ANTICIPATING POST-STROKE DEPRESSION: STRATEGIES TO PROMOTE PSYCHOSOCIAL SUPPORT

Background: This DNP project explores the most common psychiatric sequela poststroke, addressing the rising concern for depression affecting cognitive and functional recovery, and findings that contribute to inpatient hospital’s acute psychological care for stroke patients. The research focuses on general neurological conditions, stroke risk factors, and post-stroke depression within the outpatient clinic or in- and outpatient rehab facility, highlighting its significance and the need for further investigation of the benefits of early introduction to psychosocial resources. Local Problem: Duke Hospital’s neuroscience stepdown does not explicitly review PHQ-9 scores during rounds. The QI project aims to determine if implementing a standardized workflow during stroke rounds increases the unit’s provision of psychosocial resources. Methods: This study employs evidence of varying strength including a mix of 24 level one, three, and four articles. Data collection and analysis were conducted using descriptive statistics. Interventions: The study implements three academic detailing presentations for stroke providers and education for nurses, utilizes the Johns Hopkins EBP model, and incorporates surveys, QR codes, emails, and handouts to address the problem, aiming to promote provision of stress management and PSD education. Results: Data analysis revealed 56.29% of 167 patients are unable to complete PHQ-9 screening due to cognitive or aphasic post-stroke deficits. This was attributed to the low eligible sample size, for which the final results cannot determine if the intervention of implementing a workflow promoting depression screen scores increases psychosocial resource provision. Future research may benefit from exploring the appropriateness of other depression screenings for aphasic patients to address the large gap in screening. Conclusions: This DNP project contributes to the inpatient screening methods of comprehensive stroke centers by offering data supporting the need to address screening gaps in aphasic patients and different practice implications for future studies and QI projects. Additionally, the study highlights limitations and suggests directions for future research to further investigate if screening geared for aphasic patients improves psychosocial resource provision.