Unsettling the fluidity of practice and dealing with threat: the experiences of paediatric pharmacists in response to the admission of adult COVID-19 patients requiring intensive care in a paediatric tertiary hospital.

Objectives
The Covid-19 pandemic impacted the lives of pharmacists, resulting in new ways of working. Little literature focuses on the experiences and well-being of hospital pharmacists, particularly on paediatric pharmacists. The setting - a paediatric stand-alone tertiary hospital - opened to adult ICU COVID-19 patients for two time periods. Paediatric pharmacists had to shift their roles; this impacted their well-being. Paediatric ICU clinical psychologists provided support using a compassion-focused therapy (CFT) model to guide thinking, reflection and promoting behaviour change.
This study aimed to explore the experiences and perceptions of the paediatric pharmacists working in a paediatric stand-alone tertiary hospital prior to, during and after the admission of adult COVID-19 patients into ICU and their experiences of support offered by clinical psychologists.

Methods
A qualitative interpretative design using remote photo-elicitation interviews was adopted. Data analysis was undertaken using the six stages of reflexive thematic analysis.

Key findings
Five paediatric pharmacists participated; four deployed to work in the A-ICU (from PICU) and one deployed to work in the PICU (from ward-based work).
An overarching theme, ‘Unsettling the fluidity of practice and dealing with threat’, supported by four key themes ‘Context and preparation’, ‘Dread and challenges’, ‘Keeping it together’, and ‘Lessons learned’. The fluidity of the pharmacists’ practice was unsettled as they dealt with the threats and sought resources (drive) to enable optimal care delivery. Soothe techniques helped compensate threats, promote resilience and well-being.

Conclusion
The CFT model has been useful in the longer-term with the adoption of a more open, compassionate approach to their work and colleagues.