Abstract
Point-of-care ultrasound (POCUS) offers immediate clinical insight, but turning exposure into everyday practice requires more than a single course. Over four years of APP-led, interprofessional training (2021-2025), we used the Consolidated Framework for Implementation Research to understand what helped, what hindered, and what our participants needed. Findings came directly from post-course and follow-up surveys.
Facilitators. Learners consistently described progress when teaching matched how ultrasound is actually used at the bedside. Shared language, step-by-step scanning, and reviewing real cases helped them connect image acquisition to clinical decisions. Psychological safety was another major driver. Being able to ask questions, try, fail, and try again mattered—especially for novices. Small instructor-to-learner ratios gave people room to scan, get direct feedback, and build confidence. Many also emphasized how institutional support shaped their experience: having access to devices, encouragement from colleagues and supervisors, and opportunities to practice on their units made it far more likely they would continue scanning.
Barriers. Despite skill gains, participants often felt blocked by structure rather than motivation. Limited equipment, lack of confidence, and absence of credentialing or quality assurance caused hesitancy in practicing, let alone applying POCUS in clinical settings. A single course level also did not fit everyone. Newer operators wanted more fundamentals, while experienced participants pushed for advanced echocardiography or procedure-based content. Additionally, when ratios exceeded 1:5, hands-on practice dropped, feedback slowed, and confidence dipped. Moreover, some cited a lack of time and inconsistent access to patients as additional barriers to developing or maintaining POCUS skills.
Lessons learned. The surveys made one point clear: interest alone does not make ultrasound part of practice. Sustainable use requires systems that match the realities of clinical work. That means tiered training, reliable ultrasound access, ongoing practice opportunities, clear expectations for competency, and pathways for credentialing and quality assurance. When those elements are in place, APP-led curricula can broaden access to POCUS skills, support interprofessional learning, and help teams integrate ultrasound safely and meaningfully into patient care.
Notes
References:
Breimaier, H. E., Heckemann, B., Halfens, R. J. G., & Lohrmann, C. (2015). The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice. BMC Nursing, 14(1), Article 43. https://doi.org/10.1186/s12912-015-0088-4
Chelikam, N., Vyas, A., Desai, R., Khan, N., Raol, K., Kavarthapu, A., Kamani, P., Ibrahim, G., Madireddy, S., Pothuru, S., Shah, P., & Patel, U. K. (2023). Past and Present of Point-of-Care Ultrasound (PoCUS): A Narrative Review. Cureus, 15(12), e50155. https://doi.org/10.7759/cureus.50155
Chen, L. L., Tayban, K., Tomicich, J., Buchholz, T., Barzola, M., Mead, E., & Halpern, N. A. (2023). Point-of-care Ultrasound (POCUS) Program for Critical Care Nurse Practitioners and Physician Assistants in an Oncological Intensive Care Unit and Rapid Response Team. Journal of the American Association of Nurse Practitioners, 10.1097/JXX.0000000000000943. Advance online publication. https://doi.org/10.1097/JXX.0000000000000943
Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science : IS, 17(1), Article 75. https://doi.org/10.1186/s13012-022-01245-0
Elhassan, M. G., Grewal, S., & Nezarat, N. (2023). Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users. Cureus, 15(8), e43655. https://doi.org/10.7759/cureus.43655
Fischer, F., Lange, K., Klose, K., Greiner, W., & Kraemer, A. (2016). Barriers and Strategies in Guideline Implementation—A Scoping Review. Healthcare (Basel), 4(3), 36. https://doi.org/10.3390/healthcare4030036
Oto, B., Baeten, R., Chen, L., Dalal, P., Dancel, R., Fox, S., Lange Iv, C. W., Baston, C., Bornemann, P., Dugar, S., Goldsmith, A., Herbst, M. K., Kirkpatrick, J. N., Koratala, A., Lanspa, M. J., Lobo, V., Nomura, J. T., Pustavoitau, A., Senussi, M. H., Sorrell, V. L., … Sarwal, A. (2024). Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus. POCUS journal, 9(1), 95–108. https://doi.org/10.24908/pocus.v9i1.17240
Prager, R., Wu, D., Garber, G., Finestone, P. J., Zang, C., Aslanova, R., & Arntfield, R. (2024). Medico-legal risks of point-of-care ultrasound: a closed-case analysis of Canadian Medical Protective Association medico-legal cases. The ultrasound journal, 16(1), 16. https://doi.org/10.1186/s13089-024-00364-7
Sigma Membership
Alpha Tau
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Curriculum Development, Continuing Education, Teaching and Learning Strategies, Ultrasonic Imaging, Point-of-Care Testing, Mobile Learning
Recommended Citation
Aguilar, Al-Zada, "APP Led-POCUS Education: Survey Findings on Barriers, Facilitators, and Adoption" (2026). International Nursing Research Congress (INRC). 340.
https://www.sigmarepository.org/inrc/2026/presentations_2026/340
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-30
APP Led-POCUS Education: Survey Findings on Barriers, Facilitators, and Adoption
Toronto, Ontario, Canada
Point-of-care ultrasound (POCUS) offers immediate clinical insight, but turning exposure into everyday practice requires more than a single course. Over four years of APP-led, interprofessional training (2021-2025), we used the Consolidated Framework for Implementation Research to understand what helped, what hindered, and what our participants needed. Findings came directly from post-course and follow-up surveys.
Facilitators. Learners consistently described progress when teaching matched how ultrasound is actually used at the bedside. Shared language, step-by-step scanning, and reviewing real cases helped them connect image acquisition to clinical decisions. Psychological safety was another major driver. Being able to ask questions, try, fail, and try again mattered—especially for novices. Small instructor-to-learner ratios gave people room to scan, get direct feedback, and build confidence. Many also emphasized how institutional support shaped their experience: having access to devices, encouragement from colleagues and supervisors, and opportunities to practice on their units made it far more likely they would continue scanning.
Barriers. Despite skill gains, participants often felt blocked by structure rather than motivation. Limited equipment, lack of confidence, and absence of credentialing or quality assurance caused hesitancy in practicing, let alone applying POCUS in clinical settings. A single course level also did not fit everyone. Newer operators wanted more fundamentals, while experienced participants pushed for advanced echocardiography or procedure-based content. Additionally, when ratios exceeded 1:5, hands-on practice dropped, feedback slowed, and confidence dipped. Moreover, some cited a lack of time and inconsistent access to patients as additional barriers to developing or maintaining POCUS skills.
Lessons learned. The surveys made one point clear: interest alone does not make ultrasound part of practice. Sustainable use requires systems that match the realities of clinical work. That means tiered training, reliable ultrasound access, ongoing practice opportunities, clear expectations for competency, and pathways for credentialing and quality assurance. When those elements are in place, APP-led curricula can broaden access to POCUS skills, support interprofessional learning, and help teams integrate ultrasound safely and meaningfully into patient care.
Description
Using the Consolidated Framework for Implementation Research (CFIR), our APP-led POCUS curriculum identified key factors shaping adoption. Small instructor ratios, case-based scanning, and psychological safety enabled skill growth. Barriers included mixed learner readiness, limited equipment access, and inconsistent support for novice operators. Sustainable integration requires tiered curricula, equipment, and quality assurance structures.