Methodological exploration on the construction of a traditional Chinese medicine nursing expert consensus based on evidence—taking stroke as an example

To explore the methodology of the evidence-based expert consensus formulation process of traditional Chinese medicine (TCM) nursing taking stroke as an example.

First, preliminary and comprehensive presentation of all stroke-related symptoms and corresponding TCM nursing techniques involved were revealed through bibliometric analysis. Then, selection of stroke symptoms and TCM nursing techniques for inclusion in the consensus was performed using an expert consultation method. Next, we determined the search strategy for a precise evidence search; conducted an evaluation of evidence quality and the grade of the evidence; and completed evidence extraction, evidence analysis, and evidence synthesis based on the included symptoms and TCM nursing techniques. The Delphi method was then applied to determine the strength of each recommendation and the choice of nursing care points by referring to the Grading of Recommendations, Assessment, Development, and Evaluations grid. Finally, we conducted an external expert validation of the Delphi results to form an expert consensus guideline.

Through the bibliometric analysis, 22 stroke symptoms and 18 TCM nursing techniques were identified in the literature. Then, after expert consultation, 22 symptoms and 111 pairs of symptoms combined with TCM nursing techniques were selected for the evidence search. Evidence integration yielded 10 stroke symptoms corresponding to 29 bodies of evidence; these 10 symptoms were retained through the Delphi consultation, and recommendation strength results for 26 recommendations were obtained. A total of 9 symptoms were further retained for expert external validation to form 24 recommendations, with a recommendation process score range of 7.64–9.99 points and a more scientific and standardized recommendation-formation process.

Owing to the current limited conditions of evidence-based resources for TCM nursing, the present consensus-building process represents only a preliminary exploration of an evidence-based expert consensus for TCM nursing to provide a reference for a more scientific and standardized methodology.