Rehabilitation nurses’ knowledge, experiences, and perceptions of the provision of psychological care for patients post stroke in Ireland: A cross-sectional study.
Keywords:stroke, rehabilitation nurses, knowledge, experiences, perceptions, psychological care, service improvement
Introduction: Early assessment and management of depression and anxiety for patients after stroke is critical. However, suboptimal provision of psychological care is widely reported. Nurses are the largest professional group to care for patients post stroke and have an important role in addressing their emotional wellbeing.
Aim: The aim of this paper is to examine nurse’s knowledge, experiences, and perceptions of the provision of psychological care to patients post stroke in Ireland.
Methods: A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of seventy-four (n=74) nurses working in six Irish community hospital rehabilitation units.
Results: Findings demonstrate suboptimal psychological care provision for patients post stroke with no formal pre-defined care pathways. Despite nurse’s knowledge of psychological problems and symptomology, participants revealed receiving limited training in psychological monitoring and no systemic allocation of psychological care duties. This research suggests that pre-defined/formal care pathways; access to psychology expertise; further training and support for members of the Multi-Disciplinary-Team has the potential to improve the provision of psychological care for patients post stroke.
Conclusions: This study has implications for the reform and development of rehabilitation services in relation to practice, education, and research. It identifies opportunities to support nurses to improve the delivery of psychological care for patients post stroke.
Aadal, L., Angel, S., Dreyer, P., Langhorn, L., & Pedersen, B. B. (2013). Nursing roles and func-tions in the inpatient neurorehabilitation of stroke patients: A literature review. Journal of Neuroscience Nursing, 45(3), 158-170. https://journals.lww.com/jnnonline/Abstract/2013/06000/Nursing_Roles_and_Functions_in_the_Inpatient.7.aspx#:~:text=DOI%3A%2010.1097/JNN.0b013e31828a3fda DOI: https://doi.org/10.1097/JNN.0b013e31828a3fda
Ayerbe, L., Ayis, S., Wolfe, C. D., & Rudd, A. G. (2013). Natural history, predictors and out-comes of depression after stroke: systematic re-view and meta-analysis. The British Journal of Psychiatry, 202 (1), 14-21. https://doi.org/10.1192/bjp.bp.111.107664 DOI: https://doi.org/10.1192/bjp.bp.111.107664
Baker, C., Worrall, L., Rose, M., & Ryan, B. (2021a). Stroke health professionals’ management of depression after post-stroke aphasia: a qualita-tive study. Disability and Rehabilitation, 43(2), 217-228. https://doi.org/10.1080/09638288.2019.1621394 DOI: https://doi.org/10.1080/09638288.2019.1621394
Baker, C., Rose, M. L., Ryan, B., & Worrall, L. (2021b). Barriers and facilitators to implement-ing stepped psychological care for people with aphasia: Perspectives of stroke health profes-sionals. Topics in Stroke Rehabilitation, 28(8), 581-593. https://doi.org/10.1080/10749357.2020.1849952 DOI: https://doi.org/10.1080/10749357.2020.1849952
Brych, O., Cassidy, T., Harbison, J., McCormack, J., Murphy, D., O’Connor, M., Ward, M. (2021). Irish National Audit of Stroke National Report 2019. https://doi.org/10.25419/rcsi.16930006.v1
Clarke, D. J. (2014). Nursing practice in stroke reha-bilitation: Systematic review and meta‐ethnography. Journal of Clinical Nursing, 23(9-10), 1201-1226. https://doi.org/10.1111/jocn.12334 DOI: https://doi.org/10.1111/jocn.12334
Clarke, D. J., & Holt, J. (2015). Understanding nurs-ing practice in stroke units: a Q-methodological study. Disability and Rehabili-tation, 37(20), 1870-1880. https://doi.org/10.3109/09638288.2014.986588 DOI: https://doi.org/10.3109/09638288.2014.986588
Dreyer, P., Angel, S., Langhorn, L., Pedersen, B. B., & Aadal, L. (2016). Nursing roles and functions in the acute and subacute rehabilitation of pa-tients with stroke: Going all in for the patient. Journal of Neuroscience Nursing, 48(2), 111-118.https://journals.lww.com/jnnonline/Abstract/2016/04000/Nursing_Roles_and_Functions_in_the_Acute_and.11.aspx#:~:text=DOI%3A%2010.1097/JNN.0000000000000191 DOI: https://doi.org/10.1097/JNN.0000000000000191
Elo, S., & Kyngäs, H. (2008) The qualitative content analysis process. Journal of Advanced Nursing. 62(1), 107-15. doi: 10.1111/j.1365-2648.2007.04569.x. PMID: 18352969. DOI: https://doi.org/10.1111/j.1365-2648.2007.04569.x
Feigin, V. L., Brainin, M., Norrving, B., Martins, S., Sacco, R. L., Hacke, W., Lindsay, P. (2022). World Stroke Organization (WSO): global stroke fact sheet 2022. International Journal of Stroke, 17(1), 18-29. https://doi/pdf/10.1177/17474930211065917 DOI: https://doi.org/10.1177/17474930211065917
Gillham, S. & Clark, L. (2011). Psychological Care After Stroke: Improving Stroke Services for People with Cognitive and Mood Disorders. NHS improvement. Stroke. Leices-ter,UK.https://www.nice.org.uk/media/default/sharedlearn-ing/531_strokepsychologicalsupportfinal.pdf
Health Service Executive (2023) National Stroke Strategy 2022-2027. Healthy Ireland (Internet). Available at: National Stroke Strategy 2022-2027 (hse.ie),
Gurr, B. (2009). Staff perceptions of psychological care on a stroke rehabilitation unit. British Journal of Nursing, 18(1), 52-56. https://doi.org/10.12968/bjon.2009.18.1.32092 DOI: https://doi.org/10.12968/bjon.2009.18.1.32092
Loft, M. I., Martinsen, B., Esbensen, B. A., Mathiesen, L. L., Iversen, H. K., & Poulsen, I. (2019). Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disability and Rehabilita-tion,41(4), 396- 404. https://doi.org/10.1080/09638288.2017.139369 8 DOI: https://doi.org/10.1080/09638288.2017.1393698
Hackett, M. L., & Pickles, K. (2014). Part I: Frequen-cy of depression after stroke: an updated sys-tematic review and meta-analysis of observa-tional studies. International Journal of Stroke, 9(8), 1017-1025. DOI: 10.1111/ijs.12357 DOI: https://doi.org/10.1111/ijs.12357
Harbison, J., McCormack, J., Brych, O., & Prender-gast, C. (2022). Irish National Audit of Stroke organisational audit report 2021. https://repository.rcsi.com/articles/report/Irish_Nation-al_Audit_of_Stroke_organisational_audit_report_2021/20080004
Harrison, M., Ryan, T., Gardiner, C., & Jones, A. (2017). Psychological and emotional needs, as-sessment, and support post-stroke: a multi-perspective qualitative study. Topics in Stroke Rehabilitation, 24(2), 119-125. https://doi.org/10.1080/10749357.2016.1196908 DOI: https://doi.org/10.1080/10749357.2016.1196908
Herrmann, N., Black, S. E., Lawrence, J., Szekely, C., & Szalai, J. P. (1998). The Sunnybrook Stroke Study: a prospective study of depressive symp-toms and functional outcome. Stroke,29(3), 618- 624. https://doi.org/10.1161/01.STR.29.3.618 DOI: https://doi.org/10.1161/01.STR.29.3.618
Kirkevold, M. (2010). The role of nursing in the rehabilitation of stroke survivors: an extended theoretical account. Advances in Nursing Sci-ence, 33(1), E27-E40. https://journals.lww.com/advancesinnursingscience/Abstract/2010/01000/The_Role_of_Nursing_in_the_Rehabilitation_of.11.aspx#:~:text=DOI%3A%2010.1097/ANS.0b013e3181cd837f DOI: https://doi.org/10.1097/ANS.0b013e3181cd837f
Knapp, P., Dunn-Roberts, A., Sahib, N., Cook, L., Astin, F., Kontou, E., & Thomas, S. A. (2020). Frequency of anxiety after stroke: an updated systematic review and meta-analysis of obser-vational studies. International Journal of Stroke, 15(3), 244-255. https://doi.org/10.1177/1747493019896958 DOI: https://doi.org/10.1177/1747493019896958
Lehto B., Kylmä J. & Åstedt‐Kurki P. (2019) Caring Interaction with stroke survivors' family mem-bers—Family members' and nurses' perspec-tives. Journal of Clinical Nursing, 28(1-2), 300-309. https://doi.org/10.1111/jocn.14620 DOI: https://doi.org/10.1111/jocn.14620
Manning, M., Cuskelly, C., Russ, E., & Franklin, S. (2020). Supporting people with post‐stroke aphasia to live well: A cross‐sectional survey of Speech & Language Therapists in Ireland. Health & Social Care in the Community, 28(6), 2105-2116. https://doi.org/10.1111/hsc.13021 DOI: https://doi.org/10.1111/hsc.13021
Medeiros, G. C., Roy, D., Kontos, N., & Beach, S. R. (2020). Post-stroke depression: a 2020 updated review. General Hospital Psychiatry, 66, 70-80. https://doi.org/10.1016/j.genhosppsych.2020.06.011 DOI: https://doi.org/10.1016/j.genhosppsych.2020.06.011
Melnyk, B. M., Orsolini, L., Tan, A., Arslanian-Engoren, C., Melkus, G. D. E., Dunbar-Jacob, J., & Lewis, L. M. (2018). A national study links nurses’ physical and mental health to medical errors and perceived worksite wellness. Journal of Occupational and Environmental Medicine, 60(2), 126-131. https://doi.org/10.1097/JOM.0000000000001198 DOI: https://doi.org/10.1097/JOM.0000000000001198
Merrigan, G., & Bennett, L. (2023). Health Care Pro-fessionals knowledge, experiences, and percep-tions of the provision of psychological care to patients post stroke: A Systematic Review: Journal of Health and Rehabilitation Science, 1-16. DOI: https://doi.org/10.33700/jhrs.2.1.70
McClure, J., & Leah, C. (2021). Is independence enough? Rehabilitation should include auton-omy and social engagement to achieve quality of life. Clinical Rehabilitation, 35(1), 3-12. https://doi/pdf/10.1177/0269215520954344 DOI: https://doi.org/10.1177/0269215520954344
McCormick, K., & Salcedo, J. (2020). SPSS Statistics For Dummies. John Wiley & Sons.
Northcott, S., Simpson, A., Moss, B., Ahmed, N., & Hilari, K. (2017). How do speech‐and‐language therapists address the psychosocial well‐being of people with aphasia? Results of a UK online survey. International Journal of Language & Communication Disorders, 52(3), 356-373. https://doi.org/10.1111/1460-6984.12278 DOI: https://doi.org/10.1111/1460-6984.12278
Northcott, S., Simpson, A., Moss, B., Ahmed, N., & Hilari, K. (2018). Supporting people with apha-sia to ‘settle into a new way to be’: speech and language therapists’ views on providing psy-chosocial support. International Journal of Language & Communication Disorders, 53(1), 16-29. https://doi.org/10.1111/1460-6984.12323 DOI: https://doi.org/10.1111/1460-6984.12323
Robinson, R. G., & Jorge, R. E. (2016). Post-stroke depression: a review. American Journal of Psychiatry, 173(3), 221-231. https://doi.org/10.1176/appi.ajp.2015.15030363 DOI: https://doi.org/10.1176/appi.ajp.2015.15030363
Ryan, B., Bohan, J., & Kneebone, I. (2019). Help‐seeking and people with aphasia who have mood problems after stroke: perspectives of speech–language pathologists. International Journal of Language & Communication Disor-ders, 54(5), 779-793. https://doi.org/10.1111/1460-6984.12476 DOI: https://doi.org/10.1111/1460-6984.12476
Sekhon, J. K., Douglas, J., & Rose, M. L. (2015). Current Australian speech-language pathology practice in addressing psychological well-being in people with aphasia after stroke. In-ternational Journal of Speech-Language Pa-thology, 17(3), 252-262. https://doi.org/10.3109/17549507.2015.1024170 DOI: https://doi.org/10.3109/17549507.2015.1024170
Simpson, E. K., Ramirez, N. M., Branstetter, B., Reed, A., & Lines, E. (2018). Occupational therapy practitioners’ perspectives of mental health practices with clients in stroke rehabili-tation. OTJR: Occupation, Participation and Health, 38(3), 181-189. https://doi.org/10.1177/1539449218759627 DOI: https://doi.org/10.1177/1539449218759627
Towfighi, A., Ovbiagele, B., El Husseini, N., Hackett, M. L., Jorge, R. E., Kissela, B. M., Mitchell, P.H., Skolarus, L.E., Whooley, M.A. & Wil-liams, L. S. (2017). Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 48(2), e30-e43. https://doi.org/10.1161/STR.0000000000000113 DOI: https://doi.org/10.1161/STR.0000000000000113
McElwaine, P., McCormack, J., & Harbison, J. (2016). National Stroke Audit 2015. Irish Heart Foundation (IHF) & Health and Safety Execu-tive, Dublin. http://hdl.handle.net/10147/596575
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