A Delphi Study on the Development of a Traditional Chinese Medicine Syndrome–Differentiation Nursing Framework for Patients with Cirrhotic Ascites

Aim: To develop a scientifically grounded, consensus-based Traditional Chinese Medicine (TCM) syndrome-differentiation nursing framework for patients with cirrhotic ascites, thereby integrating TCM theoretical principles with modern nursing science to enhance individualized, holistic, and evidence-informed care. Methods: A modified classical Delphi method was employed between January 2022 and January 2025. Eighteen multidisciplinary experts in TCM, hepatology, and nursing participated in three iterative rounds of anonymous consultation. The preliminary framework-derived from systematic literature review and semi-structured interviews-was refined using 5-point Likert ratings and open-ended feedback. Consensus was defined as ≥80% of ratings ≥4 and coefficient of variation (CV) <0.50. Reliability was examined using intraclass correlation coefficients (ICC) and Kendall's W; content validity was evaluated via the item- and scale-level content validity indices (I-CVI, S-CVI/Ave); and thematic analysis was used to synthesize qualitative feedback. Results: The final framework comprised four domains and 48 items: (1) syndrome classification, (2) nursing assessment, (3) intervention principles, and (4) outcome evaluation. Consensus rates ranged from 89.6% to 97.8% with CV = 0.22-0.33. "Tonify Spleen and Kidney" achieved the highest rating (4.95 ± 0.10, 100% agreement). ICC values (0.89-0.97) and increasing Kendall's W (0.60→0.86, p < 0.001) confirmed strong reliability and convergence. Qualitative synthesis identified three meta-themes-integration, personalization, and standardization-reflecting the dual need for individualized care and measurable practice standards. Conclusion: This Delphi-derived framework provides a validated and clinically applicable structure for implementing syndrome-based nursing care in patients with cirrhotic ascites. By integrating TCM syndrome differentiation into routine nursing assessment, individualized intervention planning, and standardized outcome evaluation, it offers a practical guide for bedside care and follow-up management in real-world clinical settings. The framework is expected to improve the consistency and individualization of nursing care, and its effectiveness can be further evaluated through measurable outcomes such as symptom relief, ascites control, patient quality of life, nursing adherence, and inter-rater reliability.