Nurses play a critical role in helping patients manage emotional and social health or psychosocial health issues after stroke, and improved screening and assessment of psychosocial needs are essential to providing optimal patient care. These findings are highlighted in a latest position paper from the American Stroke Association, a division of the American Heart Association, titled “The Role of Nursing in Managing Psychosocial Health After Stroke,” published today within the peer-reviewed journal Association Impact.

Although there have been significant advances in stroke prevention and treatment, stroke stays the second leading explanation for death worldwide and a number one explanation for disability. Recent studies indicate that 16% to 85% of stroke survivors experience psychosocial symptoms equivalent to depression, anxiety, stress, fatigue, and/or reduced quality of life during recovery.

“Stigma often accompanies discussions about psychosocial health. Due to this fact, nurses and all health care providers must create a secure and therapeutic environment for patients and supply hope and comprehensive education on the subject,” said chair of the scientific statement writing group, Patricia A. Zrelak, RN, FAHA, a nurse quality consultant for the regional stroke program at Kaiser Permanente Northern California and a member of the American Heart Association Council on Cardiovascular and Stroke Nursing.

The scientific statement details a comprehensive review of the newest evidence published between 2018 and 2023 on the mental health of stroke survivors. The statement addresses the results, underlying causes, screening, diagnosis, and treatment of 5 key aspects of emotional and social health, including depression, stress, anxiety, fatigue, and quality of life. The scientific statement goals to ascertain guidelines for nursing care during stroke recovery, from stopping adversarial psychosocial health conditions to identifying and managing symptoms.

Emotional, cognitive, behavioral, and/or personality changes can occur after stroke. These conditions can appear immediately after the stroke or occur with a delay, sometimes greater than a yr later, and their intensity can vary over time. As well as, psychosocial symptoms are interrelated, and patients who experience one in every of them are at greater risk of developing other mental health conditions. Effective and regular screening is crucial for early detection and treatment.

Patricia A. Zrelak, PhD, RN, FAHA, Nurse Quality Consultant, Regional Stroke Program, Kaiser Permanente Northern California

Depression

Depression affects about 30% of stroke survivors and is particularly common in the primary three months after a stroke. Symptoms of depression can include persistent sadness, anxiety, or a “flat” mood; restlessness and irritability; lack of interest or pleasure in hobbies and activities; difficulty concentrating and considering; increased or decreased sleep; changes in appetite; and weight gain or loss. Depression after stroke impairs cognitive and functional recovery and increases the chance of death and/or one other stroke.

The AHA/ASA guidelines for early treatment of patients with acute ischemic stroke recommend routine screening for depression in all stroke patients. Nurses will help educate stroke survivors and their families about symptom recognition, prevention, and treatment options equivalent to medication management and/or cognitive behavioral therapy.

Stress

A 2022 study found that post-stroke stress and post-traumatic stress disorder (PTSD) affect about one in six (about 16.5%) stroke patients. These conditions can increase the chance of additional health problems, including anxiety and poor medication adherence. Screening stroke patients for stress and PTSD must be done during hospitalization and continued during rehabilitation and outpatient visits after discharge.

Nursing interventions that will help reduce patient suffering include stroke education and self-management strategies, equivalent to mindfulness and meditation. Nurses can even consider the coping kinds of stroke survivors. Individuals with high-anxiety coping styles are at significantly greater risk for developing PTSD after stroke, compared with those with low-anxiety coping styles.

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The prevalence of hysteria ranges from 20% to 25% in the primary months after stroke, increasing to 32% by the yr, with a five-year prevalence of 34%. Aspects equivalent to younger age at stroke, lower income, inability to work, social isolation, previous mental health problems, and/or stroke severity are aspects that increase the chance of hysteria. Anxiety can be related to a better risk and severity of depression.

Standard screening for anxiety and early detection can result in early treatment, greater patient engagement, and faster recovery for stroke survivors. Although there are established clinical guidelines for treating general anxiety, more research is required on interventions for anxiety after various kinds of stroke.

Tiredness

Post-stroke fatigue can develop at any time, but is most typical inside the first six months after a stroke. Symptoms of fatigue can include low physical and mental energy that interferes with every day activities, in addition to difficulties with self-control, emotions, and memory. Women and folks with depression, sleep problems, anxiety, and/or multiple health problems usually tend to develop post-stroke fatigue.

More research is required on effective strategies for managing post-stroke fatigue, as there are currently no proven treatments. Nevertheless, interventions focused on improving overall physical function may help prevent, reduce, or treat post-stroke fatigue and other components of psychosocial health.

Quality of life

Returning to the identical quality of life after a stroke is difficult, and much more so after a severe stroke. Physical strength, speech, depression, anxiety, and the flexibility to return to work and social activities are all aspects that affect a stroke survivor’s quality of life. Nevertheless, conditions equivalent to chronic pain can negatively impact recovery and independent living.

Physical activities that also include interpersonal interactions, equivalent to yoga and tai chi, have been shown to have a positive impact on patients’ quality of life. Nurses will help stroke survivors improve their quality of life after stroke by connecting patients with social services of their area, equivalent to stroke support groups and community organizations.

“Mental and emotional well-being is crucial to recovery, and nurses play a crucial role in supporting stroke patients,” Zrelak said. “It’s essential to have interaction stroke survivors and their caregivers to concentrate on these psychosocial conditions and the way they will help. Early detection and treatment have the potential to enhance stroke recovery.”

The statement also highlighted existing research that shows stroke outcomes vary significantly amongst people of various racial and ethnic groups. Social determinants of health, equivalent to structural racism, socioeconomic status, inadequate housing, and/or limited access to health care, including mental health services, can all impact a stroke survivor’s recovery.

Zrelak added: “The stroke care team has a key role to play in addressing these health inequalities, using targeted interventions and tailored treatments to enhance mental health support and overall care coordination for those most in danger. More research is required to assist us understand how best to support the psychosocial well-being of stroke survivors so that they’re higher capable of return to their every day activities and have a greater quality of life.”

This scientific statement was prepared by a bunch of volunteers on behalf of the American Heart Association’s Council on Cardiovascular and Stroke Nursing and the Council on Lifestyle and Cardiometabolic Health. American Heart Association scientific statements promote greater awareness of heart problems and stroke-related issues and show you how to make informed health care decisions. Scientific statements outline what’s currently known a couple of topic and what areas require additional research. Although scientific statements inform the event of guidelines, they don’t constitute treatment recommendations. American Heart Association guidelines are the association’s official clinical practice recommendations.