Date of Award

Spring 5-31-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Kevin Maxwell, PhD, DNP, FNP-BC

Abstract

Introduction: This Evidence-Based Practice Doctor of Nursing Practice project aimed to implement a nurse-led post-stroke depression (PSD) screening using Patient Health Queastionnaire-9 (PHQ-9) in a 12-bed progressive care neuro-stroke unit at a tertiary care hospital. The first goal of this project was to detect stroke patients at risk for depression who met specific inclusion criteria. The second goal was to provide depression education, initiate social work and medical referrals, and start pharmacological treatment to reduce the medical and socioeconomic burden associated with untreated PSD before discharge from the hospital.

Background: Globally, stroke is a prominent cause of death and disability. Depression is the second most prominent cause of disability worldwide. A stroke coupled with depression is doubly disabling. Annually, 800,000 stroke survivors develop PSD in the United States and are clinically depressed. Unrecognized and untreated PSD is associated with poor recovery, lower quality of life and functional status, and a high risk of subsequent stroke and mortality.

Methods: PHQ-9 was used by nursing staff directly involved in post-acute stroke care. Expectation Management and Medical Information (EMMI) multimedia patient education videos on depression accessed via MyChart were used and provided to stroke patients who met the inclusion criteria for screening with a score > 5. The primary stroke team and social worker were successively notified to assess the patient further, initiate treatment, and provide post-discharge resources.

Results: Of the 21 stroke patients admitted to the unit between October 2022 and December 2022, 11 met the inclusion criteria for screening, and four screened positive for depression, with scores ranging from 5–19. There was a 1000% increase in the number of patients screened, and those who screened positive were 100% likely to receive an EMMI video, social work referral, and start treatment before discharge.

Evaluation: Increased screening for PSD using the PHQ-9 identified at-risk patients and improved referral and treatment. Future projects can focus on including stroke patients with aphasia by integrating and using other depression tools, such as the Aphasic Depression Rating Scale, to improve long-term health outcomes, functional recovery, and quality of life in these patients unable to complete PHQ-9.

Keywords: stroke, depression, depression screening, patient health questionnaire, PHQ-9

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