Publication Date
Winter 3-11-2026
Document Type
Instructional Material
Executive Summary
Optimizing Healthcare Utilization: Distinguishing Between Emergency and Urgent Care
Over the past two months, our group of six nursing students worked with a local transitional housing program for families. Per the facility report, a large portion of the program’s current residents are immigrants and have had little to no exposure to the American healthcare system and their options for care. The issue we targeted for our project is the increased number of 911 calls and emergency room (ER) visits for non-emergent healthcare concerns by our target population. By creating education materials on self-triaging, ER vs. Urgent Care services, and how to access these resources and schedule appointments, we aim to increase the health literacy of our residents so they can manage their care more efficiently.
Background
Shoreline, Washington is home to many recent immigrants to the United States (US). This population specifically faces unique challenges when accessing healthcare. Although eligible for federally funded healthcare, there is still confusion, fear, and a language barrier, making participation difficult (Alarcon, 2022). In addition, this population is a part of a transitional housing program. The process of finding work and a home adds an additional barrier related to a lack of resources and increased stress (Chapman, 2024). We examined social determinants of health for this group through online research, a windshield survey, and a focus group meeting. We determined that addressing a knowledge deficit about when to go to an ER or urgent care was a top priority.
Activities with Rationale
As we began planning our intervention, we met with staff members to identify the prominent languages spoken by our target population. We found that Tigrinya is currently the most spoken language, along with English and French. In addition, we met with a group of Tigrinya-speaking residents to assess their current understanding of the U.S. healthcare system and beliefs about the use of emergency medical services. Following this, we planned to create three tools to provide the residents with education that will guide their medical emergency decision-making. We kept in mind that using a resident's native language, reviewing scientific literature, beginning with a qualitative assessment phase identifying residents' beliefs, and incorporating input from members of the same culture are the most effective methods for improving health literacy among immigrant populations (Fernández‐Gutiérrez et al., 2018). Therefore, we developed all three handouts in each of the most common languages and relied on bilingual individuals to support translation. Upon review with the Tigrinya translators, we found that the population was well-versed in medical terminology in their native language and that medical terms translated best. Due to this, we decided to use clear, simplified, and accurate medical language in our handouts.
The first handout operates as a self-triage tool by describing signs and symptoms of different medical conditions that warrant either an ER or urgent care visit, according to Frisbee Memorial Hospital (2024) and Seattle Children’s (n.d.). The second handout gives detailed explanations of what services are available at both urgent care and the ER, identifying their differences. The final handout demonstrates how to schedule a telehealth urgent care appointment at various nearby clinics and how to call the 24/7 nurse line on the back of insurance cards. We understood that the transitional housing facility’s demographics might change over time, so we designed our documents in a format that can be easily edited and translated into whichever language becomes necessary in the future. Each of the handouts will be laminated and attached with a binder ring. The facility also agreed to purchase reusable oral- axillary thermometers for each apartment, which allows the residents to check temperatures and use them to make medical decisions alongside the information provided in our education materials. These materials will be provided to all current and new residents to be kept in their apartments and taken with them after moving to permanent housing.
Outcomes and Evaluation
To evaluate the effectiveness of our tools, we met with the residents at the facility and handed out our materials to them in a small conference setting. They were given time to review the materials themselves first, and then we provided in-depth explanations of the flyers. After presenting, we left 15 minutes for questions, and they presented with none initially. We then asked them questions to gauge their understanding of the materials we presented.
To assess their understanding, we asked questions such as “Do you feel your understanding of urgent care has increased after reviewing materials?” and incorporated a teach-back method. The teach-back method is a way to confirm that what was explained is what they need to know in a manner that they understand (Indian Health Service, n.d.). The residents reported that their understanding of urgent care had increased after reviewing our materials and stated that it was easy to read through. When asked to describe the differences between urgent care and the ER, they said the ER is more expensive and time-consuming, especially for serious illnesses, while urgent care is less time-consuming and more affordable. This aligned with the information provided on our handouts.
Limitations we encountered during our project included language barriers and the assessment method used in the second focus group to confirm understanding of the tools. During the second focused group, we had the residents verbalize whether their understanding increased or not, and to summarize what the main differences were between Urgent Care and ER. Although the teachback method is a valuable way to assess understanding, the fact that it was used in the group setting decreased its validity since only some residents spoke up, with others in the group just agreeing. Moving forward, we recommend using a survey/questionnaire to be filled out by individual residents to get a more accurate consensus of understanding and effectiveness of the tools. We will also be unable to personally assess effectiveness going forward, which is another limitation, but we urge the agency to reassess effectiveness and adapt to the needs of residents and the agency by making changes to the editable documents we provided.
Conclusion
Over the past two months, we implemented an educational project focused on self-triage, understanding the differences between urgent care and the ER, and learning how to access reliable healthcare resources and schedule appointments. Through preparing materials, facilitating discussion, and guiding residents step-by-step through online navigation, we developed stronger communication skills and learned how to adjust our teaching approaches based on individuals' questions and needs.
This experience allowed us to practice leadership in practical ways by taking initiative, dividing responsibilities as a team, supporting one another, and remaining flexible when challenges arose. We learned that leadership is demonstrated through preparation, accountability, and the ability to guide others with clarity and confidence. Engaging directly with community members strengthened our ability to listen actively and respond thoughtfully, which are essential components of nursing leadership. Overall, this project expanded our understanding of how leadership functions within community health education and reinforced our role in helping individuals feel more confident navigating the healthcare system.
References
Alarcon, F. J. (2022). The migrant crisis and access to health care. Delaware Journal of Public Health, 8(4), 20–25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9621574/#:~:text=Chronic%20conditions%20like%20diabetes%2C%20high
Chapman, M. (2024, May 28). Exploring the link between housing stability and mental health. National League of Cities. https://www.nlc.org/article/2024/05/28/exploring-the-link-between-housing-stability-and-mental-health/
Fernández‐Gutiérrez, M., Bas‐Sarmiento, P., Albar‐Marín, M. J., Paloma‐Castro, O., & Romero‐Sánchez, J. M. (2018). Health literacy interventions for immigrant populations: A systematic review. International Nursing Review, 65(1), 54–64. https://doi.org/10.1111/inr.12373
Frisbie Memorial Hospital. (2024). 12 symptoms that warrant an emergency room visit. Frisbie Memorial Hospital. https://frisbiehospital.com/blog/entry/12-symptoms-that-warrant-an-emergency-room-visit
Seattle Children’s Hospital. (n.d.). All symptoms (A to Z). Seattle Children’s Hospital. https://www.seattlechildrens.org/conditions/symptom-index/ Indian Health Service. (n.d.). Teach-back. United States Department of Health and Human Services. https://www.ihs.gov/healthcommunications/health-literacy/teach-back/
Recommended Citation
Calkins, Madilyn; Dupar, Molly; Gherie, Wintana; Janczak, Marcin; Lee, Angela; and Zhang, Lena, "Optimizing Healthcare Utilization: Distinguishing Between Emergency and Urgent Care" (2026). Nursing Leadership in Community Engagement Projects. 67.
https://digitalcommons.spu.edu/shs_nlce/67
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