The gap between confidence and competence
Ask a respiratory nurse how confident she feels teaching inhaler technique and she will usually say confident. When researchers measured that confidence against performance across eight devices in a specialist respiratory unit, the average proportion of correct steps was under half, and confidence predicted nothing at all.
That gap is not a failure of individual nurses. It is what happens when respiratory care is taught through ninety-page guidelines and confidential enquiry reports written for service directors, with nothing in between for the nurse standing at the end of a bed at two in the morning.
What this handbook does
This is a working clinical guide to the six respiratory presentations that fill medical wards: COPD, asthma, bronchiectasis, interstitial lung disease, acute breathlessness, and the patient requiring non-invasive ventilation. It covers oxygen targets and device selection, a four-step method for arterial blood gas interpretation, inhaler technique by device class, chest drain and tracheostomy safety, and the discharge that determines whether the patient returns in eleven days.
Three consecutive chapters address non-invasive ventilation, because setting it up, rescuing it when it falters, and recognising when it has become a ceiling of care are three different clinical problems.
Why it is organised this way
Most respiratory references are arranged by disease, which serves the reader who already knows what she is looking for. This handbook is arranged by clinical moment: the first ten minutes, the first hour, the decision to escalate, the conversation nobody trained you for. Every guideline position is named and dated in the text, so the reader can check what has changed since. Sixteen chapters carry worked examples, escalation scripts, and review questions with explained answers.
This book is for readers who
Work on respiratory or acute medical wards and want to act with more confidence in the first hour. Have recently qualified, or are on a respiratory placement, and find the guidelines difficult to apply at the bedside. Carry a community respiratory or COPD caseload. Trained before the 2023 and 2024 changes to COPD and asthma guidance and want to know precisely what moved. Are preparing for a specialist respiratory role and need to teach this material to others.
Respiratory nursing rewards the practitioner who notices earliest, describes most precisely, and escalates most specifically. If you want a clear, practical guide to the conditions, decisions, and conversations that make up respiratory practice, this handbook offers a structured place to begin.
