Ng Shu-Wah, Lit Maggie P K, Lai Agnes Y K
Division of Respiratory Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong Special Administrative Region, People's Republic of China.
Division of Respiratory Medicine, Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2024 Dec 31;19:2775-2785. doi: 10.2147/COPD.S482243. eCollection 2024.
Persistently high rates of inhaler errors and poor adherence among Chronic Obstructive Pulmonary Disease (COPD) patients contribute to ineffective symptomatic control, high care burdens, and increased healthcare resource utilization.
This study aimed to report (i) nurses-identified common problems and errors of inhaler use in COPD patients, (ii) nurses' attitudes, practices, training needs and required support in inhaler education.
An online questionnaire survey was conducted with nurses working in Hong Kong from May to June 2023 using an exponential, non-discriminative snowball sampling strategy.
Of 156 nurses (67.3% female, 41% aged 40 or above), 37.2% and 62.8% of them had more than 10 years of experience in medical units and received respiratory-related specialist training, respectively. About 86% and 82% perceived that their patients did not have adequate basic knowledge and had incorrect use of their inhaled medications. High rates of inhaler use errors were observed by nurses across all phases: preparation (50%-92%), pre-inhalation (45%-89%), inhalation (69%-89%), and aftercare (66%-85%). Nurses with ≥10 years of working experience in medical units or specialist training showed significantly more confidence in educating on inhaler use, engaging in more discussion with patients about inhaler use, and assessing patient inhaler use techniques more frequently than those with less experience or no respiratory-related specialist training with small effect size (Cohens'd: 0.26-0.33).
Inhaler use errors were common issues among COPD patients in Hong Kong. Enhanced professional training and support in inhaler education could improve nurses' confidence and practices in conducting patient education on inhaler use.
慢性阻塞性肺疾病（COPD）患者中吸入器使用错误率持续居高不下且依从性差，导致症状控制不佳、护理负担加重以及医疗资源利用增加。
本研究旨在报告（i）护士识别出的COPD患者吸入器使用的常见问题和错误，（ii）护士在吸入器教育方面的态度、做法、培训需求以及所需支持。
2023年5月至6月，采用指数非歧视性滚雪球抽样策略，对在香港工作的护士进行了在线问卷调查。
在156名护士中（67.3%为女性，41%年龄在40岁及以上），分别有37.2%和62.8%的护士在医疗单位有超过10年的工作经验且接受过呼吸相关专科培训。约86%和82%的护士认为他们的患者没有足够的基础知识且吸入药物使用不正确。护士在吸入器使用的各个阶段都观察到了较高的错误率：准备阶段（50%-92%）、吸入前（45%-89%）、吸入阶段（69%-89%）和吸入后护理阶段（66%-85%）。在医疗单位有≥10年工作经验或接受过专科培训的护士，在吸入器使用教育方面表现出明显更高的信心，与患者就吸入器使用进行更多讨论，并且比经验较少或未接受呼吸相关专科培训的护士更频繁地评估患者的吸入器使用技术，效应量较小（科恩d值：0.26-0.33）。
吸入器使用错误是香港COPD患者中的常见问题。加强吸入器教育方面的专业培训和支持可以提高护士在对患者进行吸入器使用教育方面的信心和做法。
