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Sundowning, a change in the behaviour of a person with dementia that appears in the evening or during the night, is a well-recognised occurrence in dementia care. The behaviours observed can be agitation, aggression, anxiety or those associated with delirium. This article uses case studies to illustrate the ways in which sundowning may present, and explores possible rationales, approaches and interventions that might be useful in supporting the person, family carers and caregivers.

Psychological safety aims to reduce patient-related harm by creating high performing teams, which are open and transparent, functioning in the absence of retribution. Models for delivering nursing care, along with matrices designed to monitor their impact, can negatively affect the adoption of psychological safety in practice. Strategies have been designed at national level to ensure the adoption of psychological safety, while, at a local level, individual organisations can implement processes to improve psychological safety from floor to board.

Here, Amanda Young, director of nursing programmes (innovation and policy), Queen’s Institute of Community Nursing, looks at the opportunities that a career in community nursing can offer, from specialist practice qualifications to master’s degrees. She also emphasises the importance of ensuring that student nurses can undertake community-based placements to support them in becoming the community nurses of the future.

I hope you are enjoying the summer months and have managed to take some time away from work for yourselves. As always, this issue is filled with information to support your learning and development, challenge your practice and keep you up-to-date with current issues. Our ‘Community matters’ piece discusses how vitally important it is to support patients to take responsibility for their own health and to self-care. By educating, advising and working in partnership with patients, we can support them to make informed decisions and choices about their own health and promote self-care, ultimately enhancing health outcomes and reducing NHS pressures.

Self-care or self- management of health has become essential for sustainability of health and social care services but can be challenging to engage with for several reasons. Frustration can arise when people are unable to self-manage, perhaps through lack of confidence, willingness, outside influences (such as family members), lack of knowledge about a particular condition or procedure, disease symptoms, or even issues with digital inclusion. It can become difficult to work with people where there are barriers to self-management due to lack of time or resources to fully explore and address these alongside the person, or lack of access to professional training for skills such as coaching, which are essential to achieving effective self-management.

Malnutrition (or undernutrition) is a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function and clinical outcome (British Association for Enteral and Parenteral Nutrition [BAPEN], 2025). Malnutrition affects at least three million people in the UK, with 93% of these living in the community (BAPEN, 2025). Malnutrition has an estimated cost of £23.5 billion in the UK (Managing Adult Malnutrition in the Community, 2021), and can lead to adverse effects if unidentified and untreated, such as increased wounds, infections, complications and mortality, resulting in greater healthcare use through more hospital admissions, longer hospital stays, more GP visits and a rise in prescription costs (Stratton et al, 2018).

During World Continence Week, ERIC, The Children’s Bowel & Bladder Charity, met with key figures from the children’s health, education and social care sectors in Parliament to discuss the importance of potty training children a year earlier.

Potty training children a year earlier could solve a host of issues in the education and health service and improve children’s overall health and wellbeing — so why aren’t policymakers pushing forward measures to support families doing it sooner?

In July, Steph Lawrence MBE became the Queen’s Institute of Community Nursing (QICN) new chief executive, succeeding Dr Crystal Oldman CBE. Steph has been a nurse for more than 37 years, with the last 22 spent working in the community. She is both an adult and children’s trained general nurse, and a qualified district nurse. Steph is a Queen’s Nurse and fellow of the QICN and in 2022 was awarded an MBE for services to district nursing.

Steph was previously chief nurse at Leeds Community Healthcare NHS Trust and also spent three years at the Care Quality Commission as the national professional adviser for community services. She led the national trailblazer group for the district nurse apprenticeship standard, and co-chaired the clinical reference group for the national community nursing plan. She therefore brings a huge amount of experience and expertise to the QICN at a time when the NHS is adapting rapidly to meet new challenges