Background: Spirometry is very important in the management of chronic obstructive pulmonary disease (COPD); however, newly diagnosed patients lack confidence and technique in using it. Improper performance may lead to misinterpretation and mismanagement. Nurse-led educational interventions are increasingly identified with the role they play in enhancing patient outcomes, through outlined teaching and hands-on guidance.
Aim: This study aimed to determine the effect on confidence and the accuracy of technique in adults with newly diagnosed COPD of a nurse-led spirometry demonstration.
Methodology: A quasi-experimental study was conducted on 60 first-time spirometry patients at Hayatabad Medical Complex, Peshawar, divided into experimental and control groups. The experimental group received a nurse-led demonstration; the control group received standard verbal instructions. Confidence and technique accuracy were assessed using a Likert scale and ATS checklist, with data analyzed via t-tests in the Statistical Package for the Social Sciences (SPSS) v27.
Results: The experimental group reported significant enhancement in confidence (mean difference +1.7, p < 0.001) and technique accuracy (mean difference +2.2, p < 0.001) from the control group that reported minimal and statistically unimportant variations.
Conclusion: Demonstrations that are nurse-led can do a lot to improve the confidence and accuracy of COPD patients who are newly diagnosed with spirometry. It is possible to improve the diagnostic precision as well as increase patient engagement if such interventions are incorporated into standard medical care.

Chronic obstructive pulmonary disease, Spirometry, Nurse-led intervention, Patient confidence, Technique accuracy.

COPD is the term used to refer to the progressive respiratory disease wherein airflow is limited and not completely reversible. For this study, the term nurse-led spirometry demonstration implies hands-on and structured teaching by trained nurses who guide the patients on the correct use of a spirometer.[1] Patient confidence refers to the self-reported belief of the person that he/she can properly undertake the spirometry maneuvers. The technique accuracy is the assessment of the spirometry against standardized criteria. First-time COPD diagnosed adults refer to patients who have received a COPD diagnosis within the last month and have no experience in spirometry testing. These important ideas are the basis for examining the impact of educational demonstrations on the subjective and objective spirometry results.[2]

COPD is estimated to affect 251 million people globally, thus being the third cause of death in the world.[3] Prevalence will vary by region, but rates are as high as 19% among adults over 40 in some industrialized nations, and documentation rates that approach 70% in low and middle-income settings.[2] The current estimates reveal that in Pakistan, the prevalence of COPD among adults aged 40 years and above ranges between 10% to 13%, a situation worsened by high levels of adult smoking and indoor air pollution. Such numbers notwithstanding, many people are found to be ignorant of their pulmonary status up to the stage of illness.[4]

Spirometry with an accurate result is necessary for confirmation of diagnosis and for the guidance of management, but research shows that the quality of up to 30% of spirometry tests is poor because of incorrect technique.[5] Poor maximal inhalations, premature termination of exhalation, and loss of a tight seal of the mouthpiece are some of the typical mistakes. Such imprecisions may result in misdiagnosis of disease severity and inadequate therapy choices, highlighting the need for effective patient training.[6]

Confidence in patients has been associated with performance in different health behaviors, but the role of patient confidence in the determination of Spirometry accuracy has been poorly researched. Confidence could impact the number of efforts from patients and compliance with recommended maneuvers.[7] A low self-efficacy may lead to insufficient or hesitant exhalation, and excessively nervous patients might hyperventilate or not follow the instructions to the letter. Gaining knowledge of how confidence forms the result of spirometry is thus critical.[8]

Nursing-led educational interventions are effective in enhancing patients’ skills in self-management in various chronic diseases. Via demonstration, feedback, and correction, nurses can personalize instruction by meeting individual learning needs, reinforcing essential steps, and developing rapport that promotes patient involvement.[9] However, most of the spirometry training is short, unstandardized, and is often provided by technicians or physicians under time pressure. Such a gap indicates a possibility for the nursing-led programs to improve learning and performance.[10]

Most of the previous research was based on technician-led training and multimedia modules, and there is a lack of evidence on live nurse-led demonstration.[9] A smaller pilot study showed that video instruction enhanced spirometry acceptability, but did not report technique accuracy or confidence.[11] As of today, no quasi-experimental research has ever compared structured demonstrations by nurses to conventional verbal instructions in diabetes mellitus patients who are newly diagnosed with COPD. This lack of proof reveals an important lacuna in respiratory nursing education.[12,13]

That gap is to be addressed by the present study with the assessment of the impact of a nurse-led spirometry demonstration on the confidence and the accuracy of the technique used with regard to the COPD diagnosed adults, who have been examined for the first time. The research aims to quantify the changes in self-efficacy and performance measures to inform people of the best practices for spirometry training and enhance the reliability of diagnosis and outcomes of care for COPD patients.

This quasi-experimental study was aimed at determining the effect of the nurse-led spirometry demonstration on confidence and accuracy of technique in adults recently diagnosed with COPD at the pulmonology department of Hayatabad Medical Complex in Peshawar, a tertiary care hospital that specializes in respiratory care. The participants of the study were 30–70 years of age, patients who needed first-time spirometry performed; those with cognitive impairments, hearing disabilities, or prior spirometry training were excluded. In convenient sampling, groups of 60 participants were randomly assigned to an experimental group (n=30) receiving a structured, nurse-led demonstration and another control group (n=30) for routine technician instructions. Experimental intervention had step-by-step guidance, visual aids, and hands-on practice, but for the control group, the standard verbal instructions were followed. The outcome was assessed using a pre- and post-test survey for confidence levels and an observational checklist for accuracy in technique. Between-group analysis of data determined the effectiveness of the intervention. Ethical approvals were secured, and informed consent was used to ensure that the participants volunteered freely. Results were intended to guide clinical practices of patient education and focus on the nurse-led interventions for enhancing COPD management. The design handled potential confounding variables using inclusion and exclusion criteria and standardized implementation, whereas convenience sampling impaired generalizability. Findings are added to the evidence that structured demonstrations increase the involvement of the patients and their procedural proficiency in the field of respiratory care.

Data collection procedure: The experimental group got a three-component nurse-led demonstration in spirometry, including: an introduction to the purpose of spirometry, a step-by-step demonstration of a device, as well as a supervised patient return demonstration. In comparison to the control group, the latter went through conventional steps under general verbal instructions from a technician. Confidence in a patient was measured pre- and post-intervention (validated 5-point Likert scale questionnaire), whereas technique accuracy was observed through a blinded observer’s checklist that maps to ATS criteria in three spirometry attempts. Pre-test measurements defined the initial confidence and accuracy level of both groups. Post-test assessments administered after the intervention on the day of intervention confined temporal variability to a minimum. To allow for objectivity, the data collection method focused on the use of standardized tools and observers’ blinding. The design allowed for the comparability of groups, where nurse-led protocol focused on patient engagement and reinforcement, and the control group placed its emphasis on passive instruction. This methodology attempted to factor out the effect of structured nurse-led education on outcomes while maintaining rigor versus clinical practicality.

Data analysis: The collected data were analyzed and entered into SPSS version 27. To summarize the characteristics of the participants, descriptive statistics (mean, standard deviation, frequency, and percentage) were conducted. Paired t-tests were used in comparing pre- and post-test scores within and between groups. A p-value < 0.05 was statistically significant.

Demographic characteristics of participants: The study involved 60 respondents with a mean age of 54.0 ± 7.8 years, comprising equal groups of experimental and control. The majority of those included in both groups represented males (63.3% overall), and females accounted for 36.7%. As far as being educated, 21.7% were not educated, 31.7% did primary education, and 46.7% did secondary or higher education. Both groups were quite similar in terms of demographic distribution, which served comparability (Table 1).

Table 1: Demographic characteristics of participants (N = 60)

The experimental group has demonstrated a significant increase in confidence levels, with mean scores increased from 2.4 ± 0.6 to 4.1 ± 0.5 (p < 0.001). On the other hand, the confidence of the control group increased only slightly from 2.5 ± 0.5 to 2.7 ± 0.6 points (p = 0.08). The experimental group’s mean difference of +1.7 indicates the effectiveness of the demonstration by the nurse. These results indicate that the impact of structured education on the confidence among patients in spirometry is significantly high (Table 2).

Table 2: Pre- and Post-test patient confidence scores (Mean ± SD)

There was a significant improvement in the experimental group in technique accuracy; mean scores changed from 2.1±0.7 to 4.3 ± 0.4 (p<0.001). In the meantime, the control group demonstrated a slender, non-significant increase from 2.0 ± 0.6 up to 2.3 ± 0.5 (p = 0.09). The rather high mean difference of +2,2 in the experimental group means the positive effect of the nurse-led spirometry demonstration. This substantiates the effectiveness of structurally based training in improving the accuracy of procedural processes among the COPD patients, for the first time (Table 3).

Table 3: Accuracy of spirometry technique (Observed scores out of 5)

Comparison after intervention between groups showed significant differences in the experimental group’s scores. Confidence levels in the experimental group were 4.1 ± 0.5 versus 2.7 ± 0.6 in the control group (p < 0.001), with the mean difference of +1.4. Technique accuracy was also found to be much higher in the experimental group (4.3 ± 0.4) compared to the control group (2.3 ± 0.5); mean difference: +2.0; p < 0.001. These findings support the effectiveness of the nurse-led spirometry demonstration towards increasing confidence as well as performance accuracy (Table 4).

Table 4: Between-group comparison of post-test scores

The findings of this quasi-experimental study presented compelling evidence regarding the efficacy of the nurse-led spirometry demonstrations in improving confidence, as well as technique accuracy among adults who are newly diagnosed with COPD. Those who participated in the experimental group experienced a statistically significant enhancement of both tested variables as compared to the control group that received usual verbal directions. These results coincide with the need for the recognition of the nurse in the patient education and procedural coaching, in application to chronic diseases.

The increase in confidence levels that were noted among the participants who received the nurse-led demonstrations is in line with findings that structured and personalized instruction dramatically reduced anxiety and enhanced self-efficacy within patients going through pulmonary rehabilitation.[14] Like the current study, their intervention focused on clear communication, repetition, and patient engagement to account for improved outcomes for the patients. This brings out the need for empowering patients through organized education, particularly in the case of new and perhaps intimidating procedures such as spirometry.

In the aspect of the technique accuracy, the current study’s results are in line with the study by, which revealed that the hands-on caregiver-led techniques optimized the patients with COPD on inhaler techniques.[15] Their research pointed out that demonstration plus return demonstration largely decreased error and increased patient compliance. This is consistent with the idea that active approaches to teaching, in the form of the current research, yield to more technique mastery as opposed to passive instructional methods.

However, the findings oppose a study that observed no significant change in patients experiencing spirometry after they were followed either by written instruction or by verbal instruction.[16] Such disparity could be attributed to a lack of hands-on practice in the study by Jones, which shows that demonstration in itself might not be enough, but may not be enough without a chance for supervised practice and feedback. It is most likely due to the presence of both return demonstration components in the current study that the outcomes in the experimental group were superior.[17]

Furthermore, the present work contributes to the literature by enhancing healthcare professionals’ knowledge using nurse-led education as a cost-effective and scalable approach to the optimization of clinical outcomes. For instance, research conducted by, in an analogical low-resource setting found that nurse-led procedural training would be sufficient to decrease the burden to physicians without compromising the quality of care.[18] This is especially applicable in the case of health care systems, such as in Pakistan, where the role of nurses in patient education is becoming more prominent because of limited resources and high patient turnover.

While the study showed positive results, one should address the limitation of the convenience sampling method, which might limit generalizability. Nevertheless, the internal validity was enhanced via specific criteria of inclusion and exclusion, blinding observers, and standardization of the intervention process. More studies using randomized controlled trials and an increase in sample sizes may validate these findings further and study long-term retention of spirometry skills.

Recommendations: Based on the results presented in the study, it is proposed that nurse-led spirometry showcase become a part of the routine patient education for patients with newly diagnosed COPD in healthcare institutions. Nurses must be resourcefully equipped by training them with skills and tools to be used in giving effective demonstrations with the aid of visuals and interactive techniques. Furthermore, policies should uphold the formal incorporation of a nurse-led procedural education in pulmonology departments, particularly in limited-resource settings. Future studies should involve the measurement of long-term retention of technique accuracy and comparisons of similar interventions in a range of clinical settings with randomized controlled trials to support generalizability.

This study concluded that spirometry training conducted by a nurse significantly increased the confidence level of patients and the precision of the techniques of patients. The participants of the study were newly diagnosed with COPD. Some of the participants in groups that received structured, interactive instructions from nurses showed improvement when compared to those who received usual verbal instructions from technicians. The hands-on approach, step by step, and the patient engagement through return demonstration were more effective in preparing patients for accurate spirometry. These findings point out the crucial role of nurses in educating patients and the importance of well-defined demonstrations that contribute to improving the quality of care in respiratory practices.

The authors would like to express their sincere gratitude to Dr. Shah Hussain, Principal/Assistant Professor, Zalan College of Nursing, Swat, for his invaluable supervision, guidance, and support throughout the course of this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Corresponding Author:
Zar Tasha
Department of Nursing
Principal, Mirpur institute of medical science, Mirpur, Azad Jammu and Kashmir, Pakistan
Email: zari.kiran@gmail.com

Co-Authors:
Javid Ali
Department of Nursing
Ismail Nursing Institute, Swat, Pakistan

Shah Hussain
Department of Nursing
Zalan College of Nursing, Swat, Pakistan

Noor Khan
Department of Nursing
Saidu Teaching Hospital, Swat, Pakistan

Zar Tasha was responsible for data collection and data analysis. Javid Ali, Shah Hussain and Noor Khan handled data analysis.

Ethical approval was obtained from the institutional review board of Hayatabad Medical Complex, Peshawar (Ref No: HMC/IRB/25/35).

Zar Tasha is the guarantor of this study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

https://doi.org/10.63096/medtigo30623232

Tasha Z, Ali J, Hussain S, Khan N. Effect of nurse-led spirometry demonstration on patient confidence and technique accuracy among first-time COPD diagnosed adults: a quasi-experimental study. medtigo J Med. 2025;3(2):e30623232. doi:10.63096/medtigo30623232 Crossref