Nurses play a critical role in helping patients manage emotional and social health issues, or psychosocial health, after a stroke, and better screening and assessment of psychosocial needs is essential to providing optimal patient care, according to a study by the American Stroke Association.
While there have been significant advances in stroke prevention and treatment, stroke remains the second leading cause of death worldwide and a leading cause of disability.
Recent research indicates that 16 to 85 percent of stroke survivors experience psychosocial symptoms, such as depression, anxiety, stress, fatigue or a decreased quality of life during their recovery. “Stigma often surrounds discussions about psychosocial health.
Therefore, it is crucial for nurses and all health care professionals to create a safe and therapeutic environment for patients and offer hope and comprehensive education on the topic,” said the chair of the scientific statement writing group, Patricia A. Zrelak, a member of the American Heart Association’s Council on Cardiovascular and Stroke Nursing.
The scientific statement details a comprehensive review of the latest evidence published between 2018 and 2023 on psychological health in patients who have experienced a stroke. The statement addresses the effects, underlying causes, screening, diagnosis, and treatment of five key emotional and social health factors, including depression, stress, anxiety, fatigue, and quality of life.
The scientific statement aims to establish guidance for nursing care during a patient’s recovery after stroke, from preventing adverse psychosocial health conditions to identifying and managing symptoms. “Emotional, cognitive, behavioural and/or personality changes can occur after a stroke,” says Zrelak. “These disorders can appear immediately after a stroke or have a late onset, sometimes more than a year later, and can also fluctuate in intensity over time.
In addition, psychosocial symptoms are interrelated and patients who experience any of them are at increased risk of developing other mental health disorders. Effective and regular screening is vital for early detection and treatment.”
Depression affects around 30 per cent of stroke survivors and is particularly common during the first three months after a stroke.Symptoms of depression may include persistent sadness, anxious or “empty” mood, restlessness and irritability, loss of interest or pleasure in hobbies and activities, difficulty concentrating and thinking, increased or decreased sleep, changes in appetite, and weight gain or loss. Post-stroke depression worsens cognitive and functional recovery and increases the risks of death and/or another stroke.
The AHA/ASA guidelines for early treatment of patients with acute ischemic stroke recommend routine depression screening for all patients after a stroke. Nurses can help educate stroke survivors and their families about symptom recognition, prevention, and treatment options such as medication management or cognitive behavioral therapy.
A 2022 study found that post-stroke stress and post-traumatic stress disorder (PTSD) affect about one in six stroke survivors (about 16.5%). These conditions can increase the risk for additional health problems, such as anxiety and poor medication adherence.
Screening stroke patients for stress and PTSD should occur while they are hospitalized and continue during rehabilitation and outpatient visits after hospital discharge. Nursing interventions that can help reduce patient distress include stroke education and self-management strategies, such as mindfulness and meditation.
Nurses can also consider stroke survivors’ coping styles. People with high-anxiety coping styles face a significantly higher risk for PTSD after stroke compared with people with low-anxiety coping styles. Getting back to the same quality of life after stroke is challenging, and even more so after a severe stroke.
Physical strength, speech, depression, anxiety, and the ability to return to work and social activities are all factors that contribute to a stroke survivor’s quality of life. However, conditions such as chronic pain can negatively impact recovery and return to independent living.
Physical activities that also include interpersonal interaction, such as yoga and tai chi, have been shown to have positive effects on patients’ quality of life. Nurses can help stroke survivors improve their quality of life after a stroke by connecting them with social services in their area,such as stroke support groups and community organizations.
“Mental and emotional well-being is crucial to recovery, and nurses play an important role in supporting patients after a stroke,” says Zrelak. “It’s important to engage stroke survivors and their caregivers to be aware of these psychosocial conditions and ways they can help.
Early detection of symptoms and treatment have the potential to improve post-stroke recovery,” she adds.