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Required to communicate verbally and/or in writing with your educator throughout the assessment to ensure you understand the process and to clarify any areas of uncertainty.Required to apply your Professional Standards of Practice throughout the written and oral components of this  identify a research question/hypothesis related to a specific topic, such as: Infection control You may choose a different topic, but your educator must agree with the topic you have chosen.Your nursing research question or hypothesis may include:

 Nursing interventions applicable to the topic
 Client perceptions of the provision of this topic
 Models of nursing care that utilise the topic
 Political issues confronting nursing practice and health care provision in relation to the topicthe impact on the client and improve knowledge/skills of the healthcare professionals.

Identify the key terms of your research topic. Give a synonym or variation of the term and provide a definition.

Definition of key terms

Physical activity has been associated with a sharp decrease in morbidity and research has indicated that there are a number of health benefits associated wit physical activity. However, a small section of the common population engages in any form of physical activity for maintaining a healthy life. A daily form of moderate to light physical activity is highly recommended for bringing significant improvement in general health as vigorous form of physical activity is known to be a major barrier to carrying out exercises among people, specially those of older age. The advantages of different forms of exercises have been constantly under monitoring for understanding their best application in health promotion of individuals (Reid et al. 2016).

Tai Chi Chuan or Tai Chi is a widely practised form of Chinese Martial Arts that consists of a series of postures combined with smooth, slow and graceful movements. This form is known to be a low-intensity exercise that can develop balance and coordination, and help in maintaining emotional health and strength (Ko et al. 2016). Empirical research on the health benefits of Tai Chi has been conducted towards utilisation for the elderly population, the main aim being a reduction of falls. The other advantages are thought to be psychological benefits like improvement in the quality of life, self-efficacy and well-being, improvement in mood. Moreover, in elderly people, this form of exercise has the potential to reduce depression and prevent the negative impacts of isolation and sedentary (Hua et al. 201).

In general, there is a scarcity of valuable research that has highlighted the exact benefits of Tai Chi for the elderly population. The benefits for elderly and non-elderly patients might not be similar, and the outcomes might not be significant. Presently, there is a need for identifying the benefits of long term, simplified Tai Chi exercises in enhancing and maintaining the health of the elderly. Since there is an escalating research interest about Tai Chi and researchers across the globe are accumulating evidence for indicating the therapeutic value of the exercise form, it was thought desirable to carry out further research in this regard (Song et al. 2017). The proposed study would document the prospective health benefits of Tai Chi through exploring the influence on physical function in older adults. The study has the focus on Tai Chi in bringing reductions in functional limitations.

Tai Chi- Tai Chi Chuan (TC), or Taijiquan on an exact manner, had originated in China about three centuries ago, with considering boxing as the main form of the martial art. The term ‘Chuan’ is omitted in literature since it means ‘boxing’. Since its origin, Tai Chi has gone several phases of evolution. It was first used as a self-defense and combative form, and at present times it is being used as a health-enhancing exercise. It has been indicated that Tai Chi is a useful tool for promoting successful ageing that can limit disability and bring improvement in health. A systematic review published in the year 2015 had indicated that Tai Chi could be performed by individuals who suffer from chronic ailments such as heart failure, chronic obstructive disorder and osteoarthritis (Cole et al. 2016).

Research question and hypothesis

The research question for the proposed study is “Whether Tai Chi has a positive impact on physical function among elderly adults?’

The aim of the study would be to broaden the knowledge on health benefits of Tai Chi through assessing its impact on physical function in elderly adults. Due to the fact that Tai Chi enhances posture control balance and agility, along with lower extremity strength and flexibility, the research would have the hypothesis that Tai Chi practice would reduce limitations in these physical functioning measures.

The result from the proposed study would be useful in understanding the impact of Tai Chi in the improvement of functional limitations on the basis of the self-rated ability of the research participants. The extant research evidence would be a foundation for strong support for anecdotal evidence regarding health benefits of Tai Chi. In combination with existing pool of literature, the study would demonstrate the advantages of Tai Chi practice for older adults. This would be beneficial for nurses in health care settings in including such practices in the health intervention plan for older patients admitted to the aged care settings. Value based and cost-effective exercise programs can be considered to be included in the health promotion plan for older adult patients in different settings.

Chen et al. (2007) conducted a study to throw light on the effectiveness of long-term, simplified Tai Chi exercises in enhancing and maintaining the health of elderly individuals. The researchers selected a quasi-experimental, one-group, time series research design for the study where 51 elderly male participants were selected. A 50-minute Simplified Tai-Chi Exercise Program (STEP) was implemented for three times a week in two small groups for one year. The results of the study showed that physical health of the participants in terms of lower body flexibility, cardio-respiratory function, hand gripping strength, and mental health had significant improvement after six months of application of the intervention. This improvement was maintained throughout the end of the one-year study. It was concluded from the study that implementation of STEP along with practising suitable aids makes up an effective and feasible method for implementing a long-term activity program for achieving elderly care health improvements in aged care facilities. Patients in aged care facilities must be encouraged to practice Tai Chi.

Song et al. (2014) assessed the impact of Tai Chi exercise on bone mineral density, lower limb muscle strength and balance function of elderly women. 105 urban elderly women were selected as the study participant and were randomly divided into an observation group, and two control groups. The women in the observation group had to carry out a Tai-Chi exercise once in a day while the women in the two control groups had to dance and do brisk walking. Data pertaining to lower limb muscle strength, lower limb skeletal muscle mass, bone mineral density and balance function was taken after 4, 8 and 12 months. The results showed that in camprison to walking and dance, the impact of Tai Chi exercises for short term was not obvious. However, when the exercises were continued for the long term,  that is 8 moths and one year, there was a clear advantage of the exercise is a significant manner. The study had suggested that Tai Chi can be considered as a fitness measure when applied for the long term.

Supporting Evidence

Zhou et al. (2015) studied the efficacy of 24 weeks of Tai Chi exercise on postural control among elderly women. 43 women took part in the study with age between 55 and 68 years. The Tai Chi group had 22 women undergoing the set Tai Chi exercise while the control group had 21 women maintaining a no-regular and habitual exercise lifestyle. The researchers used the Good Balance tester for measuring the paths, time and velocity of the centre of pressure (COP) for the subjects. After the completion of the study, it was found that the Tai Chi group had significantly shorter total, mediolateral and anteroposterior COP sway paths in comparison to the control group. The results of the study indicated that 24 weeks of Tai Chi can improve the efficiency of postural control for elderly women.  Maintaining balance is crucial for elderly, and Tai Chi can, therefore, help in the prevention or reduction of falls in elderly adults.

Prior to staring the research, the Data Collection Policy would be refered to for ensuring that statutory requirements for data collection and documentation are being followed. For the proposed research, the intervention would target physically inactive older adults. 150 individuals would take part in the study who would be selected through random sampling. Random sampling eliminates the risk of any possible bias while selecting the sample population (Flick 2015). The participants would be selected from local aged care settings that would be contacted for the same purpose. The individuals would have age 65 years or above and would be low active, meaning that they would not be involved in any regular form of an exercise program in a month before taking part in the study.

The participants would need to have the willingness to take part in the study were they would be randomly assigned to a treatment condition. Informed consent would be taken from the individuals fulfilling the above mentioned inclusion criteria for the study. Out of the 150 participants, 75 individuals would be assigned to the intervention group of Tai Chi exercise practice and 75 individuals would be assigned to the wait-list control group.

Participants belonging to the intervention group would attend a one hour Tai Chi practice session thrice a week for 6 moths. The intervention would be a classical Yang style that would incorporate elements of postural alignment, concentration and balance. Each session would have 15 minutes of warm up, half an hour of main Tai Chi exercise and 15 minutes of cool-down period. Expert Tai Chi trainers would take part in this process. Instructors would be recruited through assessment of clear and effective communication skills, ability to deliver personal care, patience level and ability to promote guidance, incouragement and attention.

Participants who would form the control group would be instructed to carry out their routine activities and would be asked not to start any new form of exercise program. A 4 week Tai Chi program would be promised at the end of the study. Initially, the participants would sign a consent form that would indicate the anonymous and voluntary nature of the research. Before the participants would fill up the questionnaire having the baseline measures, instructions would be read out by the researcher and guidance would be provided for completing the questionnaire. Participants would be encouraged to come up with any questions that they feel must be answered before starting with the intervention.

Conclusion

The primary outcome of the study would be physical functioning, that would be assessed with the help of the Short-form General Health Survey after the completion of the intervention. This instrument is known to have 20 items that represent six major domains of health-related quality of life; role functioning, physical functioning, bodily pain, social functioning, health perceptions and mental health. In addition, a questionnaire would be used that would highlight the perceptions and opinion of the participants in relation to taking part in the Tai Chi program. The questions are to include the following-

  • How do you feel after taking part in the Tai Chi program?
  • Do you believe that such programs would be beneficial in bringing major improvements in health status of individuals?
  • Would you recommend such programs to other individuals of your age?

The data gathered from the research would be used for including Tai Chi programs in health promotion activities of older people in health care settings. The data would also reveal the perceptions and viewpoints of individuals undergoing such programs and therefore would be referred to while suggesting Tai Chi programs to individuals.

Generalised estimating equation (GEE) models with binary outcomes would be used for estimating the overall impact of the given intervention on physical functioning. GEE would allow for correlated observations within individuals. A logistic GEE models would be conducted where each model would be run twice. The primary hypothesis for the study relates to group*time interaction. The between-participant treatment group indicator variable would be coded as a dummy. The background characteristics to be included in individual-level covariates for all the six models would be age, gender, and age*gender interaction. All the important analysis would be conducted on an intent-to-treat basis. Statistical significance would be set at p<0.05. Odds Ratio would be calculated along with 95% confidence intervals. For the complete statistical analysis Statistical Analysis System software (v. 6.12) would be used in the study (Panneerselvam 2014).

The dependent variable for the study would be physical functioning of the study participants. The independent variable for the study would be Tai Chi intervention time duration longer than 6 months.

The research study might be facing some issues pertaining to the research design.  The first challenge might be in finding study participants. All aged care settings would be contacted and would be requested to take part in the study. The challenge might also come up while analysing the data. It is crucial to stay focused and draw on all the necessary details.

One strength of the study would be absence of gender bias. However, the cost associated with the study might be a weakness. This would be mainly due to the recruitment of Tai Chi experts.

For increasing the validity of the study, increased randomisation would be considered. The samples would not be a representative sample of the population (Flick 2015).

Two questions that can be used to help evaluate the quality of the study are-

  • What is the possible alternative explanation for the conclusions of the study?
  • Are the findings of the study generalised?

The study has the potential to have an emotional and physical impact on the participants. The health and well-being would significantly increase after the study. Subsequently, the participants would experience enhanced mental status. One physical need would be maintenance of body weight, and this can be fulfilled through proper nutritional status. One emotional need can be support and encouragement that can be fulfilled by providing constant emotional support.

While collecting data, it would be made sure that communication with the participants is culturally sensitive. The religious and ethnic background of the individuals would be understood to ensure that there beliefs and values are not offended and hurt while communicating with them (Medeiros and Teixeira 2016).

Two policies and procedures that are to be followed while applying for and conducting the research are UNSW Research Code of Conduct and Australian Code for the Responsible Conduct of Research (research.unsw.edu.au 2017).

It is inevitable to get ethics approval prior to starting a  research. The institution that would ensure that the study has received the required approval is Human Research Ethics Committee (De Smit et al. 2016).

For ensuring that all research staffs apply the duty of care throughout the study, it is necessary to provide them with sufficient training, information and oversight. Safety procedures and protocols would be provided to them in order to ensure adherence to research methodology. Confidentiality of the participants would be maintained by not disclosing the identity of the participants to secondary sources. Data collected from the study would be stored in a safe place beyond the reach of unwanted parties. Privacy of the participants would be maintained by conducting the research is settings as per the comfort and convenience of the participants (Williamson and Johnson 2017).

From the perspective of nursing research, efforts would be required for translating programs that can disseminate the findings of recent studies on significant research topics in local settings. The findings of the proposed research would be disseminated through newsletters in the local community so that aged care settings can consider including Tai Chi based interventions in their programs.

Constructing the research proposal gave me a valuable learning experience on how to work collaboratively with other team members. Team work is the main essence of undertaking an important project. I had worked with my team members with positive spirit and understanding attitude. The planning for the project was done in sequential manner after every member had put forward their opinion. I tried to exhibit clear communication skills with empathy and mutual respect in order to put forward my viewpoints and opinions. Building openness and trust were beneficial in carrying out the team work and delivering the task. I had scheduled and attended all activities carried out in due course of the project with punctuality. The lessons learnt from carrying out the project would help in understanding the means of carrying out a proper research.

References

Chen, K.M., Li, C.H., Lin, J.N., Chen, W.T., Lin, H.S. and Wu, H.C., 2007. A feasible method to enhance and maintain the health of elderly living in long-term care facilities through long-term, simplified tai chi exercises. Journal of Nursing Research, 15(2), pp.156-164.

Cole, A.R., Wijarnpreecha, K., Chattipakorn, S.C. and Chattipakorn, N., 2016. Effects of Tai Chi exercise on heart rate variability. Complementary therapies in clinical practice, 23, pp.59-63.

De Smit, E., Kearns, L.S., Clarke, L., Dick, J., Hill, C.L. and Hewitt, A.W., 2016. Heterogeneity of human research ethics committees and research governance offices across Australia: an observational study. The Australasian medical journal, 9(2), p.33.

Flick, U., 2015. Introducing research methodology: A beginner's guide to doing a research project. Sage.

Hua, Y., Xiaojuan, R., Yuefeng, W., Ying, Z. and Hongmei, D., 2016. An Empirical Study on the Effect of Tai Chi Exercise on the Physical and Mental Health of the Elderly Based on Network Data. Journal of Computational and Theoretical Nanoscience, 13(12), pp.10309-10313.

Ko, B.J., Huang, C.F., Hsu, T.Y., Wong, T.L. and Chen, P.C., 2016, November. The effect of counter movement jump performance in MiddleAged Elderly Practicing Tai-Chi exercise. In ISBS-Conference Proceedings Archive (Vol. 34, No. 1).

Medeiros, H.P. and Teixeira, E., 2016. Research methodology for nursing and health: a book review. Revista Brasileira de Enfermagem, 69(5), pp.1000-1001.

Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd..

Reid, K.F., Price, L., Harvey, W.F., Driban, J.B., Fielding, R.A. and Wang, C., 2016. Changes in leg muscle strength and power after Tai Chi exercise in patients with symptomatic knee osteoarthritis. Osteoarthritis and Cartilage, 24, p.S430.

Research.unsw.edu.au. (2017). Policies, Procedures & Forms for Researchers & Research Support Staff | UNSW Research Gateway. [online] Available at: https://research.unsw.edu.au/policies-and-procedures [Accessed 21 May 2017].

Song, Q., Tian, X., Wong, D., Zhang, C., Sun, W., Cheng, P. and Mao, D., 2017. Effects of Tai Chi Exercise on body stability among the elderly during stair descent under different levels of illumination. Research in sports medicine, 25(2), pp.197-208.

Song, Q.H., Zhang, Q.H., Xu, R.M., Ma, M., Zhao, X.P., Shen, G.Q., Guo, Y.H. and Wang, Y., 2014. Effect of Tai-chi exercise on lower limb muscle strength, bone mineral density and balance function of elderly women. Int J Clin Exp Med, 7(6), pp.1569-76.

Williamson, K. and Johnson, G. eds., 2017. Research Methods: Information, Systems, and Contexts. Chandos Publishing.

Zhou, J., Chang, S., Cong, Y., Qin, M., Sun, W., Lian, J., Yao, J., Li, W. and Hong, Y., 2015. Effects of 24 weeks of tai chi exercise on postural control among elderly women. Research in sports medicine, 23(3), pp.302-314.

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