The literature review was based on extensive survey of books, journals and international nursing studies. A review of literature relevant to the study was undertaken which helped the investigator to develop insight into the problem and gain information on what has been done in the past. An extensive review of literature was done by the investigator to lay a broad foundation for the study and a conceptual framework framed based on Peplau’s Interpersonal Theory to proceed with the study under the following headings.
For the purpose of logical sequence the chapter was divided into the following sections.
2.1 Part-I : Studies related to psychosocial impact of stroke.
2.1Part-II : Studies related to effectiveness of psychosocial interventions on psychosocial health of stroke clients.
2.1 PART-I: STUDIES RELATED TO PSYCHOSOCIAL IMPACT OF STROKE
Caso V, et al., (2012) conducted a cohort study among women aged between 54 and 79 without an history of stroke for a period of six years to identify the depressive symptoms using the mental health index score. Findings revealed that during this 6 year follow up, 1033 incidence of stroke were documented. They concluded the study by telling that having a history of depression was associated with an increased risk for total stroke.
Choi-Kwon S, et al., (2012) conducted a study on prevalence of post stroke depression (PSD) and post stroke emotional incontinence (PSEI) among 508 acute ischemic stroke clients by using Beck’s depression inventory and Kim’s criteria. Findings revealed that PSD and PSEI were present in 13.6% and 9.4% of patients, respectively, at admission and in 17.6% and 11.74, respectively at 3 months after stroke. Low social support (p=0.042) was related to PESI 3 months after stroke.
Campbell Burton et al., (2011) in the meta-analysis study reported that approximately 20% of the stroke clients experienced anxiety and depressive symptoms at some point following stroke incident.
Clau JP, Thopmpson DR., (2011) conducted a quantitative study to assess the perceived self-esteem level among 50 stroke survivors. Findings reported that self-esteem is seen to enhance people’s ability to cope with disease. Low self esteem may inhibit stroke clients participation in rehabilitation and thus result in poor health and social isolation.
Gallagher P (2011) conducted a grounded theory study to examine the emotional process of stroke recovery among 9 stroke survivors. Data was collected from formal unstructured interview and one group interview. The findings revealed that physical and emotional recovery is inseparable, becoming normal was influenced by personal strength, family support, faith and comparing self to peers.
Gurr B, Muelenz C (2011) in a descriptive follow-up study on psychological problems after stroke among 35 stroke survivors reported that early detection and review of post stroke psychological problems may optimize recovery from stroke. The study highlights the importance of mood assessment for all the stroke patients. The researcher suggest that patients with psychological distress must have an access to psychological interventions.
Buijck BI et al., (2010) conducted a longitudinal multicenter study to assess the prevalence of neuropsychiatric symptoms (NPS) among 145 stroke clients using Neuropsychiatric inventory -Nursing home version. The findings revealed that the most common NPS were depression(34%), eating changes (18%), night time disturbances(19%), anxiety(15%) irritability(12%), disinhibition (12%). The findings of the study suggest that NPS should be optimally treated to enhance the outcome of rehabilitation.
Hackett ML, et al., (2009) conducted a cohort study on psychosocial outcomes in stroke among seventy stroke survivors less than 65 years of age. They stated in their study that each year approximately 12,000 Australians of working age survive with stroke. They have the responsibility for generating the income and providing family care. The suggestions of the study were effective rehabilitative medical and social interventions must be provided for them to promote and maintain healthy ageing and mental health condition.
Sharma, et al., (2009) conducted an explorative study to explore the relationship of self esteem level, self esteem stability and admission functional status on discharge depressive symptoms in acute stroke rehabilitation among 120 stroke patients by using state self-esteem scale during inpatient and completed a measure of depressive symptoms at discharge. Functional status was rated using functional independence measure. Results suggested that patients with lower self rated self esteem and poorer functional status indicated higher levels of depressive symptoms.
Carin-levy G, et al., (2008) conducted a descriptive study among 40 stroke survivors, experience of taking part in exercise and relaxation classes were explored which contributed to improved self perceived quality of life, improved psychosocial functioning and improved motivation to take part in recovery process.
Asplaud K et al., (2007) conducted a prospective study to describe the various aspects of psychosocial function after stroke and the development of change over time on 50 stroke survivors. Findings revealed that patients with two years post stroke had more psychiatric problems. The study was concluded by stating that major depression early after stroke, functional impairment and an impaired social network interact to reduce life satisfaction for the long-term survivors.
Edward C. Jacob (2007) in the descriptive study on assessing the quality of life among stroke survivors stated in the study that stroke is been feared because of the short and the long term disability involved. Approximately around 4.4million stroke client are not able to get back to their lives productively. Quality of life scale and Barthel index score was used to collect the data. The findings revealed that in an stroke episode 30% of them require assistance in their activities of the daily living, one third of the survivors suffer from post stroke depression.
Lightbody CE et al., (2007) conducted a cross-sectional study among 28 post stroke clients to identify depression by using Geriatric mental state examination and Montogmery-Asberg depression rating scale. The findings suggested that 25% of the clients were depressed and Montogmery-Asberg depression rating scale is quicker to administer, it may prove more useful to nurses clinically.
Raju RS et al., (2007) conducted a prospective hospital based study in CMC Punjab among 1 month post stroke clients. Data regarding psychosocial problems and quality of life was analyzed by using WHO quality of life BREF scale. The conclusion of the study is that presence of anxiety, depression, and functional dependence were associated with impaired quality of life.
2.1 PART-II: REVIEWS RELATED TO EFFECTIVENESS OF PSYCHOSOCIAL INTERVENTIONS ON PSYCHOSOCIAL HEALTH OF STROKE CLIENTS
Jun EM, Roh YH., (2012) conducted a quasi experimental study to assess the effect of music movement therapy on physical and psychological outcomes among stroke patients. A convenience sampling method was used to randomize experimental and control group. The intervention music movement therapy was given for 60 minutes three times per week for 8 weeks. Findings revealed that the experimental group had significantly increased mood state in psychological function compared with control group. The study concluded by emphasizing early intervention for stroke clients during their hospitalization.
Morris J, Oliver Kroll., (2012) conducted a descriptive study among stroke clients to assess the importance of psychological and social factors in influencing the uptake and maintenance of physical activity. After a structured review of the empirical literature, the study concludes that self efficacy and social support appear relevant to physical activity behavior after stroke and should be included in theoretically based physical interventions.
Yang NC, Yeh SH., (2012) reported in the case report that patients with stroke related disabilities are at risk of depression and social isolation. While good at dealing with physical illness, nurses are often poor at attending to patients mental and spiritual needs. The author had used a model of spiritual care and in-depth evaluation to identify several underlying psychological issues of stroke clients. These included feelings of hopelessness and loss of control and motivation. The authors established trust through active listening. A multidimentional spiritual care approach was applied to help the patient shift from hopelessness to hopefulness. This enhanced motivation of the patients to participate in rehabilitation.
Cynthiya L. Flick (2011) developed a self-directed learning module to assess the stroke outcome and psychosocial consequences. She discussed on the predictive factors for mortality and functional recovery. The importance was laid on the rehabilitation programs-reintegration and socialization after stroke and management of psychosocial effects of stroke on patients and families.
Green TL, King KM (2011) conducted a descriptive correlational study to examine the relationships between mild stroke functional and psychosocial outcomes among the 38 elderly mild stroke clients. Functional outcome was measured using Modified Rankin scale, patient’s quality of life using stroke impact scale, mood using the Beck depression inventory. Findings revealed that at three months post discharge, patient’s functional status scores had significantly improved with corresponding increase in quality of life scores. The study concluded that the nurses must consider the psychological and social implications of the recovery process of stroke clients following discharge.
Kim DS, et al., (2011) conducted an experimental study to assess the effects of music therapy on mood in stroke patients. Samples selected were 20 post stroke patients divided in to experimental and control group. The experimental group participated in the music therapy program for three weeks. Psychological status was evaluated with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) before and after music therapy. Findings suggested that BAI and BDI scores showed a greater decrease in the music group than the control group. The study concluded by stating that music therapy has a positive effect on mood in post stroke patients and may be beneficial for mood improvement with stroke.
MacIssac (2011) conducted a mixed method study to explore the supportive care needs after stroke, a need assessment survey was developed and administered to 10 patients with stroke to identify the specific needs of the population and the applicability of the tool was further evaluated through a focus group of nurses working in stroke care. The results suggested that the survey aided the nurses in early identification of the supportive care needs for the patients.
Hua CY et al., (2010) conducted a descriptive study to identify the mediating roles of social support on post stroke depression and quality of life among 102 clients with ischemic stroke. The clients were assessed using social support inventory, Barthel index, quality of life index stroke version and face to face survey interviews. The results suggested that half of the clients suffered depression and social support partially mediated the prediction of post stroke depression by functional ability.
Forsblom A, et al., (2009) conducted a study on therapeutic role of music listening in stroke rehabilitation. Data was collected by two parallel interview schedule of stroke patients (n=20) and professional nurses (n=5) to gain more insight into the therapeutic role of music listening in stroke rehabilitation. Results suggested that music listening can be used to relax, improve mood, and provide both mental and physical activation during the early stages of recovery from stroke.
Salter, Folley N, Teasell., (2009) in a systemic review of literature states that psychological consequences of stroke are important determinants of health related quality of life. As many as one-third of stroke clients will experience post stroke depression, however perceived social support may be protective in terms of both onset and duration of depressed mood. Improvement of available social support could be an important strategy in reducing or preventing psychiatric distress and warding of post stroke depression.
Vickeryi CD, Sepehri., (2009) conducted a quasi-experimental study on self- esteem in an acute stroke rehabilitation sample: a control group comparison. Stroke survivors (n=80) were matched on age and education to a group of neurologically intact community dwelling control participants. Data was collected using visual analogue self esteem scale, Rosenberg self esteem scale, geriatric depression scale. Findings revealed that stroke survivors rated significantly lower mean levels of self esteem on the visual analogue self esteem scale (37 versus41) and the Rosenberg rated higher mean levels of depressive mood on the geriatric depression scale (9versus 6). Significantly higher correlations between self esteem and mood ratings were noted in the stroke group that in control group. The study suggest that lower self esteem ratings do not appear to be a byproduct of depressive mood. Clinicians may facilitate the emotional adjustment of the survivor by considering this facet of psychological impact and intervening to address self esteem.
Lamb M., (2008) in a systemic review of literature revealed that the onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery.
Mant J Winner S., (2008) conducted a descriptive study on family support for stroke. Twenty stroke clients family was visited and data was collected regarding functional dependence and used stroke impact scale, care giver burden was assessed. Findings revealed that family support is essential for stroke clients to have a regular follow-up and to alleviate the psycho social problems of stroke clients.
Robinson Smith G., (2008) conducted a study on prayer after stroke-its relationship to quality of life among eight stroke patients who used prayer after stroke as a coping strategy to improve self efficacy and quality of life. A qualitative approach using the interview method was employed to expand on spiritual practices expressed through prayer as a way of coping after stroke. Findings revealed that stroke may encourage patients to re-examine spiritual aspects of life and the challenges associated with stroke can promote spiritual growth and development. potential strategies are suggested to nurses to identify patients spiritual needs.
Vohora, R., Ogi, L., (2008) conducted a pre-experimental study to address the emotional needs of stroke survivors in a stroke rehabilitation ward at Moseley Hall Hospital, U.K. A group intervention was developed for 31patients in stroke ward. The interventions were group discussion where they share their experiences, thoughts and feelings and had group activity. The group met five times over two and a half weeks. Each session was designed to last for around an hour. To analyze the result of the intervention Patients were asked to indicate the degree to which they liked each session, 26 responses were given regarding the perceived most helpful aspects of the group, with only 5 responses were for the least helpful. The study was concluded by reporting that it is crucial to address patients emotional needs following a stroke and attention should be paid to psychological intervention. Patients reported, finding the opportunity to share experiences with others in similar situations as the most helpful aspect of the stroke group.
Bandagi R, Fox PG., (2007) in a descriptive study on coping with stroke: psychological and social dimensions on U.S patients reported that stroke patients experience physical and emotional symptoms which affect their daily functioning. Coping strategies included maintaining a positive attitude and asserting independence as much as possible in acute stroke experience. The findings revealed that Hopefulness was often inspired by interaction with family and spiritual beliefs. The study suggested that Nurses can understand the patient’s perceptions of stroke experience and increase their ability to provide interventions to promote their coping strategies.
Micheal KM, Allen JK., (2007) conducted a quantitative study to identify the relationship of social support on fatigue after stroke among stroke survivors. The severity of fatigue in a sample of 53 community dwelling subjects was assessed by using fatigue severity scale. The findings suggested that 46% of the sample had severe fatigue and patients with elevated fatigue severity score had lower social support (p<0.05).