Since the emergence of the COVID-19 pandemic, the medical and health care landscape has undergone significant changes. A survey report reveals that 63.7% of Chinese individuals are in a state of moderate sub-health.1 This indicates that the focus should not only be on disease treatment, but also on post-disease rehabilitation. The efficacy of appropriate traditional Chinese medicine techniques in disease rehabilitation has been validated extensively in clinical settings. Traditional Chinese medicine characteristic nursing, rooted in traditional Chinese medicine theory and guided by the principles of syndrome differentiation and holistic approaches to treatment, prevention, and rehabilitation, is a nursing technique with distinct Chinese characteristics.2 With remarkable therapeutic effects, high safety, no side effects, and wide public acceptance, traditional Chinese medicine nursing technology intersects with various disciplines, playing a crucial role in treatment and prevention.3 Among them, the unique advantage of traditional Chinese medicine in disease prevention and treatment establishes its significance in the field of health care. The initial purpose of establishing nursing clinics was to enhance patients’ access to nursing services, allowing nurses to focus on delivering targeted, high-quality, and cost-effective medical services to specific patient populations while freeing them from the burden of hectic clinical work.4 Traditional Chinese medicine and Western medicine are both indispensable in ensuring the health of individuals. In the “12th Five Year Plan,” the Chinese government proposed to “emphasize equal importance to traditional Chinese medicine and Western medicine, and fully leverage the unique advantages of traditional Chinese medicine,” highlighting the “active development of traditional Chinese medicine.”5 The “Healthy China 2030” plan outlines the “Great Health Concept,” which places a central focus on promoting health and emphasizes collaborative efforts among the people to establish and share good health.6 Therefore, implementing nursing outpatient services with Chinese characteristics aligns with national policies and holds great significance for the public’s well-being.

MATERIALS AND METHODS General information

Our hospital is a prestigious tertiary and first-class comprehensive health care institution, encompassing medical treatment, scientific research, training, and education. In July 2021, we established a traditional Chinese medicine specialty nursing clinic with the aim of providing patients with professional and top-quality traditional Chinese medicine nursing care. Through the application of various traditional Chinese medicine nursing techniques such as ear point therapy, acupoint application, cupping, moxibustion, bloodletting, acupuncture, massage, and scraping, we endeavor to improve patients’ health status, enhance their ability for self-management, and foster a friendly and trustworthy doctor-patient relationship. Our efforts have garnered widespread recognition from patients.

Methods Consultation room setup

The Traditional Chinese Medicine Specialty Nursing Clinic is an independent space separate from the inpatient department. It is furnished with office desks, chairs, waiting chairs, computers, printers, water dispensers, small disinfection cabinets, ultraviolet lights, billboards, consultation flow charts, cleaning cabinets (containing blood pressure gauges, thermometers, Wang Buliuxing seeds, mugwort sticks, glass jars, and other items suitable for traditional Chinese medicine techniques), sterile cabinets (stocked with disposable sterile cotton swabs, needles, gloves, 75% alcohol, and other sterile items), and a rescue vehicle. Currently, there are 6 outpatient beds divided across 3 floors to ensure patient privacy. Each floor is further divided into clean and contaminated areas.

Staffing

Since 2019, the hospital’s leadership and nursing department have been preparing for the establishment of nursing clinics. They have carefully selected Chinese medicine nursing experts for planned, targeted, and systematic training. Eventually, an expert nursing team comprising 5 experienced personnel has been formed within the hospital, all of whom are female. Their years of service range from 18 to 36 years, and one of them has been recognized as one of the first batch of national backbone talents in traditional Chinese medicine. Additionally, all team members serve as master’s supervisors. Three of them hold chief nurse positions, while the remaining 2 are deputy chief nurses with professional titles. Currently, there are 11 graduate students being mentored by nursing experts from the massage department, geriatrics department, gynecology department, orthopedics department, and nursing department.

Nursing outpatient management and quality control Appointment management

Outpatient scheduling follows a system of responsibility, wherein each nursing expert has fixed visiting hours. The clinic adopts a joint medical and nursing outpatient model. Patients can register in advance or on-site through the WeChat official account or applet. Upon arrival, they join a designated WeChat group after their initial visit and receive regular questionnaires daily. This ensures the implementation of a responsibility system during the first visit.

Quality control

Personnel are responsible for nursing outpatient management develop plans, annual work plans, work systems, and assessment methods. These are implemented in accordance with the established schedules. Regular summaries and improvements are conducted each year. Additionally, regular learning, training, and assessments are organized. Clear job responsibilities and specific work requirements are provided for each position shift, and strict adherence to work rules is emphasized. Detailed safety management rules are developed, encompassing electricity and fire safety, as well as the management of supplies and the environment. A medical waste management system is implemented. Referral procedures for changes in patient conditions, contingency plans for preventing fainting and falls, and measures for occupational exposure are developed. Various infection prevention and control systems specific to traditional Chinese medicine techniques are established, with key points for infection prevention and control in different traditional Chinese medicine practices being clearly defined. Operation flowcharts and assessment scoring tables are developed for various traditional Chinese medicine techniques, along with specific precautions. Outpatient trainees and interns are managed in accordance with regulations, with weekly teaching plans, outpatient learning, and post-training assessments and scoring being conducted.

Nursing outpatient development project Medical history collection and evaluation

The patient visit order is carefully arranged to ensure systematic collection of medical history. A patient visit registration form is completed, and the specific evaluation criteria are outlined in Table 1. Based on the patient’s condition, appropriate evaluation scales such as hand back swelling assessment, patient self-care ability assessment scale, Hamilton anxiety scale, VAS pain scoring standard, modified Ashworth spasticity assessment standard, dizziness disorder scale, lumbar JOA score, cervical JOA score, and Fugl Meyer evaluation scale are utilized. These scales aid in gathering information concerning patient complaints, physical signs, tongue images, and more, through a combination of observation, inquiry, and examination. In cases where contraindications or severe conditions requiring specialized care are encountered, it is recommended to seek medical attention from the relevant department for further treatment. In the event of unexpected situations, prompt medical attention from the emergency department is advised.

TABLE 1. - Patient Visit Information Registration Form Project Name Specific Content Evaluation Method General information Gait, nutritional status, age, chief complaint, past history, family history, personal history, diet. Two stools, sleep. Observation and consultation Physical assessment Facial color, tongue appearance, meridian movement, positive signs, corresponding scale scores, and physical type Consultation, observation, palpation, review of examination data, evaluation of corresponding scales, and identification of physical fitness Treatment plan selection Ear point therapy, cupping, massage, acupuncture, moxibustion, acupoint application, and scraping. The location, treatment frequency, and considerations regarding diet, emotions, daily life, and exercise are also taken into account. Consultation Treatment process and effectiveness Frequency and duration of treatment, post treatment effects, evaluation of effectiveness, and adjustment of treatment plans Consultation, observation and diagnosis
Instructions

Please arrange the order of patient visits and complete the following registration form. Collect the patient’s medical history and provide the necessary evaluation based on the specific content shown in Table 1. Use appropriate evaluation scales (such as hand back swelling assessment, patient self-care ability assessment scale, Hamilton anxiety scale, VAS pain scoring standard, modified Ashworth spasticity assessment standard, dizziness disorder scale, lumbar JOA score, cervical JOA score, Fugl Meyer evaluation scale) to gather patient complaints, physical signs, tongue images, and other relevant information through a combination of observation, inquiry, and examination.

In cases where there are contraindications or severe conditions that require referral, it is important to recommend seeking medical attention from the appropriate department for further treatment. In the event of unexpected situations, it is advised to promptly seek medical attention from the emergency department.

(1) Auricular Therapy

Auricular therapy encompasses the techniques of copper needle scraping, ear moxibustion, ear bleeding, and ear point pressing. These therapies can be used individually or in combination. By employing meridian acupoint evaluation instruments or observing and palpating the ears, positive acupoints on the ear can be identified. Following the differentiation of symptoms and signs, specific acupoints can be selected. After stimulating the acupoints through gentle manipulation, techniques like ear scraping, pricking, bleeding, and the application of Wangbuliuxing seed line acupoints can be performed. Auricular therapy aims to harmonize the meridians, regulate the flow of Qi and blood, and restore the balance of Yin and Yang through the stimulation of ear acupoints.7 Research has shown that ear acupoint therapy is particularly beneficial for treating insomnia, constipation, and obesity, being the most effective in these conditions. Other diseases for advantageous ear acupoint therapy include dysmenorrhea, allergic rhinitis, postoperative pain, allergic rhinitis, and myopia.8

(2) Cupping Therapy

Cupping therapy encompasses techniques such as dragon cupping, balanced cupping, Qiao’s cupping, and pricking blood cupping. This method is advantageous in treating both acute and chronic soft tissue injuries, as well as conditions resulting from imbalances of Yin and Wei, obstruction of Yin and blood, and superficial symptoms caused by wind, cold, and dampness.9

(3) Massage

Tuina massage includes pediatric chiropractic and therapeutic massage, as well as acupoint massage with medicine sticks and other techniques. In particular, pediatric massage has evolved for over 400 years, becoming highly refined and diversified, with various schools of practice that continue to this day, offering distinctive therapeutic benefits and promoting overall health.10 Massage techniques alleviate pain by enhancing local blood circulation. They are effective in addressing sources of pain such as spinal lesions, soft tissue injuries, muscle strains, as well as functional and non-inflammatory pain. Massage can also be beneficial for anatomical abnormalities and chronic visceral pain.11

(4) Needle Techniques

Acupuncture techniques involve the use of wrist and ankle needles, as well as press needles. These methods have evolved from traditional acupuncture and are primarily applied in the treatment of motor and neurological disorders.12

(5) Moxibustion Techniques

Moxibustion techniques encompass Huolong Moxibustion, Du Moxibustion, Thunder Fire Moxibustion, and Umbilical Moxibustion. Moxibustion is commonly utilized in nursing clinics during the autumn and winter seasons.

(6) Application of Acupoints

The application of acupoints involves the use of 3 fu plasters and 3 jiu plasters. It has been scientifically validated that 3-V patches offer significant therapeutic effects in the prevention and treatment of respiratory diseases, and they are extensively applied in clinical practice. Furthermore, their efficacy extends to various fields in women’s and children’s health care.13 The Sanjiu patch can enhance the body’s disease resistance through drug penetration via acupoint stimulation.14 The nursing outpatient department offers corresponding medical service projects every 3 to 9 days, effectively meeting the public’s preventive health care needs.

(7) Gua Sha Therapy

Gua Sha therapy effectively addresses conditions such as cervical spondylosis, low back pain, shoulder periarthritis, knee osteoarthritis, and thyroid-related diseases. Gua Sha has the inherent capabilities of harmonizing meridians, activating energy pathways, promoting the circulation of Qi and blood,15 and balancing the Yin-Yang. Additionally, it enhances the skin’s immune function.16

(8) Health Education

Upon concluding the visit, patients are provided with comprehensive information regarding post-treatment precautions. They receive guidance on daily dietary habits and exercise routines tailored to their physical condition and overall well-being. Recommendations are made regarding suitable exercises or techniques for health preservation, while emotional guidance is also provided. The dissemination of daily health knowledge, along with disease prevention and control suggestions, is an integral part of this health education process.

(9) Follow-up

Following a stage of treatment, patients receive follow-up care through various channels such as WeChat, electronic satisfaction questionnaires, or phone calls. The purpose is to assess the effectiveness of their diagnosis and treatment, gauge patient satisfaction, analyze the results of follow-up evaluations, identify any issues encountered, and propose corrective measures.

Statistical methods

Statistical analysis was performed using SPSS 27.0 software, with counting data being described in terms of frequency and percentage.

RESULTS Outpatient statistics

Table 2 illustrates the comprehensive statistics of the outpatient workload since the commencement of consultations in July 2021, revealing a remarkable total of over 7046 visits. Figure 1 provides a comparative analysis showcasing tongue images before and after the application of a distinctive traditional Chinese medicine technique – ear acupoint pressing.FIGURE 1.:

Comparison of tongue images before and after 1 ear acupoint application and pressure.

TABLE 2. - 2021-2023 Outpatient Statistics Project Example Percentage (%) Visit time July 2021-December 2021 340 4.8 January 2021-December 2022 4212 59.8 January 2023-July 2023 2494 35.4 Gender Female 5458 77.5 Male 1588 22.5 Age (years) 1~ 102 1.4 10~ 206 2.9 20~ 1006 14.3 30~ 1299 18.4 40~ 1526 21.7 50~ 1603 22.9 60~ 968 13.7 70~ 221 3.1 80~ 115 1.6 Disease name Insomnia 1149 16.3 Cervical spondylosis 1026 14.6 Spleen and stomach diseases 1015 14.4 Female menopausal syndrome 636 9.0 Lumbago 407 5.8 Tinnitus 384 5.5 Constipation 324 4.6 Scapulohumeral periarthritis 230 3.3 Migraine 130 1.8 Allergic rhinitis 125 1.8 Menstrual irregularities 78 1.1 Other 1542 21.8
Additional assessments

A total of 518 patients were carefully chosen to partake in telephone or questionnaire surveys with the aim of evaluating their satisfaction with nursing outpatient visits. Among them, 503 cases were deemed satisfactory, while 15 cases merited dissatisfaction. Consequently, the overall satisfaction rate reached an impressive 97.1%, accompanied by a remarkable absence of adverse events, medical disputes, and infections, all recorded at 0%.

DISCUSSION The significance of establishing specialized traditional Chinese medicine nursing clinics in meeting diverse patient needs

The establishment of specialized clinics devoted to traditional Chinese medicine nursing has bestowed upon this indispensable practice a pivotal role in various health care domains. It effectively addresses the concepts of “prevention before illness,” chronic disease management, and holistic health restoration, enabling individuals to access the benefits of traditional Chinese medicine regardless of their health condition.2 Since their inception, these clinics have offered patients a vast repertoire of suitable traditional Chinese medicine techniques, delivering comprehensive nursing services even beyond the hospital walls. Their presence has effectively optimized the health service system within medical facilities, relieving the burden of outpatient treatment while satisfying the general public’s increasing demand for traditional Chinese medicine health care and well-being.

The Guiding Role of Specialized Traditional Chinese Medicine Nursing Clinics in the Diverse Career Development of Nurses and the Cultivation of Nursing Talent

A qualitative study has yielded compelling evidence indicating that engaging in traditional Chinese medicine nursing outpatient work considerably enhances nurses’ sense of professional fulfillment and self-validation.17 Thus, the successful establishment and seamless implementation of specialized traditional Chinese medicine nursing clinics serve as a significant recognition of the capabilities possessed by nursing professionals, both in the eyes of medical institutions and society. This recognition substantially contributes to the progressive development of nursing disciplines and offers a valuable platform for the cultivation of traditional Chinese medicine nursing talent.

PROBLEM ANALYSIS AND FUTURE PROSPECTS Analysis of dissatisfaction factors and improvement strategies

In this study, the dissatisfaction rate with nursing outpatient services was remarkably low, which can be attributed to the individual differences in the population and the distinct characteristics of various suitable traditional Chinese medicine techniques. Upon careful analysis of the actual situation, it is evident that the following reasons may contribute to the instances of dissatisfaction: (1) Some patients exhibit poor compliance and are overly sensitive to acupoint reactions during the treatment process, thus hindering their cooperation. For example, insomnia patients undergoing ear acupoint therapy may experience discomfort due to pain caused by acupoint pressure, consequently resulting in less effective therapeutic outcomes. To address this issue, alternative traditional Chinese medicine techniques that patients find more tolerable can be employed; (2) Non-compliance with prescribed treatment regimens may also lead to dissatisfaction with therapeutic effects. It has been established that individuals with long-term illnesses may develop persistent psychological issues, such as medical non-compliance, emotional distress, and a lack of patience and confidence.18 However, traditional Chinese medicine emphasizes temporal continuity in the occurrence and development of diseases. As a result, treatment should be carried out in a sequential manner that aligns with the characteristics of each patient’s disease progression,19 wherein both treatment and rehabilitation are implemented systematically. Furthermore, the guiding principles of traditional Chinese medicine treatment emphasize addressing acute symptoms and mild symptoms based on different stages of each patient’s illness.20 This insight highlights the importance of effective communication and timely empathy from nursing outpatient staff during the treatment process. Strengthening emotional care and providing psychological counseling can enhance patient compliance, ensuring treatment adherence throughout the prescribed course of therapy; (3) Lastly, the diversity in diseases and traditional Chinese medicine nursing techniques within traditional Chinese medicine specialty nursing clinics can result in discrepancies in syndrome differentiation, diagnosis, and treatment approaches. In future clinical practice, enhancing publicity efforts and refining expertise registration columns can provide patients with precise and professional medical services.

Analysis of outpatient statistical results

The statistical results reveal a higher number of female patients seeking medical treatment compared to male patients, which may be attributed to women’s increased awareness of their physical health and greater willingness to engage in socialization activities. Moreover, patients aged 50 to 59 account for the highest proportion at 22.9%, followed by those aged 40 to 49 at 21.7%, potentially indicating the impact of menopause among women. The most prevalent diseases observed were insomnia, cervical spondylosis, and spleen and stomach disorders, which may be linked to hormonal changes during women’s menopausal period. Both cervical spondylosis and spleen and stomach disorders are closely associated with modern lifestyles.

Future prospects

The establishment of traditional Chinese medicine specialty nursing clinics has fostered the development of unique nursing brands that incorporate traditional Chinese medicine characteristics, thereby enriching the essence of nursing specialties. Since their inception, these clinics have gained widespread acclaim. However, due to the solidification of public perception regarding nurses’ role or insufficient promotional efforts, the majority of patients currently rely on the esteemed reputation of traditional Chinese medicine specialty nursing clinics, which has been disseminated through word-of-mouth or referrals from other outpatient doctors. I firmly believe that with the nation’s emphasis on traditional Chinese medicine and policy support, specialized nursing clinics will continue to emerge in various regions. The establishment of traditional Chinese medicine departments and the dissemination of traditional Chinese medicine knowledge in Western hospitals and community health care centers will contribute to a deeper understanding and appreciation of traditional Chinese medicine nursing techniques. Ultimately, traditional Chinese medicine’s characteristic nursing techniques will safeguard the health and well-being of an increasing number of individuals.

Relevance to clinical practice

This research platform provides opportunities for the expansion of nursing professionals’ expertise. The successful development of outpatient clinics serves as a valuable reference and source of experience for the establishment of similar specialized nursing clinics.

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