Karen Gaille Bacosa, DNP, APRN, AGCNS, RN, PCCN-K, SCRN

Abstract:

Background: As the leading cause of disability, stroke compromises physical and mental health. Stroke survivors are distressed by social challenges and emotional health problems. Many stroke survivors struggle with mental health, even with symptom resolution or returning to physical baseline. The feelings of anger, frustration, fear, and hopelessness are common emotions experienced. The sudden nature of this condition brings an overwhelming strain that significantly impacts patients’ lives. Objectives: To screen for post-stroke depression (PSD) in the inpatient setting and examine the feasibility of a nurse-led structured depression screening and early referral based on severity compared to care-as-usual. Neuman’s system model and the Iowa model of evidence-practice complemented the scholarly project by looking at patients holistically with a goal of improving their outcomes. Methods: We included two groups: a care-as-usual cohort of discharged stroke patients compared to patients screened for depression within 48 hours of admission for stroke. The Patient Health Questionnaire-9 (PHQ-9) instrument was used to screen stroke patients admitted to the hospital. Patients in the screening group were referred to the organization’s Center for Healthy Living, Depression Care Management, Social Services, and Behavioral Health Management prior to discharge. Descriptive statistics were utilized for data analysis. Results: There were 43 patients in the sample, 17 in the screening group and 26 in the care-as-usual group. Depression scores for the screening group had a mean of M = 5.7 (range 1-27). The care-as-usual group had a mean of M = 49.3 days to depression screening. Of the 43 participants, 12 (27.9%) were depressed; 7 (26.9%) in the usual care group versus 5 (29.4%) in the screening group. Conclusion: Establishing the nurse-led PSD screening protocol was feasible for identifying depression among stroke survivors within 48 hours of admission. Research is needed to establish whether the protocol can improve early referral, long-term health outcomes, and quality of care. Recognition of depression in the population of stroke patients may support patients with PSD and facilitate early management of mental health needs. 

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