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.

Study Overview

• Status: Not yet recruiting
• Conditions: COPD (Chronic Obstructive Pulmonary Disease)
• Intervention / Treatment: Behavioral: Usual training; Behavioral: Theory-based inhaler training

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 82
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yuen Kwan Agnes Lai, PhD; Phone Number: (852)3970-2917; Email: ayklai@hkmu.edu.hk
• Study Contact Backup: Name: Shu Wah Ng; Phone Number: (852)6033 9051; Email: ngsw1@ha.org.hk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

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

Exclusion Criteria:

• Unable to speak & read Chinese

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Usual Training Control group; Control group receives usual training workshop	Behavioral: Usual training; Control group receives usual training workshop, which is a face-to-face training for using different brands of inhalers.
Experimental: Theory-based Inhaler Training Intervention group; Intervention group receives theory-based inhaler training workshop.	Behavioral: Theory-based inhaler training; The workshop include a face-to face-training session with algorithm of device-specific inhaler maneuvers, standardized inhaler use competency assessment checklist, demonstration, and individual return. To support ongoing learning, participants receive follow-up instructional videos and reminders to strengthen and maintain their skills in patient inhaler education.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Trainees' correct steps inhaler use	Proportion of correct steps in inhaler use, evaluated by trained assessors with checklist. Higher percentage of correct steps achieved means better skills.	Baseline and immediate after face-to-face training session.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Trainees' correct steps inhaler use	Proportion of correct steps in inhaler use, evaluated by trained assessors with checklist. Higher percentage of correct steps achieved means better skills.	Baseline and 4-month
Trainees' knowledge on inhalation maneuvers	Proportion of correct answer for 3-item outcome-based questionnaire. Higher percentage of correct answer achieved means better knowledge.	Baseline, immediate after face-to-face training session and 4 months
Trainees' confidence in patient education on inhaler use	Confidence scale on clinical nurse practice with 5 items. Higher score means greater confidence.	Baseline, immediate after face-to-face training session and 4 months
Trainees' practice in patient education on inhaler use	Three outcome-based questions (with 5-point scale) on self-reported practice in patient education. Higher score means more practice.	4 months

Collaborators and Investigators

• Sponsor: Hong Kong Metropolitan University
• Collaborators: United Christian Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): April 9, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): February 28, 2027

Study Registration Dates

• First Submitted: April 7, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): April 16, 2026
• Last Update Submitted That Met QC Criteria: April 13, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Nurse; Training; COPD; Randomized controlled trial; Chronic Obstructive Pulmonary Disease; Inhaler
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pathological Conditions, Signs and Symptoms; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: CIRB-2025-116-3

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Did not mention during IRB application.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No