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DENOSA statement on Women’s Day tomorrow: there’s still a long way to gain full emancipation for women ...
Thursday, 08 August 2019
As tomorrow will be Women’s Day in South Africa, the Democratic Nursing Organisation of South Africa (DENOSA) would like to highlight a number of key areas that still constrain many women in the country from achieving full emancipation, and not least of which involves both little employment and leadership opportunities.
While women took it upon themselves on this day in 1956 when they dared to challenge the then establishment by marching on the streets of Pretoria in 1956 against pass laws, women still fall victims on many levels. In terms of remuneration in the workplace, there still remains a great discrimination against women in wages. Far often, a woman in the same level of employment as a male counterpart, with the same number of years of experience and qualifications, still earns less than her male counterpart.
When it comes to leadership preference, it is a fact that in many organisations women are still regarded as a second-best to men when it comes to leadership positions; this is the case even at DENOSA, whose membership is dominated overwhelmingly by women. In most cases women get elected to deputize males in many positions. There is still a lack of trust that women can champion the cause of the people.
In this regard, DENOSA would like to applaud COSATU for breaking the norm at its National Congress in September last year when it, for the first time in its history, elected a woman, cde Zingiswa Losi, as its president. DENOSA hopes this cascades down to many organisations. This is because South African population is female-dominated.
Furthermore, women still fall victims to gender-based violence, and the pace at which interventions to their suffering are brought about is excruciatingly slow. In November last year, for instance, there was a Gender-Based Violence Summit that was held and where interventions were tabled for urgent implementation. But very few of these have been implemented since then.
On employment opportunities, provincial departments of health in many provinces have reneged on their part to honour their side of the contract to hire nurses who have completed their year of community service. By far majority of these nurses are women, and departments in provinces such as KwaZulu-Natal and Limpopo have gone to the extent of choosing to let them go and find work on their own in other provinces or in the private sector despite severe shortage of nurses in such provinces. This, too, is a subconscious act of oppressing women because the thinking is that there will not be a big noise about it because most of the victims are women!
DENOSA calls for a consciousness throughout the country in advancing the cause of fair gender balance in all areas across organisations, the workplace and in the public service.
DENOSA encourages all nurses in the country to hold hands and emulate the spirit of Mama Albertina Sisulu and challenge the injustices that are directed at nurses in the workplace.
The Struggle Continues.
Wathinta Abafazi, wathinta imbokodo!
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Thandeka Msibi, DENOSA 2nd Deputy President
Mobile: 082 328 9845
Kedibone Mdolo, DENOSA Gender Coordinator
Mobile: 072 585 6847
Tel: 012 343 2315
Facebook: DENOSA National Page
DENOSA KZN statement on the Budget Vote by Health MEC...
The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal notes the Budget Vote that was presented by Health MEC in the province last week and we are especially concerned about a number of issues.
1. Growing litigations against the Department
Litigation against the department are growing at a fast pace which DENOSA has hinted to the Department some of the contributory factors. In our view, gross shortage of health workers contributes about 70% of these litigations that the department is faced with.
We proposed to the department and asked a fundamental question: why does the department not fill vacant posts instead of paying lawyers these exorbitant amounts?
2. Safety of health workers not addressed
The safety of health workers in institutions was not taken care of, except for ambulances. We note this with concern because both nurses and patients are not safe in the health institutions. The recent incident at Ngwelezane Hospital where one patient killed another patient is a case in point that highlights the need to strengthen safety in the workplace.
We thought MEC would come up with solutions in this regard.
3. Implementation of NHI in the pilot districts
The implementation of the National Health Insurance (NHI) in the pilot districts in the province has failed dismally. The pilot unearthed many infrastructural and backlogs in the districts which have not yet been addressed. Despite this, however, the national department of health is still adamant that they are ready to start NHI.
DENOSA reiterates that the NHI must not be met with the same challenges that exist today which, like the filling of vacant position created by retirement of resignation, should easily be resolved.
4. Poor infrastructure
Infrastructure of the department in almost 80% of institutions is a disgrace and unsafe for both health workers and patients.
5. Moratorium on junior category posts
The continuing moratorium on appointment of personnel to junior category posts is a problem because if a staff nurse retires or resigns their posts are not filled, which leaves the burden of workload with those remaining behind. The situation is dire and needs great leadership.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal
For more information, contact:
Mandla Shabangu, DENOSA Provincial Secretary
Mobile: 071 643 3369
Tel: 031 305 1417
DENOSA Gauteng vindicated on unfair suspension of the Mamelodi Hospital nurse ...
Monday, 05 August 2019
The Democratic Nursing Organisation of South Africa (DENOSA) in Gauteng feels vindicated about the unfair precautionary suspension of a nurse at Mamelodi Hospital who, after 60 days, has not been charged.
This has proven us right that there was never a single charge that was going to stick as the nurse was never party to the incident that occurred at Mamelodi Hospital a few months ago. This means the nurse returns to work today, as the 60 days grace period, within which the Department could have formed charges if there we any, lapsed on Friday. A representative from DENOSA accompanied her to report for duty today.
Once again, DENOSA condemns both the Minister of Health and MEC of Health in the province for their quickness in running to the media and implicating the nurse prematurely and without any solid basis. Our expression of this is because nurses, generally, do not enjoy any good public image and are seen in a negative light on many occasions. The Minister and MEC should know better and not be adding fuel to the hatred unnecessarily.
Back to the circumstances that led to the precautionary suspension of our member, in terms of Public Service Coordinating Bargaining Council (PSCBC) Resolution 1 of 2003 on Disciplinary Code and Procedures on Precautionary Suspension in the public service, states clearly that:
“If an employee is suspended or transferred as a precautionary measure, the employer must hold a disciplinary hearing within a month or 60 days, depending on the complexity of the matter and the length of the investigation. The chair of the hearing must then decide on any further postponement.”
We issue this statement because, on far too many occasions, nurses get labelled and called all sorts of names in the public domain, but whenever they are exonerated, not a single word goes to the public and it becomes a secret that their names have been cleared.
“We made a plea to the Department previously, that it also comes out at the end of the process and informs the public about the end-result,” says DENOSA Gauteng Provincial Chairperson, Simphiwe Gada.
“We hope the Department will still come out so that the dark cloud that is hanging over the nurse and many nurses working at Mamelodi Hospital is cleared so that they can render their service free of any worries.”
Issued by DENOSA in Gauteng
For more information, contact:
Simphiwe Gada, DENOSA Gauteng Chairperson
Mobile: 072 563 1923
Bongani Mazibuko, DENOSA Acting Provincial Secretary
Mobile: 072 620 8806
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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