Relationship of Functional Status and Hopelessness among Stroke

Patients

Rihhadatul Aisy

, Devi Darliana

Undergraduate Program of Nursing Science, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Department of Medical and Surgical Nursing, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Keywords: Functional Status, Hopelessness, Stroke

Abstract: Stroke might cause neurological deficit such as hemiparesis and hemiplegia which may affect a person’s

functional status. Patient with stroke needs other’s assistance in meeting their daily needs, unable to carry

out their functions and roles in the family and cannot work properly, causing anxiety, stress and depression

and trigger feelings of hopelessness. The research aimed to identify relationship between functional status

and hopelessness feeling in stroke patients. The type of the research was correlation study used cross

sectional study design. The research was conducted on 110 patients with stroke by using purposive

sampling method. Data collection was done by guided interview used Barthel Index and Beck Hopeless

Scale questionnaires. The result of the research showed that majority of patient with stroke had moderate

level dependence (49,1 %) and 37,3% had moderate level hopelessness. Spearman Rank test resulted

correlation coefficient (r) 0,569 with p=0,00 (p<0,05). It means that there was a relationship between

functional status and hopelessness in stroke patients. It is recommended for healthcare team to provide

physical and psychological supports for patients to assist them in accepting their physical limitation and

neurological deficit, so they could manage their lives optimally.

1 INTRODUCTION

Cerebro Vascular Accident (CVA) is a

disturbance in intracranial blood vessel as

resulting the sudden cessation of blood supply

to the brain which is causing loss of brain

function accompanied by neurological deficits.

Clinical manifestations of stroke patients

include impairment of consciousness,

hemiplegia and hemiparesis, paresthesia,

impaired verbal communication, visual and

cognitive impairment (Lewis, Dirksen,

Heitkemper, Bucher, Harding, 2017).

Stroke is ranked the second cause of death

and disability globally. A total of 6.2 million

deaths globally in 2015 were caused by stroke.

Stroke incidents in Indonesia in 2013 were

approximately 1.236.825 people and Aceh

province were included among 10 provinces in

Indonesia that suffered the most from stroke

with 34.313 people. More than two-thirds of

stroke patients experience long-term disabilities

for instance inability of activity daily living

(ADL) including bathing, dressing, moving and

walking due to hemiparesis and hemiplegia.

(Basic Health Research, 2013; Johnson,

Onuma, Owolabi, sachdev, 2016).

Hemiplegia and hemiparesis and various

neurological deficits can affect the functional

status of stroke patients. Functional status is the

ability of a person to perform daily activities to

be able to fulfill basic needs, carry out roles and

functions in the family, and maintain health and

welfare (Chen, Moeliono & Amalia, 2016,

Lewis et al, 2017).

Functional assessment aims to evaluate the

severity of the disease, measure a person's

treatment needs, and monitor health changes all

the time. Evaluation of functional status is very

essential to be assessed in stroke (Krishnisn,

Leong,Lye, Johar & Ismail, 2015).

Aisy, R. and Darliana, D.

Relationship of Functional Status and Hopelessness among Stroke Patients.

DOI: 10.5220/0008393900002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 11-15

ISBN: 978-989-758-413-8

According to Nanda International Inc.

(2015), hopelessness is a subjective condition

when an individual perceives limitations or lack

of alternatives or personal choices and unable to

mobilize energy for his own sake. Hopelessness

can be caused by deteriorating physiological

conditions, pain, discomfort, prolonged

weakness, inability to participate in desired

activities and barriers to functional ability:

walking, elimination and eating (Christensen,

2014; Marvin & Zeltzer, 2017)

2 METHODS

The type of research in this study was

correlation study with cross sectional study

design. Determination of samples using

consecutive sampling, so that obtained 110 post

stroke patients who were treated at the

neurology clinic of Dr. Zainoel Abidin General

Hospital Banda Aceh. Data analysis used

Spearman Rank test.

The functional status of the patients was

measured using the Barthel Index questionnaire

which consisted of 10 question items. The

Barthel Index had validity value of 0.73-0.77 (p

<0.001) and reliability value of 0.87 (p <0.001)

(Mahoney & Barthel, 1965)

Barthel index is a functional instrument to

measure the extent to which a person can

function independently and have mobility in

carrying out their daily life activities (ADL).

Activities were assessed including mobilization,

eating, taking care of yourself, taking a bath,

walking on a flat surface (mobility), using

stairs, dressing, defecating (intestinal control),

and urinating (bladder control) (Christensen,

2014; Marvin & Zeltzer, 2017)

Beck Hopelessness Scale (BHS) assessed 3

aspects i.e. affective, motivational, and

cognitive aspects. BHS consisted of 20 true-

false statements, 9 positive statements and 11

negative statements. Responses for each

statement were given a score of 0 or 1. BHS

with avalidity value of 0.86 (p <0.001) and

reliability value of 0.93 (Beck et al., 1974).

3 RESULTS

Demographic data in this study included age,

gender, marital status, last education,

employment, length of stroke, and neurological

deficits of patients.

Table 1: Demographic data characteristics of stroke patients.

Demographic data Frequency Percentage

Age

36-45 years

46-55 years

56-65 years

≥65 years

14,5

29,1

35,5

20,9

Gender

Male

Female

63,6

36,4

Marital status

Married

Not married

Widow

Widower

81,8

4,5

11,8

1,8

Last education

Basic

Middle

High

20,9

37,3

41,8

Occupation

Civil servant

Retired

Housewife

Farmer

16,4

30,9

14,5

0,9

AINC 2018 - Aceh International Nursing Conference

Demographic data Frequency Percentage

Entrepreneur

Unemployed

18,2

19,1

Length suffered stroke

≤6 months

<1 year

≥1 year

29,1

23,6

47,3

Barriers of physical mobility

Hemiparesis

Hemiplegia

71,8

28,2

Table 2: Frequency distribution of functional status of stroke patients

Functional status Frequency Percentage

Mild dependence

Moderate dependence

Severe dependence

Total dependence

17,3

49,1

30,9

2,7

Table 3: Frequency Distribution of Hopelessness feeling of Stroke Patients

Hopelessness feeling Frequency Percentage

Minimal hopelessness

Mild hopelessness

Moderate hopelessness

Severe hopelessness

10,0

36,4

37,3

16,4

Table 4: The relationship between functional status and hopelessness of stroke patients

Functional status

Hopelessness (%)

Minimal Mild Moderate Severe Total α p-value

f % f % f % f % f %

0,05 0,00

Mild dependence 6 42,8 10 20 4 9,7 1 5,5 19 17,3

Moderate dependence 5 35,7 21 52,5 17 41,5 3 16,7 54 49,1

Severe dependence 2 14,2 5 12,5 18 40 13 72,2 38 34,5

Total dependence 1 7,1 3 7,5 2 4,9 1 5,5 7 6,4

Total 14 100 40 100 41 100 18 100 110 100

Table 4 showed that 54 (49.1%) stroke

patients with moderate dependency functional

status, there were 17 patients (41.5%) who

experienced moderate hopelessness. Through

the Spearman Rank statistical test, it was

obtained p-value = 0.00 (<0.05) so that H

was

rejected which meant that there was a

relationship between functional status and

feelings of hopelessness in stroke patients.

4 DISCUSSION

The results showed that there was a relationship

between functional status and hopelessness

feeling in stroke patients. Most stroke patients

experienced a change in functional status i.e.

moderate dependence (49.1%) and 37.3% of

patients experienced moderate hopelessness.

Post-stroke disability will affect the patient's

psychosocial conditions such as feelings of low

self-esteem, feeling unlucky, grieving, anxious

and afraid. This condition is a manifestation of

feelings of hopelessness that lead to depression.

Limitations in performing daily activities make

patients very dependent on others and need

assistance in meeting their daily activities. The

greater the neurological deficit obtained by the

patient, the more unable the patient will be in

carrying out his daily activities (Lopez-espuela

et al., 2016).

The results of this study were also supported

by research conducted by Elisabet & Taviyanda

(2013) which showed that most stroke patients

in the outpatient installation of Babtis Hospital

were dependent on meeting their daily

Relationship of Functional Status and Hopelessness among Stroke Patients

activities. Patients need help with activities for

example moving, walking and climbing stairs

because the patient is difficult to move part of

his body. In addition, assistance in caring for

themselves and bathing is also needed by

patients.

Recovery of neurological deficits in stroke

patients can be rapid within the first 6 months

after a stroke. If after 6 months they still have

disability, the repair will not be too significant,

although minor repairs can still occur within 2

years. In general, disability experienced by

patients after 2 years will tend to settle. Patients

after 2 years and more than this period tend to

experience disability continuously and this is

one of the factors causing hopelessness in

patients (Ardi, 2011, Ratnasari, Kristiyawati, &

Solechan, 2012)

The results showed that the length of

patients with the most stroke was> 1 year

(47.3%) with the most neurological deficits

obtained by patients was hemiparesis (71.8%).

This is related to the long-term effects of

neurological deficits obtained by patients and

adherence of patients to post-stroke

rehabilitation therapy which serves to improve

the functional status of patients.

This study is in accordance with research

conducted by Krishnian, Leong, Lye, Johar dan

Ismail (2015) on functional status in stroke

patients who stated that the duration of stroke

affected the functional status of stroke patients.

Stroke patients who are suffered more than 24

months usually experience persistent disability

so they have functional status of severe

dependence on others. Prolonged disability and

weakness are related to hopelessness.

Research conducted by Chen et al., (2016)

on the functional status of stroke patients in

outpatient installation Hasan Sadikin General

Hospital explained that rehabilitation therapy

can improve the functional status of stroke

patients from moderate dependence to be mild

dependency in fulfilling their daily activities.

Rehabilitation therapy and post-stroke

treatment are carried out regularly from the first

6 months or even 2 years or more to reach the

optimal functional level requires quite a lot of

costs. The length of the treatment process and

stress with economic issues are also factors

cause hopelessness in patients.

Dependence on others in carrying out daily

activities will interfere with the role of patients

in the family. In this study the majority of

patients (81.8%) were married. Stroke patients

with married status were prone to experience

impaired role functions in families both in men

and women.

Male patients cannot perform their role as

head of family. Patients cannot work to make a

living, so they can cause economic problems in

the family, while patients also need a fee for

treatment. Female patients also cannot act as

wives and mothers as before due to hemiparesis

or hemiplegia. This will lead to feelings of

hopelessness in the patient because of cannot do

something better for himself and his family

(Sawab, Bahrudin, Daulima, 2015).

The results of further analysis of the study at

the Neurological Polyclinic of the dr. Zainoel

Abidin Regional General Hospital Banda Aceh

using the Spearman Rank showed that there

was a relationship between functional status

and hopelessness feelings in stroke patients

with moderate relationship. This can be seen in

the results of the study 41.5% of patients with

dependency functional status are experiencing

moderate hopelessness, which is reflected in the

feeling of sadness because they cannot perform

daily activities such as moving, eating, walking,

climbing stairs, unable to perform their

functions and roles in the family and cannot do

various other desired activities.

The inability to perform the role function

will lead to feelings of hopelessness so that

stroke patients lose the meaning of life.

Changes in the meaning of life can occur

because of feelings of underappreciation, not

being included in various activities, not being

consulted, feeling excluded and feeling useless.

This condition creates feelings of hopelessness,

depression and raises the idea of suicide (Sawab

et al., 2015).

Kosasih's (2006) study explains that post-

stroke patients experience feelings of

hopelessness, have no prospect that conditions

will get better and the impact of stroke can

AINC 2018 - Aceh International Nursing Conference

affect physical, and psychological functions

and also social relations.

5 CONCLUSION

Neurological deficit experiencing among stroke

patients can affect functional status. The higher

level of dependence showed the higher level of

hopelessness feeling on patient with stroke.

This condition needs attention from nurses and

the whole healthcare team to give support for

patients so patients keep spirit and optimistic in

spite of limitations. These efforts are expected

to avoid being hopelessness feeling with

patients’ condition.

REFERENCES

Ardi, M. 2011. Analysis of relationship cognitive and

physical disability between hopelessness on patient

stroke in Makassar. Unpublished Thesis. Retrieved

from lib.ui.ac.id/file?file=digital/20281864-

T%20Muhammad%20Ardi...

Basic Health Research. 2013. National Report 2013, 1–

384.

Beck, A. T., Weissman, A., Lester, D., & Trexler, L. 1974.

The measurement of pessimism: The Hopelessness

Scale. Journal of Consulting and Clinical Psychology,

42(6), 861–865.

Chen, L. S., Moeliono, M. A., & Amalia, L. 2016.

Functional Status of Stroke Patients at Neurologic

Outpatient Clinic Dr Hasan Sadikin General Hospital.

Althea Medical Journal, 3(1), 126–131.

Christensen, B. 2014. Barthel Index: Barthel Index.

Retrieved from

https://emedicine.medscape.com/article/2172491-

overview

Elisabet, &Taviyanda, D. 2013. Dependent level of

Activity Daily Living (ADL) to patients with stroke

infarction hemiparase. Retrived from

https://studylibid.com/doc/1050869/tingkat-

ketergantungan-activity-daily-living--adl-

Johnson, W., Onuma, O., Owolabi, M., & Sachdev, S.

2016. Stroke: A global response is needed. Bulletin of

the World Health Organization, 94(9), 634A–635A.

Kosasih, C. E. 2006. The Experience of Stroke Survivors

In Bandung, Indonesia. Sosiohumaniora, Vol. 8, 79–

91.

Krishnian, B., Leong, Lye, Johar, & Ismail. 2015.

Functional Status of Post Stroke Survivors. Med &

Health, 10(1), 32–36.

Lopez-espuela, F., Pedrera-Zamorano, J. D., Jimenez-

Caballero, P. E., Ramirez-Moreno, J. M., Portilla-

Cuenca, J. C., Lovado-Garcia, J. M., & Casado-

Naranjo, I. 2016. Fuctional Status and Disability in

Patients After Acute Stroke: A Longitudinal Study,

25(2), 144–151.

Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L.,

& Harding, M.M. 2017. Medical-Surgical Nursing:

Assessment and Management of Clinical

Problems (10th ed.). St. Louis: Elsevier.

Mahoney, F. I., & Barthel, D. W. 1965. Baltimore City

Medical Society Functional Evaluation : the Barthel

Index. Maryland State Medical Journal.

Marvin, K., & Zeltzer, L. 2017. Indeks barthel stroke.pdf.

Retrieved from https://www.strokengine.ca/assess/bi/

Nanda International Inc. 2015. Nanda International Inc.

Diagnosis Keperawatan: definisi & klasifikasi 2015-

2017. Jakarta: EGC.

Ratnasari, P., Kristiyawati, S. P., & Solechan, A. 2012.

Relationship between Activity Daily Living (ADL)

dependece and depresion on stroke patients in

Tugurejo general hospital Semarang,

1, 1–7.

Sawab, Bahrudin, M., & Daulima, N. H. C. 2015.

Experience of hopelessness in stroke. Ners, 10, 125–

132.

Relationship of Functional Status and Hopelessness among Stroke Patients