my kingdom for some corn porridge

Yesterday, I mentioned that sometimes colouring books are as good as morphine for controlling pain after surgery. I felt a little sheepish admitting how often we use crayon therapy. (Enough for it to be the first thing I think of and shout out in front of all my colleagues who were trying to actually get some education out of the session.) But today, we did a clinical trial, testing out different types of pain relief in the pediatric orthopedic patient. This trial was scientific and controlled and peer reviewed and by golly we got some important results!

It turns out that crayon therapy is only marginally effective in the presence of yovophobia. In cases where the patient suffers from a severe case of this disorder (as evidenced by screaming, flailing and shrieking in the vicinity of white people), more intense methods of pain management are in fact indicated. For patients with yovophobia and post-operative pain, it would appear that bubbles are an excellent adjuvant to crayons and colouring books, as long as the yovo operating the bubble wand stays a minimum of three feet from the bed.

In some pediatric patients, the assessment of pain is confounded by a profound sense of the dramatic. Case Study: Rachel. Rachel required only minimal pain medications overnight, when the wards were dark and she couldn't tell that people were actually looking at her. Once the lights were turned on in the morning, Rachel got dramatic, screaming in simulated pain whenever two or more healthcare professionals approached her bed. This drama was especially pronounced when her cast was being re-taped, leading onlookers to believe that she was in serious distress. However, in the case of the dramatic patient, our study has shown that a balloon tied to a magnetic hook on the ceiling and hung above the bed is as effective, if not more so, than any medications available. This was clearly demonstrated in Rachel's ability to squeal with laughter as she batted her balloon around, mere seconds after writhing in what she would have us believe was pain.

One other important case to note is that of four-year old Komlan. Komlan spent his entire pre-operative course wandering around the ward like a tiny cowboy, wrapped in nothing but a towel. In addition, he was often to be found singing in the shower. In patients like Komlan, it is imperative to understand that clothing can increase pain. It's best to allow these patients to be as naked as possible, covered only in a generous layer of baby powder. It's also advisable to sing often and loudly near their beds, as this will make them feel comfortable and will greatly reduce discomfort.

There was only one type of pain we were unable to control on the wards today. It's a type of pain rarely seen in the pediatric patient, but it can be absolutely devastating to the child; the hunger for corn porridge. When the patient suffers from hunger for corn porridge, there is absolutely nothing that can be done. Stickers, bubbles, balloons and crayons will be ineffective in controlling this pain, and the child can be expected to scream nonstop for periods exceeding an hour at a time. Patients suffering from hunger for corn porridge are often young, (in this case under three years of age) and will not understand your reasoning when you explain that crying so hard for corn porridge is going to make the doctors think you're in pain. And if they think you're in pain, home to your corn porridge is the last place you're going. There is an inverse correlation between the distance of the nurse from this patient and the decibel level of his screams.

And there you have it. There's nothing like evidence-based practice for making you a better nurse.

Unless, that is, you have a bowl of corn porridge on you somewhere?