Pediatric Burn Case

As a student nurse, I was assigned an 18 month old burned boy. My instructor thought that the extra care and attention might be helpful to getting fluids and the like into him. This was in the 60's and non-flammable clothing was not yet mandatory for children. Well, this little fellow was in a sleeper, playing in the back yard while his dad burned yard rubbish. Somehow, he fell in or got close enough for the sleeper to catch fire. It was nylon, and sort of melted into the baby. He had third degree burns on his belly, second degree on chest face and arms.

He was in isolation, so we had to "suit-up" each time we entered the room. Every time someone entered, they were met with terrified screams from what looked like the Pillbury Doughboy with leprosy. As a student, at most I would be allowed to watch some proceedure, but I was not able to do anything, like start an IV or debried a site. But after about 10 minutes of listening to him scream, I realized that we all looked alike, blue monsters, with only the skin around our eyes to distinguish us. Our hair was covered with a white cap, our face with a blue mask, and our clothing with a blue gown that tied in the back. One blue monster would come in, gently tell him that he was going to get a shot, or scrub his leg, and then offer him OJ or tea. No wonder his intake PO was zero. I left the room, frustrated and distressed.

How could I communicate with someone who could barely speak, and who would not be quiet long enough to listen to the few words he did know. How did I get hime to know that I was a Good Nurse, not one of the ones who would hurt him?
I went in search of my instructor. Knowing that she had two students rotating through Recovery (post-op), I wandered in that direction. One of the nurses from surgery passed me, then another, pushing a Guerney in the same direction that I was heading in, and faster. I caught up with the second nurse and asked who was the charge nurse that day, and she replied that she was, and asked what I needed. "I know that look. What do you want?" When I explained, she laughed and said that that was easy. I returned to the surgical suit with her, got a cart from the hallway, and filled it with gowns, draped it and returned to Pediatric Services.

Calling on the Unit Clerk assistance, I wrote a couple of signs and pasted them to the wall above the carts. The first one said: These blue gowns are for painful and distressing procedures. When dressed in them, keep speech to a MINIMUM, Just tell him what you will do, do it and leave. These are the Bad Blue Nurses. The second one read: These green gowns are to be worn when providing food, or play. They never come into the room when painful procedures are being done, but can enter later, and comfort the child. These are the Good Green Nurses.

Then I went into the room dressed in green and cavorted around, singing a silly song about good green nurses serving candy, cookies and ice cream. Then I served him some ice cream, making appropriate train choo-choo noises or airplane sounds. He settled down, and I spent the rest of the shift playing with him, and leaving the room when Bad Blue Nurses come in. The following day I was rounding the corner when I saw one of the Peds nurses strip the blues, don the greens and rush back to comfort him. "Did that Bad Blue Nurse hurt you? I'm so sorry. I brought you a popcicle. A grape one. Isn't that tasty?" I gowned up in greens, and spent another day entertaining him. The floor nurse said that he had it all figured out, and would start screaming as soon as a Bad Blue came in, and never when a Good Green entered the room.

It made the rest of his stay much less stressful, both for him, and the staff.