University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Poststroke depression (PSD) is a common complication after a stroke that frequently goes undertreated, leading to poor health outcomes. These patients often face a sudden change in self-identity, finding discrepancies between their pre-/post-stroke self, which significantly correlates with depressive symptoms and spiritual distress. The aim of this quality improvement (QI) project was to create a sustainable process for improving access to spiritual care as a holistic component of PSD treatment by (1) identifying stroke patients with an elevated Patient Health Questionnaire-9 (PHQ-9) depression screening score, (2) initiating a referral to a chaplain for those with a PHQ-9 score of ≥5, and (3) evaluating staff nurse satisfaction with the protocol. This project uses a pre-/post-test quasi-experimental design. The staff nurses of a 32-bed stroke unit in an academic medical center placed spiritual care referrals for all adult patients with a stroke diagnosis and a PHQ-9 score of ≥5 during admission. Outcomes were measured using the number of completed PHQ-9 screenings, PHQ-9 scores, the number of spiritual care referrals made, and evaluation of nurse satisfaction with the referral protocol. Goals included an improvement in the PHQ-9 screening rate from 62.4% to ≥80%, a referral rate of ≥80%, and that the nurses would find the protocol easy to implement and meaningful for patients. Over the 13-week implementation period, 108 of 121 eligible patients had completed PHQ-9 screenings for a rate of 89.3%, a statistically significant improvement (p<0.0001). 87% of patients with a PHQ-9 score of ≥5 had a spiritual care referral placed. Of the 15 nurses who responded to the post-implementation survey, 100% agreed that the protocol was easy to implement and that chaplain visits were meaningful experiences for patients. This project demonstrated how an inpatient neuroscience unit could successfully implement a referral protocol for spiritual care in response to PHQ-9 screenings of adult stroke patients. Elements of success included a standardized screening and referral protocol, an electronic medical record that supported the screening tool, and the simplicity of placing referrals without a provider co-sign. In addition, nurses were supportive, and their engagement informed changes that led to recommendations for long-term sustainability.Doctor of Nursing Practic
