Don't forget the psyche - focus on improved well-being

Up to a third of all stroke patients suffer from one or more psychosocial impairments. Recognizing and treating these impairments is crucial to improving psychosocial well-being after a stroke. But what is the best way to achieve this?

Stroke is a major cause of disability and death worldwide. After a stroke, people can suffer from various consequences, including physical impairments, communicative impairments, cognitive impairments and psychosocial impairments. Previous studies show that around 18-31% of all stroke patients struggle with one or more psychosocial impairments. These impairments can have several negative consequences, such as lower quality of life and health-related quality of life, higher mortality, poorer functional outcomes, poorer recovery after stroke, reduced social participation and slower rehabilitation. Psychosocial well-being is of crucial importance in dealing with all these impairments after a stroke.

As stroke care is highly complex and patients often have multiple needs after a stroke, care is provided by a multidisciplinary team consisting of several healthcare professionals, including nurses, doctors, therapists (e.g. physiotherapists, occupational therapists, speech therapists) and psychologists. As these healthcare professionals are jointly responsible for the care of stroke patients, a blurring of the role boundaries between the healthcare professionals can often be observed in practice. This leads to confusion and uncertainty as to which specialist is responsible for which care. Nurses play an important role in these multidisciplinary teams and therefore also in the care process after a stroke. It is believed that nurses in particular are ideally positioned to address psychosocial wellbeing as they are present 24/7 in all organizations within stroke care, have close and continuous interaction with stroke patients, and are also involved with stroke patients after discharge. In addition, nurses are often involved in helping patients restructure their daily lives and coping process by offering emotional support, encouragement and comfort, among other things. However, previous studies have shown that although carers experience psychosocial wellbeing as an important aspect to pay attention to, they often feel uncertain about providing care to improve psychosocial wellbeing after stroke and are often unsure how to provide this type of care.

Study analysis shows possibilities

A total of 60 studies were analyzed in a review, in which 39 interventions were identified that showed positive effects on psychosocial well-being after a stroke. Mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management and medication management proved to be effective intervention topics. The most frequently used intervention themes in effective interventions were coping, risk factors and secondary prevention, and emotions, followed by post-stroke consequences, self-management, recovery, values and needs, goals, mood, social support, medication management, life after stroke, problem solving, participation and mindfulness. The interventions with positive effects were mostly mediated by active information, followed by physical activity, coordination of care, passive information, relaxation, memory therapy, music therapy or sending a postcard and pharmaceutical treatment.

Caregivers are involved throughout the rehabilitation process, with the focus initially being mainly on functional rehabilitation and later shifting to a broader focus on restoring activities of daily living. Overall, caregivers are involved in the coping process and adjustments – both physical and psychosocial – in patients’ lives. Therefore, nurses are certainly in a position to take over several parts of the implementation of the measures for improved well-being. However, it is unlikely that they will be able to implement all of the measures.