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education, inhaler technique, nurse



  1. De Tratto, Katie MSN, APN, AGACNP-BC
  2. Gomez, Christy MSN, APN, AGACNP-BC
  3. Ryan, Catherine J. PhD, APN, CCRN, FAHA
  4. Bracken, Nina MSN, APN, ACNP-BC
  5. Steffen, Alana PhD
  6. Corbridge, Susan J. PhD, APN, FAANP


Purpose/Objectives: High rates of inhaler misuse in patients with chronic obstructive pulmonary disease and asthma contribute to hospital readmissions and increased healthcare cost. The purpose of this study was to examine inpatient staff nurses' self-perception of their knowledge of proper inhaler technique compared with demonstrated technique and frequency of providing patients with inhaler technique teaching during hospitalization and at discharge.


Design: A prospective, descriptive study.


Setting: A 495-bed urban academic medical center in the Midwest United States.


Sample: A convenience sample of 100 nurses working on inpatient medical units.


Methods: Participants completed a 5-item, 4-point Likert-scale survey evaluating self-perception of inhaler technique knowledge, frequency of providing patient education, and responsibility for providing education. Participants demonstrated inhaler technique to the investigators using both a metered dose inhaler (MDI) and Diskus device inhaler, and performance was measured via a validated checklist.


Findings: Overall misuse rates were high for both MDI and Diskus devices. There was poor correlation between perceived ability and investigator-measured performance of inhaler technique. Frequency of education during hospitalization and at discharge was related to measured level of performance for the Diskus device but not for the MDI.


Conclusions: Nurses are a key component of patient education in the hospital; however, nursing staff lack adequate knowledge of inhaler technique.


Implications: Identifying gaps in nursing knowledge regarding proper inhaler technique and patient education about proper inhaler technique is important to design interventions that may positively impact patient outcomes. Interventions could include one-on-one education, Web-based education, unit-based education, or hospital-wide competency-based education. All should include return demonstration of appropriate technique.