Application of the Concerns-Based Adoption Model to the installation of telemedicine in a rural Missouri nursing home.

The Concerns-Based Adoption Model (C-BAM) was developed in education for the purpose of implementing innovations and change within the school/college system. This study used the principles of the C-BAM and, for the first time, applied them to the process (implementation/training) and product (computer) of the telemedicine technologies in a rural nursing home setting in Missouri. Three rural counties of the 23 Missouri Telemedicine Network sites were chosen to pilot implementation of the computer as one mode of telemedicine technology. One rural nursing home was enlisted for an in-depth study to examine how telemedicine would affect communication between and among community health professionals. Methodological triangulation was used to study individuals' concerns about and utilization of telemedicine through interviews, participant observations, chart reviews, and the Stages of Concern (SOC) survey. Responses to the SOC over time are reported here. The participants consisted of nursing home employees: administration, nursing, housekeeping, and dietary. Forty-three of 52 employees participated in the SOC survey at Time 1 (preimplementation). Twelve months later, 40 participated in the SOC survey at Time 2. While the majority of respondents expressed awareness of the technology, they also expressed a high concern for informational and personal implications. Concern scores in all subscales decreased at Time 2. Findings from this study provided feedback for the implementation and training phases of the project. Most importantly, findings support the appropriateness of this educational model to the healthcare setting.

Post-breast cancer lymphedema: understanding women's knowledge of their condition.

PURPOSE/OBJECTIVES: To investigate chronic condition representations and treatment choices among women with post-breast cancer lymphedema (LE) to understand their receipt and use of accurate medical information. DESIGN: Qualitative, template analysis. SETTING: Midsized midwestern city and surrounding rural areas. SAMPLE: 18 Caucasian women aged 37-87 years (mean = 58.8 years) with LE. METHODS: Telephone and face-to-face interviews, lasting 45-60 minutes, were conducted by research students and graduate nursing students. Interviews were audiotaped, professionally transcribed, and verified for transcription accuracy. Self-regulation theory as a template was applied to (a) understand participants' use of health information to cope with LE and (b) evaluate the accuracy of participants' health information that may have influenced participants' abilities to make appropriate prevention or treatment choices. MAIN RESEARCH VARIABLES: Participants' illness representations and coping strategies. FINDINGS: Participants were aware of the fundamental cause of their LE--breast cancer treatment. They also were conscious of other causes of symptom onset. These causes are supported by existing empirical evidence. Participants' treatment choices were consistent (e.g., use of compression treatment, massage, elevation, pumps, therapists and therapy centers, and positive attitude and faith) and inconsistent (e.g., effectiveness of exercise and medication in management of LE) with empirical evidence. CONCLUSIONS: Future research and practice should target the role of exercise as a cause of LE and as a treatment option, investigate allergic reactions as a possible catalyst of LE symptoms, work to improve diagnosis of LE and patient education, and examine the effectiveness of medications as a treatment method. IMPLICATIONS FOR NURSING: Review of LE risk factors in the postoperative period and continued assessment and education are vital to a comprehensive approach to post-breast cancer LE care.