DENOSA urges travelers to drive safely this festive season as there may be few health workers in cases of acc...

Media statement  

Friday, 14 December 2018 

 

As many people embark on trips to various holiday destinations from, the Democratic Nursing Organisation of South Africa (DENOSA) once again urges all those who will be on the road to drive safely and obey the rules of the road at all times, because there may be few nurses to take care of accident casualties in many health facilities nearer to where accidents often take place this time of the year, especially around rural areas. 

We would like to send a reminder that during this time of the year, many patients succumb to their injuries during accidents not because of the severity of the injuries sustained, but because of the time it takes to get medical help largely due to shortage of health workers. In some health facilities on the outskirts of the cities, casualty units and other critical sections don’t have enough nurses and some patients get to be referred to facilities that are far away, and some patients are lost while on the way. 

The shortage of nurses is something that DENOSA has complained about throughout the years, and unfortunately the harsh consequences of this shortage are felt by the sick and vulnerable at the time of great need. In many health facilities, due to shortage, community service nurses (trainee nurses) and enrolled or staff nurses (whose duty is to play supportive role to professional nurses) with not enough experience are often made to head up units and be in charge of clinics, which compromises both their careers and the quality patient care service.  

To prevent exposure to this compromised quality healthcare, DENOSA urges motorists to obey the rules of the road, get enough rest whenever they get tired and drink enough water so that they remain hydrated throughout their journey.

“We also call upon community organisations to constantly monitor staffing levels in health facilities in communities where they are, so that they are able to raise red flags on time when their community members are exposed to poor health service as a result of the shortage,” says DENOSA Acting General Secretary, Cassim Lekhoathi.

“Time is of essence during accidents, and the longer it takes for patients to receive urgent care the more the patient is likely to complicate and even succumb to injuries.” 

With load shedding already upon us, DENOSA also urges management of health facilities to ensure that standby generators have been serviced and are ready to kick-start whenever power outages occur. Many facilities have been caught off-guard in the past, and critical healthcare service got interrupted.  

DENOSA also wishes all health workers in general, and nurses in particular, good health and resilience during this busy time as most will be on duty saving lives. 

On behalf of nurses, DENOSA wishes all South Africans a Healthy and Happy Christmas and a Prosperous New Year. 

End 

Issued by the Democratic Nursing Organisation of South Africa (DENOSA) 

For more information, contact:

Cassim Lekhoathi, DENOSA Acting General Secretary 

Mobile: 082 328 9671

OR 

Simon Hlungwani, DENOSA President 

Mobile: 082 328 9635 

Website: www.denosa.org.za

Facebook: DENOSA National Page

Twitter: @DENOSAORG

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Outcomes of DENOSA KZN PEC meeting ...

Media statement 

Wednesday, 12 December 2018 

 

The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal held its Provincial Executive Committee (PEC) meeting, which concluded on Monday, wherein it deliberated and resolved on key pertinent issues that affect nurses in the province. 

The PEC had invited MEC of Health in the province, Dr Sibongiseni Dhlomo, due to many concerns over a number of issues. But the MEC was unavailable and delegated the HOD to attend the PEC on his behalf. 

On announcement to create 5300 posts 

Among others, the HOD took the PEC through the announcement by Health Minister of the National Health Council’s decision to create the 5300 posts countrywide.

After thorough deliberations, the PEC resolved that it totally rejects the allocation to the province of 150 posts for Enrolled Nurses, 150 for Enrolled Nursing Assistants and not a single Professional Nurse. As DENOSA KZN, we appreciate the intention of the President to focus on health in his economic stimulus package, but we don’t accept the approach of the minister of not showing appreciation of nurses in a province that is in dire need of professional nurses. 

“Our interest as KZN is: how did they arrive at the conclusion that only enrolled nurses and enrolled nursing assistants are needed in the province, whereas the situation on the ground indicates strongly that we need more professional nurses?” asks DENOSA KZN Provincial Secretary, Mandla Shabangu. 

“Many clinics and hospitals on the rural outskirts are headed by enrolled nurses! If you were to visit a facility in a district like Mkhanyakude or Msunduzi at night, you will find staff nurses running wards and administering medication to patients, and not a single professional nurse in that unit – which are the categories that should be doing that.”

DENOSA KZN believes that Dr Motsoaledi must be told by Chief Nursing Officers on what is needed on the ground so that he does not pronounce on what is not really needed in the province. If he has consulted Chief Nursing Officers and they gave him this feedback that only enrolled nurses and enrolled nursing assistants are needed in KZN, then the Chief Nursing Officers let nurses down. 

Furthermore, these posts are not new positions, but filling of vacant positions that have not been filled many years ago whenever nurses left the service and were never replaced – it is an attempt to normalize the staffing levels today which should have been normalized in 2012. The announcement has not even attempted to deal with the current crisis caused by annual growth in population figures.   

DENOSA KZN is happy that at last porters and cleaners and other support staff will be employed, because the tasks of these cadres have been performed by nurses for far too long.  

On continuous safety concerns in the workplace 

The PEC deliberated on the continuing lack of safety of our members in many health facilities without any tangible intervention from the Department of Health. At King Edward Hospital, renovations that are taking place are still posing a serious health and safety risk to our members. Lifts are not working at the facility. 

Similarly, at Addington Hospital, lifts are not working and this has rendered the trauma unit non-functional. Nurses are forced to use stairs every single day to climb to the upper levels with patients, which is a serious risk to them and to patients.  

The PEC resolved that the MEC of Health must give DENOSA the undertaking on when these renovations will be completed at these two facilities. If they continue until end of this month, DENOSA will on 1 January 2019 instruct its members to only report for duty at ground floor and not use the stairs with patients.                   

On non-nursing duties 

The PEC discussed the ongoing issue of non-nursing duties where nurses continue to do the work of porters, collection of blood samples and cleaning. The PEC resolved that, by 1 January, no nurse should embark on this work because it is not within their scope of practice. 

On New Curriculum and CPD 

The PEC expressed a serious concern over the lack of information to nurses on the new nursing curriculum and CPD from the nursing regulatory body, the South African Nursing Council (SANC). Failure by SANC and the Department of Health to inform nurses on the developments is leaving them with great confusion. The PEC resolved to engage the Department of Health to conduct workshops for nurses across the province, because it cannot be fair that they are left in the dark for such a long period without certainty about their career. 

The PEC resolved that DENOSA Professional Institute (DPI) will carry out this work of information sharing for our members from the beginning of the New Year, because waiting for the South African Nursing Council will leave them in the dark for far longer periods. 

End 

Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal 

For more information, contact:

Mandla Shabangu, DENOSA Provincial Secretary 

Mobile: 072 151 5874  

Tel: 031 305 1417

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DENOSA statement on Universal Health Coverage Day tomorrow and the need to invest into nursing...

Media statement 

Tuesday, 11 December 2018  

As tomorrow, 12 December, marks Universal Health Coverage Day, the Democratic Nursing Organisation of South Africa (DENOSA) would like to call upon the portfolio committee on Health in Parliament, Minister of Health and Health MECs in provinces to ensure that adequate investment into the heartbeat of healthcare, nursing services, is addressed for better health outcomes patients and communities.

Investment into the country’s healthcare has been hugely lacking for many years now in South Africa, and the results of this neglect are the longer queues that patients have to endure for hours before they get help, the many conflicts between healthcare users and health workers as well as the burnout that shows in the form of negative attitude.

As DENOSA, we are making this sincere call because it has almost become a norm to expect nursing excellence to present itself automatically without any real investment into it by government or private healthcare employers.

Human Resource Development is one element that has brought the quality of healthcare to low levels in South Africa, which is tragedy. The clearest example of this tragedy is Gauteng Department of Health, which had employed a staff complement of just over 60 000 workers before the year 2000, which was looking after Gauteng’s population of 7 million people then. To date, the Gauteng Department of Health has employed just 68 000 workforce which serves a population of over 13 million! And this population figure excludes the millions of unregistered immigrants who enter South African borders daily.    

With this example of Gauteng, it is a miracle that health workers are still able to save lives in health facilities when their workload has more than doubled from the year 2000. 

With this workload, comprehensive healthcare has gone out the window in our health facilities. Instead, our nurses, who are the face of the healthcare, are forced to work to push the queues and not give the proper time in consultation room to patients because half the patients would be turned back due to shortage of nurses.  

The worsening attitude of health workers has been narrated more than enough in our media platforms and many nurses have been admonished by health minister, parliamentarians and communities at large, and yet many objections or protests over the shortages in facilities by the same health workers has not drawn the attention of the public into taking action. 

DENOSA says: if universal health coverage is to be realized in South Africa, where everyone receives quality comprehensive, affordable and accessible healthcare, investment in nursing must start today and attitude towards this investment must start with our legislatures, minister and MECs. 

DENOSA pleads with the portfolio committee on Health in Parliament to look at the reports by the Office of Health Standards Compliance (OHSC), which does inspections of the country’s health facilities, and see how low scoring many health facilities in many key areas are. 

DENOSA is reminding everyone that health is a right in South Africa, and proper investment into it must show the country’s appreciation of this right. Life Esidimeni should be a hard lesson for all of us that failure to invest in health can only bring sour consequences.    

In conclusion, because South Africans have been deprived of quality, affordable and accessible healthcare, the effects of this are also felt on the country’s economy because illnesses in citizens advance and require curative treatment which is expensive by its nature. 

End 

Issued by the Democratic Nursing Organisation of South Africa (DENOSA)

For more information, contact:

Cassim Lekhoathi, DENOSA Acting General Secretary 

Mobile: 082 328 9671 

Or 

Simon Hlungwani, DENOSA President

Mobile: 082 328 9635 

Tel: 012 343 2315 

Website: www.denosa.org.za

Facebook: DENOSA National Page 

Twitter: @DENOSAORG

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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.

REFERENCES

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


 

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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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WHY DO WE SAY NURSING IS A CALLING? ...

 
We are professionals, and let us fight to be recognised as such… 
Vuyolwethu Mashamayite - 20150728_073623
By Vuyolwethu Mashamaite 
Ever since I joined nursing in 2005 I have heard nurses say nursing is a ‘calling’ and it's not about money. I couldn't understand why they said so and I still don't.   
I believe that everyone is called by God to be in the profession or job they are doing, unless nurses consider themselves in the same umbrella as ‘Sangomas’ and ‘Preachers’. Those are the people who will leave their profession or jobs and focus on their calling or do both, regardless of whether they are paid or not. 
Perhaps this could be the reason why nurses are under-paid and left to work in extreme unfavourablecircumstances ...because it’s a "Calling".
Don't get me wrong; I have passion and great respect for human life as a nurse. But I cannot keep quiet. Nurses are the most abused professionals by the employer because they consider themselves "called" instead of being employed professionals.
Nurses you are jack of all trades doing everyone's jobs from a cleaner to a doctor but come pay day you are the ones who cry the most because you are underpaid while doing everyone's jobs. I guess it's the consequences of having been “called" instead of being professional.
We feel so comfortable working out of our scope of practice to an extent that we run a risk of performing tasks that we are not equipped to do. When told it's not your scope of practice you tell us of how long you've been doing this and you didn't kill anyone. But the South African Nursing Counci (SANC) is out there nailing nurses and not considering your "calling" but rather your profession and scope of practice.
What hurts the most is the fact that you studied for four years and someone from another discipline who studied the same years is treated and paid better than you. I guess they are professionals and you are in a "calling". 
Nurses, let's STOP hiding behind "CALLING" and start taking our profession seriously. If you don't do it, no one will do it for you. Like it or not we are professionals and let us fight to be recognised as such. 
Vuyolwethu is a nurse based in Kimberley, Northern Cape   
End

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Publications

Nursing Update

         
January 2018

Nursing Update is jointly published by the Democratic Nursing Organisation of South Afr... More.

Curationis

         
January

Curationis provides a forum for cutting-edge theories and research models related to th... More

About us

The Democratic Nursing Organisation of South Africa (DENOSA) in its current form was established on 5 December 1996.

The organisation was formed through political consensus after the transition to democracy and was mandated by its membership to represent them and unite the nursing profession. Prior to this, the South African Nursing Council (SANC) and the South African Nurses Association (SANA) were statutory bodies which all nurses had to join. It was also important after the transition to democracy to incorp... Read more