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DENOSA Gauteng statement on the endless challenge of overcrowding at Kopanong Hospital which led to all work...
Wednesday, 19 June 2019
The Democratic Nursing Organisation of South Africa in Gauteng expresses its unhappiness over the continuing deteriorating healthcare services at Kopanong Hospital in the Sedibeng region as a result of overcrowding which has now forced all workers to withdraw their labour indefinitely in protest, before they are scapegoated when something goes wrong as it has been the case in Mamelodi Hospital.
Management at the facility has been aware of the challenge of overcrowding for a long time, and nothing has been done to resolve this critical matter.
Currently in the Casualty Unit, there are 13 male psychiatric patients admitted and without beds and two female psychiatric patients that are admitted but are without beds because the hospital is designed to admit only 6 patients in Casualty. The Psychiatric Unit at the hospital has got 30 beds which are full of patients.
Most concerning in this is the deteriorating standard of healthcare that is rendered at the facility. For example, the X-Ray Department at the hospital had been closed since 8 May this year due to possibilities of radiation leaks. All X-Ray stuff members are on a special leave of two months as they are suspected to have been exposed to high radiation levels. As a result, patients that need X-Ray have to be ferried to Sebokeng Hospital by EMS vehicles for diagnostic tests. Nurses are used as escorts, which further compromises patient care as the few nurses remaining behind have to deal with the overload.
Furthermore, the X-Ray contract is rumoured to have ended in March 2019 and management has not renewed it, thus leaving the hospital in dire strait.
All workers at the hospital do not want to see the loss of life at the facility before the situation is attended to by management. DENOSA calls on the management to deal with the matter urgently.
DENOSA in Gauteng encourages its members not to expose themselves to working conditions that at the end of the day will result in them being litigated – they must not care for more than the number of patients that they can manage.
DENOSA is calling on both the MEC of Health and community members to look into the matter so that the challenge of overcrowding, which affects communities severely, can be addressed speedily. DENOSA believes it is when communities take up the matter of overcrowding and shortage of stuff to authorities that such get resolved.
Issued by DENOSA in Gauteng
For more information and comment, contact:
Sabatha Thekiso, DENOSA Sedibeng Regional Chairperson
Mobile: 071 678 7001
DENOSA statement on Youth Day commemoration on Sunday...
Friday, 14 June 2019
As Sunday will be June 16, marking 43 years since the Soweto Uprising, in the month dedicated to Youth, the Democratic Nursing Organisation of South Africa (DENOSA) calls on management of all departments of health in provinces to find it in their hearts to accommodate young people who are unemployed like Community Service and post-Community Service nurses, many of whom are sitting at home when they are fully qualified and their services are needed by communities.
The youth constitute majority of unemployed people in South Africa. It is heartbreaking when young people have met all requirements of being employed, like going to school and possess tertiary qualifications for skills like nursing which the country is in dire need of, the doors of employment are locked due to poor HR planning.
Each year, when student nurses complete their studies, they go through a year of community service as stipulated by the Nursing Act in the country. But upon completion of the community service, which qualifies them as fully-fledged professional nurses, they struggle to get placed in hospitals and clinics. Some of those who are placed get absorbed after many attempts and interventions from higher offices.
DENOSA is concerned that more and more young people will get demoralized from pursuing a career in nursing when it is infested with chaos and lethargy when it comes to finding them employment, especially when majority of nurses are over the age of 50 years and thus close to retirement. Meanwhile, patient needs health professionals in health facilities as queues are getting longer and longer.
In provinces like Limpopo, KwaZulu-Natal and Free State, many post-community service nurses are sitting at home waiting to be placed as they have been funded by government to study and need to pay back with their service as per the contract.
Doing something drastic and reversing any circular that seeks to release community service nurses to private sector will be the greatest gift to both the country and young nurses of this country especially as June is their month.
DENOSA would like to wish all the youth of South Africa all the best on their day and urges them to be resilient in the face of the many challenges that they contend with daily. They must comprehend that the struggle of the youth of 1976 was to unlock democracy. The onus now is upon the current youth to wage the struggle on many fronts, like unemployment and quality services and education.
The Struggle Continues.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Cassim Lekhoathi, Acting General Secretary - 082 328 9671
Simon Hlungwani, DENOSA President – 082 328 9635
Facebook: DENOSA National Page
DENOSA KZN cautions new Health MEC against formulating premature conclusions on the General Justice Gizenga H...
Monday, 10 June 2019
The Democratic Nursing Organisation (DENOSA) in KwaZulu-Natal had a meeting with the new MEC of Health where we cautioned her and advised her to desist from making premature conclusions on the General Justice Gizenga Hospital (GJGMH) incident.
On 31 May, a pregnant patient experienced complications with her pregnancy a few hours before her delivery at a clinic and because the complication was affecting the unborn baby and that an urgent operation was required to rescue the baby, nurses had to transfer her to a nearest General Justice Gizenga Hospital. Because it was on a weekend and nurses were made to understand that only one ambulance was operating in the area and that a driver off duty had to be called in first, it took more than 2 hours for the ambulance to arrive at the clinic to ferry the patient.
Sadly, upon arrival at the hospital, it was a little too late and both the mother and the baby could not be saved. In response to the community members' anger over this incident, the MEC addressed the community and said nurses were negligent and that a tougher action will be taken.
DENOSA in KwaZulu-Natal condemns the action of the newly appointed MEC for Health, Nomagugu Simelane Zulu of addressing the community of Isithebe without gathering facts and getting the report from the staff and management about the incidence. But the MEC agreed in future not to be careless in making accusations against nurses before getting the facts and agreed to engage DENOSA going forward.
We view this as an act of inciting violence against the staff of Isithebe particularly nurses of which she has a responsibility to protect. Already, this has led to one of the nurses to be given special leave in fear of her safety.
DENOSA KwaZulu-Natal acknowledges the seriousness of the matter and understands the public outrage. However we must always be cautious not to have predetermined outcomes on the issue which may threaten the safety of our members.
We have information that there was a delay in the ambulance services because if you have fetal distress you only have 30 minutes to save the baby so the delay could have contributed in the death of the baby.
We are saddened by the loss of two lives of a 24 year old and her baby and would like to sincerely send our condolences to the family for their sad loss.
It is sad that three months ago a similar incident happened in the same area whereby there was a delay in ambulance services and the patient lost her life. After the initial incident, one would have expected the department to have corrected this to prevent its reoccurrence.
DENOSA would like to thank nurses who identified the need to transfer the patient while it was still fetal distress. However they were let down by the system that caused delays in transporting the patient to the hospital.
We further salute nurses who stood the whole night resuscitating this patient until early hours of Saturday the 1st of June 2019.
DENOSA KwaZulu-Natal supports fully the call for a post-mortem to identify the cause of death and include other contributory factors for appropriate action to be taken where necessary to prevent similar occurrences. This incident should also be used as an opportunity to identify gaps in the system and improve those gaps.
DENOSA KwaZulu-Natal is fully behind the nurses and support them in whatever they are going through due to this incidence.
Issued by DENOSA in KwaZulu-Natal
For more information, contact:
Mandla Shabangu, DENOSA Provincial Secretary
Mobile: 071 643 3369
Trauma Nursing Matters...
Evidence based practice: Is cricoid pressure effective in preventing gastric aspiration during rapid sequence intubation in the emergency department?
By Ntombifuthi Jennet Ngiba (BN) (UKZN).
There is on-going change within trauma nursing due to increased research in the area. Practices have been routinely adopted as the norm, but subsequently on further examination proven to be useless and more of a risk to the patient (Moore & Lexington, 2012). Research has brought into question practices or techniques such as the application of cricoid pressure during rapid sequence tracheal intubation. This practise was goaled at preventing the regurgitation of gastric content into the pharynx and subsequent aspiration into the pulmonary tree, but now questioned.
Cricoid pressure was briefly defined by Sellick in 1961 as a method used to reduce the risk of aspiration during the induction phase of anaesthesia. Sellick`s technique was to apply backwards pressure to the cricoid cartilage, compressing the oesophagus against the underlying vertebral body (Ellis, Harris & Zideman 2007; Priebe 2005). In this application of pressure the oesophageal lumen is occluded, preventing the passage of regurgitated gastric content into the pharynx and subsequent aspiration into the pulmonary tree (Stewart et al, 2014). Cricoid pressure is incorporated into the overall approach in reducing the chances of aspiration through rapid sequence induction of anaesthesia (Ellis et al., 2007; Priebe 2005). Over the years rapid sequence induction has been adapted by emergency physicians to allow ventilation as required to prevent hypoxia and subsequently termed “rapid sequence tracheal intubation”. Rapid sequence tracheal intubation (RSTI) is now the most widely used technique for tracheal intubation in the emergency department (ED) and cricoid pressure is taught as a standard component of emergency airway management (Ellis et al., 2007).
Despite inadequate scientific evaluation of the risks and benefits of cricoid pressure it is adopted as an integral component of rapid sequence intubation in EDs. No randomised controlled trials have shown any benefit of its use during rapid sequence intubation (Trethewy, Burrows, Clausen & Doherty, 2012). Furthermore, the application of cricoid pressure may be linked to increased risks to the patient such as impeding airway management, prolonging intubation time by concealing laryngeal view, inducing nausea/vomiting and oesophageal rupture with excessive force (Ellis et al., 2007; Priebe 2005;Trethewy, et al, 2012). Paradoxically, cricoid pressure may promote aspiration by relaxing the lower part of the oesophagus (Ellis et al., 2007). Some case reports note that tracheal intubation was impeded by cricoid pressure and regurgitation occurred despite application of cricoid pressure, possibly due to its improper application (Trethewy, et al, 2012). According to Bhatia, Bhagat and Sen (2014) the application of cricoid pressure increases the incidence of lateral displacement of the oesophagus from 53% to 91%.
However despite this evidence and the outcome of Trethwy’s (2012) RCT the judicial system appears guided in its judgement by outdated practises. A judge in UK ruled against an anaesthesiologist for failing to apply cricoid pressure to a patient with irreducible hernia who had regurgitated and aspirated. The judge argued that “We cannot assert that cricoid pressure is not effective until trials have been performed, especially as it is an integral part of anaesthetic technique that has been associated with a reduced maternal death rate from aspiration since the 1960's” (Bhatia et al. 2014). Therefore one may say that despite cricoid pressure entering medical practice on limited evidence and only supported by common sense, it somehow remains the practice of choice (Bhatia et al., 2014).
Thus it is about time nurses and doctors embrace evidence-based practice within the emergency department and let go of traditional practice that are proven to do more harm than good. There is still a great need for further evidence-based practice within the emergency department, to investigate the validity of the notion that cricoid pressure prevents regurgitation.
Ntombifuthi Jennet Ngiba is a Professional Nurse at Greytown Hospital.
Bhatia N, Bhagat H & Sen I. (2014). Cricoid pressure: Where do we stand? J Anaesthesiol Clin Pharmacol, Vol 30 pp 3 – 6.
Ellis D.Y, Harris T & Zideman D. (2007). Cricoid pressure in the emergency department rapid sequence tracheal intubations: a risk-benefit analysis. American College of emergency physicians.Vol 50, pp 653 – 665.
Moore K & Lexington K.Y (2012). Evidence-based practise guidelines for trauma care. Journal of emergency nursing. Vol 38, pp 401-402.
Priebe H.J, (2005). Cricoid pressure: an alternative view. Elsevier. Germany.
Stewart J.C, Bhananker S, & Ramaiah R. (2014). Rapid-sequence intubation and cricoid pressure. J Crit Illn Inj Sci, Vol 4, pp 42 - 49.
Trethewy C.E, Burrows J.M, Clausen D & Doherty S.R. (2012). Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial. BioMedCentral. Australia. Retrieved 04 August 2016: http://www.trialsjournal.com/content/13/1/17
National changes in nursing training: South African perspectives 2015...
Dr. Respect Mondli Miya,(D.Lit et Phil)
Senior Lecturer: Psychiatry at Durban University of Technology, Department of Nursing Science
Nursing is a career of love rooted in rich and fertile soil governed by caring ideologies and philosophies. Individuals within the profession have strong and inexplicable desires to serve and preserve humanity at all cost. The nursing profession drives the health care system and is forever in the forefront of preventing, promoting and management of various diseases. Nurses have always been there and have survived trials and tribulations. Nursing demands not only the brain for cognitive purposes but a humble heart, selflessness in daily duty execution. An individual without passion for the sick will never survive a minute of nursing’s demanding tasks.
Nursing novices are professionally socialized and groomed on their first day of training. Noble traditions of nursing are gradually unpacked and monitored up to graduation to enhance relevance and dignity of nursing profession. Nursing demands the utmost respect for humanity even after death itself. Most professions have minimum set of working hours yet nursing philosophy calls and promotes dedication beyond duty. Nursing is a way of living not just mere qualification written on papers but lived and experienced charisma.
Historically, nursing was viewed as a religious vocation and was predominantly religious in nature which explains chapels, and meditation designated facilities utilized for prayers before commencing daily duties in old hospitals. Nursing training in South Africa before 1976 was hospital-based hence the notion of viewing nursing as a “hands-on” career has been accepted nationally and acknowledged by most prolific nursing scholars who remain sceptical to have nursing pitched at a degree level and offered in higher training of education in South Africa.
Such training exposed and subjected nurses to poor recognition as a career. Nurses were abused and viewed as medical officers’ hand maids who were good for nothing but to offer a bed pan, bathing the sick, and carry orders as prescribed without being objective. The training at that time was strict and limiting, even the scope of practice was limited and nobody could imagine a degree in nursing or university based nursing teaching and learning. Hospitals mostly trained nurses in general nursing and later midwifery.
Around 1987, nursing in South Africa was gradually introduced in tertiary education system and scope of practice and curriculum were amended. Nursing graduates were introduced to a 4-year degree obtaining general, psychiatry, midwifery and community health nursing. That made older nurses to feel bitter and never fully accepted university graduates as satisfactorily trained. Even medical officers were threatened and witness role change from nurses as hand maids into fully recognized members of the multidisciplinary health team with independent roles and functionality. These changes failed to bridge the gap of scope of practice and remuneration packages. Even to this date, the university and hospital trained nurses earn the same salary and follow same stream of training regulated by the same nursing Act 50 of 1978 as amended with specification stipulated in Regulation 425 (R.425).
The nursing act 33 of 2005 introduced community service of one year post- training for both hospital- and university-trained individuals. Errors still exist within the nursing education such as same recognition of a hospital and university trained graduate have similar scope of practice, universities are allowed to implement R425 differently. For example, some South African universities train students for six months in midwifery while others dedicate two full years for midwifery and three years for community health nursing which is offered for six months in colleges and some universities. The problem in South Africa is that there is one R.425 and implemented differently from one university to the other.
The current health ministry is proposing nursing training restructurization. In the proposal dated 23 July 2015, it recommends reintroduction of the old nursing training system with a hope of extending the nursing training duration and to phase out the R.425 of Act 50 (1978). The current proposal overlooks scope of practice and remuneration packages of such graduates irrespective of their qualification which is an error not even Occupational Specific Dispensation (OSD) could resolve in 2007. OSD failed to address issues of salaries in the nursing fraternity; an obvious error is that a nursing lecturer is graded as a nursing specialist.
The unresolved question here is: Who teaches the other? And why do they earn same salary if the other is a teacher? Up to the very same date, the public health system continues to fail to distinguish university graduates from hospital nursing graduates yet continues to differentiate auxiliary social worker from a University graduate Social Worker, and experienced Medical Officer from a Master of Medicine graduate. Why not with nursing in South Africa?
The proposed training changes are as follows: general nursing and midwifery be done in a college over a period of four years without indicating whether that shall be Bachelor of nursing offered in a college which can never materialize as colleges do not offer degrees but universities do. If agreed upon, this will mean degrading the dignity of nursing as a profession over medicine which continues to be offered in the university without interruptions.
According to the proposed plan, nursing training is extended to 9 years (four year of midwifery and general, 18 months of psychiatry and one year of community health) which is unnecessary waste of time for an undergraduate qualification yet medicines years of training have been reduced to 5 years (MBCHB).
There is absolutely no need for such drastic changes in the nursing education. It is alarming to witness MBCHB years of training have been reduced to five years and get paid a satisfactory remuneration package compared to Bachelor of Nursing graduates with stagnant remuneration. The introduction of Masters Degree in Medicines in South Africa is preparing sound clinical researchers and such projects (thesis and dissertations) are evaluated by nursing professors who in turn receive less recognition and degrading salaries compared to MMed graduates.
The South African health system requires the following:
1. Strong and vocal task team of nursing professors who shall preserve the image and dignity of nursing as a profession and strongly oppose plans to change nursing training.
2. No college shall be allowed to offer a bachelor of nursing, strictly universities only.
3. Salary packages to be reviewed and sort clear distinction of a university graduate over a hospital trained graduate.
4. Revised scope of practice, degree holders be given more opportunity to execute complex clinical procedures and be given better remuneration packages.
5. Chief Nursing Officer to be more vocal and avoid external influences to disorganise nursing training.
6. Hospitals to create portfolios and acceptable remuneration packages for all nursing qualifications from a diploma to PHD level.
7. All South African universities to adopt and implement similar training structure that is two years of midwifery, two years of psychiatry and two years of community health nursing
8. Develop a Nursing Ministry by nurses with nurses and for nurses.
9. MBCHB degree be afforded same status as B.Cur degree thereafter if need be.
10. South African nursing council to be headed by prolific PHD holders and nursing qualifications be regulated and registered up to PHD level.
11. Any qualification obtained outside university be regarded as either associate professional nurse and associated medical office until related exam has been endorsed by the regulating body.
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