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Urinary and faecal incontinence are common in the older population, yet incontinence is not a normal part of ageing. Dementia can impact upon a person’s ability to remain continent, yet incontinence is unlikely to be a symptom of dementia until the latter stages of disease progression. There is a misconception that nothing can be done if a person with dementia experiences episodes of incontinence. However, many people with dementia often experience functional incontinence caused by immobility, communication difficulties, disorientation, or the inability to find the toilet, which can all be alleviated if the right support and advice is available. Improving the identification, assessment and management of continence issues can not only enable people with dementia to maintain their dignity and improve their health, but also their sense of wellbeing and quality of life. There is also the possibility to improve relationships, reduce carer burden, and reduce the risk of a premature transition into a residential care setting. This fourth paper in the series explores some of the issues relating to dementia and continence and the impact as experienced by our two case studies, Dhriti Singh and Gregory Brewin.

The author’s trust, Leeds Community Healthcare NHS Trust, has a dynamic methodology around quality and service improvement called ‘Making Stuff Better’. It is a simple phrase, but holds some meaningful principles which the staff aim to follow. 
The first is that everyone can make stuff better at work — we can all have ideas that can result in a positive difference. The second is promoting a culture of service improvement, where this approach can just happen and flourish.

The day we got the announcement from the Care Quality Commission (CQC) confirming our nursing and telehealth service had been awarded ‘outstanding’, I felt so proud. I also thought about all the NHS nurses who are so incredibly tired and hardworking, and I wished they could all be told they too are outstanding. For after the 18 months they have had, they completely deserve it. 
Of course, I already knew that the staff we have and the service we provide is truly outstanding, but having the CQC confirm this, is such a fantastic recognition of the hard work the team at Coloplast put in every single day to make life easier for people living with intimate healthcare needs. Receiving this rating means that Coloplast is the only one in its field to have received an ‘outstanding’ rating for a service like this in England.
Our extensive experience in developing products and services for people with deeply personal medical conditions, which are often associated with trauma and taboo, means that we know it makes sense to be able to deliver care based around a person, removing some of the administrative burden, plus treating them, where possible, in a place of their choice. This administrative burden includes finding information about lifestyle, returning to work, going on holidays, diet and nutrition. We can also arrange for the collection of the GP prescription when needed and signpost to other sources
or support services.
Our CQC accredited service can be trusted to deliver for patients, their families and the NHS.

In the late ‘80s, Soul II Soul released the song ‘Keep on Movin’. At the time, I thought I was invincible. I was European and Commonwealth 400m champion and it became the anthem for my trackside warm-ups. Back then, I didn’t think about my fragility or the fact that I had a congenital heart condition to consider every time I stepped onto the track. I kept on moving. And fast. It all changed when I broke my foot and was on crutches for several months. I would have given anything to get moving again; to compete for Great Britain and challenge for medals on the track against the world’s best athletes. I slowly recovered, began moving again, and after nearly two years, was once again back on the warmup track listening to Soul II Soul and dreaming of Olympic success. 
Roll forward to today; I’m a 55-year-old with two dogs, three children, a busy family life, juggling a portfolio of businesses and living with a far greater respect for my heart condition. I’m still able to relive the glory days of winning World and Olympic medals by speaking at conferences and dinners, which often reminds me that time stands still for nobody. I am now in my sixth decade and managing my health and fitness in the best way I can, with very different goals. 

F or those living with swallowing difficulties — otherwise known as dysphagia — it is not just the physical side-effects of the condition that can be debilitating. Eating homeblended texture-modified food that one is not accustomed to can, despite best efforts, often be unappealing and have a negative impact on a person’s quality of life.
Josephine Bailey has dysphagia as a result of oesophageal cancer and did not enjoy the experience of homeblending once discharged from hospital three years ago:

I’d lost a massive amount of weight and didn’t want to be tube fed anymore. Mealtimes were becoming really stressful. I didn’t know what to eat, I was pureeing everything with my hand-held blender, which wasn’t working very well, and everything resembled mush.

The Queen’s Nursing Institute (QNI) has recently launched a new project to support recruitment of internationally trained registered nurses to community service providers in England, in line with the the overall national strategy to fill nursing vacancies and secure a sustainable workforce (www.england.nhs.uk/wp-content/uploads/2020/07/We-Are-The-NHS-Action-For-All-Of- Us-FINAL-March-21.pdf).
This work is supported by NHS England and Improvement and dovetails with the work they are undertaking to support six pilot sites around the country with their international recruitment to the community efforts (www.england.nhs.uk/nursingmidwifery/international-recruitment/). The QNI project is not limited to the pilot sites and may be of relevance to any organisation that employs registered nurses in the community. 
While the QNI does not employ nurses in a clinical capacity and is not in a position to support individual nurses who are applying from overseas, we hope that the information and learning from this project will make the process of coming to work in England smoother for employers, managers and overseas applicants alike.

Here, Fabio Trovato Monastra, who after graduating with distinction from University La Sapienza, Rome, initially began his nursing career in Italy and now has five years’ experience as deputy theatre manager and nurse at Highgate Private Hospital and for the NHS, talks about the ups and downs of being an international nurse in the UK.
Being an international nurse was one of the best choices I ever made. If you are considering an experience abroad, I would strongly recommend it. However, you may want to consider a few points before embarking on this undertaking to ensure it is the right choice for you.

Like many organisations and charities, the Covid-19 pandemic hastened a rapid period of adaptation and diversification at ERIC, The Children’s Bowel and Bladder Charity. Here, Alina Lynden, ERIC’s communications manager explains how the charity has risen to the challenge.
The beginning of lockdown back in March 2020 meant we experienced a drastic drop in income from our shop and training programme. Most of the ERIC team were furloughed. But, with the help of generous donations from our service users, supporters and emergency funding from the Charities Aid Fund, we managed to keep our helpline open so that families could continue to access one-to-one support.

Cow’s milk allergy (CMA) symptoms present in 2–3% of all infants versus 0.5% of breastfed infants in the first year of life and can impact on growth and quality of life of the child (Venter et al, 2017; National Institute for Health and Care Excellence [NICE], 2021). Once CMA is diagnosed, hypoallergenic formulas are recommended if exclusive breastfeeding is not possible or the mother chooses a mixed feeding approach (Venter et al, 2017; Fox et al, 2019; NICE, 2021). This product snapshot reviews the diagnosis and management of CMA and focuses on Alimentum® and EleCare®, hypoallergenic infant formulas that are clinically effective at the best value price (price per 100ml) (Sicherer et al, 2001; Data on File, 2020; MIMS, 2021).
Many standard infant formulas are based on cow’s milk and so babies have exposure to these proteins from an early age, when breastfeeding is not possible or parents opt for mixed feeding.

There has recently been an increased focus on the use of patient information leaflets as a means of communicating key information and engaging patients in preventative measures. The prevention and management of pressure ulcers depends on proactive and effective communication between nurses and other healthcare professionals and the patients themselves. This is particularly important in community settings, with the increasing responsibility placed on patients to self-manage their conditions. However, despite the use of patient information leaflets as part of the nursing process, there is little research evidence to support their use with regards to pressure ulcer prevention and, in particular, whether patients themselves engage with and understand the information. This article discusses the existing literature and knowledge around patient information leaflets, looking at it in light of a recent study around pressure ulcer prevention in Birmingham Community Healthcare NHS Trust.