Tag: well-being

Categories : Cardiovascular Disease Mental HealthTags :

Nurses Play a Key Role in Addressing Post-stroke Mental Well-being

On By ModernMedia
Credit: American Heart Association

Nurses play a key role in helping patients manage emotional and social health challenges, or psychosocial health, after a stroke, and improved screening and assessment for psychosocial needs are essential to provide optimal patient care. These findings are highlighted in a new statement from the American Stroke Association, a division of the American Heart Association, published in the Association’s peer-reviewed scientific journal Stroke.

While there have been significant advances in stroke prevention and treatment, stroke remains the second leading cause of death globally and a major cause of disability. The latest research indicates that 16% to 85% of stroke survivors experience psychosocial symptoms, such as depression, anxiety, stress, fatigue and/or a decreased quality of life during their recovery.

“Stigma often surrounds discussions about psychosocial health. Therefore, it is crucial for nurses and all health care professionals to create a safe and therapeutic environment for patients and offer hope and comprehensive education on the topic,” said Chair of the scientific statement’s writing group Patricia A. Zrelak, PhD, RN, FAHA, a regional stroke program quality nurse consultant for Kaiser Permanente Northern California and a member of the American Heart Association’s Council on Cardiovascular and Stroke Nursing.  

The scientific statement details a comprehensive review of the latest evidence published from 2018-2023 about psychological health in patients who experienced a stroke. The statement addresses the effects, underlying causes, screening, diagnosis and treatment for five key emotional and social health factors, including depression, stress, anxiety, fatigue and quality of life. The scientific statement aims to establish a guide for nursing care throughout a patient’s recovery after a stroke, from prevention of adverse psychosocial health conditions to identifying and managing symptoms.

“Emotional, cognitive, behavioural and/or personality changes may occur after a stroke,” Zrelak said. “These conditions can emerge immediately after a stroke or have a delayed onset, sometimes occurring more than a year later, and they may also fluctuate in intensity over time. In addition, psychosocial symptoms are interrelated, and patients who experience one are at higher risk of developing other mental health conditions. Effective and regular screening are vital for early detection and treatment.”

Depression

Depression affects about 30% of stroke survivors and is particularly common within the first three months after a stroke. Symptoms of depression may include persistent sadness, anxious or “empty” mood; restlessness and irritability; loss of interest or pleasure in hobbies and activities; difficulty in concentrating and thinking; increased or decreased sleep; changes in appetite; and weight gain or loss. Post-stroke depression worsens cognitive and functional recovery and increases the risks of death and/or another stroke.

The AHA/ASA Guidelines for the Early Management of Patients With Acute Ischemic Stroke recommend routine depression screening for all patients after a stroke. Nurses can help educate stroke survivors and their families on symptom recognition, prevention and treatment options, such as medication management and/or cognitive behavioural therapy.

Stress

A 2022 study found that post-stroke stress and post-traumatic stress disorder (PTSD) affects about one in six (about 16.5%) stroke survivors. These conditions may increase the risk of additional health issues, including anxiety and poor medication adherence. Screening stroke patients for stress and PTSD should occur when they are hospitalised and continue during rehabilitation and outpatient visits after hospital discharge.

Nursing interventions that may help lower patients’ distress include stroke education and self-management strategies, such as mindfulness and meditation. Nurses may also consider stroke survivors’ coping styles. People with high-anxious coping styles face a significantly higher risk of experiencing PTSD after a stroke in comparison to people with low-anxious coping styles.

Anxiety

The frequency of anxiety ranges from 20%-25% in the first months after stroke, increasing to 32% as the year progresses, with a five-year prevalence of 34%. Factors such as younger age at the time of the stroke, lower income, inability to work, social isolation, previous mental health conditions and/or severity of the stroke are factors that increase the risk of developing anxiety. Anxiety is also linked to a higher risk and severity of depression.

Standard screening for anxiety and prompt detection may lead to early treatment, greater patient engagement and improved recovery for stroke survivors. Although established clinical guidelines for treating general anxiety exist, more research is needed on anxiety interventions after different types of strokes.

Fatigue

Post-stroke fatigue may develop anytime, however, it is most common within the first six months after a stroke. Symptoms of fatigue may include reduced physical and mental energy levels that interfere with daily activities and difficulty with self-control, emotions and memory. Women and people with depression, sleep problems, anxiety and/or multiple health conditions are at higher risk for developing post-stroke fatigue.

More research is needed for effective management strategies for post-stroke fatigue, as there are currently no proven treatments. However, interventions focused on improving general physical fitness may help prevent, reduce or treat post-stroke fatigue and other components of psychosocial health.

Quality of life

Returning to the same quality of life after a stroke is challenging and even more so after a severe stroke. Physical strength, speech, depression, anxiety and the ability to return to work and social activities are factors that contribute to a stroke survivor’s quality of life. However, conditions such as chronic pain can negatively impact recovery and return to independent living.

Physical activities that also include interpersonal engagement, such as yoga and tai chi, have shown positive effects on patients’ quality of life. Nurses can help stroke survivors improve their post-stroke quality of life by linking patients to social services in their local area, such as post-stroke support groups and community-based organisations.

 “Mental and emotional well-being are crucial for recovery, and nurses play an important role in supporting patients after a stroke,” Zrelak said. “It’s important to engage stroke survivors and their caregivers so they are aware of these psychosocial conditions and ways they can help. Early detection of symptoms and treatment have the potential to improve post-stroke recovery.”

The statement also highlights existing research that shows stroke outcomes vary significantly among people in different racial and ethnic groups. Social determinants of health, such as structural racism, socioeconomic status, inadequate housing and/or limited access to health care including mental health services, may all influence a stroke survivor’s recovery.

Zrelak added, “The stroke care team is crucial in addressing these health inequities, using targeted interventions and customised treatments to improve mental health support and overall care coordination for those most at risk. More research is needed to help us understand how best to support psychosocial well-being for people after a stroke, so they are better able to return to their routine daily activities and have a better quality of life.”

Source: American Heart Association

Categories : Mental HealthTags :

Mental Wellbeing in the Workplace

On By ModernMedia

The state of South Africa’s mental well-being is a cause for concern

Photo by Alex Green on Pexels

In Aon’s 2024 Global Medical Trend Rates Report, mental health is listed as a major contributor to morbidity, disability, injury and premature mortality; also increasing the risk of other health conditions. The state of South Africa’s mental wellbeing is cause for concern. The world has witnessed several major events that have also had widespread impacts on people’s mental health. Events such as the COVID-19 pandemic, natural disasters, economic uncertainties, social unrest and warfare have heightened stress levels and contributed to an increased focus on mental well-being. 

South Africans are distressed and struggling with their mental health:

  • In Sapien Labs’ Mental State of the World 2022 report, South Africa was ranked as the country with the highest percentage (35.8%) of its population that are distressed and struggling with mental health.
  • Another prominent trend highlighted in the Sapien Labs report is the declining mental well-being of each successively younger generation. This is reflected in the Western Cape Government’s report on anxiety, depression and adolescent suicide which found that 9% of all teenage deaths are due to suicide.
  • According to the World Health Organisation (WHO) more than 700 000 people die by suicide every year, with South Africa rated as the country with the ninth highest suicide rate in the world at 23.5 per 100k, with suicide alarmingly being the fourth leading cause of death among 15 – 19-year-olds.
  • A WITS University study found that a quarter (25.7%) of South Africans are depressed with only a quarter of these affected individuals seeking assistance.

According to Jacqui Nel, business unit head of healthcare at Aon South Africa, depression is likely to be the world’s leading burden of disease by the year 2030, if not sooner. “It is easy to measure an individual’s weight, Body Mass Index (BMI), glucose and cholesterol levels, but it is much harder to measure what is going on in a person’s mind. The top challenge that human resource professionals are concerned with is keeping the workforce engaged and productive in the face of ongoing retrenchments, the spiralling cost of living, load shedding and the fact that 44% of South Africans have impaired credit records. All these factors are converging to create enormous contributory pressures when it comes to anxiety levels experienced by employees,” says Jacqui.

One of the leading trends in the mental well-being of employees is burnout, which places employees at risk of developing depression. It was classified as an occupational phenomenon in 2019 by the World Health Organisation (WHO) with its occurrence rate increasing on an annual basis, and it has only escalated since the onset of the pandemic and the radical changes to work models since then. “Employees that are burnt out feel exhausted, distance themselves from their colleagues and their job and show a reduction in professional efficacy,” Jacqui explains.

Finding a sustainable work-life balance model

These factors are clear indicators that there is something radically amiss in our work-life balance, and we need to do better as a society and employers in embracing a more sustainable work-life model that is cognisant of the forces that are at play in the workforce environment. “It starts by building resilience, agility and a sense of belonging at an individual and organisational level, and most of all, better support structures,” Jacqui explains.

Workforce Resilience

Workforce resilience describes a person’s fundamental sense of security at work, a strong sense of belonging with the employer and the adaptability and motivation they need to reach their full potential.  “Workforce resilience matters because businesses that put their people first are more likely to thrive. By creating a workplace environment that provides security, motivation and belonging, employees and colleagues are better able to weather and process the fiercest of storms and pressures,” Jacqui explains.

Workforce Agility

Workforce agility describes a workforce that thrives on and embraces change rather than being threatened by it, a workforce that can develop future skills at speed and naturally pivots to stand out from the competition – all the while balancing investment and people risk with agility, creating value for the employer and the customer, alike.

“By investing in impactful Employee Assistance Programmes (EAP), employers empower their employees to better measure their progress and manage risk, enabling a diverse, inclusive and agile workforce. Workforce agility is the difference between merely surviving and thriving,” says Jacqui.

“It may even extend beyond an EAP, with organisations implementing programmes that are specific to the organisation’s challenges. Insights that are underscored by data and analytics, will be able to identify employee trends and concerns, enabling employers to wisely spend money where it is most required within the wellness of employees,” she adds.

Belonging

Belonging describes a connection to a community of peers and the support that each individual feels in relation to their working environment. “It is important because it enables a positive working life experience and underpins personal and professional growth, providing a voice and an opportunity to use it and be heard, regardless of role or rank. All the while, supporting wellbeing whilst driving diversity and innovation,” Jacqui explains.

“Fostering a sense of belonging in an employee starts by assessing how well the personality traits of a possible candidate align with the cultural fit of the organisation during the recruitment phase. It also extends to how well employees are supported during their time in the organisation, allowing them to naturally become agents of change and role models for the organisation’s culture by living the company ethos and way of operating to inspire adoption throughout,” Jacqui explains.

At the heart of this entire process, is the implementation of a well-rounded Employee Assistance Programmes (EAP) that is designed to support employees in dealing with personal and work-related stressors that may affect their well-being, mental health and productivity. This could include:

  • Confidential counselling sessions.
  • Assessments of an employee’s situation and referral to the correct counselling and support.
  • Crisis intervention for employees who are dealing with trauma such as bereavement, have been victims of violent crime or gender-based violence.
  • Offering work-life services that could range from finding childcare to legal assistance or financial planning.
  • Offering educational workshops and seminars on aspects such as personal finance through to health and wellbeing.
  • Wellness programmes that promote healthy habits and stress reduction and management techniques.
  • Consultation for managers and supervisors.

“There has been a significant increase in awareness and understanding of mental health issues as efforts by mental health advocates, employer groups and individuals have contributed to destigmatising mental health. This increased awareness has led to more open conversations about mental health in various sectors of society and it is here where Employee Assistance Programmes (EAP) play a crucial role in supporting employers and opening the doors for candid conversations and getting the needed help and support. The services of a trusted and skilled advisor are key in helping organisations develop and operate an EAP that is fit for your business and your people and their unique circumstances. “

“While there is a cost involved that is carried by the business, the results far outweigh the investment.  It’s about providing employees and management with the means to weather the storms of an increasingly complex world of work, find a balance in their personal lives and come out on the other side with resilient and agile people who have a strong sense of belonging and purpose. This is about supporting employees to manage stress, improve productivity, and enhance their overall quality of life and wellbeing, which in turn improves workplace dynamics, contributing to a positive and productive work environment where skilled and valued employees want to be,” Jacqui concludes.