Feasibility of a Nurse-led Intervention for the Early Management of Depression After Stroke in Hospital

Worldwide, approximately 50 million people who survived a stroke cope with physical, cognitive, and emotional impairments, and many of these survivors depend on caregivers to manage activities of daily living (Miller, et al., 2010). Stroke is the third leading cause of disability (Johnson, et al., 2016). Depression is a frequent and serious complication after stroke impeding rehabilitation outcome, and is associated with a higher mortality risk, and a lower quality of life (Kutlubaev & Hackett, 2014; Robinson & Jorge, 2015).

There is growing evidence for successful treatment of depression after stroke (Robinson & Jorge, 2015). Recommendations of stroke guidelines on the early management of depressive symptoms have not been structurally implemented in current practice, and only a minority of the acute care stroke teams assess mood on a systematic way in daily care (Hart & Bowen, 2008; Bowen, et al., 2005). Hence, depression is still one of the most underdiagnosed and undertreated complications after stroke (Miller et al., 2010), resulting in worse patient outcomes and delayed recovery (Robinson & Jorge, 2015). In a feasibility study of the Nursing Rehabilitation Guideline for Stroke (Hafsteinsdóttir & Schuurmans, 2009) it was suggested that simplifying the guideline and integrating the recommendations into a stroke care pathway could gain a more positive attitude towards the guideline and improve its feasibility (Hafsteinsdóttir et al., 2013). Therefore, the Post-Stroke Depression toolkit (PSD toolkit), an intervention for the early management of depression after stroke, has been developed.

The feasibility of this intervention was tested following phase two of the British Medical Research Council (MRC) guidelines (Craig et al., 2013). In this study, feasibility (Polit & Beck, 2008) is measured in terms of (1) fidelity, defined as the extent to which the components of the PSD toolkit are delivered as intended, and (2) acceptability, defined as whether the PSD toolkit is judged suitable and satisfactory by the nurses (Gearing et al., 2011). After evaluating implementation, the sustainability of the PSD toolkit requires evaluation as well (Scheirer, 2005). Sustainability is defined as fidelity to the PSD toolkit six months after completing implementation.

The aims of the study were (1) to explore the feasibility of the PSD toolkit in terms of fidelity and acceptability in three phases-a pre-implementation phase, an implementation phase, and a sustainability phase six month after-and (2) to identify elements for further refinement and improvement in the toolkit to enhance its feasibility in daily stroke care during the hospital stay.

Design: An explanatory mixed-methods, before-and-after study design(Creswell, 2008).