Evidence-Based Practice Proposal: Analyzing the Impact of Technology on Health Disparities

Making decisions in nursing is critical. It is an art that depends on the results of research. Scientific research is the gold standard for obtaining information through science (Degu et al., 2022). Analyzing data provides the basis of current practice, whereas nursing practice, which includes a diagnosis and treatment, creates research questions. The gold standard for delivering care while promoting nursing excellence has been acclaimed as evidence-based practice (Degu et al., 2022). By combining clinical expertise and patient values and preferences into skilled patient care, EBP (Evidence-Based Practice) applies the highest-quality information from science in clinical decision-making. Furthermore, EBP also includes gathering the most accurate data available to make the best decisions. Nurses and nursing leaders should incorporate evidence-based practices to improve procedures and boost quality outcomes in healthcare.

(Roussel et al., 2022).

Identification of Nursing Concern

Digital technology is significantly impacting nursing worldwide. For example, Artificial Intelligence and robotic systems are on the rise, society is increasingly dependent on mobile devices, the internet and social media, and telehealth and virtual models are becoming increasingly important, especially in the wake of the covid pandemic (Booth et al., 2021). Many prevalent illnesses and clinical problems, including mental disorders, have shown racial and ethnic differences in diagnosis, treatment, and results (Saeed et al., 2021). Differences in treatment across racial, ethnic, or other demographic groups not directly due to variations in clinical requirements or patient preferences continue even after adjusting for socioeconomic factors are called disparities (Saeed et al., 2021). According to studies, most patients diagnosed with chronic diseases, such as diabetes and hypertension, can be managed with the assistance of technology (Saeed et al., 2021). Other concerns on health care utilization include the healthcare system, communication problems between doctors and patients, and the patient’s belief system. Health Information technology (HIT) can increase patient access, improve clinical outcomes, and raise the treatment standard (Saeed et al., 2021). A good illustration of these issues is the COVID-19 pandemic, which emphasizes how technology is essential to every aspect of the healthcare system. Telemedicine, remote monitoring, and work-from-home opportunities are a few examples of technology that has advanced the healthcare system.

On the other hand, several variables have a role in the technological gap. The use of technology in the healthcare system is a worldwide concern since these problems are widespread across all countries. The cost of technology, limited broadband connectivity, and poorer accessibility for people with disabilities contribute to a lack of access, understanding, and interest in technology. According to a 2018 FCC study, 92.3% of

Americans have access to broadband internet at rates of 25 Mbps or 3 Mbps as of the end of 2016 (Saeed et al., 2021). The FCC has determined that a speed of 25mbps/3mbps is required for advanced communications capabilities (Saeed et al., 2021). For effective use, greater speeds are needed in larger households and among those who use the internet more often. That suggests, at the very least, 24 million Americans did not have access to sufficient internet when the study was written for using services like video telemedicine. Rural areas, tribal territories, and regions with greater poverty levels were disproportionately impacted. Systems with self-evolving algorithms can unintentionally exacerbate societal imbalances (Booth et al., 2021).

PICOT Question

Using the PICOT question framework, analysis questions can be outlined to study the impact of technology on health disparities (Roussel et al., 2022).

Question structure (Roussel et al., 2022). The following corresponds to the question:

How do (P) Newly diagnosed autistic patients with diabetes (I) report their blood sugar levels (C) compared to teenagers in general (O) to the healthcare provider (T) within three months?

Theory

Dr. Jean Watson developed the Theory of Human Caring to transform nursing practice (Breneol et al., 2019). This concept, which is now referred to as Watson’s

Caring science places the art and science of care at the heart of nursing (Breneol et al., 2019). This approach encourages healthcare professionals to focus on the individual patient and their relational requirements. Fundamental ideas are crucial for understanding the acute care needs of technologically dependent patients and their families. Implementing fundamental ideas puts nurses in a position to lead change within an organization and encourages them to use all

their sources of knowledge to see beyond the immediate and specific needs.

Methodology

Literature search

There are certain keywords and inquiries, as well as sources, that should be identified before beginning an evidence-based search. According to the National Institute for Health and Care Excellence (NICE), “a combination of databases, websites, and other sources” should be used (Heath et al., 2022). The sources collected for this study are individual literature reviews that examine how technology affects underserved individuals in healthcare. The literature search consisted of various resources through scholarly journals and textbooks. The scholarly journals were obtained from Pub Med, the National Library of Medicine, and the National Institutes of Health databases. Key search terms included in this selection are Artificial intelligence, Intellectual disabilities, technology-assisted devices, health monitoring devices, and remote healthcare. The participants included in this proposal are those with intellectual disabilities and comorbidities, specifically diabetes. During this search, numerous studies examined the difficulties and intricacies of time, money, public perception, and ease of use of technology in healthcare. Even though the issue of technology in healthcare is expanding, especially considering COVID-19, more work must be done. More research defining care methods in various contexts is still needed (Heath et al., 2022).

Search Strategy:

1. Population (P):
   • “Newly diagnosed autistic patients with diabetes”
     • “Type 1 diabetes in autism”
     • “Autism spectrum disorder and comorbid diabetes”
   • “Teenagers without diabetes”
     • “Adolescents without diabetes”
     • “General teenage population”

2. Intervention (I):
   • “Technology in healthcare”
     • “Use of telehealth in diabetes management”
     • “Mobile health applications for diabetes”

3. Comparison (C):
   • “Comparison between autistic patients and teenagers without diabetes”
     • “Disparities in healthcare access for autistic individuals”

4. Outcome (O):
   • “Blood sugar level reporting”
     • “Effectiveness of technology in blood sugar monitoring”
     • “Patient-reported outcomes in diabetes management”
   • “Healthcare access”
     • “Barriers to healthcare access in autistic patients with diabetes”
     • “Impact of technology on healthcare equity”
   • “Health outcomes in autistic patients with diabetes”
     • “Long-term health outcomes in autistic individuals with diabetes”
     • “Quality of life in diabetic adolescents with autism”

5. Time (T):
   • “Within three months”

Search Terms:

• (“Type 1 diabetes in autism” OR “Autism spectrum disorder and comorbid diabetes”) AND (“Use of telehealth in diabetes management” OR “Mobile health applications for diabetes”) AND (“Disparities in healthcare access for autistic individuals”) AND (“Effectiveness of technology in blood sugar monitoring” OR “Patient-reported outcomes in diabetes management” OR “Barriers to healthcare access in autistic patients with diabetes” OR “Impact of technology on healthcare equity” OR “Long-term health outcomes in autistic individuals with diabetes” OR “Quality of life in diabetic adolescents with autism”) AND (“Within three months”)

Search Databases:

• PubMed
• CINAHL
• Scopus
• Google Scholar

Search Filters:

• English language publications
• Studies published between 2015 and 2023

Search Method:

• TITLE-ABS-KEY for Scopus
• Abstract Title for CINAHL
• All Text for Google Scholar

This detailed search strategy aims to capture a comprehensive range of studies exploring the impact of technology on various aspects of health outcomes in newly diagnosed autistic patients with diabetes within three months. The terms are expanded to include specific subtopics and considerations related to the PICOT question.

Research Support

These articles were chosen to examine the perspectives and experiences of patients with intellectual impairments, support workers, and medical professionals. Ten related articles were selected to examine how technology assists the underserved population in communicating with the medical community. Through questionnaires and observation, the data was gathered. The core strategy of this concept is preventive, which attempts to start early detection and maintenance of people with diabetes and disability. Like healthcare, technology is always evolving. According to Haleem et al. (2021), telemedicine is a health-related service provided with electronic information and communication technology. It is used for many things, such as telehealth, remote monitoring, rehabilitation, and private online patient assistance. The main ways that telehealth helps patients, according to Haleem et al. (2021), are by improving their access to healthcare, improving the quality and effectiveness of emergency services, speeding up diagnosis and treatment times, and lowering costs for both patients and physicians by streamlining clinical processes and lowering travel time to hospitals. While many refer to telemedicine as disruptive innovation, it is also seen as inventive technology (Haleem et al., 2021).

Technology still needs support systems and occasionally has gadget outages, even if medical improvements have made using it simpler. Additionally, there is a significant risk of stealing patient medical data, particularly when the patient accesses telemedicine via an unencrypted channel or a public network (Haleem et al., 2021). Technology can delay the administration of medication when a patient needs emergency treatment, mostly because a doctor cannot do laboratory testing or provide life-saving care from a distance. Different states have different regulations, so practitioners also need to make sure the telemedicine services they employ are legal and safe. Another source suggests that treating metabolic regulation is the most pertinent diabetes-related problem. To maintain adequate glucose control, type 1 diabetes requires extensive educational intervention and many follow-up visits (de Kreutzenberg, V., 2022).

Conversely, type 2 diabetes affects over 90% of all diabetic people and necessitates a considerable number of governmental resources, particularly to prevent chronic problems (de Kreutzenberg, V., 2022). A third study aimed to examine the effects of cognitive assistive technology (CAT) on the professional practice of support workers for persons with intellectual impairments living in a home environment. Interviews were conducted with eight of the participants, ranging from 25 to 48. According to Söderström et al. (2023), group interviews are a useful tool for examining the traits and dynamics of groups as significant formative factors in the formation of meaning and social practices. Despite most survey participants stating that implementation was favorable and beneficial, it also exposed certain obstacles.

Implementing an innovative technology like the electronic medical record requires tight collaboration, and certain conflicts, such as power dynamics, arise (Söderström et al., 2023).

As the healthcare business strives to integrate technology, privacy concerns are rising. According to Theodos et al. (2020), a serious gap exists between technological improvements, consumer informatics tools, and privacy rules due to a lack of updated, overarching legislation. Attempts were made through the legislature to recognize digital health data, but privacy remains an issue. For example, the 21st Century Cures Act was passed into legislation in 2016, signifying a significant effort in the pharmaceutical sector to modernize drug development and introduce novel paths and clinical trials (Theodos et al., 2020). Although this law addressed data interchange difficulties and stressed a patient’s right to access their information, it did not go far enough to update or reclassify patient privacy or further define the data protected by privacy regulations (Theodos et al., 2020). According to Saeed et al. (2021), socioeconomic determinants of health impact access to technology because of the expense of technology, limited internet connectivity, poor access for people with disabilities, and the usage of lower-performing devices (such as laptops or tablets). According to 2016 research, there has been a decrease in digital exclusion since 2011 (Saeed et al., 2021). However, the same study found that older people with more chronic diseases and mental health disabilities have greater rates of exclusion.

Research Design

The candidates chosen for this experimental assignment were preselected individuals such as autistic patients with diabetes, teenagers, and healthcare providers. A permission form and a conflict-of-interest form were given to each participant to sign. By doing this, the risks to patients and medical personnel are reduced. These study techniques ensured long-term, quantifiable, reliable results (Bohr et al., 2020). There are benefits and drawbacks to using this suggestion’s quasi-experimental methodology. This quasi-experimental approach has several limitations, such as not employing conventional patients or control group randomization for treatments.

Furthermore, people still need to make errors. However, there are also advantages, such as various design options. Additionally, this is the optimal approach when patients have ethical dynamics and cannot be randomly assigned.

Sampling

There is a small portion of the target audience used in this sample. A maximum of twenty individuals under 50 years old with autism, cerebral palsy, and schizophrenia diagnoses were selected. These people can follow directions and are high-functioning participants. Apart from analyzing the similarities between each person, consent and confidentiality documents were completed as part of this plan to safeguard everyone’s privacy. One initial problem identified was the low statistical power to identify any differences between the groups. A non-probability sampling choice is chosen. Non-probability sampling provides an efficient and affordable means of obtaining data. However, the sample’s ability to conclude hinges on how effectively the population is represented.

Data Collection and Analysis Plan

The data collection and analysis plan for the proposed intervention involves measuring specific variables, a data collection timeline, and applying statistical methods.

Variables to be Measured:

The primary variables to be measured include blood sugar levels and communication patterns. These variables are central to understanding the effectiveness of the intervention. Blood sugar levels are a quantitative health metric, while communication patterns provide insights into the interaction between patients and healthcare providers.

Data Collection Timeline:

The data collection will span three months, allowing for an adequate observation of changes in the measured variables over time. This timeframe is chosen to capture the technological intervention’s short-term and potential longer-term impacts. A three-month duration provides sufficient data points for analysis while accommodating the need for continuous monitoring.

Statistical Methods:

Descriptive Statistics for Quantitative Data:

Descriptive statistics, such as means, standard deviations, and frequency distributions, will be employed to summarize and describe the central tendencies of blood sugar levels. This analysis will provide a snapshot of the participant’s health status and how it evolves throughout the intervention. Descriptive statistics offer a clear and concise overview of the quantitative aspects of the study.

Thematic Analysis for Qualitative Data:

Thematic analysis will be employed for the qualitative data related to communication patterns. This method involves identifying, analyzing, and reporting patterns within the data. Patient feedback surveys and reported health issues will be qualitatively analyzed to extract common themes. This qualitative aspect complements the quantitative data, providing a richer understanding of the impact on communication dynamics.

Combining descriptive and inferential statistics for quantitative data and thematic analysis for qualitative data ensures a comprehensive approach to evaluating the intervention’s outcomes. This mixed-methods approach allows for a nuanced understanding of technological intervention’s multifaceted effects on health metrics and communication patterns. The statistical methods employed aim to provide robust insights into the effectiveness of the proposed intervention. They contribute to the evidence base supporting technology integration in healthcare settings, particularly concerning individuals with intellectual disabilities and diabetes. The data collection and analysis plan aligns with best practices in research methodology, emphasizing both quantitative rigor and qualitative depth.

Proposed Implementation

During the implementation phase, the support staff members need to collaborate closely with one another. To engage personnel, mutual understanding, and education are essential. It can be quite challenging to do this, however. Four factors might be contributing factors to problems with implementation. These include the amount of time, education, population exposure to technology, and the notion of purposeful technology usage.

This strategy includes examining people’s social practices and seeing how they explain them, as well as their experiences and presumptions (Söderström et al., 2023). Health executives focus on a specific technology’s efficacy while deploying innovative technology and maintaining open communication with end users, such as practitioners and patients (Liu et al., 2022).

It is important to take cultures and customs into account. It is particularly true when the implementation impacts a rural service area or a home-based service environment, like a municipality, where resources are scarce and efficient usage is required (Söderström et al., 2023).

Since quality standards are always changing, moving swiftly and prioritizing the elements that will have the biggest impact on an evidence-based proposal is critical. A healthcare organization may face several difficulties, but as the need for high-quality patient care rises, it is critical to uphold the standards of delivering treatment that is safe, effective, timely, equitable, and efficient (Abuzied et al., 2023). To improve processes and quality, the healthcare industry created a popular approach called Focus-PDSA (Abuzied et al., 2023). Combined with the multidisciplinary team, this approach is appropriate for underserved patients with telemedicine (de Kreutzenberg, 2022). For the nursing profession to advance in the development of digital technology, a basic grasp of the current systems is required. The next step for the nurse leader is to help and motivate other nurses to master the instruments and equipment available. Clinical settings with mobile assistance, electronic health records, and clinical decision support tools would be a suitable place to start. Subsequently, every unit should designate a nurse liaison to instruct staff members on the principles of healthcare technology and its advantages in promoting high-quality patient outcomes. The method must be assessed six weeks after it is implemented. Feedback from patients and staff, both good and bad, should be included in the review.

Implications for Practice

The successful implementation of the proposed intervention holds the potential to significantly impact health disparities, particularly in the realm of reducing barriers for individuals with intellectual disabilities. The implications for practice are multifaceted, focusing on enhanced access to care, equitable healthcare delivery, improved health outcomes, and specific recommendations for healthcare providers. One of the primary implications is the promise of enhanced access to care. Improved communication and reporting mechanisms facilitated by technology can act as a bridge across existing gaps in healthcare access, especially for individuals with intellectual disabilities. The proposed intervention seeks to empower patients by streamlining communication channels, ensuring they can readily engage with healthcare providers and actively manage their health. Equitable healthcare delivery is another critical outcome. The tailored use of technology ensures that patients from underserved populations, such as those with intellectual disabilities, receive care that considers their unique needs. This approach strives to move beyond a one-size-fits-all model, acknowledging the diverse requirements of patients and promoting equity in healthcare services. It aligns with the broader healthcare goal of providing personalized and inclusive care to every individual, regardless of their background or abilities. The study aims to improve health outcomes by addressing disparities in reporting and communication. For individuals with diabetes, timely and accurate reporting of health metrics, such as blood sugar levels, is crucial for effective management. By leveraging technology to enhance reporting mechanisms, the proposed intervention seeks to prevent diabetes-associated complications. This preventive approach aligns with the broader paradigm shift in healthcare, emphasizing proactive and patient-centered care to enhance overall health outcomes.

Healthcare providers are encouraged to adopt specific practices in light of the anticipated outcomes. Embracing telehealth and remote monitoring is recommended to integrate technology into routine care practices. Leveraging telehealth solutions and remote monitoring tools can enhance patient engagement and healthcare delivery, particularly for those facing challenges accessing traditional healthcare settings. Furthermore, fostering a patient-centered technological approach is paramount. Providers should prioritize patient-centered design in the development and implementation of technology solutions. This involves considering diverse patient populations to ensure inclusivity and accessibility. By incorporating user-friendly interfaces and accommodating the unique needs of individuals with intellectual disabilities, healthcare providers can maximize the effectiveness of technological interventions.

Expected Outcome

The proposed evidence-based practice intervention focuses on two key aspects: improving blood sugar level reporting among autistic diabetic patients and enhancing communication with healthcare providers. In addressing the challenges of consistent and accurate reporting of blood sugar levels among autistic patients, the intervention relies on technology-mediated reporting systems. The rationale behind this approach is to overcome communication barriers and enhance engagement. By tailoring interfaces to meet the specific needs of this population, the study aims to improve the overall experience of reporting blood sugar levels.

Quantitative data collection methods are employed to assess the intervention’s impact rigorously. Metrics include self-reported blood sugar levels, frequency of reporting, and system usability assessments. These measures provide objective and subjective insights into the effectiveness of technology-driven reporting tools. Comparative analysis before and after the intervention allows for a robust evaluation of changes over time. The hypothesis predicts a statistically significant increase in the regularity and accuracy of blood sugar level reporting among the targeted population. The anticipated outcomes go beyond statistical changes; they envision a transformation in how autistic patients with diabetes engage with and utilize technology for health reporting, contributing to better-informed healthcare decisions and improved long-term health outcomes.

The hypothesis on enhanced communication to healthcare providers aims to address disparities in healthcare access. Integrating telehealth platforms and improved communication channels seeks to create a more inclusive and patient-centric healthcare environment. Timely reporting health concerns, medication adherence, and overall well-being is crucial for reducing disparities and enhancing the overall quality of care. The study employs qualitative and quantitative data collection methods to assess the impact on communication comprehensively. Patient feedback surveys provide qualitative insights into the patient experience, while quantitative data includes the frequency of communication with healthcare providers and the analysis of reported health issues. This multifaceted approach ensures a nuanced understanding of the intervention’s effects. The hypothesis anticipates a notable increase in patient-initiated communication with healthcare providers. This expected outcome aligns with the broader goal of fostering proactive management of health issues. The study aims to improve patient satisfaction and overall healthcare experiences by reducing disparities in healthcare access. The emphasis on patient-initiated communication reflects a shift towards patient empowerment and participation in healthcare decision-making.

The expected results section outlines clear hypotheses, grounded rationales, robust methods of measurement, and detailed anticipated outcomes. Through a meticulous combination of quantitative and qualitative assessments, the study aims to provide meaningful insights into leveraging technology to address health disparities among autistic patients with diabetes.

Conclusion

This study presents a strategic use of technology aimed at minimizing health disparities through reporting the blood sugar levels of diabetic patients with autism. The summation of the proposal, the reason why it is vital, and possible avenues for future consideration in the research are discussed in this section. The main emphasis of the proposal relates mainly to using technology to enhance the reporting of blood sugar levels, a crucial aspect of diabetes control in the population with autism. This study intends to improve adherence and user-friendliness using specialized interfaces designed for artists. These projected results are specified in the expected results section and hypothesize improvement in the frequency and accuracy of recording blood glucose in the target population. It is important because it aims to improve nursing excellence by promoting patient-centered care. This research meets modern demands concerning the changing and developing healthcare environment, where technology is a major player. This approach uses evidence-based and emerging technology to transform patient outcomes and quality improvement. The proposed intervention addresses health disparities. The research acknowledges specific populations like autistic people who may experience additional difficulties regarding health care access and communication. Research targets this particular group, providing an avenue for reducing disparities and making the healthcare environment more inclusive.

The envisaged intervention is a gateway to further studies and discoveries. Monitoring, evaluating, and constantly improving ensure an intervention has a lasting influence. In the future, it would be important to consider the scalability of similar technology interventions to different patient populations and healthcare settings. This would greatly enhance the evidence-based nursing practices about the generalizability and efficacy of such interventions in different situations. In addition, one can consider the long-term effects of such technologies on health outcomes and patient satisfaction and how such interventions affect the healthcare disparity. Such longitudinal studies about patient’s involvement with technology and its implications on the overall health journey may offer great insights into the long-lasting effects of such interventions.

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