Improving the assessment and management of post-stroke depression amongst nurses using participatory action research

Abstract

Background: Stroke is defined as a neurological condition that occurs because of an interruption of the blood supply that results in ischaemia in the brain. Moreover, stroke is associated with various other comorbidities. The most common neuropsychiatric disorder present in stroke-survivors is Post-Stroke Depression (PSD), with incidence rates ranging from 18 to 33%. At times, however, it is still being underdiagnosed and underestimated. This is shown to greatly affect the patients’ quality of life. Furthermore, PSD is most likely to affect patients who are more vulnerable to the complications associated with stroke, especially when there is physical and speech impairment. However, research shows that with early detection and proper management of the disease, patients will achieve better outcomes. Consequently, the use of screening assessment tools is regarded as being very effective for the early detection of PSD. Aim: The aims of this study is to increase awareness of PSD amongst nurses and to improve their nursing assessment and management of patients living with PSD. Research Design: This study opted for a qualitative research design using Participatory Action Research (PAR). Setting: Six nurses (the participants) were recruited from a Stroke Rehabilitation Unit at Karen Grech Hospital. Participants: Participants were chosen by means of purposive sampling. Method: Focus groups were the main method for data collection. Four focus group sessions were done over a period of six weeks. The sessions were recorded, transcribed and analysed using the Participatory Action Research approach. All ethical issues were taken into consideration to safeguard the privacy of the participants. Sensitivity, trustworthiness, and rigour was maintained throughout the whole process data collection and analysis at all times. Findings: In this PAR, four super-ordinate themes were identified, namely: PSD symptoms, restricted nurses’ function, lack of communication between the nurse and psychologist/psychiatrist, and a need for better nursing practices. A new screening tool: “Post-Stroke Depression Screening Checklist” was developed by the researcher and the participants. The tool was piloted at the Stroke Rehabilitation Unit for four weeks. During this period, its effectiveness as to whether it improved the current nursing assessment and management of patients with PSD, was tested. Conclusion: The findings of this study highlighted how nurses are best positioned to assist patients in receiving timely psychological reviews and assessments. This tool proved that nurses are capable of performing PSD assessments. The participates believed that using such a tool, is one method to improve the current nursing assessment and management of PSD. It is being recommended to expand this study further with a larger number of participants, so as to further evaluate the effectiveness of this tool, validate it, and scale it up to be used in other settings.