Date of Graduation

Fall 12-18-2015

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

First Advisor

KT Waxman

Second Advisor

Juli Cordelia Maxworthy

Third Advisor

Wanda Borges

Abstract

Statistics in the United States (US) have shown an increase in the prevalence of Cardiovascular Disease (CVD) or risk for developing CVD. Approximately 78 million American adults, 20 years and older, have hypertension, 31.9 million have elevated serum cholesterol levels, and 68.2 million use tobacco products. Within California, San Francisco (SF) was ranked 8th among counties with adult residents that have CVD. It is estimated that approximately 1.02% of these individuals will have a stroke each year and 16.25% will die from stroke. Of those that survive, it is estimated that at least half will develop neurologic deficits, and at least a third will develop post-stroke depression (PSD). The high prevalence of post-stroke depression (PSD) greatly influences stroke survivor mortality, hospital length of stay (LOS), and Quality of Life (QOL) further fueling the projected rise of indirect annual costs associated to the loss of productivity of stroke survivors and ongoing healthcare costs. Despite best practice recommendations and guidelines from health agencies, current stroke care processes of stroke care facilities deviate from these recommendations and lack the inclusion of a post-stroke neuropsychiatric sequelae protocol or screening measure that leaves PSD undetected and untreated. This project aimed to implement the inclusion of a depression screening measure and (pharmacologic and non-pharmacologic) intervention in the current stroke care processes of a 395-licensed bed, urban, general acute care hospital (GACH) located in the downtown Tenderloin area of San Francisco, California. Despite the low volume of stroke patients admitted during the 3-month period, the project was moderately successful on multiple levels. The project produced the intended outcomes of cost-effective staff training and education on the timely administration of PSD screening measures and intended pharmacological interventions. It was able to moderately raise nurses’ comfort levels in the administration of BH screening questions and answering questions related to its use. Nurses reported moderate increase in confidence on the overall clinical utility of PSD screening as part of stroke care processes. The project’s success on improving stroke outcomes as it relates to timely screening and intervention of PSD was considered low. However, there appears to be a strong link between good communication, good training, and staff compliance to small tests of change aimed towards improving patient care. Ultimately, depression screening and early intervention on post-stroke patients has the potential to provide cost savings or cost avoidance equal to $29159.95 over a 3-month period.

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