Introduction
This essay examines the long-term condition of stroke through the fictional case study of Bayani Grigoryan, a 73-year-old retired lecturer who recently suffered a stroke affecting the left side of his brain. Stroke is a significant health concern in the UK, with approximately 100,000 people experiencing a stroke each year (Stroke Association, 2023). It is a leading cause of disability, often resulting in physical, cognitive, and emotional challenges for individuals and their families. The impact on family dynamics, particularly for caregivers like Bayani’s wife, Ch arra, can be profound, with increased stress and health concerns. This essay will explore key themes related to Bayani’s condition, including the pathophysiology of stroke, its psychosocial implications, coping strategies, and appropriate nursing assessments. The focus remains on understanding Bayani’s experience to inform nursing practice.
Altered Physiology and Signs & Symptoms
A stroke occurs when blood flow to part of the brain is interrupted, either due to a blockage (ischaemic stroke) or a rupture (haemorrhagic stroke), leading to brain cell damage (NHS, 2022). In Bayani’s case, the stroke affected the left side of his brain, likely involving areas such as the motor cortex and Broca’s area, which are responsible for movement and speech production, respectively. This explains his right-sided weakness, expressive aphasia (difficulty in producing speech), and dysphagia (difficulty swallowing). The left hemisphere’s role in controlling the right side of the body accounts for Bayani’s poor mobility, as damage to the motor pathways disrupts voluntary movement (Feigin et al., 2017). Similarly, aphasia arises from impaired language processing, often causing frustration, as seen in Bayani’s slow speech recovery.
Physiologically, the brain’s lack of oxygen during a stroke triggers cell death, inflammation, and oedema, exacerbating damage. This can contribute to secondary symptoms such as headaches and nausea, which Bayani experienced prior to the stroke, possibly indicating early warning signs or related vascular issues (Feigin et al., 2017). Dysphagia, another critical symptom, results from impaired coordination of swallowing muscles due to neurological damage, increasing the risk of aspiration and malnutrition (Smithard, 2016). Bayani’s physical wellbeing is thus significantly affected, with reduced independence in mobility and self-care, necessitating assistance from his wife.
Furthermore, the impact on Bayani’s mental wellbeing is evident through his anxiety and emotional lability. Post-stroke depression and anxiety are common, affecting around one-third of survivors due to neurochemical changes and the psychological burden of disability (Hackett et al., 2014). Bayani’s reluctance to be left alone and withdrawal from community activities suggest feelings of isolation, compounded by his frustration with slow speech improvement. These symptoms highlight the interplay between physical deterioration and mental health challenges, illustrating the holistic impact of stroke on an individual’s life. Research emphasizes that early intervention, such as physiotherapy and speech therapy (as provided to Bayani), can mitigate some physical deficits, though emotional recovery often requires longer-term support (Feigin et al., 2017). Bayani’s case underscores the need for integrated care that addresses both bodily and psychological needs.
Assessment & Care
To monitor Bayani’s physical deterioration, particularly his right-sided weakness and poor mobility, the Barthel Index is a suitable assessment tool. This scale measures a patient’s level of independence in activities of daily living (ADLs), such as mobility, dressing, and toileting, with scores ranging from 0 (completely dependent) to 100 (fully independent) (Mahoney & Barthel, 1965). It is administered through direct observation or patient/caregiver interviews, allowing nurses to quantify functional ability over time. For Bayani, assessing mobility with the Barthel Index would highlight specific deficits, such as his refusal to use a walking stick, which increases fall risk—a critical concern given his history of stroke (NHS, 2022).
Upon detecting acute deterioration, such as a significant drop in Barthel scores indicating worsening mobility, nurses must respond promptly. Immediate actions include a comprehensive falls risk assessment using tools like the Morse Fall Scale and implementing safety measures, such as ensuring a clutter-free environment and providing temporary mobility aids (Stubbs, 2011). Furthermore, nurses should collaborate with physiotherapists to reinforce mobility training and educate Bayani on the importance of using prescribed aids. Evidence suggests that consistent multidisciplinary intervention post-stroke improves functional outcomes and reduces secondary complications (Langhorne et al., 2011). Prioritising nursing care for Bayani would involve regular monitoring, patient education on risk prevention, and emotional support to encourage adherence to mobility aids, thereby enhancing safety and promoting gradual independence.
Integrated Psychosocial Care
Bayani’s case reveals significant psychosocial challenges, particularly related to emotional lability and social isolation. Emotionally, Bayani’s increased anxiety and tendency to become very emotional post-stroke reflect a common psychological response among survivors. Research indicates that up to 31% of stroke patients experience anxiety, often triggered by fears of dependency or recurrent strokes (Hackett et al., 2014). This impacts nursing care by necessitating empathetic communication and mental health screening using tools like the Hospital Anxiety and Depression Scale (HADS). Nurses must provide reassurance and facilitate access to counselling or support groups, though Bayani’s reluctance to engage with outsiders may pose a barrier, requiring a sensitive, family-focused approach.
Sociologically, Bayani’s withdrawal from community voluntary work and preference for immediate family interaction highlight a shift in social identity. Stroke often disrupts social roles, leading to isolation, as individuals grapple with perceived stigma or reduced capacity (Northcott et al., 2016). For nursing care, this underscores the importance of assessing social support networks and encouraging gradual reintegration, potentially through family-mediated community activities. Culturally, Bayani’s and Ch arra’s emphasis on independence may reflect personal or societal values, influencing their reluctance to accept external help. Nurses must respect such beliefs while tactfully discussing available support, ensuring culturally competent care that balances autonomy with safety (Northcott et al., 2016). Addressing these psychosocial dimensions holistically can enhance Bayani’s wellbeing and support his wife, who faces her own health concerns.
Coping
Bayani’s coping strategies post-stroke reveal a complex interplay of individuality, fears, and beliefs. His frustration with slow speech recovery and anxiety about being alone suggest a struggle to adapt to his new reality, reflecting an internalised fear of dependency. Such emotional responses are common among stroke survivors, who often grapple with a loss of control over their bodies and roles (Northcott et al., 2016). Bayani’s background as an independent, community-active individual likely intensifies this frustration, as his self-identity clashes with current limitations. His refusal to use a walking stick further indicates a denial or resistance to accepting help, possibly rooted in a belief that doing so signifies weakness.
Moreover, Bayani’s concern for his wife’s health, particularly her recent chest pain, adds an additional layer of stress, potentially hindering his coping capacity. Research suggests that caregiver burden reciprocally affects patient wellbeing, creating a cycle of mutual anxiety (Hackett et al., 2014). Nurses can support Bayani by acknowledging his unique concerns and tailoring interventions, such as involving Ch arra in therapy sessions to alleviate isolation fears. Encouraging small, achievable goals in speech and mobility can also foster a sense of agency. Ultimately, Bayani’s coping is shaped by personal values and emotional fears, requiring individualised, empathetic nursing care to rebuild confidence and resilience in managing his long-term condition.
Conclusion
This analysis of Bayani Grigoryan’s fictional case study highlights the multifaceted impact of stroke on physical, emotional, and social wellbeing. Key learning points include the physiological basis of symptoms like right-sided weakness and aphasia, the necessity of structured assessments like the Barthel Index for monitoring deterioration, and the importance of psychosocial care in addressing anxiety and isolation. These insights can be applied to nursing practice by emphasising holistic, patient-centered care that respects individuality and cultural values. For Bayani, this means integrating physical rehabilitation with emotional support and family involvement. Ultimately, this case underscores the need for nurses to adopt a comprehensive approach, ensuring both immediate care needs and long-term coping strategies are addressed to improve quality of life for stroke survivors and their families.
References
- Feigin, V.L., Norrving, B., and Mensah, G.A. (2017) Global burden of stroke. Circulation Research, 120(3), pp. 439-448.
- Hackett, M.L., Anderson, C.S., House, A., and Xia, J. (2014) Interventions for treating depression after stroke. Cochrane Database of Systematic Reviews, (10), CD003437.
- Langhorne, P., Bernhardt, J., and Kwakkel, G. (2011) Stroke rehabilitation. The Lancet, 377(9778), pp. 1693-1702.
- Mahoney, F.I. and Barthel, D.W. (1965) Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, pp. 61-65.
- NHS (2022) Stroke. NHS Choices.
- Northcott, S., Moss, B., Harrison, K., and Hilari, K. (2016) A systematic review of the impact of stroke on social support and social networks. International Journal of Language & Communication Disorders, 51(2), pp. 111-133.
- Smithard, D.G. (2016) Dysphagia management and stroke units. Current Physical Medicine and Rehabilitation Reports, 4(4), pp. 287-294.
- Stroke Association (2023) Stroke Statistics. Stroke Association.
- Stubbs, B. (2011) Falls in older adult psychiatric patients: Equipping nurses with knowledge to make a difference. Journal of Psychiatric and Mental Health Nursing, 18(5), pp. 457-462.
