DNP 851A Module 2 Educating the Staff Who Deliver It Example

Teaching the Teachers: Preparing Nurses and Staff to Deliver Asthma Action Plans and Inhaler Technique Coaching

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 851A: Project Implementation

Instructor Name

Month Day, Year

Teaching the Teachers: Preparing Nurses and Staff to Deliver Asthma Action Plans and Inhaler Technique Coaching

An intervention delivered by staff is only as good as their preparation. My DNP project asks registered nurses in a pediatric primary care clinic to complete a written asthma action plan with each family, coach correct inhaler and spacer technique until the child can show it back, and send the plan to the school nurse when the family agrees. Each of those tasks depends on skills that cannot be assumed. This paper describes how the staff were educated: what each role needed to learn, how the teaching was designed, how competence was checked, what the first observed visits revealed and how the education was adjusted in the third week.

What Each Role Needed to Learn

The education began with a task analysis of the visit. Nurses needed four skills: filling in a symptom-based plan whose three color zones matched the child's prescribed medicines; demonstrating and checking metered-dose inhaler use with a spacer; using teach-back so that the parent and child explained the plan in their own words; and holding a short consent conversation about sharing the plan with school. Medical assistants needed to room children for the longer visit type, place placebo inhalers and spacers in the room, and give the age-appropriate asthma control questionnaire before the nurse arrived. Front-desk staff needed to schedule the 40-minute visit, make reminder calls in the family's language and flag families who had asked for an interpreter.

Why Technique Coaching Needed Special Attention

Inhaler technique was the skill most likely to be done badly. A systematic review of 28 studies found that children's technique is generally very poor, better with a spacer than without one, and improved by counseling, and it urged every member of the care team to check technique at every opportunity (Gillette et al., 2016). A second review of educational interventions found that they improve technique in the short term, that the effect appears to fade over time, and that reinforcement is needed (Klijn et al., 2017). Staff education therefore had to produce nurses who could not only demonstrate the steps but spot errors quickly and correct them, and it had to plan for reinforcement from the start.

How the Teaching Was Designed

Nurses completed a three-hour session in two parts. The first hour covered the action plan: the zones, how to match them to each child's medicines, and common errors such as a yellow zone that tells the family to double a controller dose the prescriber did not order. The second part used simulation. A pediatric nurse practitioner, the site mentor, played a parent in four scripted scenarios, including a parent who says the child already knows how to use the inhaler, and each nurse ran a full visit while the others observed and then debriefed. The design drew on a study in which a class led by pediatric nurse practitioners and built around simulation raised physicians' action plan knowledge from 44.8% to 80.4% and increased their confidence in teaching families (Borgmeyer et al., 2017).

Teach-back was taught as a method rather than a single question. A systematic review found teach-back used widely in patient education, most often by nurses, with improvements in outcomes such as knowledge and self-care, but with wide variation in how it was carried out (Talevski et al., 2020). The session therefore set a standard: the nurse asks the parent and, when old enough, the child to explain what to do in each zone and to show the inhaler steps, then corrects and repeats until the explanation and demonstration are right. Medical assistants and front-desk staff completed separate 45-minute sessions on their tasks.

Checking Competence

Each nurse was signed off only after meeting two standards. First, the nurse completed a 10-step spacer technique checklist on a placebo device without error and correctly scored a colleague's deliberate errors. Second, the nurse completed one simulated visit in which the observer confirmed every core element: the action plan matched the medication list, teach-back was used for the zones and the device, and the school consent was offered. A 15-item knowledge quiz given before and after the session showed mean scores rising from 9.7 to 13.8 among the three nurses and from 6.1 to 11.9 among the six medical assistants. Scores are reported as descriptive only, since the groups were small.

What the First Observed Visits Showed

The project lead observed the first 12 visits. Action plans were accurate in all 12, and school consent was offered in all 12. Technique coaching was weaker. In four visits, the nurse accepted a child's demonstration that skipped the step of breathing out fully before the puff, and in three visits teach-back was used for the zones but not for the device. The pattern suggested that the checklist was being treated as a script to read rather than a standard to verify. It also matched the review's finding that technique teaching fades without reinforcement.

The Week-Three Refresher

In week three, a 30-minute refresher focused on the two missed steps. Each nurse watched short video clips of children making the common errors and practiced spotting them. The checklist was revised so that the breath-out and the slow inhalation steps were printed in bold and required a tick for the child's own demonstration, not the nurse's. Observation of the next 10 visits found technique teach-back completed in all 10 and the breath-out step checked in nine. The refresher will be repeated for all nurses at week eight, and new staff will complete the full session before they deliver any visit.

Conclusion

Staff education for this project was built from the tasks of the visit, grounded in evidence about why inhaler technique teaching so often fails, delivered through simulation and teach-back practice, and checked against observable standards. The first observed visits showed where it fell short, and a targeted refresher closed most of the gap. Education will continue through the project rather than ending at launch.

The same approach, with a shorter session and one observed visit, will be used for float nurses who cover the clinic.

References

Borgmeyer, A., Gyr, P. M., Ahmad, E., Ercole, P. M., & Balakas, K. (2017). Pediatric nurse practitioners effective in teaching providers the asthma action plan using simulation. Journal of Pediatric Nursing, 34, 53-57. https://doi.org/10.1016/j.pedn.2017.01.002

Gillette, C., Rockich-Winston, N., Kuhn, J. A., Flesher, S., & Shepherd, M. (2016). Inhaler technique in children with asthma: A systematic review. Academic Pediatrics, 16(7), 605-615. https://doi.org/10.1016/j.acap.2016.04.006

Klijn, S. L., Hiligsmann, M., Evers, S. M. A. A., Román-Rodríguez, M., van der Molen, T., & van Boven, J. F. M. (2017). Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: A systematic review. NPJ Primary Care Respiratory Medicine, 27, Article 24. https://doi.org/10.1038/s41533-017-0022-1

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), Article e0231350. https://doi.org/10.1371/journal.pone.0231350