Author: McCurley JL1,2,3, Funes CJ1, Zale EL1,2, Lin A1, Jacobo M1,2, Jacobs JM1,2, Salgueiro D3, Tehan T3, Rosand J2,3,4, Vranceanu AM5,6,7
Affiliation: <sup>1</sup>Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA.
<sup>2</sup>Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA.
<sup>3</sup>Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA.
<sup>4</sup>Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, USA.
<sup>5</sup>Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA. avranceanu@mgh.harvard.edu.
<sup>6</sup>Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA. avranceanu@mgh.harvard.edu.
<sup>7</sup>Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA. avranceanu@mgh.harvard.edu.
Conference/Journal: Neurocrit Care.
Date published: 2018 Nov 12
Other:
Special Notes: doi: 10.1007/s12028-018-0641-6. [Epub ahead of print] , Word Count: 260
BACKGROUND/OBJECTIVE: Chronic emotional distress (e.g., depression, anxiety, post-traumatic stress) is common after stroke and interdependent between patients and their informal caregivers. We measured stroke survivors', caregivers', and neurocritical care nurses' views of primary drivers of distress during the stroke experience, and needs and preferences for the structure, topics, mode of delivery, and timing of an intervention to promote emotional recovery.
METHODS: We conducted semi-structured interviews with 24 patient-caregiver dyads within the Neuroscience Intensive Care Unit (Neuro-ICU). Additionally, we conducted two focus groups with 15 nurses. Interviews and focus groups were audio-recorded, transcribed, and coded using NVivo 11 (QSR International) software.
RESULTS AND CONCLUSIONS: The challenges and impacts of stroke most commonly reported by dyads were: uncertainty about future health, fear of recurrent strokes, negative emotions, and role changes post-stroke. Dyads and nurses agreed that resiliency skills such as mindfulness/focusing on the present, problem solving, gratitude/optimism, self-care, interpersonal communication and developing a supportive team of family, friends, and medical staff are beneficial to optimize recovery. The potential barrier to intervention delivery was accessibility, due to challenges of time and travel to appointments. Participants agreed that starting the intervention at hospitalization and continuing via live video after discharge is an ideal delivery modality. Stroke survivors, caregivers, and Neuro-ICU nurses believe that a resiliency skills-based intervention to prevent chronic emotional distress is necessary and urgent. This qualitative study provides valuable information on the challenges faced by dyads, intervention topics to prioritize, and strategies to maximize feasibility, acceptability, and effect.
KEYWORDS: Caregivers; Depression; Nurses; Post-traumatic stress; Stroke
PMID: 30421266 DOI: 10.1007/s12028-018-0641-6