Practice of the construction and management of TCM nursing outpatient service — takes a breast specialty in a third-grade hospital in Beijing as an example

: Through the phased construction, the breast specialty traditional Chinese medicine (TCM) nursing clinic of our hospital has achieved good results. From 2017 to 2019, the number of patients increased by 7.6%, and the clinical cure rate increased by 9.4%. Take the breast specialty TCM nursing clinic of our hospital as an example, introduce the registration method of TCM nursing clinic, the TCM nurse home call qualification, service mode, and the clinical diagnosis and treatment effect of specialty TCM nursing. It is pointed out that the construction of TCM nursing clinic needs to be guided by clinical efficacy, and to provide patients with professional TCM care through clear positioning, disease refinement, medical division of labor, and highlighting the technical characteristics of TCM nursing. By reviewing the construction and development of breast specialty TCM nursing clinic in our hospital, we introduced the experience in detail, in order to provide ideas and guidance for the construction of other clinical specialty TCM nursing clinic.


Practice of the construction and management of TCM nursing outpatient service takes a breast specialty in a third-grade hospital in Beijing as an example
Hong Chen1* , Su-Na Li 1 , Rui-Jing Jia 1 , Cui Liu 1 , Dong-Sheng Zhu 1 , Xue-Ling Ma2*

Introduction
The National Nursing Development Plan (2016-2020) stressed that China should vigorously cultivate traditional Chinese medicine (TCM) nursing talents, promote appropriate TCM nursing technology, and promote the development of TCM nursing technology.Specialized TCM nursing outpatient service can fully reflect the overall nursing and TCM syndrome differentiation.Western medicine, nurse group and doctor group has formed a clear division of labor and cooperation mode.In 2015, National Administration of Traditional Chinese Medicine issued about the nursing manual of traditional Chinese medicine technology notice, the clinical common 18 traditional Chinese medicine nursing technology for the industry specification, to ensure the safety of operation and nursing quality.Through the phased construction, the breast specialty TCM nursing clinic of our hospital has accumulated certain practical experience.From 2017 to 2019, the number of patients increased by 7.6% and the clinical cure rate increased by 9.4%.This paper hopes to discuss the construction and management of breast TCM nursing clinic to provide ideas and guidance for the construction of clinical TCM nursing clinic.

Construction of Breast Specialty TCM Nursing Clinic
Our breast specialty consists of 9 doctors, 10 nurses, including 4 outpatient nurses.In 2017, Beijing launched the construction of "specialty nursing clinics" and established 8 specialized traditional Chinese medicine nursing clinics in Beijing medical institutions.Among them, our hospital's nursing as a national key clinical construction project was approved as a breast care clinic in November 2017.The visiting nurse is composed of 4 TCM nursing backbone, and has set up 1 group leader.The visit time is all day from Monday to Friday and on Saturday and Sunday morning.

Strengthen the top-level design and improve the outpatient structure
Under the leadership of the project management team of the Nursing Department, the hospital is responsible for the quality supervision and management of the entire construction process (Figure 1).Through the "seven constructions and three managements" (Seven constructions: organization management, system construction, consulting facilities, personnel qualifications, service items, quality monitoring, effect evaluation; Three managements: optimization of annual treatment and patient satisfaction and process optimization, establishment of health files, establishment of evaluation mechanism management project operation mode.
In terms of organization, a complete standardized management model of breast Chinese medicine nursing clinics has been established, and a management team of breast Chinese medicine nursing clinics has been established.The team is responsible for the specific implementation and coordination of the supervision work.It is supervised by the Nursing Department and consists of 4 Chinese medicine backbone nursing staff.
In terms of system construction, the responsibilities and systems of nurses in breast specialist traditional Chinese medicine nursing clinics have been established, and the diagnosis and treatment process and the patient diagnosis and treatment process have been optimized.Implement an appointment registration system to shorten the waiting time for patients.
Facilities: According to the characteristics and subject needs, the breast specialist traditional Chinese medicine nursing clinic has an independent area, two internal and external rooms, with a total of 25 square meters.There are 4 diagnosis beds, 1 syndrome differentiation nursing clinic, and 2 treatment beds.The environment layout fully reflects the cultural characteristics of traditional Chinese medicine, and is equipped with 12 infrared treatment instruments.
Personnel qualifications: Nurses have a bachelor degree or above and have worked for more than 5 years.The nurse members have obtained the national TCM nursing backbone talents or the qualification certificates of specialist nurses at or above the provincial or municipal level.In addition, nurses should have a solid knowledge of the basic theories of Chinese medicine, strong ability in syndrome differentiation and protection, and skilled Chinese medicine nursing techniques.
Service items: Breast specialist TCM nursing outpatients mainly include hyperplasia of mammary glands and acute mastitis during lactation.For patients with these two diseases, the department mainly developed TCM nursing techniques such as creams, manual massage, and milk drainage.In the whole process, a standardized TCM nursing operation procedure was implemented.This can highlight the unique advantages of TCM and create a brand of breast specialist TCM nursing.
Quality control: The department carries out clinical evaluation of breast specialist nursing.Every month, the breast specialist nursing quality control, disinfection, work quality, effect evaluation, nursing clinic quality management level, clinical efficacy, patient satisfaction content evaluation, nurse core competence, characteristic TCM nursing technical operation technology, etc. are evaluated.This continues to effectively improve the diagnosis and treatment capabilities and professional skills of breast specialist nursing nurses.

Clarify the division of labor of medical care and clarify the post responsibilities
Since ancient times, Chinese medicine has not been separated.The Guizhi Decoction conditioning method in "Treatise on Febrile Diseases" defaults the behavior of after-medicine care to the work of the doctor.Therefore, in the construction of TCM nursing clinics, we must first clarify the division of labor between doctors and nurses.When the patient enters the treatment room, the doctor receives the medical certificate, checks the patient's information, inquiries about the condition, and gives corresponding examinations and treatments through look, listen, question and feel the pulse.The treatment is completed by visiting nurses, and syndrome differentiation nursing and health education are given during the treatment.After the treatment, the receiving doctor checked the treatment effect again, and the patient was discharged.

Process-based diagnosis and treatment to improve the timeliness of the work
There are two ways to optimize the treatment process.One is that the patient goes directly to the Chinese medicine nursing clinic for treatment, and the other is to go to the Chinese medicine nursing clinic for treatment after a medical expert's diagnosis, which effectively supplements the doctor's diagnosis and treatment.The first patient was referred to a Chinese medicine nursing clinic by a medical expert.After treatment by the visiting nurse, the patient was given syndrome treatment and corresponding treatment.The next appointment is after treatment, and the patient will be directly transferred to the TCM Figure 1 Strengthen the top-level design and improve the outpatient structure nursing clinic for the second visit.Finally, a "convenient", "efficient" and "sustainable" breast specialist traditional Chinese medicine nursing outpatient service model will be formed.
Establish health records: According to recorded living habits, past medical history, diagnosis and treatment, family medical history, current medical history, physical examination results, the process of occurrence, development, treatment and outcome of the disease, develop a personalized and differentiated health care plan to alleviate the suffering of patients.
Establish evaluation mechanism: Establish an evaluation mechanism for breast specialist TCM nursing outpatient clinics, fill in the efficacy observation evaluation form before and after treatment, and conduct monthly efficacy analysis and summary.Self-designed nursing outpatient satisfaction questionnaire, mainly including treatment environment, treatment process, service attitude, service quality, service skills, service effect, etc.The subjects of the survey are all patients.

Improving clinical efficacy
In the past three years, under the condition of limited space, the number of treatments for patients has steadily increased, and the clinical efficacy of patients has gradually improved (Table 1).

Patient satisfaction was improved
During the construction of our breast specialist Chinese medicine nursing clinic, we continuously optimize the diagnosis and treatment process of patients, improve the medical system, and reduce the waiting time of patients.The appointment system is implemented so that patients can flexibly arrange their own diagnosis and treatment time and so on.In addition, nurses are also trained and assessed on the basic theories of traditional Chinese medicine and operation, so as to continuously improve nurses' professional skills and dialectical nursing ability.

Improve patients' awareness of self-health management and improve patient compliance
National Nursing Career Development Plan (2016-2020) [1] was proposed that hospitals should vigorously promote the development of traditional Chinese medicine nursing, and give full play to the therapeutic management role of traditional Chinese medicine nursing in disease treatment, chronic disease management, health care, rehabilitation promotion, and health care.Exploring the standardized management model of TCM specialist nursing clinics and establishing the service model of TCM specialist nursing clinics is one of the important measures for the development of TCM nursing.
Specialized TCM nursing clinics inherit the theory of TCM nursing, innovate TCM nursing technology, and provide outpatients with comprehensive nursing services integrating specialized nursing, rehabilitation care, health care and chronic disease management [2].It can also be used as a training base for specialized characteristic technology to provide a clinical practice base for clinical teaching and training of specialized nurses.
Breast-related diseases belong to the dominant diseases of TCM, and the related diseases mainly include: breast inflammation, breast tumor, breast hyperplasia, etc.For example, therapeutic breast massage during lactation can relieve the blockage of clogged catheters and prevent mastitis.The most commonly used TCM nursing methods are: TCM external application, technique massage, skin needle, moxibustion and so on.Except for a few sudden and serious diseases, most symptoms have strong periodic manifestations and have little impact on daily life and work.Most of the TCM nursing operations related to breast specialists are single time-consuming and long-term.For such patients, the establishment of TCM nursing clinics greatly facilitates the daily treatment of patients.This reflects the "simple and inexpensive" work characteristics of traditional Chinese medicine services [3].And it is of great significance to improve patients' self-health management awareness and improve patient compliance.

The training of excellent TCM nursing talents is the key to the construction and development of TCM nursing clinic
The TCM nursing clinic adopts the nurse independent home visit mode, which has high requirements for the comprehensive ability of the nurses.The professional ability of the visiting nurses is an important premise to ensure the service quality of the TCM nursing clinic and the safety of the patients.At present, among the nursing teams of hospitals of traditional Chinese medicine, few nurses graduate from universities of traditional Chinese medicine, most of them lack the relevant education and training of the basic knowledge of TCM [4].The lack of systematic knowledge of TCM nursing has seriously affected the clinical practice and further in-depth learning and personal development of TCM nursing staff [5].The training of nursing personnel is the key to the construction and development of nursing discipline, and the knowledge structure of nursing staff directly affects the effect of the implementation of nursing measures [6].In the future, while strengthening the training of Chinese medicine nursing talents, more targeted training

Deficiency and outlook
Although the TCM nursing clinic has gradually become popular in China, nurses have no right to prescribe and lack supporting policies and legal protection measures [7].The fees related to TCM nursing technology and the labor value of nursing staff are generally low, which restricts the construction and development of TCM nursing.Therefore, relevant departments need to increase supporting policies, and open some non-pharmaceutical prescription permissions, and raise the charging standard of traditional Chinese medicine nursing technology [8].In addition, the nurses generally lack a sense of professional honor.The establishment of TCM nursing clinic in hospital is set up in different departments and lacks systematic management.In order to mobilize the enthusiasm of the majority of nursing workers, it is necessary to promote profound changes in the nursing model and management model [9].Nurses in TCM hospitals should seize the opportunity, highlight their core competitiveness, find a suitable construction path for the development of TCM nursing, and improve the autonomy and happiness of the majority of TCM nursing colleagues.

Conclusion
In practical work, the inheritance, development and innovation of TCM nursing technology are the foundation for the development of TCM nursing clinics.Modifying the problems existing in the process is conducive to optimizing the nursing service process, improving the efficiency of nursing service, improving the nursing service experience, and realizing the creation of favorable conditions for scientific nursing management.