Factors Influencing ICU Nurses' Proficiency in Point-of-Care Gastrointestinal Ultrasound: A National Cross-Sectional...

To evaluate point-of-care gastrointestinal ultrasound (GI-POCUS) proficiency, identify influencing factors, and examine its clinical application among intensive care unit (ICU) nurses in China.

GI-POCUS supports gastrointestinal function assessment, enteral nutrition guidance, and dysfunction detection in patients who are critically ill. However, its use among ICU nurses remains limited, and the factors influencing proficiency are unclear.

A national cross-sectional survey was conducted among 2009 ICU nurses from 21 provinces in China using a structured online questionnaire covering their demographic and unit characteristics, GI-POCUS training, practice, skills, proficiency, and clinical application. Participants were recruited from various ICU settings, with the majority from adult ICUs and a small proportion from pediatric and neonatal ICUs. Data were analyzed using SPSS 27.0 with descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression.

Only 297/2009 (14.8%) of ICU nurses rated their GI-POCUS proficiency as "good," whereas 1205/2009 (59.9%) rated it as "poor." GI-POCUS proficiency was significantly associated with billability, training participation, usage frequency, documentation of GI-POCUS findings in nursing charts, proficiency in probe operations, ability to perform qualitative and quantitative analyses, and diagnostic accuracy and sensitivity (p < 0.05). Clinically, only 492/2009 (24.5%) of ICU nurses could identify intestinal necrosis or ischemia. 1232/2009 (61.3%) applied GI-POCUS to assess gastric emptying and residual volume, and 1069/2009 (53.2%) used it to guide feeding tube placement. 1032/2009 (51.4%) of ICU nurses could identify gastric transverse and longitudinal section images, whereas the recognition rate for intestinal wall blood flow signals was the lowest at only 369/2009 (18.4%).

GI-POCUS proficiency among ICU nurses in China is low. Promoting sustainable implementation requires organizational support, leadership engagement, and integration into routine critical care nursing practice.

Nursing leaders should establish structured GI-POCUS training pathways, integrate ultrasound use into routine ICU workflows and electronic documentation systems, and advocate for institutional recognition including billing mechanisms. These leadership actions can enhance nurses' proficiency and promote sustainable nurse-led GI-POCUS implementation.