NUR 502 Module 4 Teaching Plan example

Breath, Hold, Repeat: A Teaching Plan for Inhaler Technique in a Pulmonary Rehabilitation Group

[Student Name]

Southern New Hampshire University

NUR 502: Teaching and Learning in Nursing

Module Four Teaching Plan

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Breath, Hold, Repeat: A Teaching Plan for Inhaler Technique in a Pulmonary Rehabilitation Group

Rationale

Inhaled medications are the foundation of treatment for chronic obstructive pulmonary disease, and international guidance emphasizes that inhaler technique should be taught and regularly rechecked, because poor technique undermines the effect of the medication (Global Initiative for Chronic Obstructive Lung Disease, 2024). Errors are common and persistent. A systematic review of studies spanning four decades found that incorrect inhaler technique remained frequent among patients and had not improved over time, despite new devices and repeated teaching (Sanchis et al., 2016). A patient who uses the right medicine the wrong way may be labeled as having worsening disease when the real problem is technique.

Pulmonary rehabilitation is a good setting for teaching because patients attend regularly, are motivated to improve their breathing and can practice between sessions. This plan describes a single one-hour session within the program.

The Learners

The session is for six adults aged 58 to 79 in a composite hospital pulmonary rehabilitation program. All have moderate to severe COPD. Between them they use three device types: a pressurized metered-dose inhaler, two different dry powder inhalers and a soft mist inhaler. Four also use a spacer at home. Two participants have arthritis in their hands, one has mild cognitive impairment, and one reads little English and prefers Spanish; her daughter will attend. At the program's intake visit, the respiratory therapist observed each participant's technique and found that five of the six made at least one critical error, most often not exhaling before inhaling, inhaling too weakly through a dry powder device, or failing to hold the breath afterward.

Learning Objectives

When the hour is over, every participant should be able to: state why correct technique matters for their own device; demonstrate every essential step for their own inhaler without a critical error, using a placebo device; explain when to use a spacer, if their device is used with one; and identify one situation in which they should ask for help, such as an empty counter or a new device. These objectives address cognitive, psychomotor and affective learning, following the planning principles used in nursing education (Bastable, 2019).

Session Outline

The table below sets out the one-hour session.

Table 1

Inhaler Technique Session Outline

Choice of Methods

Because inhaler use is a psychomotor skill, the plan relies on demonstration and return demonstration rather than lecture. Participants are grouped by device so that each group sees only the steps relevant to them, which reduces cognitive load for older learners. The nurse uses placebo devices so participants can practice repeatedly without taking extra doses. Checklists for each device list the essential steps, allowing the nurse to give precise feedback, such as breathe out fully away from the mouthpiece before inhaling, rather than general encouragement. Peer discussion of common mistakes lets participants learn from each other and normalizes errors, which reduces embarrassment.

Adaptations

Several adaptations address the learners' needs. For the two participants with arthritis, the nurse will demonstrate inhaler grips and, if needed, recommend assistive devices or discuss with the prescriber whether a different device would be easier to use. For participants who cannot generate a strong inspiratory breath, the nurse will check whether a dry powder inhaler is appropriate and flag concerns for the pulmonologist. The participant with mild cognitive impairment will receive a single-page picture card and her spouse will be invited to the next session. Materials and teach-back will be offered in Spanish for the participant who prefers it, with her daughter present. Throughout, the nurse will use plain language and avoid terms such as actuation and inspiratory flow.

Learning Environment and Learner Comfort

The environment matters for learners who are short of breath. The session will be held in the rehabilitation gym's small classroom with chairs that have arms, so participants can sit upright and rest their elbows while practicing. It is scheduled after the exercise portion of the program, when participants are warmed up but not exhausted, with a short rest at the midpoint. Supplemental oxygen tubing will be long enough to allow participants to move to their device groups, and water will be available because dry powder inhalers can cause throat irritation. The nurse will speak slowly, face the group and keep background noise low, since several participants wear hearing aids. Attention to these details reduces fatigue and anxiety, both of which interfere with learning a physical skill.

Evaluation

Learning will be evaluated in three ways. Before leaving, every participant will show the nurse their own device, and the nurse will record the number of essential steps performed correctly on the checklist, with the goal of no critical errors. Teach-back will confirm that participants can state why technique matters and when to ask for help. Because skills fade, the respiratory therapist will recheck technique with the same checklist at the next rehabilitation visit one week later and again at program discharge, and any participant with a critical error will receive individual coaching. The session itself will be evaluated by a short participant feedback form and by comparing the number of participants with critical errors before and after the session.

Conclusion

Incorrect inhaler technique is common and persistent, and it reduces the benefit of essential COPD medications. This one-hour plan targets that problem with clear objectives, a timed structure centered on hands-on practice, device-specific checklists, adaptations for physical and literacy needs, and an evaluation that measures both immediate learning and retention. A short, focused session built this way can make every later dose of medication more effective.

References

Bastable, S. B. (2019). Nurse as educator: Principles of teaching and learning for nursing practice (5th ed.). Jones & Bartlett Learning.

Global Initiative for Chronic Obstructive Lung Disease. (2024). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2024 report. https://goldcopd.org

Sanchis, J., Gich, I., & Pedersen, S. (2016). Systematic review of errors in inhaler use: Has patient technique improved over time? Chest, 150(2), 394-406. https://doi.org/10.1016/j.chest.2016.03.041