How to effectively improve the patient’s depression, anxiety, sleep quality and somatic symptoms after stroke: Management of Chronic Disease Assignment, ENU Singapore, Singapore

Purpose: This study aimed to explore the effects of evidence-based nursing (EBN) intervention on anxiety, depression, sleep quality and somatic symptoms of patients with acute ischemic stroke (AIS)

Introduction
Stroke is the second-most cause of mortality worldwide, and there are about 2.5 million new stroke cases occurring in China each year.1,2 The leading subtype of stroke is acute ischemic stroke (AIS), which is triggered by cerebral ischemia, leading to the dysfunction of brain vascular components.3 It has been reported that a large number of AIS patients faced serious post-stroke complications such as depression and anxiety after stroke.

2 Given its great incidence following stroke, stroke-induced PTSD may be a substantial new risk factor for recurrent stroke, which is also rather prevalent.4 These post-stroke complications can adversely affect stroke clinical outcomes, increase the risk of functional dependence and reduce the quality of life (QOL).

5 Depressive feelings and a lack of self-efficacy in the rehabilitation process are linked to a poor level of physiotherapy effectiveness6 Therefore, effective management to reduce post-stroke complications in AIS patients is essential.
Biopsychosocial factors, such as a patient’s age, gender, and time since the onset of stroke, as well as socioeconomic status and the effectiveness of formal and informal care, appear to be the most important areas of study in post-stroke rehabilitation. This is because the factors that affect a patient’s recovery after a stroke can differ greatly from person to person. As a result, bio-psychosocial assessment of patients and evidence-based nursing interventions is essential to their recovery. In recent years, evidences from previous studies have indicated that the specialized nursing care contributed to the improvement of post-stroke depression and anxiety.2,5 For example, Verberne et al found that nurse-led stroke aftercare, which included the procedures such as psychoeducation, cognitive and emotional screening, and specialist care, showed beneficial for emotional well-being in comparison to care-as-usual.5 Zhang et al2 demonstrated that a newly designed
intensive caregiver education program conducted by nurses could effectively reduce anxiety and depression in patients with AIS. Evidence-based nursing (EBN) intervention is a nursing strategy that uses credible scientific research results as evidence in combination with patient needs to implement patient care, providing patients with personalized nursing services.

6,7 EBN has been widely applied in clinical practice and makes great progress in the management of diseases such as chest pain,8 postpartum depression6 and acute coronary syndrome.9 For stroke, previous studies have shown that
using EBN theories could reduce the morbidity and mortality associated with stroke.10,11 Based on previous research results on post-stroke depression and anxiety, we hypothesized that EBN might have benefits on improving psychiatric outcomes of patients with AIS. Thus, we established an EBN team which composed of the head nurse and the nurses in charge of the Department of Neurology in our hospital. We aimed to explore the effects
of EBN intervention on anxiety, depression, sleep quality and somatic symptoms of patients with AIS.

Question Proposing
(a) How to effectively improve the patient’s depression, anxiety, sleep quality and somatic symptoms after stroke;

(b) How to implement effective psychological suggestion for patients with stroke;

(c) How to improve the patient’s post-stroke nursing effect.