and a nurse who speaks the same language as the patient is ideal, enhancing continuity of care for those where there is language discordance between themselves and the healthcare provider may be helpful to address disparities and reduce hospital readmission rates,” says Allison Squires, PhD, RN, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author.
Improving Outcomes in Home Care
Research shows that home care patients who speak a language other than English are at a higher risk for readmission to the hospital. Language gaps between patients and healthcare providers contribute to disparities in health outcomes and may be particularly challenging in home healthcare. Home care agencies frequently rely on telephone interpretation services since many of their clients need the level of internet access required for video interpretation. Interpreter services are often only reimbursed by insurance if state law requires it.
“Home care agencies should aim to hire and retain nurses that speak the same languages as their patients, but realistically, there are not enough nurses to meet this demand,” says Squires.
A growing body of research shows that having the same provider—known as continuity of care—across multiple home care visits can improve health outcomes and may be a more viable staffing solution to prevent hospital readmissions.
Same Nurse or the Same Language?
To understand the impact of having a consistent provider or someone who speaks the same language on hospital readmissions, the researchers examined data from 22,103 patients receiving home care in New York City following a hospitalization. The patients spoke Spanish, Korean, Chinese, or Russian as their primary language.
The researchers found that having the same nurse across home care visits who spoke the same language as the patient had the best chance of reducing the risk of hospital readmissions. However, having the same nurse across home care visits, even if they didn’t speak the same language as the patient, was also linked to lower hospital readmissions. Having different nurses increased the risk of readmission with this population, but the risk varied by language.
“It is thought that the more often a nurse interacts with a patient, the more likely they are to get to know them and their family or caregivers, regardless of whether there is a language barrier,” says Squires.
What This Means for Home Healthcare Agencies
The researchers conclude that healthcare providers should maximize continuity of care after hospitalization—particularly when language barriers cannot be addressed directly through staffing.
“For providers referring patients to home healthcare services and coordinating these referrals, it may be worth considering an agency’s ability to support continuity of skilled nursing care to reduce the odds of hospital readmission,” says Squires. “Home healthcare organizations should assign providers with an eye towards ensuring that a patient’s preferred nurse can remain involved in their treatment throughout their care.”
Squires notes that being able to assign the same home health nurse across visits has its challenges, given the home care industry’s difficulty attracting and retaining providers and their heavy reliance on per-diem workers.
“Achieving continuity of care is only possible if a home care organization can recruit and retain nurses,” says Squires.
According to a new study, people giving birth report more positive experiences when cared for by midwives in both hospitals and community settings than physicians. Additionally, those receiving midwifery care at home or birth centers reported better experiences than those in hospital settings.
Physicians attend the majority of U.S. births (88%), while midwives attend 12% of births. Most births occur in the hospital, with less than 2% occurring in community settings, including homes and freestanding birth centers. Midwives attend most community births.
Measures of quality around maternity care often focus on clinical markers such as complications or rates of C-sections, leaving the lived experience of childbearing people unmeasured and neglected.
“In contrast to the standard obstetrical model, midwifery care is rooted in a philosophy that honors pregnancy and birth as a physiological, social and cultural process, not solely a clinical event,” write the authors, including lead author Mimi Niles, PhD, MPH, CNM, assistant professor at NYU Rory Meyers College of Nursing. “The care relationship between the client and the midwife serves as the primary vehicle through which values such as autonomy, respect, and informed decision-making are operationalized to preserve an overall satisfying experience of childbearing.”
To better understand people’s experiences during childbirth, the researchers examined 1,771 responses to the national Giving Voice to Mothers survey assessing four domains of the childbirth experience: communication and decision-making autonomy, respect, mistreatment, and time spent during visits. The researchers then analyzed differences between provider type and birth settings, breaking responses down into those cared for by a midwife at a community birth, a midwife at a hospital birth, and a physician at a hospital birth.
Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy and were five times more likely to report that their providers showed them high levels of respect. They also reported lower odds of mistreatment.
The researchers also found significant differences across birth settings: patients cared for by midwives at home or birth centers had significantly better experiences than those in the hospital settings across all four measures—autonomy, respect, mistreatment, and time spent. For instance, people cared for by midwives in the community were 14 times more likely to report having enough time in prenatal visits than those cared for by physicians, while people receiving midwifery care in hospital settings were nearly twice as likely to report having enough time during prenatal visits. Their findings generate more evidence that while the midwifery care model offers enhanced experiences of care, access to midwifery across all settings is needed to improve health outcomes for birthing people.
“Our findings add to evidence showing the model itself seems to be strongly influenced by the setting in which care is given—with community settings (home and freestanding birth centers) offering greater likelihood of support and the hospital settings being limited by the constraints of a medical approach to care which deprioritizes experiential outcomes,” Niles and her co-authors write.
NYU Rory Meyers School of Nursing has been expanding its offerings focused on LGBTQ+ health to better prepare nursing students to provide culturally affirming and inclusive care to this population.
“It is rare for nursing schools to offer coursework dedicated to the health and well-being of LGBTQ+ individuals, despite the unique issues they face and growing interest from students. Our goal is to empower new nurses to provide care for people across sexual orientations and gender expressions that promote health and improves patient outcomes,” said Jeff Day, DNP, AGPCNP-BC, clinical assistant professor at NYU Rory Meyers College of Nursing, who developed and is teaching a new elective course on LGBTQ+ health.
LGBTQ+ individuals face barriers to healthcare, including stigma and discrimination, as well as longstanding health disparities—for instance, an increased risk for substance use, suicide, and sexually transmitted infections. Nurses have historically been leaders in caring for this patient population, particularly in advocating for people living with HIV and AIDS, but many health
professionals lack an understanding of LGBTQ+ issues in healthcare.
Research shows that undergraduate nursing programs spend an average of only 2.12 hours teaching content about LGBTQ+ health topics. Some nursing schools have taken steps to add LGBTQ+ content to their curricula: At NYU Meyers, educators recently introduced an LGBTQ-focused simulation to prepare nursing students to create a safer healthcare environment for all
patients irrespective of their gender and sexual identity. The simulation demonstrates the use of inclusive language during an imagined emergency room visit.
In 2019, Day was approached by students in one of his courses who were eager to learn more about LGBTQ+ health, prompting the development of the new standalone elective. “While ideally LGBTQ+ content would be woven throughout the entire nursing curriculum, we recognized that this amount of change takes time, so we developed an elective course to help fill the gap in LGBTQ+ educational content” said Day.
The new undergraduate course delves into the role of the nurse in providing culturally inclusive care for LGBTQ+ patients. Students learn about the history of LGBTQ+ health issues, physical and mental health concerns unique to this population, and laws and policies governing LGBTQ+ care. Topics covered include improving the care of transgender patients, HIV/AIDS, and addressing discrimination in healthcare.
The course was successfully piloted at NYU Meyers in Spring 2022 and will officially be part of the curriculum as an elective in Fall 2022.
Nurses care for patients with asthma exacerbated by poor air quality and heat exhaustion during heat waves. They respond during natural disasters like hurricanes and flooding. Now, a growing number of nursing schools are incorporating an underlying driver of these health issues into their courses: climate change and the environment. Their goal is to prepare nurses to better care for patients and communities in a world with a changing climate.
At NYU Rory Meyers College of Nursing, faculty have developed content focused on climate change and the environment for several courses. In 2020, the college added a module on the clinical relevance of climate change in health care decision-making to the applied epidemiology course for Doctor of Nursing Practice (DNP) students, and the following year added modules on the environment for the health policy-focused course for PhD and DNP students.
Beginning this fall (2022), NYU Meyers will devote a brand-new course to climate and environmental health: The Environment and Health of Populations. The course is designed for graduate nursing students, but undergraduate students can enroll with permission from professors.
Historically, nurses may have learned about air quality and its effects on respiratory health, but haven’t necessarily been taught to care about dirt and water sources, which can become contaminated or carry pathogens, putting communities at risk. New coursework focused on climate might cover issues such as disaster preparedness, severe weather and health (for instance, protecting older adults during storm-related flooding or rising temperatures and infectious diseases) and sustainability in healthcare.
Robin Klar, DNSc, RN, a clinical associate professor at NYU Meyers who focuses on the environmental context for nurses in the U.S. and around the world, said that this growing interest in climate change demonstrates nursing education’s eye on the future—as healthcare evolves, so does how we train nurses. “Nursing is not static; it’s a dynamic profession,” said Klar.
NYU Meyers is one of 53 schools currently taking part in the Nurses Climate Challenge, a national campaign to mobilize nurses to educate 50,000 health professionals on the impacts of climate change on human health. Thus far, the movement has reached nearly 36,000 health professionals, including more than 15,000 nursing students.
Twelve med students and twelve BSN students from NYU Rory Meyers College of Nursing are learning how to work together in a groundbreaking interprofessional collaboration program.
The future nurses and physicians are doing their clinical rotations in tandem based on a new collaborative model for nursing education, with an emphasis on considering the environmental factors that influence a patient’s health.
“To my knowledge, there isn’t another structured interprofessional education program like this at other nursing schools.”
The program, which takes place at NYU Langone Hospital—Long Island, aims to develop effective working relationships between different types of healthcare students and practitioners to support health outcomes. Research shows that interprofessional healthcare has many benefits, not only improving patient care, but collaboration can lead to fewer preventable errors, reduced healthcare costs, and improved working relationships.
“To my knowledge, there isn’t another structured interprofessional education program like this at other nursing schools. Some schools do one-off interprofessional simulations or experiences, but our program at NYU Langone Hospital—Long Island is unique,” said Selena Gilles, associate dean of the undergraduate BS nursing program at NYU Meyers and a Long Island resident.
“The essence of what healthcare should be in the 21st century.”
Twelve nursing students were selected to participate in the program’s first cohort, which began in the fall of 2021. On their clinical days at NYU Langone Hospital—Long Island, each nursing student is paired with a medical student. The dyads are assigned to care for the same patients and work together to assess them, develop care plans, and attend rounds and “huddles” of interdisciplinary healthcare teams where their assessments and care plans are discussed.
“This program speaks to the importance of collaborative practice,” said Vincenza Coughlin, the director of professional nursing practice and education at NYU Langone Hospital—Long Island. “We each bring our unique and complementary knowledge and skills when working together in patient care.”
Notably, the students assess patients’ social determinants of health—the environmental conditions such as housing, education level, income, and access to healthy foods that can influence one’s health. This holistic view of people encourages students to think beyond a diagnosis, including how patients end up in the hospital, what hospital services could benefit them, and how to improve health after discharge, beyond the hospital setting.
“Nursing and medical students forming one team, and working toward the same goal of moving patients toward wellness, is really the essence of what healthcare should be in the 21st century,” said Alice Nash, system senior director of nursing professional development & clinical outcomes at NYU Langone Health.
The interprofessional education program, which will run for five years, is funded by a $7 million gift from Howard Meyers and his late wife Rory. The funds provide full-tuition scholarships plus room and board for the school year for the nursing students selected.
“Throughout the COVID-19 pandemic, healthcare professionals have pivoted to work in new ways as interdisciplinary teams, with nurses working closely alongside doctors, respiratory therapists, physical therapists, and others,” said Eileen Sullivan-Marx, dean of NYU Rory Meyers College of Nursing. “While interprofessional education has long been an interest of ours at NYU, teamwork has never been more important and we are thrilled that this interprofessional program is now underway preparing a new generation of nurses and physicians.”
Historically, nurses may have learned about air quality and its effects on respiratory health, but haven’t necessarily been taught to care about dirt and water sources, which can become contaminated or carry pathogens, putting communities at risk. New coursework focused on climate might cover issues such as disaster preparedness, severe weather and health (for instance, protecting older adults during storm-related flooding or rising temperatures and infectious diseases) and sustainability in healthcare.