Point of Care Ultrasound (PoCUS) by the Family Nurse Practitioner in the Primary Care Setting

Abstract

Abstract Ultrasound (US) is currently found predominantly in specialty practices and is not generally utilized within the primary care environment at the point of care. While several medical schools have included US training as part of their curriculum and residency programs, it remains a skill set not commonly taught or even offered to family nurse practitioners (FNP’s). Literature review revealed that primary care physicians are beginning to integrate ultrasound into the examination of patients in the primary care setting with multiple benefits during an initial encounter for diagnostic purposes and procedural guidance (Morris, 2015, p. 3). No research or papers concerning family nurse practitioner use of US in primary care settings were found. FNP’s are not usually offered training in the use of US, except in acute-care settings and the military, even though ultrasound performed at the point of care can have a great influence on the ability to “provide high quality, cost effective healthcare by expediting diagnosis and decreasing costly ancillary testing that utilizes ionizing radiation” (Soni & Lucas, 2015, p. 123). Initial familiarization for PoCUS was offered to a cohort group of FNP students and other providers at Womack Army Medical Center (WAMC). Familiarization training consisted of a series of didactic and hands-on training sessions focused on procedural guidance and assessment of the heart, lungs, vascular (deep vein thrombus, abdominal aortic aneurysm, fluid overload and dehydration), kidney, gallbladder, bladder, liver, and musculoskeletal systems. Initial training was accomplished in 16 hours of instruction. Assessment of knowledge and skill was performed pre- and post-training using a Likert scale tool. After training, the FNP students and providers were assessed for their likelihood to comfortably embrace the use of US/PoCUS, and their willingness to receive further training. As interest in and knowledge about ultrasound grows, it has the potential to replace or supplement other diagnostic and assessment methods currently used. While the FNP of today may not use ultrasound, training and adoption of its use may soon render it an indispensable part of the FNP provider’s practice. Keywords: Ultrasound, Point of Care, Primary Care, Family Nurse Practitioners, Education.