Trainee Advanced Nurse Practitioner
Place of work
Intensive Home Support Services, Primary Care, East Lancashire Hospitals NHS Trust
Inhaled medication remains the preferred route of administration for the treatment of COPD and Asthma (Barnett 2012). The aims of inhaled therapy are to achieve optimal disease control by limiting exacerbations and symptoms, improving lung function and quality of life.
Currently there is a lack of formal training delivered to healthcare professionals on the correct use of inhaled medications (Bades, 2012), despite worldwide recommendations made by NICE (2011) and GOLD (2011). The evidence suggests that many nurses are not experienced at assessing or teaching inhaler technique to their patients (Self et al. 2007) with 94% of previously educated patients continuing to practice an incorrect technique (Souza et al. 2009).
Internal audit results using nursing volunteers demonstrated that the required steps for effective inhalation were performed inadequately by 19 out of the 20 participants, further highlighting the necessity for increased education in this area of practice.
An eight stage change model devised by Kotter (1996), with expertly driven training delivered by Respiratory Specialists, demonstrated exact teaching methods using placebo devices, in conjunction with video and PowerPoint presentations. Written literature, diagrammatic references and placebo inhalers issued to staff reinforced their learning and provided a further resource to be used in patient education.
The Project’s efficacy was evaluated using concepts influenced by Donabedian’s (1966) and Kirkpatrick’s (1994) evaluation models. A pre and post education survey identified staff knowledge of inhaler therapies both pre and post education delivery, thus indicating that the multi-faceted training program has proved successful. Finally, staff and patient satisfaction surveys identified any deficiencies in the proposed regime and indicated where further training is required.
The implementation of a multi-faceted teaching strategy to improve inhaled therapy education amongst nursing staff enhanced patient care.
Three key learning points
1. Lack of formal inhaler training leads to inconsistencies with delivery of patient education.
2. NICE Guidelines (2011) recommend that all healthcare professionals involved in the education of patients regarding inhaler use are up to date with current knowledge and have undergone adequate training.
3. A multi-faceted staff teaching strategy could be used to assist with optimal disease control, limit exacerbations and improve patients’ quality of life.
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