The effect of single educational intervention on improving nurses' proficiency in using different inhaler devices in a tertiary care setting

CONTEXT: Inhalation medications are administered by different inhalers such as pressurized metered-dose inhaler (pMDI) with or without the spacer, dry-powder inhaler (DPI), and nebulizer. Many health-care providers including nurses may have deficiencies in knowledge about using inhalers. This can result in improper techniques of using inhalers adapted by patients, which may lead to wastage of time, medicine, and money and thereby poor outcome in terms of relief. AIMS: The aim is to study the proficiency of inhalers in nurses and the effect of educational intervention to improve the same. SETTINGS AND DESIGN: It was a hospital-based educational interventional type of study. SUBJECTS AND METHODS: Technique of usage of inhalers in 87 nurses was assessed. The steps assessed were as follows (1) Preparation, (2) Administration, (3) Inhalation, (4) Coordination, and finally, (5) Instructions given to patients. Important and necessary steps such as able to identify empty device, advising mouth gargles after administration of the drug via the inhaler device and proper breath holding were also assessed. After an initial assessment, nurses were given an individualized educational session regarding the correct usage of various inhaler devices. They were again reevaluated after one month for the same. STATISTICAL ANALYSIS USED: The proportion of the participants performing the steps properly before and after the intervention was calculated and compared with Z-test for proportions. The relationship between the years of experience and score for task post intervention was seen through Karl Pearson's correlation coefficient (r). RESULTS: After the intervention, the proficiency of nurses with the use of each device improved as follows: for pMDI from 21.8% to 36.8%, for DPI from 21.8% to 62.18%, for pMDI with spacer from 2.3% to 21.%, and for nebulizer from 33.3% to 53.21%. For important steps such as identification of empty MDI, only 28.7% of the nurses did it correctly, which improved to 64.4% after the intervention. For proper holding of the device, the proficiency of nurses increased from 29.9% to 69.7%. For proper coordination, the proficiency increased from 18.39% to 67.1%. About 11.4% of the nurses held breath correctly before, which improved to 60.5% after teaching. About 40.2% of the nurses advised gargles after using inhalers before the intervention, which improved to 86.8% afterward. CONCLUSIONS: Our individualized training has made a difference and improved knowledge as well as skills regarding the use of different inhaler devices in nurses, although there is still a lot of scope for further improvement.