Feasibility of a nurse-led intervention for the early management of depression after stroke in hospital

Aim: To explore the feasibility of the Post-Stroke Depression toolkit in terms of fidelity and acceptability in daily nursing practice. Background: Depression after stroke is common and influences patients’ recovery significantly. Although stroke guidelines recommend early depression screening and treatment, depressive symptoms remain unrecognized. To enhance adoption of evidence into the context of the daily practice of stroke treatment, we developed the Post-Stroke Depression toolkit, an evidence-based nurse-led intervention for the early management of depressive symptoms after a stroke for use in the hospital setting. Design: An explanatory mixed-methods before-and-after study design. Methods: Data were collected continuously from March 2012 - June 2013 during three phases: pre-implementation, the implementation phase (where implementation strategies guided the implementation) and the sustainability phase (executed without the implementation strategies) and involved patient chart audits and surveys and individual and focus group interviews with nurses. Results: A total of 775 patient charts were audited to examine fidelity. Implementation of the Post-Stroke Depression toolkit during the implementation phase resulted in an increase in depression screening (+72.9%) and more patients receiving nursing interventions (+11.1%). During the sustainability phase, screening for depression decreased (−16.3%), while the application of the nursing interventions remained unchanged (+0.6%). The acceptability of the toolkit was judged to be good. Conclusions: The Post-Stroke Depression toolkit was found to be feasible in terms of fidelity and acceptability, improving structural screening for depressive symptoms as well as the application of nursing interventions in case of a positive screening. Trial registration: ClinicalTrials.gov Identifier: NCT03500250