Think:Health cultivates and articulates the best in health research and news.
The following program, which aired on Sunday 1st November 2015, features:
- whether we should believe the World Health Organisation when they say we need to eat less red meat (01:16);
- how midwives screen women for domestic violence during pregnancy (9:31); and
- the effects of a NSW inquiry into keeping registered nurses in nursing homes (21:00);
Guests:
- Bernard Stewart - Professor at the UNSW Faculty of Medicine.
- Rachel Smith - Lecturer at the UTS Faculty of Health.
- Professor Lynn Chenoweth - Professor of Aged and Extended Care Nursing at the UTS Faculty of Health.
Presenter:
- Ellen Leabeater, 2ser
Transcript:
[Introduction]
Male: This is think Health on 2SER 107.3.
Facilitator: Hello. Welcome to Think: Health where we cultivate and articulate the best in new health research. I'm Ellen Leabeater and you're tuned into 2SER 107.3. Today on the show, an inside look into how midwives screen for domestic violence.
Female: Even more unfortunately the domestic violence will often increase during pregnancy, or present for the first time in pregnancy. So pregnancy's a risk factor really for domestic violence.
Facilitator: We exam the recommendations of a recent New South Wales enquiry into why registered nurses should stay in nursing homes. First on the program; did you have bacon and sausages for breakfast? Maybe you're considering firing up the barby for dinner tonight now that summer is officially around the corner. Well, you probably heard the news earlier this week that red meat is linked to cancer.
It's research that has been floating around for quite a while, but here in Australia it's caused a bit of an outcry. We're a country of meat eaters and meat exporters, and it's considered un-Australian by some, to say no to a snag. We decided to fire up the debate here on Think: Health, and find out just how much meat there is to these claims.
Male: The scourge of un-Australianism has even infected our national day. A balanced Australia Day diet should consist of a few nice juicy lamb chops and beer, and perhaps a bit of pavlova for those with a sweet tooth.
Female: Well, actually I was thinking about a tender loin sirloin.
Female: What?
Female: A tender lean sirloin, grilled on each side and sprinkled with fresh basil and oregano, and served with loads of crispy fresh green salad and...
Male: To attain an overall sense of vitality and wellbeing...
Male: Lamb cutlets - that's the way, Billy - good to see you putting in some...
Male: You need protein.
Male: What's good for you is good for the team.
Male: Omega 3s.
Male: Meatballs - now you're talking.
Male: Iron.
Male: Over two million years ago our ancestors took a giant leap; they jumped out of the trees and started to eat red meat.
Male: The natural protein's helped our brain grow. Hunting forced us to think.
Male: Red meat was helping us come to be.
Facilitator: There is nothing like a summer's afternoon spent at a mate's place by the pool, cooking up a storm on the barby, but is our favourite steak, sausage or pork chop putting us at an elevated risk of cancer? Earlier this week the World Health Organisation released a report that looked at the link between red meat and cancer. Normally we are taught to be sceptical of any big dietary claims, but 22 experts from 10 countries looked at over 800 studies to come to this conclusion, so unfortunately we might have to believe this one.
Male: In this particular case WHO convened an international group of scientists to review from the ground up all of the studies, and there's more than 800 of them, addressing the association of red meat and processed meat consumption with cancer generally, and bowel cancer in particular, and out of that came a conclusion that arguably is more solidly based on the available scientific data than anything previously available.
Facilitator: Bernard Stewart is a professor in the faculty of medicine at the University of New South Wales. He was part of the team that analysed the studies. He says that we don't really know how red meat causes cancer, but the link is there nonetheless.
Male: It's believed there may be a number of carcinogens in red meat, but it's not known with certainty what the mechanism of cancer causation is. What is known that consuming processed meat specifically is associated with, or is causally associated with bowel cancer, but the mechanism whereby this occurs is, as I said, subject to investigation, but not proven.
Facilitator: The study looked at red meat and processed meat, but let's start today with processed meat. This includes bacon and salami. According to the research processed meat is classified in the same group of carcinogens as tobacco and asbestos. It's called Group 1, which is not great news if you're a tobacco smoking, asbestos chomping, and prosciutto loving person.
Male: What is being asserted by consumption of processed meat being placed in Group 1 is that the evidence of a causal relationship between the particular exposure and the development of cancer is as strong for consuming processed meat as it is for benzene or asbestos.
Facilitator: However, just because it's in this group doesn't make it as bad for you as tobacco and asbestos. More people die from smoking related cancer than meat related cancer. So there'll be no calls to ban processed meat. Red meat, on the other hand, also got a bad rap, but it's not as bad as processed meat. Red meat like steak and pork is classified in a lower group, but there's still a risk of bowel cancer.
Male: The scientific understanding of a causal relationship between eating red meat and an increased risk of bowel cancer is not proven. However, the evidence is substantial to the point that the technical term in respect of the IARC monograph terminology is probably carcinogenic to humans. That indicates a substantial body of evidence, but evidence which nonetheless falls short of definitive proof.
Facilitator: If you are worried that reducing your meat consumption will affect your guns, eat spinach. Actually, maybe not; apparently Popeye got it wrong - spinach isn't the best of iron. Sarah Taki is a dietician and PhD student at the University of Technology Sydney. She says there are plenty of other foods you can substitute meat for.
Female: You can definitely get iron, zinc, vitamin B12 and protein - you can get them from other sources such as legumes, lentils and also vegetables as well. It's just as important because you will get the different minerals and vitamins that our body does need. So it will just encourage us to consume a variety of healthy foods rather than just sticking to red meat.
Facilitator: Sarah says it's probably a wise idea to cut down on meat. Australians eat far too much meat as it is.
Female: The average Australian consumption of red meat is 111 kilograms per year, and the recommended amount is 26 kilograms per year. So there is definitely room for improvement.
Facilitator: So Australians on average are eating over two kilograms of meat a week, but to meet the Australian dietary guidelines we only need three to four servings a week.
Female: The latest Australian dietary guidelines which were released in 2013 - they suggest no more than 65-100 grams of red meat, three to four times a week maximum.
Facilitator: A serving is the size of your palm. So if you want to pig out on red meat this Australia Day, you might want to think about a meat fast in the weeks leading up to the day, or else face the wrath of Sam Kekovich.
Male: It's an absolute disgrace, and people ask why we need capital punishment.
Facilitator: You're listening to Think: Health on 2SER. Coming up next...
Female: In the past 12 months have you been hit, slapped or hurt in any way by your partner or ex-partner? The second question is; are you frightened by your partner or ex-partner.
Facilitator: How midwives identify victims of domestic violence.
Male: Thanks so much for your support of 2SER during our recent supporter drive. Every dollar goes towards coming up with more great stories, ideas and music for you. If you haven't signed up yet, there's still time. Go online to 2SER.com or call us on 95149514. Every dollar counts. 2SER 107.3 - we can't do what we do without you.
Facilitator: Welcome back to Think: Health on 2SER. I'm Ellen Leabeater. Think about the women in your life. This might be your mother, your daughter, sister, aunty or maybe even you. One of you has experienced domestic abuse. That's the frightening statistic to come out of Australia with nearly 20 per cent of women having faced violence within the home at some point in their life.
Domestic abuse can come in many forms. It can be physical, emotional - it can also be financial control, and in some cases it can even occur when a women is pregnant. A seminar coordinated by the Centre for Midwifery, Child and Family Health at UTS is looking at the best ways to support women and protect children affected by domestic violence.
Rachel Smith is a lecturer in nursing, midwifery and health at UTS and is speaking as part of the seminar. She'll be talking about screening and responding to domestic violence, and told Jake Morcom that pregnancy is a high risk parent.
Female: Routine screening in pregnancy in relation to domestic violence refers to a policy in New South Wales and in other states and territories across Australia that recommend that midwives routinely ask women a standard set of questions in pregnancy in regard to assessing their risk of or their experience of domestic violence. So the routine screening in New South Wales are a set of four questions, and we ask these questions to all women, and we explain that to women first, in terms of setting up the questions.
We say that unfortunately domestic violence is common in our society, and even more unfortunately that domestic violence will often increase during pregnancy or present of the first time in pregnancy. So pregnancy's a risk factor really for domestic violence. So we explain this to women, and then we ask them - we gain their consent to ask them the routine screening questions. The first question is; in the past 12 months have you been hit, slapped or hurt in any way by your partner or ex-partner?
The second question is; are you frightened by your partner or ex-partner? So if the woman responds no to either of those, we give all women information and we have a Z-card which is a sort of non-descript pamphlet so that women can just tuck it in their wallet. It's got no cover sheet on it.
It's got no - it's just a patterned pamphlet, and it has the domestic violence helpline, and it has a little bit about domestic violence, because some women are not aware that violence also includes emotional violence, financial control - so it's not just physical. If the women respond positively to the questions, we ask them are they safe to go home, and do they want any help with this but we also have another set of questions that if they respond positively we ask about children in their care.
We ask whether they have children in their care and do the children witness the violence? We know that the witnessing or being exposed to violence, both in utero and during childhood has a negative impact.
Male: In this initial screening process, what is the response like from a lot of these women? Domestic violence is something still taboo, and if a woman is experiencing that, she doesn't necessarily want to talk about it. So when you do address this for the first time, are they receptive or does that vary?
Female: No, women are pretty receptive, and it's remarkable - I find it remarkable, the number of women that are able to trust you enough to respond honestly to that question. I know if I was attending care, and I'd only just met someone, I'm not sure that I'd feel that safe in responding. So we understand that some women, even though they are experiencing violence will respond a negative to the questions, but we also know that from evidence - research that's been done, that the vast majority of women find the questions acceptable.
Many women are surprised that we have to ask them, and that's why we include in the preamble the reasons why we're asking them, but most women - yeah, the vast majority of women find the questioning acceptable, and some of the women are very responsive to it or very thankful, because it's the first time anybody's asked them about the violence that they're experiencing.
So women find that it's an opportunity actually say, yes that's happening to me. The way we set up the question is that it happens to a lot of women and we're here basically to help if that's what you want.
Male: How do you kind of evaluate that there might be domestic violence in the screening process? What are the signs?
Female: Well, some of the risk factors for domestic violence are exposure to abuse or violence as a child. So part of the entire social and emotional screening that we do as midwives - we also ask women about their memories of childhood, and we ask women about their current situation in terms of emotional wellbeing.
So we ask women if they've had any major stresses in the last 12 months and they may have had financial stresses or they may indicate to us that their partner has lost a job, which is not an indicator of domestic violence, but it would be a flag for us to then maybe, if they do respond negatively to the domestic violence questions, just to flag that and maybe ask them again the next time that you see them. In terms of midwifery care, the ideal care is having the same midwife look after the one woman right the way through her pregnancy.
That was a trusting relationship can be built up. So where those models of care do exist, we see women every few weeks where it would be four weeks initially and then every couple of weeks towards later pregnancy. Then we build up good relationships and women will tell us more than women who have not met their caregiver before.
So that's another area of midwifery that we support and that we lobby for so that in terms of ensuring that women are both physically and emotionally well for their entry or continuation into mothering, the ideal situation is for the women to see the same midwife.
Male: Let's look now at the responding side of this, so addressing when it's an issue or screening for that; what are some strategies in place, or how do you go about responding to those who are experiencing domestic violence?
Female: Although we routinely ask the questions, midwives and other health professionals who work with women in pregnancy feel unprepared generally to respond. It's a highly emotional area of practice, and for most you don't quite know what to say. So what we're doing is we're working with midwives and with the student midwives, and preparing them for responding appropriately.
So an appropriate response for a woman who discloses that she's experiencing domestic violence is thanking her for telling you because it must be hard to tell someone, particularly when they don't really know someone - so thanking her for being honest and for sharing what is a difficult problem for her,
Reminding her that it's not okay; that domestic violence is not normal, and that it is a crime, but also reassuring her that she's not alone in this, and that we know one in four women across their lifetime have experienced violence, so she's not alone and that there is help out there for her, and there's a range of help from making a phone call to actually assistance in leaving the violent relationship.
Male: How do the domestic violence services work in hand with health services? Is there unity between the two?
Female: There are different levels of service provision and service cohesion across the whole of Australia obviously, and that's one of the issues that various reports have identified. In New South Wales, Government are rolling out a new framework in relation to responding to domestic violence, called It Stops Here, and it's about bringing services together to provide seamless provision of services across the full range. So that's health, finance, housing, counselling services.
So they've rolled out the It Stops Here pathways in a couple of areas, and they're now rolling them out in more areas across the state in a similar framework as in progress in Queensland as well, and other states and territories. So whilst some areas do it very well, other areas - their services are quite fragmented, which makes it difficult for the women. So the ideal situation is that the women can seamlessly move from service to service without having to re-tell her story over and over again.
So a woman who's experiencing domestic violence, who's pregnant will be seeing a midwife or another health professional that cares for women in pregnancy. She might also be having dealings with legal services, with police, with housing - Department of Housing, or any number of other services, and each time she presents to those services she has to tell her story again. So there's new information sharing legislation that's come about in New South Wales to make that process for women much more seamless.
Facilitator: Jack Morcom speaking there to Rachel Smith. If this report has raised any concerns with you, please call Lifeline on 131114. You're tuned into Think: Health on 2SER. Thanks for joining me this morning. Stay tuned. Shortly we'll be discussing the good and bad of a New South Wales enquiry into registered nurses in nursing homes.
[Advertisements]
Male: You're listening to Think: Health on 2SER 107.3.
Facilitator: Hello, and welcome back to Think: Health on 2SER. Would you go into hospital without a trained doctor? How about live in a nursing home without a trained nurse? In New South Wales it is compulsory for nursing homes to have a registered nurse on duty 24/7, but changes to federal government funding of nursing homes earlier this year meant that some residents will be left without a registered nurse. Registered nurses are important for providing skilled care.
As we discussed last week on the program, they have specialist knowledge that other staff members may not have, especially in the area of dementia care. A New South Wales parliamentary enquiry was set up to review the changes and their report was released late last week.
Among the recommendations was for registered nurses to remain nursing homes, although remote and rural nursing homes may be exempt. To discuss the recommendations further we spoke to Lyn Chenoweth. Lyn is the professor of aged and extended care nursing at the University of Technology Sydney.
Female: Well, there's been such a lot of distress amongst staff themselves working in age care, amongst family carers and residents who live in them, about the quality of services provided, and the amount of services able to be provided with the reduced number of staff that are available.
Facilitator: This enquiry has said that New South Wales nursing homes should still have a registered nurse in nursing homes. What do you think of that recommendation?
Female: Yeah, well it's something certainly that I have supported for many years, and I'm sure that all nurses would. If you know anything about age care you know that the people who live in them are very, very unwell - very, very old, very frail. They have multiple co-morbidities, on multiple medicines, many of them have a cognitive impairment and a lot of them have depression as well as other mental illnesses associated with neurological deterioration.
So to think that these people are not deserving of proper care, which includes medical care, nursing care, Allied Health care and treatment, is an astonishing idea. So I certainly am pleased that the New South Wales government at least has taken a moral stance with regard to this.
Facilitator: One of the concerning recommendations was with those registered nurses - that rural and remote nursing home may be exempt on a case by case basis. How do you respond to that finding?
Female: Well, I find it surprising, because in rural and remote health very often little nursing homes find it very difficult to sustain productivity because they have only small numbers of residence. They have very few registered nurses and skilled staff like doctors available to help care for these older people. So what they have done is to create multi-purpose services.
These services combine age care services, residential plus day care services, plus outreach to the community, plus emergency services, and acute in-patient services in the one facility. Those services operate very well, and generally speaking, if for example you have 20 aged care beds you'll probably have at least two registered nurses available in that whole facility. So those registered nurses are able to both provide support in emergency situations, in in-patient services and in the residential services. That's a good model.
So I think they must be talking about very remote communities, and communities which have only very small numbers of residents. Now, in some cases the residents come into these little tiny homes, come in not as high care residents - this is low care, because they're no longer able to live alone in a remote home on a property in a country. So they come in to make sure that they get well looked after with regard to nutrition, hydration and care services, and housekeeping and things like that, because they can't manage their own home.
So those residents are not really the type of residents that we're talking about in most nursing homes. Most nursing homes have very, very sick people who are very old with a cognitive impairment. So if that type of resident is going to be living in one of these homes, they do need a registered nurse, because they'll have multiple medications which have to be managed according to the need of the person, and the registered nurse is needed to be able to negotiate services with Allied Health, including GPs who might be hundreds of miles away.
So that registered nurse has to take full responsibility for the safety and care of that person, and you can't expect a care worker with no training or education in psycho-geriatrics to be able do that job. So I find the idea of that rural and remote nursing home not having a registered nurse on board is quite frightening.
Facilitator: In reading some of the submissions, I think Mission Australia said that not all residents who need high care need high levels of medical care, and they were concerned that having to have a registered nurse in nursing homes would also be very costly. Do you think that the benefits of the registered nurse outweigh the cost?
Female: Absolutely, because people don't stay the same. So somebody might come in who is not heavily dependent, but within a very short space of time they're going to become very unwell and dependent because the estimated rate of a person's life in a nursing home is two years or less. So that means that when the person comes into the home they might be able to manage - they might be able to self-care, but they will need help with some things.
For example they might need help with bathing, with toileting - they might need help with medication management, and they'll certainly need help with meal preparation and things like that. Now, you may not need a registered nurse for those things, but when that person's illness - and most people come in with a chronic illness - when that illness becomes more chronic, that person's going to have exacerbations of that chronic illness from time to time.
The registered nurse is the only person who will really know whether that person needs to go to hospital for further investigation or treatment - whether the person can be managed safely in an age care facility with higher level care services, and that includes things like managing diabetes, managing chronic respiratory and cardiac illness, preventing urinary tract infections, preventing musculoskeletal loss and weight loss.
Only registered nurses have the abilities and skills and knowledge to know how to prevent some of these things happening, and if illness does happen, they're the only ones who really know how to alert other health services like doctors on what is going on. They're able to pick up on the signs and symptoms of illness and know where to act and how to act. A care worker is pretty much similar to a family carer at home who really doesn't have this expert knowledge.
So how are they going to pick up on these things if something occurs? What will happen is, if we don't have skilled staff in facilities where people are aging and becoming unwell over time, we're going to have major dramas occurring where we're going to have litigation. The families and the residents themselves will start to be suing people because they're not picking up on illness.
Facilitator: Lyn Chenoweth, Professor of Age and Extended Care Nursing at the University of Technology Sydney, ending that story. If you'd like to find out more about that story or listen to any of our past programs, head to our website at 2SER.com/thinkhealth. This show is produced with the support of the University of Technology Sydney, Faculty of Health. Please remember that you should not consider the contents of this show medical advice, and you should consult your physician if you have any concerns. I'm Ellen Leabeater. This has been Think: Health. See you next week for more in health research and news.
END OF TRANSCRIPT