The COVID-19 pandemic has radically changed how healthcare is delivered in the UK. Pharmacy professionals working across all clinical settings have had to adapt and transform how they provide pharmaceutical services. Individuals have been redeployed to front line practice or have returned from retirement. We have encountered clinical situations and scenarios that we are unfamiliar with, necessitating the rapid development of new skills and assimilating knowledge.
Often there is a limited evidence base or clinical precedent to resolve the problems encountered so solutions are found by going back to first principles or basic science. The critical analysis of information and decision making in complex environments has become a skill that is essential. COVID-19 is likely to be with us for the foreseeable future and the delivery of healthcare will need to continue to adapt to the ever-evolving situation.
How stress affects the ability to learn and make decisions
It is only natural to feel significant stress and anxiety in this unfamiliar situation. The Kübler-Ross change model, often referred to as the ‘five stages of grief’, concisely describes how individuals cope with change. Individuals progress through the stages of denial, anger, bargaining, depression and acceptance at different speeds. Challenging experiences provoke a stress response which may lead to blinkered thinking or feeling overwhelmed. Furthermore, long term stress can lead to both physical and mental health problems, resulting in an inability to move through the stages of change positively. To ensure that pharmacy teams continue to deliver the high quality care that is required, we need to develop strategies to actively reduce stress and learn to work in the new reality of healthcare during a pandemic.
Although stress can be powerful in the formation of new memories, conversely it can also impair learning. Individuals move from a flexible form of cognition to a more rigid habit-like approach during challenging times. The outcome of this is a loss of flexibility when dealing with new challenges and consequently an inability to adapt or learn in the new situation. The COVID-19 pandemic has caused radical change within the healthcare system. Individuals have also had significant personal challenges including worry about the virus itself, the social disruption of lockdown and the associated disturbance of support networks.
Continuing to learn and adapt under ongoing pressure
It was reassuring to see that, once the virus outbreak started, pharmacy professionals started to rapidly reach out to seek new knowledge to help them deal with the challenges they were facing. There was a surge of sharing of resources, information and support via social media platforms and other networks. Resources were rapidly produced by the Royal Pharmaceutical Society (RPS), UKCPA, e-learning for health, Specialist Pharmacy Services (SPS), and many other organisations. The speed with which webinars and guidelines were produced was unprecedented, particularly considering the pressures that the authors were under.
As the pandemic continues, lockdown restrictions begin to ease and we get used to that awful phrase of the “new normal”, individuals may be likely to ‘burn-out’. The continued levels of pressure and the disruption to everyday life will inevitably cause individuals to suffer with stress and mental health issues. The challenge now is how to maintain that initial enthusiasm to learn and continue to deliver high quality pharmacy services in the new healthcare landscape.
The outcome of [stress] is a loss of flexibility when dealing with new challenges and consequently an inability to adapt or learn in the new situation
In all sectors of pharmacy, how we deliver services and care for patients has radically changed. Supporting patients who are shielding, new clinical challenges, and workplaces that need to implement social distancing are all the reality of current pharmacy practice. The use of technology has increased dramatically and will only continue to grow.
Equally, the methods that pharmacy staff use to learn and develop have changed. Face to face meetings and learning events have all been postponed or cancelled. At the time of writing, the pathway to registration for Pre-Registration pharmacists is being transformed due to the pandemic, understandably causing considerable stress for individuals involved. Even pharmacy teams’ informal support networks, such as family and friends, have been disrupted, so the ability to seek advice when we encounter problems either clinically or personally is not easily accessible. It is essential that pharmacy professionals continue to access high quality education and support to enable them to adapt and maintain the standards of pharmacy practice, whilst also maintaining their own personal wellbeing.
Learning to cope with overwhelming information
The sheer quantity of new information related to COVID-19 can be overwhelming: new clinical guidelines and government advice is published on a regular basis, and it can feel very difficult to keep up to date with information. This is especially difficult as many decisions are made with a limited evidence base. Often the scenarios that pharmacy teams are encountering have not been researched and decisions need to be made on best available information or using the fundamental scientific principles. However, when overwhelmed with sheer volume of information, decision making becomes more difficult because the usual patterns and contextual clues that aid cognitive processes are altered.
Here is some advice on how you can continue to learn, adapt and support each other through the ongoing pressure of the COVID-19 pandemic:
- There are numerous organisations producing guidance to condense new information into a manageable format. Resources such as the Specialist Pharmacy Services (SPS) medicines guides, NICE rapid guideline and evidence summaries or royal college and speciality groups advice all provide easy access summaries. The challenge is to apply this new knowledge into practice.
- It is often our experiences that drive learning. By utilising a suitable reflective model, individuals can identify their learning needs and develop strategies to learn.
- Mental health and wellbeing are fundamental to enable effective learning and stress can impede learning. Engaging with self-reflection can help to manage stress and therefore enable learning. Trying to focus on positive experiences will help promote critical thinking.
- It can be challenging to highlight positives when dealing with stressful situations. Talking to others and engaging with support networks can help by allowing you to view problems from different perspectives. The lockdown and social isolation of COVID-19 can often feel like we are in our own bubble, but sharing experiences with others can reveal that challenges are being experienced across the family of pharmacy. Peer support may not be accessible face to face but virtual networks (such as the UKCPA forums) and IT solutions have dramatically changed how we can share and collaborate.
- Support can be sought not just from pharmacy professionals but also the wider multi-disciplinary team. Enabling individuals to make sense of their experiences, apply learning into practice and utilise support from others, will ensure that pharmacy services maintain high standards of care and support individuals’ confidence to make decisions in these challenging times.
- Pharmacy already has robust structures to enable these conversations, including GPhC revalidation methods and RPS developmental pathways. Learning tools such as practice based assessments (such as case-based discussions) provide structure to aid reflection. By using a planned approach with support from others, individuals can progress their development rapidly towards expertise.
The COVID-19 pandemic has presented unprecedented challenges to pharmacy practitioners across all sectors and locations. Education and learning are essential to enable pharmacy teams to continue to adapt and provide high quality patient care. We would encourage you to continue to access high quality learning resources, seek support to aid your learning and reflect upon your experiences to respond to changes. We need to ensure we look after our own mental health and stress to enable us to respond, adapt and learn to face the challenges that COVID-19 continues to present.
The opinions expressed in this article are those of the authors. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.
Competing interest statement:
The authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.