Inhaler Training to Enhance Nurses' Competency in Patient Inhaler Education

Effectiveness of Theory-based Inhaler Training to Enhance Nurses' Competency in Patient Inhaler Education: a Randomized Controlled Trial

Nurses play a pivotal role in assessing, educating, and regularly reviewing patients' inhaler techniques. However, inadequate knowledge and skills among nurses can hinder their ability to accurately assess patients' inhaler technique or provide effective guidance to those receiving inhaler therapy. This project aims to develop an effective educational tool/program on inhaler education for healthcare workers and nurses.

This is an assessor-blinded, two-armed randomized controlled trial with a 4-month follow-up. The study will be conducted at a training institute of the Hong Kong Hospital Authority, the Institute of Advanced Nursing Studies. The intervention consists of a theory-based, face-to-face inhaler training workshop grounded in Social Learning Theory. The workshop integrates cognitive aids, hands-on demonstrations, and competency assessments using a standardized checklist. To support ongoing learning, participants will receive follow-up instructional videos and periodic reminders to reinforce and maintain their skills in patient inhaler education.

Questionnaires will be used to collect participants' demographic information and knowledge and skills regarding inhaler use at baseline, immediate post-training session and 4-month follow-up. Qualitative feedback from trainees will be collected.

COPD is the fourth leading cause of death and imposes a significant burden on healthcare systems worldwide. Inhalation therapy is the cornerstone of management for patients with COPD. However, the high rate of inhaler use errors among these patients underscores the critical need for regular monitoring and correction of inhalation techniques.

Consistent assessment and correction of inhaler use errors by nurses can significantly reduce patients' incorrect steps of inhaler use. However, inadequate knowledge and skills among nurses may hinder their ability to accurately assess patients' inhaler techniques or provide effective guidance for those undergoing inhaler therapy. By integrating cognitive aid tools with theory-based training, this study aims to develop an effective educational program on inhaler use for healthcare workers and nurses.

This study aims to examine the effectiveness of theory-based inhaler training in enhancing nurses' competency and confidence in theory-based patient inhaler education, compared with usual training. It is an assessor-blinded, two-armed randomized controlled trial with a 4-month follow-up, conducted at the Institute of Advanced Nursing Studies, Hong Kong Hospital Authority.

The intervention progresses through the four stages that begins with the attention stage, where clear demonstrations of correct inhaler techniques ensure that nurses fully understand the procedure. This is followed by the retention stage, supported by cognitive aids such as algorithms and videos to help participants remember the steps effectively. In the reproduction stage, nurses engage in return demonstrations, practicing inhaler techniques while receiving immediate feedback to reinforce their skills. Finally, the motivation stage is sustained through regular e-learning reminders and ongoing practical reinforcement, encouraging long-term mastery and consistent application of proper inhaler use.

The control group receives a face-to-face usual training. Self-administered questionnaires are used for all participants in both groups at baseline, immediately post-training, and at the 4-month follow-up. Competency in using inhalers and providing patient education will be assessed by trained assessors who are specialized respiratory nurses. Confidence in providing patient education will be assessed by questionnaire and qualitative feedback from from trainee. Statistical analyses are performed using the Statistical Package for the Social Sciences (SPSS), version 29.

Inclusion Criteria:

• Registered nurses
• Holding valid practicing certificate issued by the Nursing Council of Hong Kong

Exclusion Criteria:

• Unable to speak & read Chinese