Identifying barriers and facilitators to therapeutic cuddling in the paediatric intensive care unit: A survey guided by the theoretical domains framework
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".