Educational effectiveness of a Tele-POCUS training program for home care nurses in remote and rural settings

Background In Japan, demand for home care is increasing owing to population aging and rising health care costs. However, timely assessment in remote and rural areas remains challenging because of physician shortages. Tele-POCUS (point-of-care ultrasound) has attracted attention as a potential educational and collaborative approach in home care settings; however, evidence regarding Tele-POCUS-oriented education for home care nurses remains limited. Methods We conducted a pre–post educational study of a Tele-POCUS-oriented POCUS training course for visiting nurses and nurses working in long-term care facilities on Fukue Island, Nagasaki Prefecture, Japan. The course consisted of lectures, hands-on sessions, and Tele-POCUS workflow training simulating remote collaboration between nurses and physicians. The primary outcome was the change in the image interpretation score, and the secondary outcome was confidence score. The image interpretation examination included both basic and case-based domains and was administered using ultrasound video clips. Results Participants were recruited through an island-wide open call on Fukue Island, and 36 nurses from five visiting nursing stations and six long-term care facilities were included in the analysis. The overall interpretation score (± standard deviation) improved from 31.4 ± 16.1 to 50.8 ± 13.0 (mean difference 19.4, 95% confidence interval [CI] 14.4–24.5, p < 0.001). The basic domain score increased from 14.1 ± 9.6 to 31.7 ± 10.4 (mean difference 17.6, 95% CI 14.3–20.9, p < 0.001). The case-based domain showed no significant change (17.3 ± 8.2 to 19.2 ± 6.1; mean difference 1.8, 95% CI − 1.2–4.9, p = 0.229). The proportion achieving ≥ 60% in the post-course examination was 27.8% for the overall score. Confidence scores (overall score) increased from a median 20.0 (interquartile range [IQR] 20.0–21.5) to 60.0 (IQR 47.5–69.5) ( p < 0.001), with significant improvements across all subdomains (all p < 0.001). Conclusions A Tele-POCUS-oriented POCUS training course improved basic image interpretation scores and confidence among home care nurses in a remote island setting. However, short-term training alone may be insufficient for developing advanced clinical reasoning abilities. Tele-POCUS education may serve as an introductory educational approach for supervised remote collaboration between nurses and physicians in home care settings. Further studies are needed to evaluate long-term competency development and practical application in clinical settings.