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

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.