1. __________________ ’S COPING PLAN
Here are some of Marty’s coping
ideas that we can try to help make
pokes less painful and scary.
Choose a few that interest you!
□Swaddling or held close
□Comfort positioning
□Personal blanket or toy
□Music, singing, or soft voice
□Light-up or sound toys
□Numbing cream □SweetEase
□Cold Spray □Buzzy
□Blowing Bubbles □Counting
□Deep breathing □Stress ball
□Search & find book □iPad
□Guided Imagery □Music
□Conversation □TV/movie
What is a coping plan?
The purpose of this coping plan is to provide you and your family with the
opportunity to express your preferences when it comes to needle pokes.
There are many ways that we can try to help so needle pokes are not as
uncomfortable. We encourage you and your family to fill out the coping plan
together. Please, complete your coping plan, return it to your nurse or child
life specialist, and feel free to express any questions or concerns that you
may have. Thank you!
For the Parent or Caregiver:
I would like to be present in the room when my child gets a needle poke.
□Yes □No □Unsure
For the Patient:
How would you describe your own experience(s) with needle pokes?
□No Problems □Stressful/Worried/Afraid □No Previous Experience
If you have had a previous experience, is there a best spot to poke?
□Yes □No □No Previous Experience
If yes, where? _____________________________________________
During a needle poke, I would like:
□Staff to count so I know when it will happen or □Staff not to count
□To watch what is happening or □Not to watch what is happening
□To sit on parent/caregiver’s lap or □To sit by myself
HELP US HELP YOU!
(Patient’s Name)
Staff & Parent/Caregiver Comments: What worked well?
This patient (did / did not) require extra staff to assist with
holding during the poke.
FOR NEEDLE POKES
This Coping Plan was adapted from and developed with assistance from the University
of Iowa Children’s Hospital and the University of Iowa Health Care.

2. COPING PLAN
What is a coping plan?
The purpose of a coping plan is to provide patients and their families with the opportunity to express their
thoughts when it comes to time spent in the hospital. There are many ways that hospital staff can try to
help make patients and their families more comfortable. Staff should encourage the patient and his or her
family to fill out the coping plan together. There are no right or wrong answers. After the coping plan is
completed, it should be collected and posted near the white board in the patient’s room. It should be easy
to access and read so that other staff members can utilize the coping plan as they enter the patient’s
room and interact with the patient and family throughout hospitalization.
Which coping plan should I use?
There are two types of coping plans available to choose from. You may choose one or the other, or both!
Coping Plan for Needle Pokes
The first coping plan is blue and green. It is designed specifically to address a patient’s experiences with
needle pokes. Needle pokes are often times the worst part of a child’s hospital experience. The coping
plan for needle pokes will be available for all staff to utilize. It will have information including:
 Patient and family preferences such as where he or she would like to be during the needle poke. Par-
ents may prefer to leave the room or remain present. Patients may want to be positioned alone, or on
a parent/caregivers lap
 Tips for what a staff member can do during a needle poke such as counting for the poke, using cold
spray or applying a numbing cream prior to the poke
 If the patient has had a previous needle poke, perhaps they can provide information for where the
needle poke has previously been successful.
 If the patient requires other staff to be present in the room to help with holding for the needle poke
This coping plan is designed to be quick, easy and efficient for patients and families to fill out. The majori-
ty of the coping plan can be filled out by just checking appropriate boxes. The simple design is to help
staff members such as nursing and phlebotomy, have easy information to reference for a needle poke.
Coping Plan
The second coping plan is orange and gray. It is designed to help address feelings or preferences that
the patient and family may have regarding their overall hospital experience. This coping plan may be used
for patients who do not have issues with needle pokes; however, it can also be used in addition to the
Coping Plan for Needle Pokes.
This coping plan has open-ended questions which will help prevent omission of certain methods of coping
that are not readily observable by others. The open-ended questions facilitate responses from the child’s
point of view and frame of reference, which more adequately will reflect the child’s perception, attitudes,
and knowledge of coping strategies. This coping plan is ideal for older school-aged patients through ado-
lescent patients. Parents/caregivers should be encouraged to help their child fill out this coping plan.
This coping plan also has a section for patients and families to share some of the patient's interests. This
is a quick and easy reference for staff to use if the patient is looking for something to do while in his or her
room. These activities may be found in the playroom or in the teen lounge in the Pediatric Unit.

3. COPING PLAN
Why should I use a coping plan?
A coping plan will help facilitate preparation and implementation of coping strategies and is ideally a col-
laborative effort. Interdisciplinary communication and understanding enhances this collaboration. A coping
plan that requires collaboration will not only benefit the patient, but will also help enhance communication
and understanding between the patient, patient’s family, and patient’s care providers. Collaborative work
promotes an environment in which psychological preparation, coping, and individualized needs can be
addressed; therefore, delivering a better quality of care.
Quality of care is important and with the costs of health care today, patients and families expect the best
services possible. To evaluate these services, patient satisfaction surveys are utilized to address a patient
and family’s comfort levels throughout their hospital stay. A coping plan will help benefit the survey results
and increase patient satisfaction as it enhances communication, understanding and individualizes the pa-
tient’s overall health care experience.
When should I use a coping plan?
A blank coping plan should be administered to each pediatric patient/family receiving medical care. Cop-
ing plans should be completed within 24 hours of admission and should be reviewed by the nurse and
child life specialist to address potential questions or concerns. If a patient is unable to complete his or her
own coping plan a parent should be encouraged to complete it to the best of their ability. The coping plan
should then be posted near the white board in the patient’s room so that it is easy for staff to access and
read.
Check for the patient’s coping plan upon entering the room or when meeting for the first time. The coping
plans will have valuable information that you can utilize while providing health care services.
What are other things that I can do to help the patient and
family’s overall medical experience?
Contact a Child Life Specialist.
A Child Life Specialist is a certified professional who can provide developmentally appropriate preparation,
coping techniques, and distraction/support to help the child get through a medical event or procedure.
Look for the Child Life Specialist contact cards located in your work area or request to have one available.
Consider a pain relief measure.
 Buzzy: Buzzy uses vibrations and a wing-shaped cold pack to confuse the patient’s pain receptors
from the poke and can also help decrease pain that is present. It may be placed above the area of the
poke, “between the pain and the brain.”
 Numbing Cream (EMLA, LMX): This is a topical anesthetic that is applied on the skin to help numb it.
In order to have full effect, the cream should be placed on the skin about 30-45 minutes prior to the
poke.
 Cold Spray (Ethyl Chloride Spray): This spray has an instant effect and can be applied to the skin
directly before the needle poke. It helps numb the skin for up to a minute. For full effect, spray on the
skin for 7-10 seconds prior to the poke.
 SweetEase (Sucrose): This is a sugar water solution that can be used by dipping a pacifier or a
gloved finger from the solution to an infants mouth. It appeals to an infant’s taste buds and confuses
pain receptors in the brain often resulting in a less stressful procedure that may be invasive. It is ideal
for patients who are six months of age or younger.

4. COPING PLAN
What are other things that I can do, continued...
Encourage comfort positioning.
The purpose of comfort positioning is to increase the comfort of the patient, as well as the parent/
caregiver and the medical staff. A comfort position on a parent or caregiver’s lap may be more sup-
portive and effective rather than holding a child down. Some examples of comfort positioning are pic-
tured below. Look for the Positioning for Comfort posters located in your work area or request one
through Child Life.
Choose words carefully when communicating with children and families.
Many words have double meanings. In the medical setting, there are many that should be avoided
when possible. When using medical terms, always explain in a developmentally appropriate manner.
Use concrete examples that are familiar to children.
For example:
 An IV: “A tiny, bendy, straw that gives your body medicine or food”
 A shot: “Medicine through a tiny straw”
 A tourniquet: “A rubber band that gives your arm a tight hug”
 An alcohol prep pad: “A tiny washcloth to clean your skin”
Be direct and honest while also using an approach that maintains trust. Avoid setting up negative sug-
gestions and give the child options/choices.
For example:
 “How would you like it to feel?”
 “Some kids say it feels like….I wonder how it will feel for you?”
References:
Boyd, J., & Hunsberger, M. (1998). Chronically ill children coping with repeated hospitalizations: Their perceptions and
suggested interventions. Journal of Pediatric Nursing, 13(6), 330-341.
This Coping Plan was adapted from and developed with assistance from the University of Iowa Children’s Hospital and the
University of Iowa Health Care.