Traditional Chinese Medicine Nursing Competency: Status and Influencing Factors Across Healthcare Settings

Traditional Chinese Medicine Nursing Competency: Status and Influencing Factors Across Healthcare Settings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Traditional Chinese Medicine Nursing Competency: Status and Influencing Factors Across Healthcare Settings Ming Jin, Jing Yang, Zhining Liu, Qian Hou, Yiman Hou, Yue Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8033013/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective: Given the profound cultural heritage of traditional Chinese medicine and the growing demand for traditional Chinese medicine nursing services in Guangyuan, as well as the contradiction between the existing service capabilities and the insufficient capacity for such services. To investigate the current status of Chinese medicine nursing capacity in different types of medical institutions in Guangyuan, and analyze the enterprise influence factors for providing scientific basis for improving the quality of traditional Chinese medicine nursing services, optimizing resource allocation, and formulating targeted improvement strategies in the region. Methods: The study used a combination of stratified and random sampling, 1,300 frontline nurses from twenty medical institutions in Guangyuan were assessed via a Likert-scale questionnaire. Structural equation modeling examined traditional Chinese medicine (TCM) nursing competence pathways and verified direct/indirect factor effects. Cluster analysis was used to classify groups of nurses with different competency levels and summarize the characteristics of each group. Results: The total TCM nursing competency score of medical institutions in Guangyuan was 3.19±0.91. Among them, the score of basic theoretical knowledge was 3.07±0.92, the score of common nursing techniques was 3.43±0.97, and the score of advanced clinical practice was 3.07±1.01. Multiple linear regression analysis showed that the main influencing factors included the type of hospital (β=-0.45), the number of trainings (β=0.19), and the education level (β=0.35). Cluster analysis indicated that nurses in TCM hospitals were mainly distributed in the high-competence group. Conclusion: TCM nursing competence among medical institutions in Guangyuan was moderate, influenced by multiple factors. Competence varied significantly across institution types, with specialized TCMhospitals exhibiting superior performance to non-specialized counterparts. Factors significantly affecting TCM nursing competence included nursing staff education, institution type, number of TCM nursing skills mastered, training willingness, and organizational support. Strengthening TCM nursing education, optimizing resource allocation, and disseminating best practices from specialized TCM hospitals are recommended to enhance service quality and support sustainable development, ultimately better meeting public health needs. Patient or Public Contribution: No Patient or Public Contribution. Clinical trial number: Not applicable. Traditional Chinese medicine nursing Nursing competence Influencing factors cross-sectional study current landscape of TCM nursing TCM nursing technical Figures Figure 1 Figure 2 Figure 3 1. Introduction In the current healthcare systems, Traditional Chinese Medicine (TCM) nursing provides a gentle and personalized care program for patients with its core concepts of holism and evidence-based treatment [1-3]. Guangyuan boasts profound TCM cultural heritage and a robust TCM healthcare infrastructure, making it an ideal practicum site for evidence-based TCM nursing education. As a regional hub of TCM culture in Northern Sichuan, Guangyuan’s healthcare challenges and innovations in TCM nursing reflect common issues faced by underdeveloped areas in Western China. Studying this region provides critical insights for optimizing TCM resource allocation in similar socioeconomic contexts. However, with the transformation of the modern medical model and population aging, TCM nursing is facing a contradiction between increased service demand and insufficient service capacity [4-6]. This misalignment between service provision and population health needs is particularly pronounced within primary healthcare institutions [7-8]. Guangyuan as a national pilot zone for integrated TCM-Western medicine reform further amplifies the urgency of addressing these gaps, as its outcomes may inform nationwide policy adjustments. A central challenge in modernizing TCM nursing, lies in reconciling the preservation and enhancement of its unique strengths with the effective integration of modern nursing concepts and technologies [9-11]. Currently, the TCM nursing service in Guangyuan is deficient in human resource allocation, service quality control, and nursing technology innovation. These factors work together to affect the practical effect of TCM nursing, and affect the satisfaction of patients and health outcomes. In recent years, the Guangyuan government and the Health Committee have recognized these issues and introduced a series of policy initiatives aimed at enhancing nursing services and elevating care quality standards, such as the Implementation Plan of Guangyuan Municipal Action Plan for Further Improvement of Nursing Services (2023-2025) . The implementation of these policies provides a policy context and practice platform for research, creating opportunities to evaluate policy impacts and refine implementation strategies. This study aims to conduct an in-depth investigation into the current landscape of TCM nursing practices across healthcare institutions in Guangyuan. Meanwhile, it explores the multidimensional factors affecting the quality of TCM nursing services, such as the nursing staff competency, patient knowledge and acceptance of TCM nursing, healthcare organizational resource allocatio, and the policy environment. The results will provide improvement suggestions and strategies for TCM nursing services in Guangyuan and even in other regions. This study will promote the sustainable development of TCM nursing services and better meet the health needs of the people. 2. Information and methods 1,300 clinical nurses working for healthcare institutions in the Guangyuan were chosen at random to participate in the study. Inclusion criteria: Persons need to work in TCM nursing positions, and their departments should provide TCM nursing services and implement related programs. Participants need to participate in the survey voluntarily on the basis of fully understanding the content of the study. Exclusion criteria: Nurses in training who is on short-term study in the unit. Nurses who do not perform routine work for their own reasons or special assignments. 2.1 Research method 2.1.1 General information questionnaire To assess the competency state of nurses in TCM nursing in Guangyuan hospitals, the study conducted a thorough literature analysis and engaged in-depth discussions with subject-matter experts. Based on these preparations, the study designed a questionnaire to collect basic information from the nurses. The questionnaire covered the nurses' basic information, occupational status, and clinical responsibilities. 2.1.2 Questionnaire on TCM nursing competence To assess TCM nursing competencies, the study used a specialized questionnaire developed in 2018 [ 12 ]. This questionnaire assessed three main areas: basics of TCM nursing, TCM nursing techniques, and advanced TCM nursing clinical practice. A Likert 5-point scale was used to measure familiarity with each component, ranging from 1 (very unfamiliar) to 5 (very familiar). Higher scores indicated better mastery. 2.1.3 Questionnaire on nursing training needs in TCM To understand the TCM training needs of the nursing staff, another questionnaire was used in the study [ 12 ]. This questionnaire contained six questions about the level of importance, training frequency, training willingness, method of theory and skill training, and specific content of training. The validity and reliability of questionnaire were examined in a pre-survey to make sure it was reliable before it was formally used. 2.2 Sample size estimation The study used Kendall's guidelines for sample size estimation to determine the sample size, which recommended that the sample size be calculated using five to ten times the total number of items in the questionnaire. The questionnaire used for the survey contained three sections with a total of fifty-three questions. The TCM nursing competency assessment section had thirty-seven questions. The general information section consisted of ten questions. The TCM nursing training needs section had six questions. Considering the possibility of invalid questionnaires, the study expected a 20% rate of invalid questionnaires. Three hundred and eighteen was determined to be the minimal sample size needed based on these variables. 2.3 Sampling methods The study adopted a random sampling method to select survey respondents. Specifically, twenty public medical institutions in Guangyuan were selected, all certified as Level II or higher with demonstrated capacity for independent TCM nursing service delivery. These included the provision of TCM services and the implementation of TCM nursing programs. Among them, there were 8 conventional TCM hospitals and 3 hospitals of level III or above, and 12 non-conventional TCM hospitals and 4 hospitals of level III or above. The total number of samples collected was 1,300, and 90 invalid questionnaires were excluded, resulting in a valid sample of 1,210. 2.4 Data collection Between January and October 2024, the investigator conducted data collection. After obtaining permission from the hospital's nursing management and the head nurse, the researcher clearly explained the research objectives, methods, contents, and the confidentiality agreement of questionnaire information to the nursing staff. The QuestionStar e-questionnaire was completed anonymously to ensure that each respondent fully understood and agreed to participate in the survey, and answers were limited to one submission per IP address. Any questions that arose during the course of the survey were answered by the surveyor. Once all questionnaires were submitted, the Star system stopped accepting new responses to ensure data integrity. During the data processing stage, questionnaires with logical contradictions, a single repetitive option, and not answered in accordance with the requirements were excluded to guarantee the accuracy and validity of the data. 2.5 Methods of structural equation modeling analysis The study clarified the direct and indirect effects (IDE) of each potential variable on TCM nursing capacity by constructing and validating a multiple influence pathway model of TCM nursing capacity in Guangyuan medical institutions. This could provide a scientific basis for optimizing TCM nursing services. Three hypotheses were made in the analysis, including hospital type has a direct effect (DE) on TCM nursing competence, academic qualifications indirectly affect TCM nursing competence through the number of trainings, and willingness to train and training emphasis have direct and IDEs on nursing competence. The observed variables included TCM nursing competence total score, hospital type, nursing staff education, number of trainings, willingness to train, and training emphasis [ 13 – 15 ]. Among them, the number of training was set as the mediator variable, and the type of hospital, education, willingness to train, and training emphasis were the independent variables. TCM nursing competence was the dependent variable. The design pathway contained direct pathway and indirect pathway. Four direct pathways were delineated as shown in Fig. 1 . The design pathway: type of hospital to TCM nursing competence, educational qualifications to TCM nursing competence, willingness to train to TCM nursing competence, and training importance to TCM nursing competence. 2 indirect paths: education to number of trainings to TCM nursing competence, and training emphasis to number of trainings to TCM nursing competence. ( Fig. 1 ) Root mean square (RMS) error of approximation < 0.08, normalized root mean square residual (RMSR) 0.90 were the model fit requirements. 2.6 Cluster analysis methods The study used cluster analysis to classify the TCM nursing competencies of different types of healthcare organizations or groups of nurses to identify differences between groups and summarize characteristics. The cluster analysis process is shown in Fig. 2 . Prior to performing the cluster analysis, categorical factors including hospital type and education were coded, and the data were first normalized using the sklearn module in Python to make sure all variables were on the same scale [ 16 – 18 ]. The input variables contained TCM nursing competency scores, hospital type, educational level, willingness to train, training emphasis, and number of skills mastered. The contour coefficient approach was used to find the ideal number of clusters. The contour coefficients of groups 2–6 were compared in an attempt to determine the ideal number of clusters [ 19 – 20 ]. Then the K-mean clustering algorithm was initialized with K clustering centers, and the Euclidean distance from the samples to each clustering center was calculated to group the samples to the nearest clustering center. The clustering center was updated to the mean of each group of samples, and the iteration was repeated until the clustering center was stable. The mean and standard deviation were calculated for each group of samples, focusing on the differences in TCM nursing competency scores, willingness to train, and number of skills mastered. 2.7 Statistical analysis The study was conducted with the help of SPSS 25.0 software to analyze the collected data and P -value less than 0.05 was used as a criterion for statistical significance difference (SSD). For the base data, it was described by calculating frequencies and percentages. In assessing the TCM nursing competency scores, if the data distribution showed normality, the mean and standard deviation were utilized for quantitative description. Conversely, if the data distribution deviated from normality, the median with interquartile spacing was presented. When the data met a normal distribution with consistent variance, either a one-way analysis of variance or a two independent samples t-test was used to compare the baseline data with the self-assessed TCM nursing competence of various groups. The rank sum test was employed in the event that the data did not fit the normal distribution. Meanwhile, the study also utilized multiple linear regression analysis to explore the multiple factors affecting TCM nursing competence. 2.8 Ethical principle The study was cross-sectional study in nature and did not involve any intervention with the participants. The three ethical principles of respect, justice, and beneficence as outlined in the Belmont Report were strictly followed throughout the study. Before the study was conducted, it was ensured that all participants joined voluntarily with a full understanding of the objectives and values of the study, and that they were free to opt out throughout the study. To protect the privacy of the participants, the questionnaire was filled out anonymously, and all research data would be kept anonymously and used only for academic research, ensuring absolute confidentiality of the information.All procedures adhered to the ethical guidelines of Guangyuan Central Hospital institution's ethics committee, with the ethical review number (GYZXLL2024010). Verbal and written informed consent was obtained from the participants. The study was conducted in accordance with the principles of the Declaration of Helsinki. 3. Result 3.1 Scores of nursing competence in TCM In the scoring of TCM nursing abilities in different types of medical institutions in Guangyuan, the overall dimension comparison of TCM nursing abilities between traditional and non-conventional TCM hospitals has SSD ( P < 0.05), as shown in Table 1 . 3.2 Competency scores for basic theoretical knowledge There was an SSD comparison between conventional TCM hospitals and non-conventional TCM hospitals in Guangyuan medical institutions in terms of TCM basic theoretical knowledge competency scores ( P < 0.05), as shown in Table 2 . 3.3 Scores for nursing technical competences in TCM Among the scores of common TCM nursing technical competence in different types of medical institutions in Guangyuan, there was a SSD comparison between conventional TCM hospitals and non-conventional TCM hospitals ( P <0.05), as shown in Table 3 . 3.4 TCM nursing clinical practice competency scores Among the scores of advanced TCM nursing clinical practice competence in different types of medical institutions in Guangyuan, there was a SSD comparison between conventional TCM hospitals and non-conventional TCM hospitals ( P < 0.05), as shown in Table 4 . Table 1 Scores of TCM care in different types of medical institutions Projects Overall score (n = 1210) 95% confidence intervals for overall means Conventional TCM hospitals (n = 650) Non-conventional TCM hospitals (n = 560) Difference 95% confidence interval t-test t-value P-value Basic theoretical knowledge of TCM 3.07 ± 0.92 3.07(3.02,3.12) 3.45 ± 0.72 2.63 ± 0.92 0.83(0.74,0.92) 17.55 0.001 Common TCM nursing techniques 3.43 ± 0.97 3.43(3.37,3.48) 3.94 ± 0.69 2.83 ± 0.89 1.12(1.03,0.21) 24.52 0.001 Advanced TCM nursing clinical practice 3.07 ± 1.01 3.07(3.02,3.13) 3.51 ± 0.81 2.57 ± 0.98 0.94(0.84,1.04) 18.34 0.001 Total nursing competency score for TCM 3.19 ± 0.91 3.19(3.14,3.24) 3.63 ± 0.66 2.67 ± 0.88 0.96(0.88,1.05) 21.69 0.001 Table 2 Competency scores of TCM basic theoretical knowledge in different types of medical institutions Projects Overall score (n = 1210) 95% confidence intervals for overall means Conventional TCM hospitals (n = 650) Non-conventional TCM hospitals (n = 560) Difference 95% confidence interval t-test t-value P-value Yin-yang and five elements 3.16 ± 0.97 3.16(3.11,3.22) 3.51 ± 0.77 2.76 ± 1.03 0.75(0.65,0.85) 14.49 <0.001 Theory of visceral manifestation 2.91 ± 1.05 2.92(2.86,2.97) 3.32 ± 0.87 2.45 ± 1.03 0.87(0.77,0.98) 15.91 <0.001 Qi-blood-body fluid 3.00 ± 1.01 3.00(2.94,3.05) 3.36 ± 0.82 2.57 ± 1.05 0.79(0.69,0.90) 14.72 <0.001 Basic knowledge of meridians and acupoints 3.02 ± 1.02 3.02(2.97,3.08) 3.40 ± 0.84 2.59 ± 1.03 0.81(0.70,0.91) 15.03 <0.001 Etiology and pathogenesis 2.99 ± 1.02 2.99(2.94,3.05) 3.35 ± 0.87 2.59 ± 1.03 0.76(0.65,0.87) 13.98 <0.001 Four diagnostic methods 3.32 ± 1.08 3.32(3.25,3.38) 3.67 ± 0.87 2.90 ± 1.15 0.77(0.66,0.89) 13.34 <0.001 Dialectic 3.06 ± 1.04 3.06(3.00,3.12) 3.45 ± 0.86 2.61 ± 1.04 0.84(0.73,0.95) 15.34 <0.001 Basic knowledge of TCM 2.82 ± 1.05 2.83(2.77,2.88) 3.12 ± 0.99 2.48 ± 1.02 0.64(0.52,0.75) 10.99 0.001 Advantageous diseases 3.12 ± 1.13 3.12(3.06,3.19) 3.67 ± 0.90 2.49 ± 1.03 1.17(1.06,1.28) 21.11 <0.001 Basic knowledge of TCM nursing 3.28 ± 0.99 3.28(3.22,3.34) 3.69 ± 0.79 2.81 ± 1.00 0.88(0.78,0.98) 16.97 0.001 Common TCM nursing Techniques 3.42 ± 1.05 3.43(3.37,3.48) 3.94 ± 0.78 2.83 ± 1.00 1.11(1.01,1.21) 21.56 <0.001 Interpretation of TCM ancient books 2.73 ± 1.06 2.73(2.67,2.79) 2.99 ± 1.02 2.43 ± 1.03 0.57(0.45,0.68) 9.56 <0.001 Table 3 Scores of common TCM nursing technical competencies in different types of healthcare organizations Projects Overall score (n = 1210) 95% confidence intervals for overall means Conventional TCM hospitals (n = 650) Non-conventional TCM hospitals (n = 560) Difference 95% confidence interval t-test t-value P-value Moxibustion 3.8 ± 1.10 3.80(3.74,3.86) 4.39 ± 0.705 3.11 ± 1.07 1.28(1.18,1.38) 24.83 <0.001 Acupoint injection 3.38 ± 1.25 3.38(3.31,3.45) 4.02 ± 1.01 2.64 ± 1.08 1.38(1.26,1.50) 22.90 <0.001 Guasha 3.43 ± 1.12 3.43(3.37,3.5) 3.95 ± 0.88 2.83 ± 1.06 1.12(1.01,1.23) 20.05 <0.001 Cupping therapy 3.47 ± 1.12 3.47(3.4,3.53) 3.97 ± 0.89 2.88 ± 1.07 1.10(0.98,1.21) 19.38 <0.001 TCM enema 3.65 ± 1.12 3.65(3.59,3.72) 4.19 ± 0.81 3.03 ± 1.09 1.16(1.05,1.27) 21.04 <0.001 Acupressure massage 2.98 ± 1.12 2.98(2.92,3.04) 3.30 ± 1.08 2.61 ± 1.04 0.68(0.56,0.81) 11.17 <0.001 Acupoint application 3.75 ± 1.16 3.76(3.69,3.82) 4.38 ± 0.74 3.03 ± 1.13 1.36(1.25,1.46) 25.06 <0.001 Auricular point sticking 3.74 ± 1.17 3.74(3.67,3.81) 4.41 ± 0.71 2.96 ± 1.13 1.44(1.34,1.55) 27.03 <0.001 Wax therapy 2.9 ± 1.16 2.90(2.83,2.96) 3.20 ± 1.15 2.55 ± 1.05 0.66(0.53,0.78) 10.25 <0.001 TCM soaking and washing 3.37 ± 1.15 3.37(3.31,3.44) 3.78 ± 1.07 2.9 ± 1.07 0.88(0.76,1.00) 14.22 <0.001 Fumigation with TCM 3.51 ± 1.14 3.51(3.44,3.57) 3.97 ± 0.98 2.97 ± 1.09 0.99(0.88,1.11) 16.76 <0.001 TCM Ironing 3.5 ± 1.24 3.50(3.43,3.57) 4.23 ± 0.85 2.65 ± 1.07 1.58(1.47,1.69) 28.63 <0.001 TCM sealing package 3.26 ± 1.20 3.26(3.19,3.32) 3.68 ± 1.10 2.77 ± 1.13 0.90(0.78,1.03) 14.08 <0.001 TCM application 3.55 ± 1.14 3.55(3.49,3.61) 4.13 ± 0.86 2.88 ± 1.05 1.25(1.14,1.36) 22.79 <0.001 Ion introduction of Chinese medicine 2.93 ± 1.172 2.93(2.87,3.00) 3.33 ± 1.14 2.47 ± 1.04 0.86(0.74,0.98) 13.66 <0.001 Rubbing with Chinese herbs 3.6 ± 1.149 3.60(3.53,3.66) 4.16 ± 0.89 2.94 ± 1.06 1.23(1.12,1.34) 21.89 <0.001 Table 4 Clinical practice competency scores for advanced TCM nursing in different types of medical institutions Projects Overall score (n = 1210) 95% confidence intervals for overall means Conventional TCM hospitals (n = 650) Non-conventional TCM hospitals (n = 560) Difference 95% confidence interval t-test t-value P-value TCM nursing checkup 3.32 ± 1.11 3.32(3.26,3.38) 3.88 ± 0.83 2.66 ± 1.03 1.22(1.12,1.33) 22.814 <0.001 TCM chronic disease management 3.10 ± 1.005 3.10(3.04,3.16) 3.5 ± 0.89 2.63 ± 1.03 0.86(0.76,0.97) 15.643 <0.001 Evidence-based practice in TCM nursing 3.00 ± 1.06 3.01(2.95,3.06) 3.37 ± 0.95 2.58 ± 1.01 0.79(0.68,0.90) 14.002 <0.001 Research on the technical specifications of TCM 2.97 ± 1.07 2.97(2.91,3.03) 3.36 ± 0.96 2.53 ± 1.01 0.83(0.72,0.94) 14.594 <0.001 Diagnosis and treatment of specialized diseases 3.10 ± 1.09 3.10(3.03,3.16) 3.58 ± 0.91 2.54 ± 1.03 1.04(0.93,1.15) 18.718 <0.001 Advantageous disease TCM nursing program argumentation 3.09 ± 1.09 3.09(3.03,3.15) 3.60 ± 0.89 2.51 ± 1.02 1.09(0.98,1.20) 19.909 <0.001 New advances in nursing research in TCM 2.92 ± 1.06 2.93(2.87,2.98) 3.27 ± 0.97 2.52 ± 1.00 0.75(0.64,0.86) 13.196 <0.001 3.5 Factors influencing nursing competence in TCM 3.5.1 Results of single factor analysis Univariate analysis showed that there was a SSD in all quantitative ( P < 0.05), as shown in Table 5 . 3.5.2 Results of multiple linear regression analysis In Table 6 , the study's independent variables for multiple linear regression analysis were a number of variables having SSD (P < 0.05) in univariate analysis, with the TCM nursing ability score serving as the dependent variable. 3.6 Structural equation modeling analysis Table 7 displays the results of the structural equation modeling analysis. In the total effects decomposition, the total effect of education was a DE of 0.28 + an IDE of (0.30×0.19) = 0.34. The total effect of training emphasis was a DE of 0.20 + an IDE of (0.25×0.19) = 0.25. The chi-square test value of the model fit was 45.21, df = 20, P -value = 0.002. The comparative fit index reached 0.95, which was in excellent fit. The RMSE of approximation was 0.042 and the standardized RMSR was 0.038, both sign standards. The model finds that hospital type has the greatest impact on TCM nursing competence, with a path coefficient of 0.45, indicating that conventional TCM hospitals are more conducive to nursing competence. The effect of education is indirectly enhanced by the number of trainings, which plays a mediating role in the enhancement of nursing competence, and its importance is second to hospital type and education. Table 5 Univariate impact analysis of nursing competence in TCM Projects Options Nursing competence in TCM (scores) Statistical value P Genger Male 53 3.26 ± 0.75 0.556 0.578 Female 1157 3.19 ± 0.91 Age 20–30 years of age 490 3.25 ± 0.90 1.221 0.301 31–40 years of age 475 3.15 ± 0.90 41–50 years of age 202 3.15 ± 0.88 51 years and over 42 3.13 ± 1.11 Length of service 0–5 years 293 3.21 ± 0.81 1.077 0.366 6–10 years 333 3.30 ± 0.88 11–15 years 313 3.18 ± 0.97 16–20 years 76 3.00 ± 1.02 More than 21 years 195 3.05 ± 0.92 Title Primary 618 3.19 ± 0.92 0.039 0.962 Intermediate 463 3.19 ± 0.89 Professional title of associate professor or above 128 3.21 ± 0.87 Mode of employment Be on regular payroll 317 3.20 ± 0.89 0.105 0.916 Not on regular payroll 892 3.19 ± 0.91 Education attainment Secondary specialized school 24 1.05 ± 0.06 102.475 <0.001 Junior college 327 2.96 ± 0.94 Bachelor degree or above 859 3.33 ± 0.81 Number of nursing techniques in TCM 1–2 items 464 2.89 ± 0.91 44.097 <0.001 3–4 items 271 3.33 ± 0.88 More than 5 items 474 3.40 ± 0.84 Level of willingness to train Extremely resistant 18 3.46 ± 0.98 33.07 <0.001 Resistant 30 2.46 ± 0.94 Indifferent 83 2.67 ± 0.83 accept 767 3.10 ± 0.78 Willing to accept 312 3.60 ± 1.03 Level of emphasis on training Extremely neglected 11 2.72 ± 1.34 97.677 <0.001 Neglected 18 1.80 ± 0.52 Normal 167 2.36 ± 0.73 Follow with interest 559 3.13 ± 0.71 Positive attention 455 3.64 ± 0.89 Number of trainings Extremely lacking 51 2.34 ± 1.12 125.719 <0.001 Not enough 299 2.76 ± 0.8 Unclear 156 2.62 ± 0.75 Just enough 704 3.56 ± 0.77 Table 6 Multiple linear regression analysis of nursing competency scores in TCM B Standard error Beta t Significance 95.0% confidence interval for B lower limit upper limit (Constant) 0.55 0.20 - 2.70 0.007 0.15 0.95 1. Type of hospital located -0.45 0.05 -0.25 -8.75 <0.001 -0.55 -0.35 17. The current number of TCM nursing training received 0.19 0.02 0.21 8.53 <0.001 0.15 0.24 7. Educational background 0.35 0.04 0.20 9.13 <0.001 0.28 0.43 16. Evaluation of the current department's emphasis on TCM nursing training 0.20 0.03 0.18 6.68 <0.001 0.14 0.26 10. The number of TCM nursing techniques that can be carried out 0.17 0.03 0.17 6.09 <0.001 0.12 0.22 15. Willingness to participate in TCM nursing training 0.13 0.03 0.11 4.60 <0.001 0.08 0.19 Table 7 Structural equation modeling analysis Approach Standardized path coefficient (β) Standard error Significance ( P -value) Hospital type to TCM nursing competence 0.45 0.05 < 0.001 Academic qualifications to TCM nursing competence 0.28 0.04 < 0.001 Willingness to train to TCM nursing competence 0.13 0.03 < 0.001 Training emphasis to TCM nursing competence 0.2 0.03 < 0.001 Academic qualifications to number of trainings 0.3 0.04 < 0.001 Priority of training to number of trainings 0.25 0.05 < 0.001 Number of trainings to TCM nursing competence 0.19 0.02 < 0.001 3.7 Cluster analysis results After it was determined that three clusters were the ideal number, the samples were split into three groups: high, medium, and low ability. The clustering results are shown in Fig. 3 . In Fig. 3 a, compared to the other groups, the high-competence group's nursing competence score was substantially higher at 4.25 ± 0.43 ( P < 0.001). Among them, the average number of techniques mastered was 5.72. Moxibustion (4.8 ± 0.5), acupoint application (4.7 ± 0.4), and herbal fumigation (4.6 ± 0.3) scored the highest. The willingness to train score reached 4.61, indicating a very high motivation to participate in training. Ninety percent of the samples in the high-competence group were from conventional TCM hospitals. In Fig. 3 b, the nursing competence score of the medium-competence group was 3.36 ± 0.47, which was close to the overall mean ( P < 0.001). The mean number of techniques mastered in the medium competency group was 3.89. Among them, guasha (3.8 ± 0.4) and cupping (3.6 ± 0.3) were predominant. The willingness to train score was 3.78, indicating a moderate willingness to train. General hospitals accounted for 75% of the sample in the medium-competence group. In Fig. 3 c, compared to the other groups, the low-competence group's nursing competence score was substantially lower ( P < 0.001), at 2.54 ± 0.52. Their average number of techniques mastered was only 2.01. Among them, the lowest scores were for ionic introduction of TCM (1.8 ± 0.4) and wax therapy (1.6 ± 0.3). Among them, 85% were in primary care organizations. 4. Discussion 4.1 Overall situation analysis of nursing competence in TCM To ensure a representative and broad sample, the study used stratified and random sampling Through structural equation modeling and cluster analysis, the multidimensional influencing factors of TCM nursing competence were further validated, providing a scientific basis for subsequent policy formulation and training programs. In addition, the improvement of TCM nursing competence not only relied on the efforts of individual nursing staff, but also was closely related to the hospital management policy, the allocation of training resources, and the social cognition and acceptance of TCM nursing. Through a survey of 1,300 clinical nurses in 20 medical institutions in Guangyuan, the study found that the overall score of TCM nursing competence in Guangyuan was 3.19 ± 0.91, which was at a medium level. This result indicated that although the nursing competence of TCM in Guangyuan had a certain foundation, there was still much greater potential for improvement. Among them, the score of TCM basic theoretical knowledge reached 3.07 ± 0.92. These data collectively demonstrate that nursing staff exhibited relatively stronger performance in common TCM nursing techniques compared to their proficiency in fundamental theory and advanced practice domains. With the promotion and application of TCM medicine worldwide, as an important part of traditional Chinese medicine, TCM nursing has gradually been emphasized [ 21 – 23 ]. However, the transformation of the modern medical model and the aging of the population have caused TCM nursing to face the contradiction between the increasing service demand and the insufficient service capacity [ 24 ]. Although a series of documents have been issued from the national to local levels in recent years to strongly support the development of TCM, there is still a certain gap in the nursing capacity of TCM in Guangyuan compared to large hospitals in coastal cities. Located in northern Sichuan Province, Guangyuan has relatively underdeveloped medical facilities. Coupled with geographical constraints and economic limitations, this has resulted in an overall nursing capacity that needs improvement. Guangyuan City, an area with deep cultural heritage in TCM, reflects the common problems of TCM nursing across the country, namely deficiencies in both foundational theoretical knowledge and advanced practical skills within primary care institutions. 4.2 Current status of nursing competence in TCM in different types of hospitals The outcomes revealed that TCM nursing competencies were significantly higher in conventional TCM hospitals than in non-conventional TCM hospitals. The total score of TCM nursing competence in conventional TCM hospitals was 3.63 ± 0.66, while it was only 2.67 ± 0.88 in non-conventional TCM hospital. Specifically, conventional TCM hospitals scored significantly higher than non-conventional TCM hospitals in three dimensions, including basic theoretical knowledge of TCM, common nursing techniques of TCM, and advanced clinical practice of TCM nursing. This result reflected the advantages of conventional TCM hospitals in the field of TCM nursing. Conventional TCM hospitals usually have richer TCM resources and a more systematic TCM nursing training system, which can provide more practice opportunities and training resources for nursing staff. In contrast, non-conventional TCM hospitals, especially general hospitals and primary care organizations, lack systematic TCM nursing training and practice opportunities, resulting in a relatively weak TCM nursing capacity. The lack of systematic TCM nursing training and practice opportunities has resulted in a relatively weak TCM nursing capacity. With the promotion of TCM in general hospitals, more and more general hospitals have started to set up TCM departments. However, the lack of a systematic training system for TCM nursing care has led to a slow improvement in TCM nursing capacity [ 25 – 26 ]. In the future, TCM nursing training should be strengthened in both general hospitals and primary healthcare organizations, drawing on the successful experience of conventional TCM hospitals to enhance TCM nursing capabilities. The enhancement of these advanced NP capabilities not only relies on the mastery of theoretical knowledge and basic techniques, but also requires continuous clinical research and innovation. The strengths of conventional TCM hospitals in these areas may be related to long-term accumulation and research investment in TCM nursing. 4.3 Factors affecting nursing competence in TCM The study pinpointed a number of core elements that shape TCM nursing competence with the help of analytical tools. Among these elements, the type of hospital played the most critical role, with a path coefficient of 0.45. This indicated that conventional TCM hospitals had a significant advantage in enhancing TCM nursing competence. The effect of education on TCM nursing competence was mainly reflected indirectly through the number of trainings, with a path coefficient of 0.30. It indicated that highly educated nursing staff were more inclined to participate in more TCM nursing trainings to enhance their nursing competence. The effects of willingness to train and the degree of emphasis on training on TCM nursing competence were 0.13 and 0.20, respectively. It indicated that the positive attitude of nursing staff towards training and the degree of emphasis on training in hospitals play an important role in enhancing TCM nursing competence. The educational level and professionalism of TCM nursing staff have gradually become important factors affecting TCM nursing capacity. Highly educated nursing staff usually have stronger learning ability and practical ability, and can better master the theory and technology of TCM nursing. In addition, the hospital's emphasis on TCM nursing training and the nursing staff's willingness to train also directly affect the enhancement of their TCM nursing competence. The educational level and professionalism of nursing personnel should be upgraded by strengthening TCM nursing education, training and optimizing the allocation of resources. This can enhance their motivation and participation in TCM nursing training, thus comprehensively improving TCM nursing capacity and promoting the sustainable development of TCM nursing services. 4.4 Policy and practice recommendations The Implementation Plan for Further Improving Nursing Services in Guangyuan City (2023–2025) issued by the Health Commission of Guangyuan mentions the need to enhance TCM nursing capabilities. It encourages the development of nursing "Western learning in Chinese" training and training in TCM suitable nursing techniques, and standardizes the training of TCM nursing backbone talents in Guangyuan. The study also suggests that more investment should be made in TCM nursing education, especially in terms of basic theoretical knowledge and advanced practice skills. The professionalism and practical ability of nursing staff can be enhanced by offering more TCM nursing courses and training sessions. The government and medical institutions should optimize the allocation of TCM nursing resources, especially in primary medical institutions and general hospitals. The capacity of TCM care in these institutions can be upgraded through increased investment in TCM care equipment and technology. Conventional TCM hospitals have significant advantages in TCM care, and their successful experience should be promoted, especially in terms of training systems and management policies. A cooperative mechanism can be established to allow conventional TCM hospitals to share their experience and resources with other medical institutions. 5. Conclusion This study analyzed the current status and influencing factors of TCM nursing capacity across diverse medical institutions in Guangyuan, identifying current deficiencies and k main influencing factors. In the future, targeted interventions are imperative, including enhanced professional education, systematic training programs, and strengthened policy support. By enhancing TCM nursing capacity, the sustainable development of TCM nursing services will be promoted to better serve the health needs of the people. Declarations Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. CRediT authorship contribution statement Ming Jin and Jing Yang: Methodology, Investigation, Data collection, Data analysis & editing. Zhining Liu: Investigation, Data collection & Data analysis. Qian Hou : Review & editing. Yiman Hou: Investigation & Data analysis. Yue Yu: Funding acquisition & review. All authors reviewed and approved the final version of the manuscript. Funding This work was Supported by Guangyuan Science and TechnologyProgram（23ZDYF0043） Eclarations Ethics approval and consent to participate Prior to the study, ethics committee approval was obtained from theGuangyuan Central Hospital institution's ethics committee, dated September 20, 2024, and numbered GYZXLL2024010. Verbal and written informed consent was obtained from the participants. The study was conducted in accordance with the principles of the Declaration of Helsinki. References Zhang S, Wang J, Liu L, et al. Does abusive supervision lead nurses to suffer from workplace violence? A cross‐sectional study. Journal of Nursing Management, 2022, 30(6): 1396-1406. Nie P, Liu F, Lin S, et al. The effects of computer‐assisted cognitive rehabilitation on cognitive impairment after stroke: A systematic review and meta‐analysis. 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Effects of Baduanjin exercise on cognitive function and cancer-related symptoms in women with breast cancer receiving chemotherapy: a randomized controlled trial. Supportive Care in Cancer, 2022, 30(7): 6079-6091. Additional Declarations No competing interests reported. Supplementary Files FileS1.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 09 Dec, 2025 Reviewers invited by journal 04 Dec, 2025 Editor assigned by journal 01 Dec, 2025 Editor invited by journal 11 Nov, 2025 Submission checks completed at journal 11 Nov, 2025 First submitted to journal 11 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Introduction","content":"\u003cp\u003eIn the current healthcare systems, Traditional Chinese Medicine (TCM) nursing provides a gentle and personalized care program for patients with its core concepts of\u0026nbsp;holism\u0026nbsp;and evidence-based treatment [1-3]. Guangyuan boasts profound TCM cultural heritage and a robust TCM healthcare infrastructure, making it an ideal practicum site for evidence-based TCM nursing education.\u0026nbsp;As a regional hub of TCM culture in Northern Sichuan, Guangyuan’s healthcare challenges and innovations in TCM nursing reflect common issues faced by underdeveloped areas in Western China. Studying this region provides critical insights for optimizing TCM resource allocation in similar socioeconomic contexts.\u0026nbsp;However, with the transformation of the modern medical model and\u0026nbsp;population aging, TCM nursing is facing a contradiction between increased service demand and insufficient service capacity [4-6].\u0026nbsp;This misalignment between service provision and population health needs is particularly pronounced within primary healthcare institutions\u0026nbsp;[7-8].\u0026nbsp;Guangyuan as a national pilot zone for integrated TCM-Western medicine reform further amplifies the urgency of addressing these gaps, as its outcomes may inform nationwide policy adjustments.\u003c/p\u003e\n\u003cp\u003eA central challenge in modernizing TCM nursing,\u0026nbsp;lies in reconciling the preservation and enhancement of its unique strengths with the effective integration of modern nursing concepts and technologies\u0026nbsp;[9-11]. Currently, the TCM nursing service in Guangyuan is deficient in human resource allocation, service quality control, and nursing technology innovation.\u0026nbsp;These factors work together to affect the practical effect of TCM nursing, and affect the satisfaction of patients and health outcomes.\u003c/p\u003e\n\u003cp\u003eIn recent years, the Guangyuan government and the Health Committee have recognized these issues and introduced a series of policy initiatives aimed at enhancing nursing services and elevating care quality standards, such as the \u003cem\u003eImplementation Plan of Guangyuan Municipal Action Plan for Further Improvement of Nursing Services (2023-2025)\u003c/em\u003e. The implementation of these policies provides a policy context and practice platform for\u0026nbsp;research,\u0026nbsp;creating opportunities to\u0026nbsp;evaluate policy impacts and refine implementation strategies.\u003c/p\u003e\n\u003cp\u003eThis study aims to conduct an in-depth investigation into the current landscape of TCM nursing practices across healthcare institutions in Guangyuan. Meanwhile, it explores the multidimensional factors affecting the quality of TCM nursing services, such as the\u0026nbsp;nursing staff competency,\u0026nbsp;patient\u0026nbsp;knowledge and acceptance of TCM nursing, healthcare organizational resource allocatio, and the policy environment. The results will provide improvement suggestions and strategies for TCM nursing services in Guangyuan and even in other regions.\u0026nbsp;\u003cstrong\u003eThis study will\u0026nbsp;\u003c/strong\u003epromote the sustainable development of TCM nursing services and better meet the health needs of the people.\u003c/p\u003e"},{"header":"2. Information and methods","content":"\u003cp\u003e1,300 clinical nurses working for healthcare institutions in the Guangyuan were chosen at random to participate in the study.\u003c/p\u003e\u003cp\u003eInclusion criteria: Persons need to work in TCM nursing positions, and their departments should provide TCM nursing services and implement related programs. Participants need to participate in the survey voluntarily on the basis of fully understanding the content of the study.\u003c/p\u003e\u003cp\u003eExclusion criteria: Nurses in training who is on short-term study in the unit. Nurses who do not perform routine work for their own reasons or special assignments.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Research method\u003c/h2\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003e2.1.1 General information questionnaire\u003c/h2\u003e\u003cp\u003eTo assess the competency state of nurses in TCM nursing in Guangyuan hospitals, the study conducted a thorough literature analysis and engaged in-depth discussions with subject-matter experts. Based on these preparations, the study designed a questionnaire to collect basic information from the nurses. The questionnaire covered the nurses' basic information, occupational status, and clinical responsibilities.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.1.2 Questionnaire on TCM nursing competence\u003c/h2\u003e\u003cp\u003eTo assess TCM nursing competencies, the study used a specialized questionnaire developed in 2018 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This questionnaire assessed three main areas: basics of TCM nursing, TCM nursing techniques, and advanced TCM nursing clinical practice. A Likert 5-point scale was used to measure familiarity with each component, ranging from 1 (very unfamiliar) to 5 (very familiar). Higher scores indicated better mastery.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.1.3 Questionnaire on nursing training needs in TCM\u003c/h2\u003e\u003cp\u003eTo understand the TCM training needs of the nursing staff, another questionnaire was used in the study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This questionnaire contained six questions about the level of importance, training frequency, training willingness, method of theory and skill training, and specific content of training. The validity and reliability of questionnaire were examined in a pre-survey to make sure it was reliable before it was formally used.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Sample size estimation\u003c/h2\u003e\u003cp\u003e The study used Kendall's guidelines for sample size estimation to determine the sample size, which recommended that the sample size be calculated using five to ten times the total number of items in the questionnaire. The questionnaire used for the survey contained three sections with a total of fifty-three questions. The TCM nursing competency assessment section had thirty-seven questions. The general information section consisted of ten questions. The TCM nursing training needs section had six questions. Considering the possibility of invalid questionnaires, the study expected a 20% rate of invalid questionnaires. Three hundred and eighteen was determined to be the minimal sample size needed based on these variables.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Sampling methods\u003c/h2\u003e\u003cp\u003eThe study adopted a random sampling method to select survey respondents. Specifically, twenty public medical institutions in Guangyuan were selected, all certified as Level II or higher with demonstrated capacity for independent TCM nursing service delivery. These included the provision of TCM services and the implementation of TCM nursing programs. Among them, there were 8 conventional TCM hospitals and 3 hospitals of level III or above, and 12 non-conventional TCM hospitals and 4 hospitals of level III or above. The total number of samples collected was 1,300, and 90 invalid questionnaires were excluded, resulting in a valid sample of 1,210.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Data collection\u003c/h2\u003e\u003cp\u003eBetween January and October 2024, the investigator conducted data collection. After obtaining permission from the hospital's nursing management and the head nurse, the researcher clearly explained the research objectives, methods, contents, and the confidentiality agreement of questionnaire information to the nursing staff. The QuestionStar e-questionnaire was completed anonymously to ensure that each respondent fully understood and agreed to participate in the survey, and answers were limited to one submission per IP address. Any questions that arose during the course of the survey were answered by the surveyor. Once all questionnaires were submitted, the Star system stopped accepting new responses to ensure data integrity. During the data processing stage, questionnaires with logical contradictions, a single repetitive option, and not answered in accordance with the requirements were excluded to guarantee the accuracy and validity of the data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Methods of structural equation modeling analysis\u003c/h2\u003e\u003cp\u003eThe study clarified the direct and indirect effects (IDE) of each potential variable on TCM nursing capacity by constructing and validating a multiple influence pathway model of TCM nursing capacity in Guangyuan medical institutions. This could provide a scientific basis for optimizing TCM nursing services. Three hypotheses were made in the analysis, including hospital type has a direct effect (DE) on TCM nursing competence, academic qualifications indirectly affect TCM nursing competence through the number of trainings, and willingness to train and training emphasis have direct and IDEs on nursing competence. The observed variables included TCM nursing competence total score, hospital type, nursing staff education, number of trainings, willingness to train, and training emphasis [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Among them, the number of training was set as the mediator variable, and the type of hospital, education, willingness to train, and training emphasis were the independent variables. TCM nursing competence was the dependent variable. The design pathway contained direct pathway and indirect pathway. Four direct pathways were delineated as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe design pathway: type of hospital to TCM nursing competence, educational qualifications to TCM nursing competence, willingness to train to TCM nursing competence, and training importance to TCM nursing competence. 2 indirect paths: education to number of trainings to TCM nursing competence, and training emphasis to number of trainings to TCM nursing competence. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e Root mean square (RMS) error of approximation\u0026thinsp;\u0026lt;\u0026thinsp;0.08, normalized root mean square residual (RMSR)\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and comparative fit index\u0026thinsp;\u0026gt;\u0026thinsp;0.90 were the model fit requirements.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Cluster analysis methods\u003c/h2\u003e\u003cp\u003eThe study used cluster analysis to classify the TCM nursing competencies of different types of healthcare organizations or groups of nurses to identify differences between groups and summarize characteristics. The cluster analysis process is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePrior to performing the cluster analysis, categorical factors including hospital type and education were coded, and the data were first normalized using the sklearn module in Python to make sure all variables were on the same scale [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The input variables contained TCM nursing competency scores, hospital type, educational level, willingness to train, training emphasis, and number of skills mastered. The contour coefficient approach was used to find the ideal number of clusters. The contour coefficients of groups 2\u0026ndash;6 were compared in an attempt to determine the ideal number of clusters [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Then the K-mean clustering algorithm was initialized with K clustering centers, and the Euclidean distance from the samples to each clustering center was calculated to group the samples to the nearest clustering center. The clustering center was updated to the mean of each group of samples, and the iteration was repeated until the clustering center was stable. The mean and standard deviation were calculated for each group of samples, focusing on the differences in TCM nursing competency scores, willingness to train, and number of skills mastered.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Statistical analysis\u003c/h2\u003e\u003cp\u003eThe study was conducted with the help of SPSS 25.0 software to analyze the collected data and \u003cem\u003eP\u003c/em\u003e-value less than 0.05 was used as a criterion for statistical significance difference (SSD). For the base data, it was described by calculating frequencies and percentages. In assessing the TCM nursing competency scores, if the data distribution showed normality, the mean and standard deviation were utilized for quantitative description. Conversely, if the data distribution deviated from normality, the median with interquartile spacing was presented. When the data met a normal distribution with consistent variance, either a one-way analysis of variance or a two independent samples t-test was used to compare the baseline data with the self-assessed TCM nursing competence of various groups. The rank sum test was employed in the event that the data did not fit the normal distribution. Meanwhile, the study also utilized multiple linear regression analysis to explore the multiple factors affecting TCM nursing competence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e2.8 Ethical principle\u003c/h2\u003e\u003cp\u003eThe study was cross-sectional study in nature and did not involve any intervention with the participants. The three ethical principles of respect, justice, and beneficence as outlined in the \u003cem\u003eBelmont Report\u003c/em\u003e were strictly followed throughout the study. Before the study was conducted, it was ensured that all participants joined voluntarily with a full understanding of the objectives and values of the study, and that they were free to opt out throughout the study. To protect the privacy of the participants, the questionnaire was filled out anonymously, and all research data would be kept anonymously and used only for academic research, ensuring absolute confidentiality of the information.All procedures adhered to the ethical guidelines of Guangyuan Central Hospital institution's ethics committee, with the ethical review number (GYZXLL2024010). Verbal and written informed consent was obtained from the participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Scores of nursing competence in TCM\u003c/h2\u003e\u003cp\u003eIn the scoring of TCM nursing abilities in different types of medical institutions in Guangyuan, the overall dimension comparison of TCM nursing abilities between traditional and non-conventional TCM hospitals has SSD (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Competency scores for basic theoretical knowledge\u003c/h2\u003e\u003cp\u003eThere was an SSD comparison between conventional TCM hospitals and non-conventional TCM hospitals in Guangyuan medical institutions in terms of TCM basic theoretical knowledge competency scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Scores for nursing technical competences in TCM\u003c/h2\u003e\u003cp\u003eAmong the scores of common TCM nursing technical competence in different types of medical institutions in Guangyuan, there was a SSD comparison between conventional TCM hospitals and non-conventional TCM hospitals (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.4 TCM nursing clinical practice competency scores\u003c/h2\u003e\u003cp\u003eAmong the scores of advanced TCM nursing clinical practice competence in different types of medical institutions in Guangyuan, there was a SSD comparison between conventional TCM hospitals and non-conventional TCM hospitals (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eScores of TCM care in different types of medical institutions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eProjects\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall score (n\u0026thinsp;=\u0026thinsp;1210)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e95% confidence intervals for overall means\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eConventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;650)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNon-conventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;560)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDifference 95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003et-test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003et-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic theoretical knowledge of TCM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.07(3.02,3.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.83(0.74,0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e17.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommon TCM nursing techniques\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.43(3.37,3.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.12(1.03,0.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e24.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvanced TCM nursing clinical practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.07(3.02,3.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.94(0.84,1.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e18.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal nursing competency score for TCM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.19(3.14,3.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.96(0.88,1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e21.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCompetency scores of TCM basic theoretical knowledge in different types of medical institutions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eProjects\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall score (n\u0026thinsp;=\u0026thinsp;1210)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e95% confidence intervals for overall means\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eConventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;650)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNon-conventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;560)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDifference 95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003et-test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003et-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYin-yang and five elements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.16(3.11,3.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.75(0.65,0.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheory of visceral manifestation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.92(2.86,2.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.87(0.77,0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQi-blood-body fluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.00(2.94,3.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.79(0.69,0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic knowledge of meridians and acupoints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.02(2.97,3.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.81(0.70,0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEtiology and pathogenesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.99(2.94,3.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.76(0.65,0.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFour diagnostic methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.32(3.25,3.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.77(0.66,0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialectic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.06(3.00,3.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.84(0.73,0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic knowledge of TCM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.83(2.77,2.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.64(0.52,0.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvantageous diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.12(3.06,3.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.17(1.06,1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e21.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic knowledge of TCM nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.28(3.22,3.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.88(0.78,0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommon TCM nursing Techniques\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.43(3.37,3.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.11(1.01,1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e21.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterpretation of TCM ancient books\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.73(2.67,2.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.57(0.45,0.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eScores of common TCM nursing technical competencies in different types of healthcare organizations\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eProjects\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall score (n\u0026thinsp;=\u0026thinsp;1210)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e95% confidence intervals for overall means\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eConventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;650)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNon-conventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;560)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDifference 95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003et-test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003et-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoxibustion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.80(3.74,3.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e3.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.28(1.18,1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e24.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcupoint injection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.38(3.31,3.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.38(1.26,1.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e22.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGuasha\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.43(3.37,3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.12(1.01,1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e20.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCupping therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.47(3.4,3.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.10(0.98,1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e19.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCM enema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.65(3.59,3.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.16(1.05,1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e21.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcupressure massage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.98(2.92,3.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.68(0.56,0.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcupoint application\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.76(3.69,3.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.36(1.25,1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e25.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuricular point sticking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.74(3.67,3.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.44(1.34,1.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e27.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWax therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.90(2.83,2.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.66(0.53,0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCM soaking and washing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.37(3.31,3.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.88(0.76,1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFumigation with TCM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.51(3.44,3.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.99(0.88,1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCM Ironing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.50(3.43,3.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.58(1.47,1.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e28.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCM sealing package\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.26(3.19,3.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.90(0.78,1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCM application\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.55(3.49,3.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.25(1.14,1.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e22.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIon introduction of Chinese medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.93(2.87,3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.86(0.74,0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRubbing with Chinese herbs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.60(3.53,3.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.23(1.12,1.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e21.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical practice competency scores for advanced TCM nursing in different types of medical institutions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eProjects\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall score (n\u0026thinsp;=\u0026thinsp;1210)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e95% confidence intervals for overall means\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eConventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;650)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNon-conventional TCM hospitals (n\u0026thinsp;=\u0026thinsp;560)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDifference 95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003et-test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003et-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCM nursing checkup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.32(3.26,3.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.22(1.12,1.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e22.814\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCM chronic disease management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.10(3.04,3.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.86(0.76,0.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvidence-based practice in TCM nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.01(2.95,3.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.79(0.68,0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResearch on the technical specifications of TCM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.97(2.91,3.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.83(0.72,0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiagnosis and treatment of specialized diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.10(3.03,3.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.04(0.93,1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e18.718\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvantageous disease TCM nursing program argumentation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.09(3.03,3.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.09(0.98,1.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e19.909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNew advances in nursing research in TCM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.93(2.87,2.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.75(0.64,0.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Factors influencing nursing competence in TCM\u003c/h2\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e3.5.1 Results of single factor analysis\u003c/h2\u003e\u003cp\u003eUnivariate analysis showed that there was a SSD in all quantitative (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.5.2 Results of multiple linear regression analysis\u003c/h2\u003e\u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, the study's independent variables for multiple linear regression analysis were a number of variables having SSD (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in univariate analysis, with the TCM nursing ability score serving as the dependent variable.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Structural equation modeling analysis\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e displays the results of the structural equation modeling analysis.\u003c/p\u003e\u003cp\u003eIn the total effects decomposition, the total effect of education was a DE of 0.28\u0026thinsp;+\u0026thinsp;an IDE of (0.30\u0026times;0.19)\u0026thinsp;=\u0026thinsp;0.34. The total effect of training emphasis was a DE of 0.20\u0026thinsp;+\u0026thinsp;an IDE of (0.25\u0026times;0.19)\u0026thinsp;=\u0026thinsp;0.25. The chi-square test value of the model fit was 45.21, df\u0026thinsp;=\u0026thinsp;20, \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.002. The comparative fit index reached 0.95, which was in excellent fit. The RMSE of approximation was 0.042 and the standardized RMSR was 0.038, both sign standards. The model finds that hospital type has the greatest impact on TCM nursing competence, with a path coefficient of 0.45, indicating that conventional TCM hospitals are more conducive to nursing competence. The effect of education is indirectly enhanced by the number of trainings, which plays a mediating role in the enhancement of nursing competence, and its importance is second to hospital type and education.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate impact analysis of nursing competence in TCM\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProjects\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOptions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNursing competence in TCM (scores)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStatistical value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGenger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.556\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.578\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;30 years of age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e490\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1.221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40 years of age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e475\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;50 years of age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 years and over\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eLength of service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e1.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.366\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u0026ndash;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 21 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e618\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.962\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional title of associate professor or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMode of employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBe on regular payroll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.916\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot on regular payroll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e892\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEducation attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary specialized school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e102.475\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e327\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor degree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e859\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNumber of nursing techniques in TCM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2 items\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e44.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026ndash;4 items\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 5 items\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eLevel of willingness to train\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtremely resistant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e33.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResistant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndifferent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eaccept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e767\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWilling to accept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eLevel of emphasis on training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtremely neglected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e97.677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeglected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFollow with interest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e559\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive attention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNumber of trainings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtremely lacking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e125.719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot enough\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnclear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJust enough\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e704\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple linear regression analysis of nursing competency scores in TCM\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStandard error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBeta\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95.0% confidence interval for B\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003elower limit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eupper limit\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Type of hospital located\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-8.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17. The current number of TCM nursing training received\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Educational background\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16. Evaluation of the current department's emphasis on TCM nursing training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. The number of TCM nursing techniques that can be carried out\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15. Willingness to participate in TCM nursing training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStructural equation modeling analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApproach\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandardized path coefficient (β)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificance (\u003cem\u003eP\u003c/em\u003e-value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital type to TCM nursing competence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic qualifications to TCM nursing competence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWillingness to train to TCM nursing competence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraining emphasis to TCM nursing competence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic qualifications to number of trainings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePriority of training to number of trainings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of trainings to TCM nursing competence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Cluster analysis results\u003c/h2\u003e\u003cp\u003eAfter it was determined that three clusters were the ideal number, the samples were split into three groups: high, medium, and low ability. The clustering results are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ea, compared to the other groups, the high-competence group's nursing competence score was substantially higher at 4.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among them, the average number of techniques mastered was 5.72. Moxibustion (4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5), acupoint application (4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4), and herbal fumigation (4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3) scored the highest. The willingness to train score reached 4.61, indicating a very high motivation to participate in training. Ninety percent of the samples in the high-competence group were from conventional TCM hospitals. In Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb, the nursing competence score of the medium-competence group was 3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47, which was close to the overall mean (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean number of techniques mastered in the medium competency group was 3.89. Among them, guasha (3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4) and cupping (3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3) were predominant. The willingness to train score was 3.78, indicating a moderate willingness to train. General hospitals accounted for 75% of the sample in the medium-competence group. In Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ec, compared to the other groups, the low-competence group's nursing competence score was substantially lower (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), at 2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52. Their average number of techniques mastered was only 2.01. Among them, the lowest scores were for ionic introduction of TCM (1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4) and wax therapy (1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3). Among them, 85% were in primary care organizations.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Overall situation analysis of nursing competence in TCM\u003c/h2\u003e\u003cp\u003eTo ensure a representative and broad sample, the study used stratified and random sampling Through structural equation modeling and cluster analysis, the multidimensional influencing factors of TCM nursing competence were further validated, providing a scientific basis for subsequent policy formulation and training programs.\u003c/p\u003e\u003cp\u003eIn addition, the improvement of TCM nursing competence not only relied on the efforts of individual nursing staff, but also was closely related to the hospital management policy, the allocation of training resources, and the social cognition and acceptance of TCM nursing. Through a survey of 1,300 clinical nurses in 20 medical institutions in Guangyuan, the study found that the overall score of TCM nursing competence in Guangyuan was 3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91, which was at a medium level. This result indicated that although the nursing competence of TCM in Guangyuan had a certain foundation, there was still much greater potential for improvement. Among them, the score of TCM basic theoretical knowledge reached 3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92. These data collectively demonstrate that nursing staff exhibited relatively stronger performance in common TCM nursing techniques compared to their proficiency in fundamental theory and advanced practice domains.\u003c/p\u003e\u003cp\u003eWith the promotion and application of TCM medicine worldwide, as an important part of traditional Chinese medicine, TCM nursing has gradually been emphasized [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, the transformation of the modern medical model and the aging of the population have caused TCM nursing to face the contradiction between the increasing service demand and the insufficient service capacity [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Although a series of documents have been issued from the national to local levels in recent years to strongly support the development of TCM, there is still a certain gap in the nursing capacity of TCM in Guangyuan compared to large hospitals in coastal cities. Located in northern Sichuan Province, Guangyuan has relatively underdeveloped medical facilities. Coupled with geographical constraints and economic limitations, this has resulted in an overall nursing capacity that needs improvement. Guangyuan City, an area with deep cultural heritage in TCM, reflects the common problems of TCM nursing across the country, namely deficiencies in both foundational theoretical knowledge and advanced practical skills within primary care institutions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Current status of nursing competence in TCM in different types of hospitals\u003c/h2\u003e\u003cp\u003eThe outcomes revealed that TCM nursing competencies were significantly higher in conventional TCM hospitals than in non-conventional TCM hospitals. The total score of TCM nursing competence in conventional TCM hospitals was 3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66, while it was only 2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88 in non-conventional TCM hospital. Specifically, conventional TCM hospitals scored significantly higher than non-conventional TCM hospitals in three dimensions, including basic theoretical knowledge of TCM, common nursing techniques of TCM, and advanced clinical practice of TCM nursing. This result reflected the advantages of conventional TCM hospitals in the field of TCM nursing. Conventional TCM hospitals usually have richer TCM resources and a more systematic TCM nursing training system, which can provide more practice opportunities and training resources for nursing staff. In contrast, non-conventional TCM hospitals, especially general hospitals and primary care organizations, lack systematic TCM nursing training and practice opportunities, resulting in a relatively weak TCM nursing capacity. The lack of systematic TCM nursing training and practice opportunities has resulted in a relatively weak TCM nursing capacity.\u003c/p\u003e\u003cp\u003eWith the promotion of TCM in general hospitals, more and more general hospitals have started to set up TCM departments. However, the lack of a systematic training system for TCM nursing care has led to a slow improvement in TCM nursing capacity [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In the future, TCM nursing training should be strengthened in both general hospitals and primary healthcare organizations, drawing on the successful experience of conventional TCM hospitals to enhance TCM nursing capabilities. The enhancement of these advanced NP capabilities not only relies on the mastery of theoretical knowledge and basic techniques, but also requires continuous clinical research and innovation. The strengths of conventional TCM hospitals in these areas may be related to long-term accumulation and research investment in TCM nursing.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Factors affecting nursing competence in TCM\u003c/h2\u003e\u003cp\u003eThe study pinpointed a number of core elements that shape TCM nursing competence with the help of analytical tools. Among these elements, the type of hospital played the most critical role, with a path coefficient of 0.45. This indicated that conventional TCM hospitals had a significant advantage in enhancing TCM nursing competence. The effect of education on TCM nursing competence was mainly reflected indirectly through the number of trainings, with a path coefficient of 0.30. It indicated that highly educated nursing staff were more inclined to participate in more TCM nursing trainings to enhance their nursing competence. The effects of willingness to train and the degree of emphasis on training on TCM nursing competence were 0.13 and 0.20, respectively. It indicated that the positive attitude of nursing staff towards training and the degree of emphasis on training in hospitals play an important role in enhancing TCM nursing competence.\u003c/p\u003e\u003cp\u003eThe educational level and professionalism of TCM nursing staff have gradually become important factors affecting TCM nursing capacity. Highly educated nursing staff usually have stronger learning ability and practical ability, and can better master the theory and technology of TCM nursing. In addition, the hospital's emphasis on TCM nursing training and the nursing staff's willingness to train also directly affect the enhancement of their TCM nursing competence. The educational level and professionalism of nursing personnel should be upgraded by strengthening TCM nursing education, training and optimizing the allocation of resources. This can enhance their motivation and participation in TCM nursing training, thus comprehensively improving TCM nursing capacity and promoting the sustainable development of TCM nursing services.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Policy and practice recommendations\u003c/h2\u003e\u003cp\u003eThe \u003cem\u003eImplementation Plan for Further Improving Nursing Services in Guangyuan City (2023\u0026ndash;2025)\u003c/em\u003e issued by the Health Commission of Guangyuan mentions the need to enhance TCM nursing capabilities. It encourages the development of nursing \"Western learning in Chinese\" training and training in TCM suitable nursing techniques, and standardizes the training of TCM nursing backbone talents in Guangyuan. The study also suggests that more investment should be made in TCM nursing education, especially in terms of basic theoretical knowledge and advanced practice skills. The professionalism and practical ability of nursing staff can be enhanced by offering more TCM nursing courses and training sessions. The government and medical institutions should optimize the allocation of TCM nursing resources, especially in primary medical institutions and general hospitals. The capacity of TCM care in these institutions can be upgraded through increased investment in TCM care equipment and technology. Conventional TCM hospitals have significant advantages in TCM care, and their successful experience should be promoted, especially in terms of training systems and management policies. A cooperative mechanism can be established to allow conventional TCM hospitals to share their experience and resources with other medical institutions.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study analyzed the current status and influencing factors of TCM nursing capacity across diverse medical institutions in Guangyuan, identifying current deficiencies and k main influencing factors. In the future, targeted interventions are imperative, including enhanced professional education, systematic training programs, and strengthened policy support. By enhancing TCM nursing capacity, the sustainable development of TCM nursing services will be promoted to better serve the health needs of the people.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMing Jin and Jing Yang: Methodology, Investigation, Data collection, Data analysis \u0026amp; editing. Zhining Liu: Investigation, Data collection \u0026amp; Data analysis.\u0026nbsp;\u003cstrong\u003eQian Hou\u003c/strong\u003e:\u0026nbsp;Review \u0026amp; editing. Yiman Hou: Investigation \u0026amp; Data analysis.\u0026nbsp;Yue Yu: Funding acquisition \u0026amp; review.\u0026nbsp;All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was Supported by Guangyuan Science and TechnologyProgram（23ZDYF0043）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to the study, ethics committee approval was obtained from theGuangyuan Central Hospital institution's ethics committee, dated September 20, 2024, and numbered GYZXLL2024010. Verbal and written informed consent was obtained from the participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhang S, Wang J, Liu L, et al. Does abusive supervision lead nurses to suffer from workplace violence? A cross‐sectional study. Journal of Nursing Management, 2022, 30(6): 1396-1406.\u003c/li\u003e\n \u003cli\u003eNie P, Liu F, Lin S, et al. The effects of computer‐assisted cognitive rehabilitation on cognitive impairment after stroke: A systematic review and meta‐analysis. Journal of Clinical Nursing, 2022, 31(9-10): 1136-1148.\u003c/li\u003e\n \u003cli\u003eMao J J, Pillai G G, Andrade C J, et al. Integrative oncology: Addressing the global challenges of cancer prevention and treatment. CA: A Cancer Journal for Clinicians, 2022, 72(2): 144-164.\u003c/li\u003e\n \u003cli\u003eWu C, Zhang L, Zhang X, et al. Factors influencing career success of clinical nurses in northwestern China based on Kaleidoscope Career Model: Structural equation model. Journal of nursing management, 2022, 30(2): 428-438.\u003c/li\u003e\n \u003cli\u003eZhong M, Jiang J, Zhang H, et al. Combination of flipped learning format and virtual simulation to enhance emergency response ability for newly registered nurses: a quasi-experimental design. Interactive Learning Environments, 2023, 31(8): 5127-5140.\u003c/li\u003e\n \u003cli\u003eYepes-P\u0026eacute;rez A F, Herrera-Calderon O, Quintero-Saumeth J. Uncaria tomentosa (cat\u0026rsquo;s claw): a promising herbal medicine against SARS-CoV-2/ACE-2 junction and SARS-CoV-2 spike protein based on molecular modeling. Journal of Biomolecular Structure and Dynamics, 2022, 40(5): 2227-2243.\u003c/li\u003e\n \u003cli\u003eZhou L W, Ghobad-Nejhad M, Tian X M, et al. Current status of \u0026lsquo;Sanghuang\u0026rsquo;as a group of medicinal mushrooms and their perspective in industry development. Food Reviews International, 2022, 38(4): 589-607.\u003c/li\u003e\n \u003cli\u003eZhang S, Liu Y, Li G, et al. Chinese nurses\u0026apos; innovation capacity: The influence of inclusive leadership, empowering leadership and psychological empowerment. Journal of Nursing Management, 2022, 30(6): 1990-1999.\u003c/li\u003e\n \u003cli\u003eXu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A Meta‐Analysis. Nursing in critical care, 2023, 28(2): 159-166.\u003c/li\u003e\n \u003cli\u003eLi Z, Marshall A P, Lin F, et al. Registered nurses\u0026rsquo; approach to pressure injury prevention: A descriptive qualitative study. Journal of advanced nursing, 2022, 78(8): 2575-2585.\u003c/li\u003e\n \u003cli\u003eWenxia Z, Feifei C, Min H, et al. The status and associated factors of junior nurses\u0026apos; transition shock: a cross‐sectional study. Journal of Nursing Management, 2022, 30(3): 716-723.\u003c/li\u003e\n \u003cli\u003eLin H. Analysis and strategy of traditional Chinese medicine nursing in a county medical and health institution in Chongqing[D].Hunan University of Traditional Chinese Medicine,2022.DOI:10.27138/d.cnki.ghuzc.2022.000134.\u003c/li\u003e\n \u003cli\u003eGunawan J, Aungsuroch Y, Watson J, et al. Nursing administration: Watson\u0026rsquo;s theory of human caring. Nursing science quarterly, 2022, 35(2): 235-243.\u003c/li\u003e\n \u003cli\u003eZhu J, Shi K, Yang C, et al. Ethical issues of smart home‐based elderly care: A scoping review. Journal of nursing management, 2022, 30(8): 3686-3699.\u003c/li\u003e\n \u003cli\u003eHan J, Zhang L, Liu Y, et al. Effect of a group‐based acceptance and commitment therapy programme on the mental health of clinical nurses during the COVID‐19 sporadic outbreak period. Journal of nursing management, 2022, 30(7): 3005-3012.\u003c/li\u003e\n \u003cli\u003eLuo R, Ji Y, Liu Y, et al. Relationships among social support, coping style, self‐stigma, and quality of life in patients with diabetic foot ulcer: A multicentre, cross‐sectional study. International Wound Journal, 2023, 20(3): 716-724.\u003c/li\u003e\n \u003cli\u003eLi L, Mao M, Wang S, et al. Posttraumatic growth in Chinese nurses and general public during the COVID-19 outbreak. Psychology, health \u0026amp; medicine, 2022, 27(2): 301-311.\u003c/li\u003e\n \u003cli\u003eWhear R, Abbott R A, Bethel A, et al. Impact of COVID‐19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: Systematic review. Journal of Advanced Nursing, 2022, 78(1): 78-108.\u003c/li\u003e\n \u003cli\u003eWei L, Chai Q, Chen J, et al. The impact of Tai Chi on cognitive rehabilitation of elder adults with mild cognitive impairment: a systematic review and meta-analysis. Disability and rehabilitation, 2022, 44(11): 2197-2206.\u003c/li\u003e\n \u003cli\u003eHwang G J, Tang K Y, Tu Y F. How artificial intelligence (AI) supports nursing education: profiling the roles, applications, and trends of AI in nursing education research (1993\u0026ndash;2020). Interactive Learning Environments, 2024, 32(1): 373-392.\u003c/li\u003e\n \u003cli\u003eZhao W, Jones C, Wu M L, et al. Healthcare professionals\u0026apos; dementia knowledge and attitudes towards dementia care and family carers\u0026apos; perceptions of dementia care in China: An integrative review. Journal of Clinical Nursing, 2022, 31(13-14): 1753-1775.\u003c/li\u003e\n \u003cli\u003eChang C Y, Kuo S Y, Hwang G H. Chatbot-facilitated nursing education. Educational Technology \u0026amp; Society, 2022, 25(1): 15-27.\u003c/li\u003e\n \u003cli\u003eKiguba R, Olsson S, Waitt C. Pharmacovigilance in low‐and middle‐income countries: a review with particular focus on Africa. British journal of clinical pharmacology, 2023, 89(2): 491-509.\u003c/li\u003e\n \u003cli\u003eWang D, Xie X, Tian H, et al. Mental fatigue and negative emotion among nurses during the COVID-19 pandemic. Current Psychology, 2022, 41(11): 8123-8131.\u003c/li\u003e\n \u003cli\u003eMireles C, Sanchez M, Cruz-Ortiz D, et al. Home-care nursing controlled mobile robot with vital signal monitoring. Medical \u0026amp; Biological Engineering \u0026amp; Computing, 2023, 61(2): 399-420.\u003c/li\u003e\n \u003cli\u003eWei X, Yuan R, Yang J, et al. Effects of Baduanjin exercise on cognitive function and cancer-related symptoms in women with breast cancer receiving chemotherapy: a randomized controlled trial. Supportive Care in Cancer, 2022, 30(7): 6079-6091.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Traditional Chinese medicine nursing, Nursing competence, Influencing factors, cross-sectional study, current landscape of TCM nursing, TCM nursing technical","lastPublishedDoi":"10.21203/rs.3.rs-8033013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8033013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eGiven the profound cultural heritage of traditional Chinese medicine and the growing demand for traditional Chinese medicine nursing services in Guangyuan, as well as the contradiction between the existing service capabilities and the insufficient capacity for such services.\u003cstrong\u003e \u003c/strong\u003eTo investigate the current status of Chinese medicine nursing capacity in different types of medical institutions in Guangyuan, and analyze the enterprise influence factors for providing scientific basis for improving the quality of traditional Chinese medicine nursing services, optimizing resource allocation, and formulating targeted improvement strategies in the region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe study used a combination of stratified and random sampling, 1,300 frontline nurses from twenty medical institutions in Guangyuan were assessed via a Likert-scale questionnaire. Structural equation modeling examined traditional Chinese medicine (TCM) nursing competence pathways and verified direct/indirect factor effects. Cluster analysis was used to classify groups of nurses with different competency levels and summarize the characteristics of each group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe total TCM nursing competency score of medical institutions in Guangyuan was 3.19±0.91. Among them, the score of basic theoretical knowledge was 3.07±0.92, the score of common nursing techniques was 3.43±0.97, and the score of advanced clinical practice was 3.07±1.01. Multiple linear regression analysis showed that the main influencing factors included the type of hospital (β=-0.45), the number of trainings (β=0.19), and the education level (β=0.35). Cluster analysis indicated that nurses in TCM hospitals were mainly distributed in the high-competence group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eTCM nursing competence among medical institutions in Guangyuan was moderate, influenced by multiple factors. Competence varied significantly across institution types, with specialized TCMhospitals exhibiting superior performance to non-specialized counterparts. Factors significantly affecting TCM nursing competence included nursing staff education, institution type, number of TCM nursing skills mastered, training willingness, and organizational support. Strengthening TCM nursing education, optimizing resource allocation, and disseminating best practices from specialized TCM hospitals are recommended to enhance service quality and support sustainable development, ultimately better meeting public health needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient or Public Contribution:\u003c/strong\u003e No Patient or Public Contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable.\u003c/p\u003e","manuscriptTitle":"Traditional Chinese Medicine Nursing Competency: Status and Influencing Factors Across Healthcare Settings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 06:47:16","doi":"10.21203/rs.3.rs-8033013/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-19T14:51:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136757050273840720155563889287802799663","date":"2025-12-11T23:57:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75994751615681787711524686035113851780","date":"2025-12-10T02:01:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T12:42:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-01T21:44:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-12T00:10:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-11T08:36:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-11-11T08:27:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cac3f2cd-f11b-48b9-bbff-cc155116effe","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T06:47:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 06:47:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8033013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8033013","identity":"rs-8033013","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}