DENOSA’s Budget expectations: Fair allocation of resources to health as part of investment and preparation...

Media statement


Tuesday, 19 February 2019  

As the Finance Minister, Tito Mboweni, will deliver his maiden Budget Speech in Parliament tomorrow, the Democratic Nursing Organisation of South Africa (DENOSA) expects that he announces reasonable allocation of funds to deal with the backlog of shortage of health workers as well as renovation of decaying infrastructure of many healthcare facilities as part of government’s commitment to investing in health so that majority citizens could be healthy and contribute to the very economic recovery of the country. 

These two have become non-negotiables if the country’s public healthcare system is to be resilient enough, and these will contribute greatly to the bigger vision of government of laying the ground for an effective National Health Insurance (NHI). 

The healthcare system in South Africa is so overstretched that the quality that it has been known for providing over the years is getting compromised due to human resource shortages, and shortages of equipment and medication as well as insufficient support of health workers in our facilities. 

DENOSA would like to reiterate that, while it is a noble idea, the NHI is not going to be effective in the country if the underlying challenges as mentioned above are not addressed one by one. Key to the effectiveness of NHI is the strengthening of primary healthcare; and that means hiring enough nurses in our clinics and improving the infrastructure overall.  

As DENOSA, we understand that the Minister faces a bigger challenge of balancing the books of the country in a period marred by fewer foreign direct investments and a shrinking tax revenue pool, but the world has also awoken to the hard reality that health is actually the source of potential economic growth of every nation. At least the President has begun to understand this basic; we therefore hope that the minister will not be left behind.

DENOSA also hopes that the Minister will do the most honourable thing and reduce the VAT back to 14% at least so that the majority citizens could be given a breather – groceries have become fewer for many families, and that also affects the health of many citizens.   

End 

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

For more information, contact:

Cassim Lekhoathi, 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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DENOSA in full support of COSATU National Strike against job losses tomorrow ...

Media statement 

Tuesday, 12 February 2019 

 

The Democratic Nursing Organisation of South Africa (DENOSA) is in full support of, and will be joining, the Cosatu National Strike in all provinces tomorrow to highlight the negative impact of job losses in both the private and public health sectors in the country.

Key to our concerns in the job losses in the health sector is the implementation of the National Health Insurance (NHI) as a country’s vehicle towards achieving Universal Health Coverage (UHC) whereby all citizens will access quality healthcare regardless of their socio-economic standing. But this objective will not be realized anytime soon if community service nurses are not employed as soon as they are qualified nurses and nurses who retire or resign do not get replaced for years in many health facilities, as is often the case. 

DENOSA has always said, and continues to say, that the universal health coverage in South Africa will never be realized if provincial governments continue to withhold filling of vacant positions for nurses. This is because, by its nature, the healthcare system is largely driven by nurses. If the numbers that are employed are still below the levels as indicated in organograms of health facilities, then the quality healthcare service will continue to suffer severely. 

Furthermore, the universal health coverage will be realized and felt by many South Africans through re-engineering of primary healthcare whereby more clinics are fully equipped and refurbished and nurses are skilled with study opportunities on PHC and services are available at all times. 

DENOSA hopes the established NHI and quality improvement War Room in the Presidency as announced in his State of The Nation Address (SONA), consisting of key departments to address the crisis in the public health system while preparing for the implementation of the NHI, will look into the Human Resource development as it is a key contributory factor to the current deteriorating quality healthcare.   

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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DENOSA urges hospital and clinic management to ensure stand-by generators are functioning during this load-s...

Media statement

Monday, 11 February 2019  

 

With the announcement by power utility Eskom of stages 2 and 4 of load shedding countrywide today alone, the Democratic Nursing Organisation of South Africa (DENOSA) would like to urge all CEOs and management of hospitals and clinics throughout the country to ensure that back-up generators are well-maintained and fully serviced as many health facilities may get affected by power outages. 

In previous experiences where load shedding was announced, many facilities, especially those in the rural areas, were caught unprepared and health workers lost patients because generators could not kick in as soon as load shedding in their areas was effected.

DENOSA makes this call because health workers encounter difficulties at work where patients’ lives easily get lost, especially in critical units such as maternity, ICU and paediatric. 

Therefore, functionality of generators in our health facilities is, no pun intended, a matter of life and death for our patients. 

DENOSA calls on all its shop stewards and members to be extra vigilant and report cases where generators are not repaired in facilities where they work, because this could spell disaster for many patients.   

End 

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

For more information and comment, 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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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   
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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