In my continued endeavor to win Mother of the Year, I really racked up some points this week. 

Isaac, my youngest son, took a nice spill last Friday while skiing. 

He suffered what we thought was simply a sprained wrist. He complained little to not at all, and as a result, we waited five — yes, five! — days to have an X-ray, and only at the encouragement of the school nurse.

You see, Isaac, true to his name, always wears a smile and has one of the most fantastic giggles. The name Isaac is of Hebrew origin and means “laughter.” It is thought to derive its meaning from the fact that when Sarah and Abraham conceived, people laughed because they were so old. 

Perhaps it’s being the fourth in a line of five children and learning not to complain too much. 

Perhaps it’s his personality or a high threshold for pain. 

Either way, as a mother, when the doctor counts on his hands and says, “One, two, three, four, five … This happened FIVE days ago?”

“Yes, sir,” I say, looking down at the floor. “YEP!” Isaac says with a smile.

Long story short, his wrist wasn’t sprained. It was broken. After visits to urgent care and to the ortho for casting, we arrived home. Me exhausted and Isaac feeling pretty cool to show off his new, green cast. 

What I have learned from this experience, and what therapists all know, is that everyone experiences pain differently — emotionally and physically.

Recognizing physical pain

In the skilled nursing facility environment, physical therapists often encounter patients who may downplay or underreport their pain. It is crucial for therapists to adopt a keen observational approach to identify subtle cues that may indicate discomfort. 

Changes in facial expressions, body posture or even slight hesitations during movements can be indicative of underlying physical pain. Paying attention to verbal cues, no matter how subtle, is equally important. Patients may not always vocalize their pain outright, but careful listening can reveal valuable information about their physical well-being.

Moreover, understanding the patient’s medical history and the nature of their condition is essential. Some individuals may have a higher pain threshold, like Isaac, and may not express pain as overtly as others. Regular assessments and open communication are key components of providing effective pain management in a skilled nursing facility.

Unmasking emotional pain

Beyond physical pain, therapists in skilled nursing facilities must also be attuned to emotional distress. 

Patients, especially in long-term care settings, may grapple with feelings of isolation, anxiety or depression. It’s not uncommon for individuals to put on a brave face, concealing emotional pain beneath a smile. Therapists should create a supportive and open environment where patients feel comfortable expressing their emotions.

Encouraging conversations about mental well-being and actively listening to patients’ concerns can uncover emotional pain that might otherwise go unnoticed. Incorporating mental health assessments into the therapeutic process allows therapists to address both the physical and emotional aspects of pain, promoting holistic well-being.

Tailoring treatment approaches

Once physical or emotional pain is identified, therapists can tailor their treatment approaches to address the specific needs of each patient. In the case of physical pain, adjustments to exercise intensity, frequency or technique may be necessary. Collaborating with other healthcare professionals, such as physicians and nurses, ensures a comprehensive approach to pain management.

For emotional pain, therapists can integrate mindfulness techniques, relaxation exercises and therapeutic communication into their sessions. Building a strong therapeutic alliance with patients fosters trust and encourages them to share their emotions more openly. Additionally, involving patients in their care plans empowers them to actively participate in their journey toward recovery.

In conclusion, Isaac’s adventure with his broken wrist served as a reminder of the multifaceted nature of pain. As I boarded a flight this morning with a tug at my heart for leaving, I later learned Isaac was the first child up and ready to go to school today. Oh, the stories I am sure he will tell. 

In the skilled nursing facility setting, therapists play a pivotal role in recognizing and addressing both physical and emotional pain. By adopting a holistic approach, therapists can ensure that their patients receive comprehensive and tailored care, enhancing overall well-being.

Through keen observation, open communication and personalized interventions, therapists contribute significantly to the holistic healing of their patients. 

Renee Kinder, MS, CCC-SLP, RAC-CT, serves as the Executive Vice President of Clinical Services for Broad River Rehab. Additionally, she contributes her expertise as a member of the American Speech Language Hearing Association’s (ASHA) Healthcare and Economics Committee, the University of Kentucky College of Medicine community faculty, and an advisor to the American Medical Association’s (AMA) Current Procedural Terminology CPT® Editorial Panel, and a member of the AMA Digital Medicine Payment Advisory Group. For further inquiries, she can be contacted here.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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