Search

Background People with dementia and their informal caregivers get in touch with the healthcare system predominantly via contacts with primary care providers. Among these, community pharmacists have been denominated as the health professionals most accessible to the public. Communication with and counselling people with dementia and their informal caregivers present particular challenges to pharmacists. Aim This study aims to research the challenges faced and strategies used by community pharmacists who deal with people living with dementia and their informal caregivers. Methods Within the context of two workshops with 74 participants, 15 small groups were formed, each of which generated and discussed a small story. Fourteen of those narratives were reported, tape recorded and transcribed. In these 14 narratives, community pharmacists reflected on their experiences with people with dementia or their informal caregivers. The narratives were systematically analysed and interpreted. Findings Among the main challenges reported by the workshop participants are the difficulty of identifying a person with dementia; the question of what appropriate communication is; the only partially successful networking with doctors, nursing personnel and support institutions; unsuccessful counselling; and the tension between the economic situation and the care for people with dementia and their informal caregivers. In general, strategies for dealing with people with dementia are characterised by uncertainty whereas communication with informal caregivers is well rehearsed and effective. Conclusions Community pharmacies require possibilities to retreat for counselling as well as the possibility for pharmacists to take time for people with dementia and their informal caregivers in everyday pharmacy life. Reflective spaces for narrations about difficult situations provide relief for staff in community pharmacies.

The need for integrated, accessible and person-centred care for people with dementia to foster quality of life and facilitate life in the community has been voiced by health policy. Pharmacies have the potential to provide easily accessible information and support for people with dementia, caregivers and the public. The ‘Dementia-friendly Pharmacy’ programme aimed at re-orienting community pharmacy in Austria, focusing on stronger inclusion of professional counselling into core services. It followed principles of health promotion and person-centred care, aiming at empowering all actors involved, and at fostering quality of life. Methodologically, the programme was based on participatory health research, thus involving all relevant actors and consolidating their perspectives on issues related to dementia care. In the course of the programme, a workshop series covering topics relevant for dementia care in community pharmacy, as well as prototypes for small-scale projects were developed, and measures were taken for securing sustainability. Findings related to programme development and implementation encompass pharmacy staff’s motivation to participate in the programme, counselling knowledge and skills development, experience with building community partnerships and cross-organizational development and sustainability. Furthermore, effectiveness of the programme has been established. These findings are discussed against the background of re-orienting pharmacies.

Background: Caring for and caring about people with dementia require specific communication skills. Healthcare professionals and family caregivers usually receive little training to enable them to meet the communicative needs of people with dementia. This review identifies existent interventions to enhance communication in dementia care in various care settings.Methods: We searched MEDLINE, AMED, EMBASE, PsychINFO, CINAHL, The Cochrane Library, Gerolit, and Web of Science for scientific articles reporting interventions in both English and German. An intervention was defined as communication skills training by means of face-to-face interaction with the aim of improving basic communicative skills. Both professional and family caregivers were included. The effectiveness of such training was analyzed. Different types of training were defined. Didactic methods, training content, and additional organizational features were qualitatively examined.Results: This review included 12 trials totaling 831 persons with dementia, 519 professional caregivers, and 162 family caregivers. Most studies were carried out in the USA, the UK, and Germany. Eight studies took place in nursing homes; four studies were located in a home-care setting. No studies could be found in an acute-care setting. We provide a list of basic communicative principles for good communication in dementia care. Didactic methods included lectures, hands-on training, group discussions, and role-play.Conclusion: This review shows that communication skills training in dementia care significantly improves the quality of life and wellbeing of people with dementia and increases positive interactions in various care settings. Communication skills training shows significant impact on professional and family caregivers’ communication skills, competencies, and knowledge. Additional organizational features improve the sustainability of communication interventions.

This chapter focuses on communities, their resources and organizational structures, and their procedures aiming at 'increasing their community's resilience, support, and openness toward those affected by death, dying, and loss'. It describes issue of dementia-friendly community pharmacies, as a frame of reference. The main responsibility of a community pharmacy is to provide medicines to the general population, which includes the management of pharmacotherapy, health education and counselling. The chapter overviews situation of community-based dementia care in German-speaking countries, as well as on the health and social care system in Austria and its uptake of issues related to dementia. Palliative care plays an important role in dementia care. The chapter speaks about 'direct participation' when for example caregivers and pharmacy staff meet in person to speak for themselves. It concludes by discussing some implications for further engagement of healthcare settings like community pharmacies in the development of compassionate communities.

Ethics and gender issues in palliative care in nursinghomes: an Austrian participatory research project. International Journal of OlderPeople Nursing 9, 131–139. doi:10.1111/opn.12049Background. The development of palliative care in nursing homes in German-speaking countries has gained in importance within the past 15–20 years. Ethicaland gender issues are core aspects of a palliative care culture and should therefore bebetter understood.Aims and objectives. The aim of this study was tohighlight insights regarding ethicaland gender issues, based on the experiences of professionals in nursing homes.Design. A 2-year participatory action research study was performed in collaborationwith three nursing homes in Austria.Methods. The article focusses on 10 group discussions with interdisciplinaryprofessional teams that were conducted to generate ethical narratives. Thematic andnarrative analysis was undertaken both individually and within the interdisciplinaryresearch team. Findings and interpretations were validated with practitioners andresearchers.Findings. Atotalof36narrativeswerecollectedandsummarisedwithineightthemesconcerningthetheoreticaljourneyofanursinghomeresidentwithrelativesfromentryinto the house until death. The most burdensome ethical dilemmas are not the onesaround death and dying but rather those relating to small-scale everyday work/lifeissues.Sharingexperiencesandfeelingsinethicaldiscussionsprovidesrelief.Emotionsare important facilitators of insight into ethical dilemmas. Gender issues can beobservedincaresituationsaswellasintheorganisationalstructureofnursinghomes.Conclusions. Opportunities to share experiences and perspectives around ethicalquestions in interdisciplinary group discussions help professionals to betterunderstand difficult issues and find appropriate ways of managing them.Implications for practice. There is a need for communication structures such asfacilitated ethical discussions that enable nursing home staff to reflect their everydaydecisions. Expression of emotions should be encouraged in ethical decision-makingprocesses in nursing homes. Gender-sensitive reflection supports the development ofpalliative care as organisational culture.Key words: ethics, gender, long-term care, palliative care, participatory research

Background Inspired by the Ottawa Charter for Health Promotion, which is a major point of reference also for the “Compassionate Communities”, we would like to propose that communities consolidate various settings like schools, workplaces, and health care organisations like community pharmacies, all of which might be included in a compassionate communities approach. Aim We aim at enabling community pharmacies to offer informal consulting and support for people with dementia and their informal caregivers. Furthermore we want to support pharmacies to reach out in the community through various activities. By this means the project seeks to contribute to de-stigmatising dementia. Method The project is based on the approach “Participatory Health Research” (Hockley, Froggatt, Heimerl 2013; Wright et al. 2010). The core elements of the approach are participation, action and reflection. Approximately 40 staff (almost exclusively women) in 18 community pharmacies actively participates in the project, i.e. needs assessment, interactive workshops, practice projects and evaluation. People with dementia and their informal care givers are included in the needs assessment and in different steps of the programme. Results Community pharmacy staff raised several issues, closely related to communication, counselling and providing advice in a community pharmacy setting: They believe further development of professional practice to be important, since dementia care will become a more prominent issue for the community pharmacy. Moreover, a high frequency of contact with people living with dementia and their caregivers was reported by the majority of staff. Professional competencies related to dementia care are a key issue, and community pharmacy personnel viewed their practice with a critical eye: Communicating with disoriented persons poses some challenges, as does communicating with caregivers. Conclusion In the still ongoing project the raised issues are being dealt with in practice projects that are performed by the pharmacies with the support of the project staff. Several projects reach out to the community through self-help groups, cinema performances, public presentations and discussions. Informal care givers have engaged in direct contact with the included pharmacies and become part of selected practice projects. People with dementia have been included in the needs assessment and the design of the project logo.