| Summary: | It is important for lymphedema practitioners to know what adherence facilitators and barriers their clients face when they are discharged to their self-care programs from outpatient therapy. Client nonadherence with lymphedema self-care can lead to hospitalization, infection, wounds, and the need for additional courses of lymphedema therapy. The lymphedema clinic at Virginia Mason Memorial Hospital is located in a rural, medically underserved area and is one of a few clinics that treat lymphedema in central Washington state. Waiting lists are long and practitioners have a vested interest in promoting self-care adherence in order to reduce client demand for more therapy in a clinic that is understaffed to meet client need. There are numerous reasons why clients do not or cannot adhere with their self-care programs but there are few, if any, resources that practitioners can use to objectively identify leg lymphedema self-care barriers during the course of therapy that will help them design personalized self-care programs that promote adherence by discharge. The Information-Motivation-Behavioral Skills (IMB) model is designed to understand and promote health-related behavior. The IMB model asserts that a client who is well informed, motivated to act, and possesses the requisite behavioral skills for effective action will likely initiate and maintain health-promoting behaviors. This model has been used by the author as a framework to understand and describe the causes of the clinical problem, organize and research strategies that have been used by others to ameliorate the problem, and to design a program specifically for use at the lymphedema clinic. According to Jane Wigg, a nurse who runs a training academy for lymphedema practitioners: Clients gain more knowledge, skill, motivation, and confidence if practitioners take the time to find out their knowledge baseline, direct clients to appropriate learning experiences to fill their knowledge gaps, and provide clients with experiential and skill building opportunities. This program will provide practitioners with training on new assessment materials and how to use assessment data to design a self-care program, and introduce practitioners to new client resources to improve information, motivation, and behavioral skill gaps.
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