Identifying barriers and facilitators to therapeutic cuddling in the paediatric intensive care unit: A survey guided by the theoretical domains framework

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OBJECTIVE: The objective of this study was to describe barriers and facilitators to paediatric intensive care unit (PICU) therapeutic cuddling (TC) perceived by healthcare professionals (HCPs). BACKGROUND: TC is a potential intervention to prevent/manage pain, agitation, delirium, and analgosedation exposure in PICUs. However, it is not widely practiced. Given the complexity of TC in critically ill children, PICU HCPs' perspectives of barriers and facilitators are essential to inform implementation and evaluation. METHODS: A cross-sectional survey, guided by the Theoretical Domains Framework, was administered to PICU HCPs between December 2023 and July 2024. Items were asked based on age groups of patients (<1, 1-2, 3-4, 5-8, 9-12, and >12 years) and severity of illness. Nominal data were summarised using frequencies (percentage) based on the number of responses received per item. Subgroup analyses were conducted for professions with five or more respondents for items related to professional role and TC. Free-text responses were analysed utilising inductive and deductive content analysis. RESULTS: Respondents (n = 228) were predominantly women (88.6%), nurses (60.1%), physicians (17.1%), or respiratory therapists (11.8%). Most respondents (67.9%-86.4% depending on patient age group) agreed it was possible to provide TC to all PICU patients. However, respondents reported rarely (4.3%-52.6%) or never (0.5%-35.6%) observing/participating in TC, depending on child age group, with a larger proportion reporting rarely or never as age group increased. Potential determinants affecting the implementation of TC in PICUs were identified for all 14 domains of the Theoretical Domains Framework. Concerns about patient safety, staffing, and lack of supportive unit culture were identified as key barriers. Family engagement and partnership and beliefs about positive consequences were key facilitators. CONCLUSIONS: Most PICU HCPs believe that TC can be implemented for all critically ill children. Important barriers include concerns about safety, staffing, and lack of a cuddling-supportive culture. Leveraging patient and family engagement is a key facilitator to support implementation of this intervention.

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