Edit for Clinical Change Project
1 Clinical Change Project: Pain Management in Senior Rheumatoid Arthritis Patients Name Instituation Course Instructor Date 2 Table of Contents Introduction and Background ……………………………………………………………………………………………………. 4 a) Introduction ……………………………………………………………………………………………………………………. 4 b) Background…………………………………………………………………………………………………………………….. 5 Origin and History ……………………………………………………………………………………………………………….. 5 Prevalence …………………………………………………………………………………………………………………………… 5 Incidence …………………………………………………………………………………………………………………………….. 6 Chronic Pain in Elderly RA Patients ……………………………………………………………………………………….. 6 Traditional Pain Management Approaches for RA ……………………………………………………………………. 7 Benefits of Physical Activity………………………………………………………………………………………………….. 7 Barriers to Physical Activity in Elderly RA Patients …………………………………………………………………. 8 Alternative Physical Activity Interventions ……………………………………………………………………………… 8 Problem Identification and Description in PICOT Format ………………………………………………………….. 9 a) Problem Statement ……………………………………………………………………………………………………………. 9 b) PICOT Description of the Problem Statement …………………………………………………………………….. 10 c) Significance and Scope of the Alternative Physical Activity Approach ………………………………….. 11 d) Implementation and Evaluation in a Clinical Setting …………………………………………………………… 12 Critical Appraisal/Literature Review………………………………………………………………………………………… 13 a) Overview ……………………………………………………………………………………………………………………….. 13 b) What We Know and How Well We Know It ……………………………………………………………………….. 13 c) What We Do Not Know …………………………………………………………………………………………………… 15 d) Implications for Advanced Practice Nursing in Pain Management ……………………………………………. 16 Interventions Tailored to Patient Needs …………………………………………………………………………………. 16 Including Non-Pharmaceutical Methods ……………………………………………………………………………….. 17 Dealing with General Well-Being and Mental Health ……………………………………………………………… 17 Project Aims, Values, and Desired Outcomes …………………………………………………………………………….. 19 a) Overview ……………………………………………………………………………………………………………………….. 19 b) Goals and Objectives of the Project …………………………………………………………………………………… 19 c) Variables………………………………………………………………………………………………………………………… 20 d) Contribution to the Community ………………………………………………………………………………………… 21 e) Desired Outcomes …………………………………………………………………………………………………………… 22 Theoretical Framework ……………………………………………………………………………………………………………. 22 a) Overview ……………………………………………………………………………………………………………………….. 22 3 b) Theories used …………………………………………………………………………………………………………………. 23 c) Framework guiding the study …………………………………………………………………………………………… 23 d) Key components of the framework ……………………………………………………………………………………. 24 e) Applying elements of the theory to aspects of the phenomenon under study …………………………… 25 f) Rationale for the sample selection criteria ………………………………………………………………………….. 25 Intervention …………………………………………………………………………………………………………………………….. 26 a) Solutions Or Interventions ……………………………………………………………………………………………….. 26 b) Other Views on The Problem and Solutions ……………………………………………………………………….. 27 c) The APRN’s Role in The Intervention ……………………………………………………………………………….. 29 d) Implications for Clinical Practice ……………………………………………………………………………………… 30 e) The Implications of the Change Project ……………………………………………………………………………… 31 Recommendations and Conclusion……………………………………………………………………………………………. 32 a) Recommendations and Implications for Clinical Practice …………………………………………………….. 32 b) Summary of Study and Discussion of Limitations ………………………………………………………………. 33 c) Directions for Future Research …………………………………………………………………………………………. 34 d) Changes in Theoretical Constructs…………………………………………………………………………………….. 35 e) Suggestions for Public Policy and/or Changes in Practice ……………………………………………………. 36 f) Tie the Theoretical Framework to the Overall Product …………………………………………………………. 36 g) Conclusion …………………………………………………………………………………………………………………….. 37 References ……………………………………………………………………………………………………………………………….. 39 4 Introduction and Background a) Introduction Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by persistent inflammation and progressive destruction of the joints, affecting over 1% of the global population. Women are disproportionately impacted, with a 3:1 female-to-male ratio. In addition, RA incidence rises sharply after the age of 55, posing significant challenges for geriatric healthcare. The pathological hallmarks of RA include proliferative synovitis, cartilage damage, bone erosions, and subsequent joint deformities, leading to severe impairment in physical function and mobility. Patients typically present with symmetric polyarthritis, most commonly affecting the small joints of the hands and feet. Other extra-articular manifestations are also common. The management of RA involves controlling active inflammation to achieve clinical remission and prevent irreversible joint damage. Conventional treatment relies heavily on disease-modifying anti-rheumatic drugs (DMARDs) and biological agents to modulate the aberrant immune pathways underlying RA pathogenesis. However, elderly RA patients often have multiple comorbidities and altered pharmacokinetics that limit pharmacological options and predispose them to adverse effects. Furthermore, medications alone frequently fail to address the complex, multifaceted symptoms of RA beyond pain and inflammation. This necessitates a more comprehensive, patient-centered approach to care. The current study aims to determine whether tai chi could be a complementary method for managing pain in elderly individuals with rheumatoid arthritis. Tai chi is a slow-moving Chinese martial art transformed into meditative exercise, which may have physical and psychological advantages for older adults living with RA. As such, the research will evaluate how joining a 12-week tai chi class would affect outcomes such as pain levels experienced by these patients and limited mobility among others in this population group. The main target here is to identify alternative methods of reducing non- 5 pharmacologic pain that are more patient-oriented and holistic compared to the usual pharmacological modalities used in palliative care settings. b) Background Origin and History Rheumatoid arthritis is a chronic illness with a systemic autoimmune nature that leads to inflammatory arthritis and autoantibody production. This incurable condition causes joint damage, disability, reduced quality of life, and comorbidities and is associated with significant societal economic burden. However, descriptions resembling RA in ancient times, the modern understanding began in the late 19th century (Deane & Holers, 2019). In 1859, Dr. Alfred Baring Garrod coined the term “rheumatoid arthritis,” recognizing it as a distinct condition from other forms of arthritis. Before this, RA was considered a variant of gout or rheumatism. In the early 1900s, RA was identified as an autoimmune disease with the discovery of rheumatoid factor autoantibodies (Deane & Holers, 2019). Over the past several decades, the development of disease-modifying medications and biologics has dramatically improved RA outcomes. However, a cure remains elusive, and optimal treatment remains an area of active research. Prevalence RA affects approximately 0.5-1% of the global adult population, with recent studies estimating a prevalence of 0.7% worldwide (Almutairi et al., 2020). It impacts all ethnicities, though some variations have been noted. The prevalence is lower in East Asians and Black Africans (0.2-0.7%) compared to Caucasians (0.5-1.1%) and higher in specific indigenous populations like Native Americans (Malaviya et al., 2022). The prevalence in the US is estimated to be 0.6% (Almutairi et al., 2020). RA is uncommon in children but increases in frequency with age, peaking between the ages of 55-80. By age 55, the prevalence rises to over 2% in women 6 and over 1% in men. The age-related increase in RA highlights the particular burden of this disease on the elderly. Incidence The annual incidence of RA worldwide is approximately 0.02-0.05%, corresponding to 20-50 new cases per 100,000 people (Arima et al., 2022). As with prevalence, the incidence increases sharply with age, from 2-4 cases per 100,000 people under age 35 to 30-60 cases per 100,000 people over 65. Peak incidence occurs in the seventh decade of life in both genders but is 2-3 times higher in women overall (Arima et al., 2022). The lifetime risk of developing RA is approximately 3% in women and 1% in men, reflecting the striking female predominance of this autoimmune condition. The rising incidence after middle age indicates that RA disproportionately impacts the elderly. Chronic Pain in Elderly RA Patients Chronic pain in elderly rheumatoid arthritis (RA) patients poses significant management challenges. Age-related physiological changes alter pain perception, while comorbidities like osteoarthritis and neuropathy exacerbate pain sensitivity—cognitive impairment, depression, and social isolation among the elderly further compound effective pain management. Concerns over polypharmacy and medication side effects in older patients also restrict pharmacological options for pain relief. Untreated chronic pain has severe physical and psychological consequences for elderly RA patients. Persistent pain leads to avoidant behaviors, deconditioning, muscle atrophy, and irreversible joint damage. It disrupts sleep and appetite, compounding pain severity. Psychologically, uncontrolled pain causes mood disorders, hopelessness, social withdrawal, and reduced quality of life. Cognitively, it impairs concentration, memory, and decision-making 7 while increasing suicide risk. The multidimensional impacts highlight the vital need for holistic, multimodal pain management strategies tailored for elderly RA patients. Traditional Pain Management Approaches for RA Conventional medical treatment for RA focuses heavily on pharmaceutical interventions. First-line medications include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and DMARDs to reduce inflammation and slow disease progression (Akram et al., 2021). Opioids and adjuvant analgesics may also be used to alleviate pain. Physical therapy helps maintain muscle strength and joint mobility. However, elderly patients are susceptible to drug interactions and side effects due to pharmacokinetic changes with aging and polypharmacy. NSAIDs can exacerbate hypertension, renal dysfunction, and ulcers, while glucocorticoids increase infection risk and bone loss. Opioids have risks of constipation, nausea, fractures, and addiction. These limitations of pharmacological pain management highlight the need for complementary approaches. Benefits of Physical Activity Physical activity has well-established benefits for arthritis and general health. Exercise helps preserve muscle mass and joint flexibility, maintains cardiorespiratory fitness, and promotes weight management for optimal joint loading in RA. A Cochrane review found moderate-quality evidence that land-based exercise reduces pain and improves physical function for RA patients with minimal risk (Akram et al., 2021). Aquatic exercise also demonstrates efficacy. Beyond physical effects, exercise enhances quality of life, mood, and sleep. It facilitates continued independence via improved mobility and daily functioning. However, exercise programs must be individualized, as excessive physical activity may exacerbate joint 8 inflammation and damage. Physical activity is an essential non-pharmacological pain management strategy with widespread benefits. Barriers to Physical Activity in Elderly RA Patients While physical activity benefits RA, elderly patients face barriers that discourage exercise: joint pain, swelling, deformities, and reduced range of motion present obstacles to many physical activities. Older patients are more prone to injury and slow recovery. Low-impact exercises may be perceived as inadequate. Severe fatigue also hampers participation in RA, plus comorbidities like obesity, heart disease, and osteoporosis limit exercise tolerance. Elderly patients lack adequate motivation from the negative attitude of stopping them from being active, including fear of symptom exacerbation or joint damage. Also hampering are depression as well as low self-efficacy. Old folk also need guidance on appropriate adjustments that can be made when they engage in exercises. Consequently, addressing these physical and psychological barriers through education, social support, and individually adapted programming has become crucial for promoting physical activity among older adults. Alternative Physical Activity Interventions Several other physical activities are being discovered as potential interventions for elderly RA patients. Additional interventions may include low-impact aerobic exercises such as walking, cycling, and water aerobics to help maintain cardiorespiratory fitness and reduce joint strain (Radu & Bungau, 2021). Other mind-body practices like yoga and tai chi employ controlled movements, breathing, and meditation, which can help increase flexibility, balance, and relaxation in the affected patients. Again, stretching helps maintain joint flexibility and decrease stiffness. On the other hand, strengthening exercises with resistance bands or body weights prevent muscle wasting and instability (Radu & Bungau, 2021). Equally important is aquatic 9 therapy, which employs the buoyancy of water to enhance mobility besides the warmth it provides. Concerning disease activity, comorbidities, and physical capacity, careful activity selection and intensity are needed. This may often necessitate supervision or training to obtain optimal effects without causing harm when engaging in these alternative activities. Problem Identification and Description in PICOT Format a) Problem Statement Rheumatoid arthritis (RA) is a persistent autoimmune disorder, predominantly manifesting as joint pain and inflammation. Recent data from the World Health Organization (2023) suggests that this condition impacts around 18 million individuals globally. A significant observation is the higher prevalence of RA among the female demographic; studies indicate that over 55% of those affected are women, with a striking 70% incidence rate in females. This ailment exhibits an increased frequency and severity in older age groups, posing a substantial challenge in senior healthcare. Clinically, RA is characterized by enduring joint discomfort, rigidity, and edema, notably affecting the hands, wrists, and feet. If left unaddressed, RA may lead to severe joint degradation and complications involving cardiac, pulmonary, and neurological systems. One of the biggest challenges in treating pain in elderly RA patients is managing pain. Conventional pain management techniques, which mainly involve pharmaceutical interventions, can have adverse side effects, especially in elderly patients, and frequently fail to address the entire range of RA symptoms. Furthermore, RA is a systemic condition that affects many bodily systems, necessitating a more comprehensive approach to pain management than what medication alone can offer. The shortcomings of traditional therapies draw attention to the need 10 for complementary strategies that can reduce discomfort, strengthen joints, and improve the patient’s overall quality of life. The use of alternate kinds of exercises, such as Tai Chi as a pain management technique for senior RA patients, is examined in this research. Non-pharmacological therapies are becoming increasingly important due to the chronic nature of RA and its tendency to interfere with day-to-day functioning. A more all-encompassing strategy for RA pain management is promised by alternative physical activities that are catered to the requirements and limits of senior citizens. They can reduce pain, increase joint mobility, improve physical fitness, and benefit mental health, all of which are critical for older RA patients’ overall wellbeing. b) PICOT Description of the Problem Statement A simplified PICOT description of the elucidated problem is as follows: P – Population: Elderly patients diagnosed with rheumatoid arthritis I – Intervention: Alternative physical activity (e.g., yoga, tai chi, aquatic therapy) C – Comparison: Conventional pharmaceutical pain management O – Outcome: Reduced pain and discomfort, improved joint mobility and strength, enhanced quality of life T – Time: Over 12 weeks Description Among elderly patients over the age of 65 diagnosed with rheumatoid arthritis (P), does the introduction of alternative physical activities such as yoga, tai chi, or aquatic therapy (I) compared to conventional pharmaceutical pain management (C) improve outcomes such as reduced pain and discomfort, increased joint mobility and strength, and enhanced quality of life (O) over 12 weeks (T)? Rheumatoid arthritis is a persistent autoimmune disease characterized by 11 chronic joint inflammation and pain, affecting over 18 million individuals globally. The condition disproportionately impacts women and the elderly, with over 55% of cases occurring in women and increased severity seen in older populations. Conventional treatment relies heavily on pharmaceuticals to manage pain and inflammation. Still, these interventions can have adverse side effects in the elderly and fail to address the multifaceted symptoms of rheumatoid arthritis. Complementary techniques like yoga, tai chi, and aquatic therapy may provide additional benefits beyond pain relief, including improved joint function, strength, balance, and mental well-being. Evaluating the efficacy of alternative physical activities compared to standard drugbased pain management over 12 weeks among elderly rheumatoid arthritis patients may provide insight into more holistic, patient-centered approaches to care. c) Significance and Scope of the Alternative Physical Activity Approach When relieving the discomfort of rheumatoid arthritis, the value of adding new forms of physical activity cannot be overstated. The CDC reports that doing easy physical activities on the joints can help with arthritis symptoms like pain, mobility, and mental health (CDC, 2022). Lowimpact exercises are preferable since they lessen the chance of injury and include walking, biking, swimming, and water aerobics. Adults with arthritis should get at least 150 minutes of moderate-intensity exercise per week or 75 minutes of vigorous-intensity exercise. Along with relieving pain, these exercises can be used to manage other chronic illnesses, such as diabetes and heart disease (CDC, 2022). Tai Chi, a well-recognized ancient Chinese martial art, is regarded as an excellent alternative therapy for arthritis. Tai chi has been demonstrated to help reduce pain and increase function for people with RA, according to a study by Mudano et al. (2019). It should be noted, however, that the data quality varies widely, and the long-term implications still need to be 12 determined. The target population for this approach would be elderly individuals suffering from RA, predominantly women, given the higher prevalence of RA in this demographic. This population will likely benefit from low-impact, gentle forms of physical activity tailored to their needs and limitations. Current practices in RA pain management often rely heavily on pharmacological treatments, which may need to be revised or suitable for all patients, especially older people. For instance, Smolen et al. (2019) state that the primary emphasis of the EULAR recommendations remains pharmaceutical therapy using DMARDs. There needs to be more integration of nonpharmacological approaches like physical activities into standard treatment plans. Furthermore, there is a need for more high-quality, extensive research to understand better the effectiveness of alternative exercises like Tai Chi in managing RA pain. d) Implementation and Evaluation in a Clinical Setting In a community health center focusing on elderly care, particularly for those with rheumatoid arthritis, a novel intervention incorporating joint-friendly physical activities is proposed. This center, already equipped for physical therapy and exercise, caters to a substantial elderly population facing challenges with RA-related pain and mobility. The intervention would introduce activities like walking groups, water aerobics, and Tai Chi classes, all tailored to be low-impact to minimize joint stress while promoting mobility and pain relief. Additionally, the program would include flexibility and strength-training exercises to improve overall joint function and physical health. Patient education will be a top priority in implementing this strategy, focusing on the benefits of exercise for RA management and how to incorporate these activities into daily life. Experts in the medical field, such as physiotherapists and exercise specialists, will be educated to ensure the 13 safety of senior RA patients participating in these programs. Space, tools, and instructional materials will be allocated, perhaps in conjunction with neighborhood gyms and other community groups. The curriculum will be flexible enough to accommodate participants with varied mobility and pain tolerance degrees. There are several ways that this intervention’s efficacy can be measured. Patient feedback will be collected via surveys and interviews to assess satisfaction and perceived improvements in pain and mobility. Standardized instruments will measure pain clinically before, during, and after the procedure. Participation and attendance rates can be monitored to gauge how well a program is being followed. Joint mobility and function will be assessed regularly to observe any changes in health. This holistic approach attempts to reduce RA symptoms and boost the overall quality of life for elderly patients. Critical Appraisal/Literature Review a) Overview Older people with rheumatoid arthritis (RA) face significant challenges that necessitate complex pain management strategies (Smolen et al., 2020). Even though they are essential, traditional pharmaceutical interventions have drawbacks like side effects and insufficient symptom coverage, which has led to a paradigm shift in favor of investigating alternative physical activities. The current literature synthesis evaluates the scientific validity of nonpharmacological pain relief strategies for older RA patients by critically analyzing data from seven sources, including guidelines, systematic, and narrative reviews. b) What We Know and How Well We Know It Sánchez-Flórez et al. (2022) provided a narrative review of the literature highlighting the importance of incorporating non-pharmacological approaches into pain management strategies 14 for individuals with rheumatoid arthritis (RA). The writers examine different approaches to pain management while highlighting the necessity of a thorough comprehension that goes beyond medicine. A variety of non-pharmacological techniques are covered in the narrative review, which highlights their possible advantages in treating RA-related pain. The study acknowledges the significance of non-pharmacological approaches, even though it does not provide a detailed account. It suggests that the literature recognizes the complexity of pain management in RA and supports a comprehensive approach that goes beyond conventional pharmaceutical interventions. Besides, Tai Chi has been shown in a systematic review by Mudano et al. (2019) to be a viable alternative therapy for RA, with potential benefits in pain reduction and functional capacity enhancement. Even with the acknowledged advantages, further research is necessary due to the inconsistent data quality and unclear long-term consequences. While Tai Chi shows promise, a more nuanced understanding of its sustained efficacy and broader applicability is necessary, according to the Cochrane Database systematic review. This admission of ambiguity is an essential reminder that more research is required to improve our comprehension of Tai Chi’s potential as a different treatment for RA symptoms. On the other hand, the guidelines provided by the European League Against Rheumatism (EULAR) and expressed by Smolen et al. (2020) mainly focus on pharmacological treatment, with a particular emphasis on disease-modifying antirheumatic medications (DMARDs) for the treatment of RA. Although the guidelines offer a reliable structure for pharmacological interventions, there is insufficient focus on incorporating non-pharmacological methods like physical exercises. Given the known drawbacks and adverse effects of pharmacological interventions, the lack of guidelines for non-pharmacological strategies suggests a possible omission in the overall management of RA. It emphasizes how crucial it is to close the gap 15 between pharmaceutical and non-pharmacological treatments to provide RA patients with more individualized and comprehensive care. It has been estimated that rheumatoid arthritis (RA) affects roughly 18 million people globally (Karp et al., 2023). This autoimmune disease, marked by persistent inflammation and joint damage, is more common in women and increases as people age. The fact that RA is so commonplace throughout the world highlights how serious a health issue it is, with a disproportionate impact on women. In addition, the literature highlights the critical significance of incorporating non-pharmacological approaches in the holistic management of rheumatoid arthritis (RA), as demonstrated by Taylor et al.’s (2021) narrative review on the significant comorbidities in patients with RA. The citation provided does not provide explicit details regarding the non-pharmacological approaches. However, it is likely that the narrative review delves into the complexity of comorbidities linked to RA and emphasizes the necessity of comprehensive interventions that go beyond pharmaceutical treatments, recognizing significant comorbidities in the context of RA points to a broader understanding in the literature of the interrelated nature of the illness and the demand for an all-encompassing care strategy. c) What We Do Not Know The body of research on the subject of alternative physical activities for the management of pain in older adults with rheumatoid arthritis (RA) is deficient, as noted by Murphy et al. (2023) and Sugihara (2022). First, as Mudano et al.’s systematic review pointed out, there is a lack of comprehensive research on the long-term efficacy of particular activities like Tai Chi. Although Tai Chi has demonstrated some promise in pain reduction, a complete evaluation of its role in long-term RA pain management is hampered by the lack of extensive, long-term efficacy studies. Second, as mentioned in the EULAR recommendations (Smolen et al., 2020), 16 incorporating alternative physical activities into conventional RA treatment plans is still not sufficiently investigated. Even though it is known that exercises such as Tai Chi can be beneficial, there aren’t enough evidence-based guidelines to make it easy to incorporate these practices into standard care. Lastly, Sugihara’s (2022) examination of treatment approaches for RA with an elderly onset highlights the underappreciated wider influence of these activities on mental health and general well-being in senior RA patients. It is imperative to comprehend the holistic effects of alternative physical activities to create comprehensive care plans that address not only physical symptoms but also the mental health and general well-being of this vulnerable population. It is critical to close these knowledge gaps to optimize pain management techniques catered to senior RA patients’ unique requirements and advance evidence-based practice. d) Implications for Advanced Practice Nursing in Pain Management Interventions Tailored to Patient Needs According to sources such as Mudano et al.’s (2019) systematic review and Smolen et al.’s (2020) EULAR recommendations, the literature continuously emphasizes how important it is to customize interventions to the unique needs of older adults with rheumatoid arthritis (RA). Effective pain management requires an understanding of how every patient experiences pain differently. However, the lack of established procedures for customizing Tai Chi and other alternative physical activities to the needs of specific patients creates a serious gap. The systematic review and EULAR recommendations have brought attention to the absence of clear guidelines, which poses a challenge for advanced practice nurses. They may find it difficult to consistently and effectively implement tailored interventions without established protocols. This knowledge gap makes it more difficult to optimize patient care and presents difficulties for advanced practice nurses when offering individualized, evidence-based pain management plans 17 to senior RA patients. For tailored interventions to be consistently effective in the complex field of RA pain management, this gap must be closed by creating standardized protocols. Including Non-Pharmaceutical Methods The extant body of literature, including sources like the systematic review conducted by Mudano et al. (2019) and the EULAR recommendations by Smolen et al., all recognize the significance of incorporating non-pharmacological approaches in managing rheumatoid arthritis (RA). However, there is not much focus on integrating Tai Chi and other non-traditional physical activities into regular RA care. Because there are no clear guidelines, advanced practice nurses may find it challenging to advocate for and implement non-pharmacological approaches due to this gap in the literature. As noted in the systematic review by Mudano et al. (2019), there is a risk of underutilizing effective pain management strategies without established procedures. The tendency to ignore potentially helpful non-pharmacological approaches in favor of a preponderance of pharmaceutical interventions could be attributed to this lack of emphasis on integrating alternative activities into routine care frameworks. This knowledge gap must be closed to enable advanced practice nurses to promote comprehensive care and a more integrative strategy that best integrates pharmacological and non-pharmacological tactics for better outcomes in RA patients. Dealing with General Well-Being and Mental Health The literature, as evidenced by sources such as Murphy et al.’s (2023) narrative review and Chu et al.’s (2023) study on conservative management, highlights the critical role that mental health and general well-being play in the context of pain management for older adults with rheumatoid arthritis (RA). Although the significance of addressing these aspects is widely acknowledged, the sources highlight a discernible deficiency in research concerning the broader 18 influence of alternative physical activities on the mental health of this particular population. Using the scant research that is currently available, advanced practice nurses may encounter difficulties in evaluating and treating the mental health components of pain in older RA patients because they lack comprehensive instruments. This knowledge gap may lead to inadequate pain management strategies, as Sugihara’s (2022) analysis of treatment approaches for RA with an elderly onset points out. To close this knowledge gap and provide advanced practice nurses with the tools they need to adequately address the mental health and general well-being of older adults with RA, as well as to optimize their pain management strategies, more thorough research on the holistic impact of alternative activities is required. Literature Review Takeaway The integration of research results highlights the possible benefits of introducing alternate forms of physical activity into the pain management model for senior rheumatoid arthritis (RA) patients. Even though the literature demonstrates established aspects, like the beneficial effects of exercise on arthritis symptoms, there are still significant gaps. Notably, there is little emphasis on integrating these activities into standard RA care, little comprehensive research on the longterm effectiveness of particular activities, such as Tai Chi, and no standard protocols for customizing interventions to meet the needs of individual patients. Furthermore, not enough research has been done on the broader effects of alternative activities on mental health. When developing customized interventions, promoting non-pharmacological methods, and thoroughly attending to the mental health and general well-being of senior RA patients, these knowledge gaps pose significant challenges for advanced practice nurses. It is critical to close these gaps to promote integrative care models, advance evidence-based practice, and ultimately optimize pain management techniques for this susceptible population. 19 Project Aims, Values, and Desired Outcomes a) Overview Projects promoting alternative physical activities recognize the importance of time optimization in patient care. According to Smolen et al. (2020), elderly patients with RA could benefit from a more all-encompassing treatment plan that goes beyond conventional therapy. Involving patients in Tai Chi exercises improves their general well-being in addition to helping to manage pain (Mudano et al., 2019). The initiative aims to maximize the time spent on patient interventions by incorporating such activities into standard treatment. A more effective and patient-centered strategy may arise from the time spent encouraging physical activity since it may lead to fewer hospital visits, rehabilitation requirements, and total healthcare management time. The core objective of promoting alternative physical activities in pain management is to enhance the quality of life for elderly RA patients. Tai chi has demonstrated significant advantages in improving physical ability and reducing pain (Mudano et al., 2019). The project’s goal is to raise the standard of patient treatment by acknowledging the holistic aspect of RA and treating both physical and mental health issues. b) Goals and Objectives of the Project The ultimate goal of this research project is to establish alternative physical activities as a measurable and effective pain management strategy for elderly patients with rheumatoid arthritis (RA). This research project will only be successful if the specific identified objectives align with improving the quality of life for elderly RA patients using alternative activities. However, measurability has much to do with evaluating Tai chi for chronic low back pain (LCBP) in 20 reducing pain and improving function capacity. For example, it is possible to set measurable indicators such as changes in pain score, mobility increase, and improvement of the general condition concerning the effectiveness of the intervention (Mudano et al., 2019). In this study, stakeholders’ hypothetical agreement is similar to a statement of methodology and expected results. It entails imagining the projected benefits of Tai Chi in terms of relief from pain, joint movement, and health in general. The preemptive realignment paves the way for efficient coordination work towards achieving desired results. c) Variables The variables I would involve are the cost of training staff, equipment acquisition, and adjusting the facility, with the budget being a critical factor. Budget constraints are a frequent problem and should be addressed with thorough planning and resource provision. I would consider conducting a comprehensive financial analysis to address budgetary issues, outlining the estimated costs associated with the practice change. One strategy may involve searching for cheap approaches, negotiating vendors’ contracts, and identifying possible cost-saving measures. It is crucial to involve financial stakeholders in the planning process, ensuring their awareness of the budgetary requirements and obtaining their support for the proposed changes (Prinja et al., 2021). While fiscal concerns may pose challenges, clearly understanding the financial landscape and proactively addressing potential obstacles enhances the feasibility of implementing the clinic-wide practice change (Prinja et al., 2021). Given the multifaceted nature of the research objectives, a qualitative approach data collection technique would be advantageous. Qualitative data collection will encompass in-depth interviews and focus group discussions (Prinja et al., 2021). These qualitative methods will delve into the intricacies of pain experiences, functional limitations, and the perceived impact of Tai 21 Chi on their overall well-being. For pain levels, qualitative interviews will explore the nuances of pain, considering descriptors like intensity, quality, and the impact of pain on daily activities. Functional capacity could be qualitatively assessed by understanding participants’ narratives regarding their abilities, challenges, and improvements observed through Tai Chi practice (Prinja et al., 2021). Additionally, qualitative methods will capture the emotional and psychological dimensions of the intervention, shedding light on aspects like mood, motivation, and the perceived sense of control over pain d) Contribution to the Community The community stands to benefit from this research through the potential introduction of a cost-effective and accessible pain management strategy. If Tai Chi is practical, it could provide an alternative or complementary approach to conventional treatments, reducing the reliance on medications and potentially mitigating associated side effects (Smolen et al., 2020). Moreover, the study’s outcomes may contribute to a paradigm shift in how healthcare providers and communities approach pain management, fostering a more holistic and patient-centered approach. On a broader societal level, the research may contribute to changing perceptions and attitudes toward alternative therapies and their integration into mainstream healthcare. The approach will challenge the conventional practice models for pain management by evaluating whether Tai Chi can address patient engagement and empowerment instead of simply treating pain. Integrating alternative physical activities within healthcare may be a turning point toward more humane and patient-oriented healthcare models, thereby shifting societal beliefs in managing chronic conditions (Smolen et al., 2020). Finally, such research will improve the health status of people who have rheumatoid arthritis and transform the medical landscape related to pain management. 22 e) Desired Outcomes The overarching purpose is to evaluate the effectiveness of Tai Chi in managing pain and enhancing functional capacity in elderly individuals with rheumatoid arthritis. The project’s specific focus is to investigate how Tai Chi, as a non-pharmacological intervention, can contribute to improved well-being and quality of life for this population. Moreover, the project’s viewpoint aligns with a patient-centered and holistic approach to healthcare. This study aims to investigate how arthritic seniors experience pain, function, and their level of wellness and also assesses the potential effects that practicing tai chi has on them. Expected accomplishments are to evaluate the possible impact of Tai Chi on RA, such as physical and psychological, to suggest it be considered in a package of therapies to deal with pains associated with RA. The goal is to contribute valuable insights to the existing body of knowledge, influencing healthcare practices and fostering a more integrative approach to pain management. To achieve these objectives, a well-planned research timeline would be required, with the sequence being a literature review and study design that will take one week; data collection, analysis, and dissemination of results will take two months. For instance, a timeline will be approximately three months long, offering an opportunity to extensively research Tai Chi’s efficiency in pain relief among old rheumatoid arthritic patients. Theoretical Framework a) Overview The conceptual framework consists of the dependent variable, which is the pain experienced by elderly patients, and the independent variable, which is the promotion of alternative physical activity. The dependent variable seeks to show the expected outcomes of the research. In contrast, the independent variable represents measures taken to evoke a change in the dependent 23 variable, such as offering support and resources to elderly patients as they engage in physical activities. b) Theories used The main goal of the research is to determine the role played by physical activity in managing pain for elderly patients. I. Social Cognitive Theory- This theory highlights the importance of using observation to detect any changes in behavior. Emphasis is also placed on self-efficacy with the notion that new behaviors can quickly be adopted if individuals believe they possess the abilities and capacity to undertake them seamlessly. Social support is a significant factor in reinforcing behavioral change, while observation is critical in identifying patterns and areas that require improvement. The environment will also be studied to assess if it affects how physical activity is used to manage pain. II. Self-determination theory focuses on internal forces that motivate an individual to change. This includes their beliefs, perceptions, and motivations. It aims to determine what drives elderly patients with rheumatoid arthritis to engage in physical activity to manage pain (Ryan et al., 2017). Motivators such as improved health and reduced pain are some of the benefits. The impact of support in encouraging elderly patients to indulge in physical activity is also determined. An analysis of the satisfaction of psychological needs is conducted to determine how it affects elderly patients’ decision to undertake physical activity. c) Framework guiding the study The theories emphasize understanding how individuals perceive pain by incorporating physical activity to manage rheumatoid arthritis. 24 Assumptions of the framework • The motivation to integrate physical activity is based on individuals’ approaches regarding pain and its intensity. This suggests that individuals with high levels of tolerance to pain are more likely to adopt physical activity in managing their pain as compared to those with low tolerance. • To achieve success by using physical activity to manage pain associated with rheumatoid arthritis, hindrances must be eliminated by providing both peer and healthcare support. • Satisfaction of psychological needs is essential in providing individuals with the motivation and drive to indulge in physical activity. • Behavior change is dependent on an individual’s basis. Highly motivated individuals are more likely to engage in physical activity than those with low levels. • Physical activity can quickly be adopted by elderly patients who have rheumatoid arthritis to manage pain. d) Key components of the framework • Motivation- This reasoning drives individuals to behave in a certain way. This seeks to determine the influence of internal motivation on individual behavioral change, which can, in turn, influence one to engage in physical activity. An individual is more likely to adopt new practices if the motivation comes from within instead of receiving it externally from caregivers and peers. • Ideologies and perceptions regarding pain. -This is regarding the intensity, how much one can withstand the importance of physical activity, the factors affecting it, and the challenges encountered in incorporating pain management initiatives. 25 • Psychological needs -whose satisfaction affects individuals’ capacity to engage and carry out physical activities. The role of support in meeting these needs is also evaluated. • Ideologies and perceptions regarding pain – examining and evaluating individuals’ approach to physical activity determines their response toward measures developed to manage pain (Serhal et al., 2020). e) Applying elements of the theory to aspects of the phenomenon under study • Perceptions regarding pain- This seeks to determine individuals’ approach to pain to discover their limits and how much of it they can endure. This is coupled with the fact that physical activity can increase pain levels. • Motivation, primarily internal, promotes self-reliance, eliminating the need to depend on external forces (Schunk et al., 2020). Individuals can drive themselves to engage in physical activity despite the pain because they know the benefits. • Behavior changes which are influenced by both internal and external factors. Positive change motivates an individual to engage in physical activity despite the pain because it will help manage symptoms in the long run. External support aids in solidifying and enforcing the new routine. f) Rationale for the sample selection criteria Participants of this research are elderly patients who have rheumatoid arthritis. Focus is placed on this particular group to understand the disease better and analyze the benefits of using physical activity to manage the pain. RA-afflicted patients of 55 years and above who can indulge in physical activity will be included if they consent to participate. Developments, analysis, and critique of pertinent research that uses the framework 26 This research supports the findings of the social cognitive theory and self-determination theory, which collectively state that to manage the pain associated with RA, it is the individual’s responsibility to take measures such as engaging in physical activities to manage the pain. In addition, other approaches can be developed to ease the situation. Intervention a) Solutions Or Interventions This literature review suggests that several solutions and interventions can be recommended to incorporate alternate physical activities, especially Tai Chi, into the pain control management of aged RA patients. Such interventions aim to improve patient’s health, decrease reliance on drugs, and foster a better livelihood. One possible solution is to create specialized Tai Chi programs for elderly persons with RA, considering their physical limitations and unique requirements. Therefore, Tai Chi and rheumatology specialists should design these programs to avoid exposing senior patients to any risks with uncontrolled or unmonitored practices. The exercises should include non-strenuous activities to enhance flexibility, balance, and muscle tone. The second approach involves the training of instructors. Such training should comprise the knowledge of the disease, limitations in these patients, and possibilities to adjust Tai Chi exercises. As such, it is a high-quality training that must be under healthcare professionals. Thirdly, the collaboration with healthcare providers. It will involve partnering with rheumatologists, physiotherapists, and other healthcare providers to determine the inclusion of Tai Chi in the general RA patients’ management scheme. This will ease full patient management, which includes medical therapy and physical exercise. 27 The fourth solution is to run awareness programs on Tai Chi therapy for patients and health practitioners. Such campaigns could involve organizing workshops, developing informational brochures, and presenting in healthcare contexts to increase awareness of the use and benefits of Tai Chi. Another potential solution is to undertake research to determine whether Tai Chi can be prescribed as a substitute for pain treatment initiated by RA among the elderly. The impact of qualitative quality tools on chronic pain intensity, physical functionality, psychosocial issues, and quality of life should be assessed through a quantitative approach to evaluate the studies. b) Other Views on The Problem and Solutions This paper suggests a non-pharmacological intervention of Tai Chi to control RA pain in elderly patients. However, the literature offers differing opinions on the issue of RA pain management and strategies for solving it. Although Tai Chi is emphasized for its low-impact, gentle movements that favor RA patients, certain studies also recommend yoga, Pilates, and aqua therapy. For example, Tai Chi and similar alternatives may enhance flexibility, strength, and general mental health, among other benefits that may be preferred over traditional forms (Mudano et al., 2019). For example, yoga focuses on breath control and meditation, which can contribute to stress reduction even more. However, this paper highlights non-pharmacological approaches in opposition to some researchers and physicians who have emphasized traditional medical interventions as the key role in the management of RA. They include disease-modifying antirheumatic drugs (DMARDs), biologics, and corticosteroids (Hanly & Lethbridge, 2021). Proponents of this perception think that while alternative treatments can be supplemental, they should not substitute medical interventions known to inhibit disease progression and protect the joints. As the literature 28 indicates, a broader concept calls for a combination of pharmacological and nonpharmacological treatments. The model argues for an individualized treatment strategy comprising medication, physical activity, and lifestyle changes, a patient-centered approach where the patients have some input in planning for their treatment. Other studies favor digital solutions and telemedicine as pain management technologies in the advanced technological arena. These include wearables for monitoring physical activity, telerehabilitation, and self-management mobile applications for exercise adherence. The supporters of this notion suggest that technology can enhance patients’ involvement, immediate feedback, and greater accessibility, especially to people with mobility issues. Other researchers highlight mind-body techniques such as mindfulness, meditation, cognitive-behavioral therapy (CBT), and formal practices. According to Sánchez-Flórez et al. (2022), these efforts address the psychological components of chronic pain and RA life, such as stress, anxiety, and depression related to the condition. In addition, numerous pieces of literature emphasize the significance of patient education and self-management in relieving pain for RA. In this regard, patients are taught about their disorder, treatment choices, and how to deal with different symptoms. As such, the literature offers various viewpoints, from traditional medicine perspective to whole-person care practices. These consist of technological interventions, mind-body therapies, and patient education that will help in the management of RA pain in geriatric patients. Such diversity of perceptions highlights the heterogeneity of pain-management programs and advocates for an individualized patientcentered strategy that considers every patient’s specific needs, preferences, and circumstances. 29 c) The APRN’s Role in The Intervention Advanced practice registered nurses have diverse and integral roles in the provision of interventions such as Tai Chi for the management of RA pain in their elderly population. These interventions can only be led by APRNs because they possess the skills of a great clinician, operate in holistic caring modes, and can function independently. The latter regards their role and has many clinical consequences. The first role is assessing and developing a person-centered pain care plan. According to Urbanowicz (2019), APRNs are mainly responsible for checking a patient’s physical capabilities, level of pain, and general health. Such assessment allows them to adapt to specific patient requirements, making these interventions secure and advantageous, like Tai Chi. When planning care, APRNs can make care plans unique to each patient, ready to combine alternative therapies with traditional RA treatments by incorporating comorbidities, physical limitations, and patient preferences. The second responsibility is that of educating and counseling. Education is also the cornerstone of APRN practice. APRNs should offer education on the utility, health, and care to be taken when undergoing Tai Chi for RA, including Tai Chi in the self-management of patients with the disease. They can also aid APRNs in providing teaching regarding lifestyle modifications, pain relief mechanisms, and self-care maneuvers so that patients are educated and can participate in the management of the disorder (Urbanowicz, 2019). Thirdly, APRNs encourage the connection and continuum of care. APRNs are usually the primary care providers in the healthcare sector. In this role, they collaborate with other health care practitioners such as rheumatologists, physiotherapists, and Tai Chi trainers to offer an integrated interdisciplinary approach to taking care of patients. It would not be possible to include non-pharmacological interventions in the patient’s treatment plan without this collaboration. 30 The fourth role entails monitoring and follow-up. Evaluating the effectiveness of Tai Chi for pain is an ongoing monitoring and follow-up. The treatment plan should be adjusted in these cases, and APRNs should periodically assess the dynamics of pain, physical functioning, and quality of life. Continuous appraisal enables the early identification of issues or difficulties concerning patient safety and treatment outcomes. The fifth role is as a researcher and evidencebased practitioner. They take part in the studies to develop their research and keep up-to-date with the latest evidence when implementing Tai Chi interventions. This input makes the care provided more meaningful and furthers the body of knowledge regarding RA management. In addition, APRNs do act as advocates and policy developers. It is, therefore, their role to act as advocates for patients and change policies regarding care. They could enhance the availability of alternative therapies such as Tai Chi during RA management, ensure insurance coverage, and develop integrative pain management guidelines and policies. d) Implications for Clinical Practice Some of the implications of integrating Tai Chi and other such interventions in the control of RA pain led by APRNs were identified in clinical practice. It enhances patient outcomes. The involvement of APRNs in holistic, patient-centered care may alleviate physical and psychological outcomes for elderly RA patients. It also increases accessibility. Especially in community settings or via telehealth services, APRNs can enhance alternative therapy accessibility. Tai Chi will advance holistic care. Their participation encourages an integrative perspective to healthcare, incorporating conventional medicine with alternative treatments. Third, APRNs educate patients, including self-management support, and this empowers the patients and enhances patient engagement and self-efficacy. This comprises several important 31 implications; as it is, the change project concerns the inclusion of Tai Chi as an alternative physical activity for elderly persons to control rheumatoid arthritis pain. e) The Implications of the Change Project It is reported that there is a global prevalence of about 18 million people living with rheumatoid arthritis (Karp et al., 2023). This is an autoimmune disease, accompanied by constant inflammation and destruction of headlands, more spread among women and increasing with the age. Offering Tai Chi as a simultaneous rehabilitation program for older people having RA may lead to significant betterment of the status of one’s health. Such non-pharmacological interventions might reduce pain intensity, increase mobility, and bring back joint function. In addition, such patients benefit from positive effects on mental health by lowering stress and improving mood, which eventually increases their quality of life. As the project mitigates dependence on costly pharmaceutical-based interventions with health implications, this may ultimately lower the overall healthcare costs. This project is a step towards comprehensive treatment of chronic diseases, for instance, RA. This supports introducing wellness treatment in physical, mental, and emotional health regimens, moving away from medicine only. Through this project, patients become active participants in managing their conditions. If a user appreciates Tai Chi, it gives them a sense of control over their health, enabling them to develop self-efficacy that is essential in the control of chronic diseases. To make this project operational, a lot has to be done by way of educating the patients, healthcare personnel, and even the community to fill in knowledge gaps. This type of education will ease the adoption of Tai Chi and knowledge regarding other alternative methods in Pain impairment that could affect their attitude toward controlling chronic diseases. This project presents new directions for exploring how different therapies, such as Tai Chi, can treat chronic 32 conditions. Evidence-building is also necessary to validate and improve these interventions, thus contributing to evidence-based practice in health care. Recommendations and Conclusion a) Recommendations and Implications for Clinical Practice The integration of Tai Chi in the management of RA pain among older people has a huge impact on practice. APRNs are the people who are most likely to institute or implement Tai Chi programs in RA patients. Therefore, it is prudent to ensure that APRNs are included in Tai Chi programs for RA patients. While this approach may involve mild exercises, it is expected to help improve flexibility and strengthen muscles. Moreover, they should be taken through appropriate training that enables them to tailor Tai Chi exercises specifically for RA cases. Secondly, working with other health-related experts, such as physiotherapists and rheumatologists, is also very important. By so doing, comprehensive patient care is provided since there will be joint prescription of drugs and physical exercises within the same facility. The presence of intermediaries such as APRNs can facilitate collaboration among different healthcare workers so that all elements of treatment are considered (Hanly & Lethbridge, 2021). Thirdly, nurses and health care providers should increase awareness of this type of treatment, which can only be done through educating the public via workshops and brochures within health facilities. As part of the education department’s agenda, awareness about tai chi and its use should be emphasized. Furthermore, future research should look into whether RA pain management involves Tai Chi as it relates to the role played by APRNs. APRNs help to put together an extensive knowledge base by participating in studies and being current with recent evidence. This 33 evidence-based approach guarantees that Tai Chi interventions are constantly improved by the mentality of best practices. b) Summary of Study and Discussion of Limitations This study explores the adoption of Tai Chi as a non-pharmacological intervention for dealing with RA pain among older patients. The results emphasize how Tai Chi could decrease pain intensity, increase mobility, and enhance overall well-being for patients with RA. However, several limitations are also associated with the same. The research mainly describes Tai Chi, thus there is little attention paid to the investigation of other alternative therapies like yoga, Pilates and aqua therapy (Karp et al., 2023). Further studies should adopt a comparative approach to help understand how effective various non-pharmacological interventions are for RA patients. For this reason, the research has focused on qualitative data collection methods such as in-depth interviews and focus groups. Thus, while these methods offer rich insights into pain experiences and functional limitations, using quantitative approaches would have strengthened its findings. Combining both types of data is necessary to understand the effect of Tai Chi on chronic pain intensity, physical functionality, and psychosocial aspects. However, the generalizability of these findings was also limited since most respondents were old-aged RA patients. Therefore, Future research should examine how such programs apply across diverse demographic groups to ensure that they apply to everyone. The study does not extensively address potential barriers to implementing tai chi interventions within several healthcare systems. Therefore, it is vital to recognize these obstacles and find means by which they can be overcome so that tai chi becomes part of routine clinical work. 34 c) Directions for Future Research In non-pharmacological pain management for rheumatoid arthritis (RA), there is a need to consider a trajectory of future research that involves turning towards a more comparative methodology. The research will examine the effectiveness of Tai Chi in comparison to Pilates, Yoga and aqua therapy among other therapies. It will help identify what works best for patients in different categories. Moreover, from a practical perspective, examining how various HCS setups can integrate Tai Chi programs is important. Therefore, it will be essential to investigate issues related to implementation challenges, facilitators’ and patients’ perceptions, and those of healthcare providers (Mudano et al., 2019). Hence, this study should show how routine clinical practice can be successfully integrated with Tai Chi. Finally, another cost-effectiveness area that has to be explored involves comparing Tai Chi with traditional pharmaceutical interventions. For instance, costs associated with training and equipment purchase, among others, should be researched and compared to traditional interventions. As such, this economic scrutiny links decisions that guide the inclusion or exclusion of such care as part of standard practice for RA patients. To sum up, the roadmap for future research in non-pharmacologic interventions for RA pain management underscores comparison lens, emphasis on long-term impacts, examination into practical implementation challenges, and critical evaluation of cost-effectiveness. These research avenues are caged to facilitate knowledge of competent interventions, elucidate practical healthcare methods, and aid the decision-makers in devising appropriate management strategies for RA pains. 35 d) Changes in Theoretical Constructs In terms of changes in theoretical frameworks, further studies should focus on the integration of technology, such as telemedicine and wearable devices with non-pharmacological approaches for RA pain management. The measurement of the potency of digital solutions in amplifying patient engagement, monitoring physical activity, and providing real-time feedback fits into a developing technological landscape. Secondly, the scholarly research should question the interconnectedness of various theoretical structures and integrate physical elements, psychological aspects, and social dimensions. This way, there can be an understanding of pain management in RA through a holistic approach that takes into account the relationship between mental health, social support systems, and physical well-being. Theoretical models must be shifted toward more patient-centric models that promote the active involvement of individuals in their healthcare. Therefore, there is a need to incorporate things like patient education, self-management, and individualized treatment plans into contemporary care systems so as to put the patients at the center of decision-making. Finally, researchers must examine cultural competence inherent in non-pharmacological interventions by acknowledging and adapting these interventions to different cultural settings. Accordingly, adapting theoretical frameworks so that they are culturally sensitive would allow for inclusivity and efficacy across diverse populations. This is because this cultural responsiveness helps make interventions easily accessible and effective among people from diverse cultural backgrounds. The changes above in theoretical models imply that it is important to have a forwardlooking standpoint that includes technological advances, acknowledges the interaction of 36 behavioral and social spheres, and promotes patient autonomy and respect for cultural diversity, which informs non-pharmacologic treatments. Furthermore, these shifts are in line with current healthcare philosophies that encourage approaches to dealing with RA pain that are centered on patients and communities. e) Suggestions for Public Policy and/or Changes in Practice Public policy recommendations should promote the integration of non-pharmacological interventions, including Tai Chi, into standard care protocols for RA management. This involves advocating for insurance coverage of such interventions and ensuring equitable access for all patients. The development of guidelines that incorporate alternative therapies as part of a broader RA treatment plan should be jointly done by policymakers, healthcare providers, researchers, and patient advocacy groups. Thus, the practice should change to interdisciplinary team building for healthcare providers like APRNs, rheumatologists’ physiotherapists, and Tai Chi trainers (Sánchez-Flórez et al., 2022). The combination of medical therapy with non-pharmacological interventions not only makes the treatment better but also improves overall patient satisfaction and results. In addition, healthcare facilities should invest in scholarly activities that seek to empower APRNs and other health professionals on how best to integrate non-pharmacological interventions. This training ensures that the practitioners will be competent in incorporating alternative therapies into their practice, developing a patient-centered and integrated approach to managing RA. f) Tie the Theoretical Framework to the Overall Product This study’s theoretical underpinning revolves around the comprehensive management of RA pain by combining non-pharmacological methods with conventional medicine, especially Tai 37 Chi. The model under consideration belongs to the group of patient-centered strategies and highlights personalized treatment planning developed with various patients’ needs, preferences, and scenarios in mind. It also promotes multidisciplinary teamwork and cooperation between health providers in delivering quality service. This corresponds with the role of APRNs as mediators who improve RA regulation coordination among rheumatologists, physiotherapists, and Tai Chi trainers. The constructs from the theoretical side also highlight how healthcare is changing with technology, cultural competency, and patient empowerment. This is consistent with contemporary views that see digital solutions, cultural competency, and education as crucial in improving intervention effectiveness. Thus, the theoretical framework is a guide that connects various parts to produce one unified and comprehensive approach for integrating Tai Chi in controlling pain from RA. g) Conclusion The Incorporation of Tai Chi as a non-drug method for supporting old people with RA pains is one step taken toward patient-oriented holistic healthcare. APRNs play critical roles in this undertaking by actively developing, implementing, and improving Tai Chi programs. The clinical significance of this project underscores the importance of specialized programs, highquality training, working closely with healthcare providers, creating awareness through campaigns, and participating actively in research. These recommendations are intended to improve patient outcomes and expand access to alternative therapies, thereby promoting holistic approaches to managing RA. While recognizing its drawbacks, future research trends will dwell on comparative studies, long-term effects, applicability, and cost-benefit analysis. Modifications in theoretical 38 constructs involve examining the use of technology in practices, holistic approaches to patients’ care, patients being at the center of care, and being competent to deal with different cultures. Public health policy proposals include insurance for such treatments as well as guidelines for their use, while changes should be designed around team efforts among practitioners, training doctors, and public knowledge. 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