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DENOSA KZN statement on the state of readiness of the province for NHIÂ ...
Tuesday, 16 July 2019
Following the announcement of a 10-Point Plan as part of the process of rolling out National Health Insurance (NHI) by Health Minister in his Budget Vote in Parliament on Friday, the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal is not convinced that the province is ready for NHI yet, given the slow pace of solving the current outstanding critical issues that have a direct impact on the patient experience in public health facilities.
While Minister of Health, Dr Zweli Mkhize, highlighted the need to address the issue of staff shortage and shortage of resources in facilities, the reality is that these challenges have been experienced by the province for a long time and there appears not to be any political will to address them.
DENOSA in the province understands that the NHI is about financing the healthcare service in the country, but we are always the first people to point out that such healthcare service is not going to be rendered in the sky, but will be provided by the same current health facilities, unless government's hope will rest on the few well-resourced facilities in the private healthcare sector.
More critical to our concerns is the abandonment of the current solution to the shortage of nurses within the healthcare system in the province, where hundreds of newly-qualified nurses cannot be absorbed by the health system, despite a glaring shortage in our facilities. As a result, the provincial government is considering releasing these nurses to other provinces and to the private sector, thereby dashing any immediate hope of addressing the chronic shortage in health facilities.
Furthermore, gaps that have been identified during the pilot phase of NHI in the province, such as Ideal Clinics, Family Teams and Schools Health Programme, have not been addressed and poor resources are at the core of their ineffectiveness.
Many clinics have scored poorly from assessments, which are done twice a year, on critical areas like resuscitation equipment and only 11 percent of clinics are ready for NHI in the eThekwini District, and staffing norms (WISN) are not used when hiring staff.
The integrity of infrastructure scored not more than 27 percent in clinics, and the response of EMS to emergencies is only at 39 percent while a whopping 43 percent of clinics have non-functional ablution facilities.
While there were areas of improvement on infrastructure in some districts, which is a positive sign, the challenges of human resource and shortage of equipment far outweigh the positives in this regard.
Issued by DENOSA in KwaZulu-Natal
For more information, contact:
Mandla Shabangu, Provincial Secretary
Mobile: 071 643 3369
DENOSA welcomes the adoption of NHI Bill by Cabinet, and hopes todayâ€™s Health Budget Speech will outline cl...
Friday, 12 July 2019
The Democratic Nursing Organisation of South Africa (DENOSA) warmly welcomes the adoption of the National Health Insurance (NHI) Bill by Cabinet as announced by Minister in the Presidency earlier yesterday, and hopes the parliamentary processes of passing it into an Act will expedite so that all people can finally get access to quality healthcare services regardless of their socio-economic well-being.
We hope the Health Budget Vote, to be delivered by Health Minister in Parliament today, will provide a clear outline of the implementation process as well as provide solutions to what have become hindering nodes to its implementation.
DENOSA reiterates its long-standing support of the NHI with its noble intentions and calls for its immediate implementation without any further delays so that patients and communities could have access to Universal Health Coverage.
Just as we have said before to the previous health minister, NHI will not arrive like manna from heaven and solve every inefficiency in our healthcare system that has been neglected for years, and neither will the existent systemic challenges sort themselves out automatically once NHI is ushered in.
There is serious work that still needs to be done today to lay the ground for what will become a successful implementation of NHI. Key to this work is in the following critical areas:
1. Strengthen and improve Human Resource Planning.
a) Minister needs to deal with shortage of nurses in our hospitals and clinics, especially those in the rural areas, whereas there are hundreds of unemployed nurses sitting at home. Nurses who have completed their community service are also piling up at home and wait for years to be absorbed in provinces.
b) Minister must also deal with shortage of medicines and intervene in provinces like Limpopo where clinics are without critical medication, and yet government in Limpopo comes out and says there is enough medication, which incites communities against nurses.
c) Minister must also look at and fulfil the non-negotiables before embarking on extending the operating hours of many clinics into 24-hour service centres in our facilities and ensure this extension is also done in dispensary, and through addition of nurses, clerks and cleaners as well as security because in the absence of these support staff nurses end up performing non-nursing duties.
d) Improving these will ensure that as a country we usher in NHI in an environment that is welcoming and conducive for both patients and health workers.
2. Safety and security in health facilities
a) The minister must outline the concerning area of safety in health facilities, which have become soft targets for thugs due to its slackness. DENOSA is more interested to know how government will invest in this area because outsourcing this service has proven to be a futile and dangerous exercise by government.
b) Patients and health workers have become victims inside healthcare facilities recently, and more incidents are certain to occur because very little has been done to tighten and improve security in facilities.
DENOSA awaits with baited breath on how the Budget Vote and Policy statement by Minister will respond to these critical challenges.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Cassim Lekhoathi, Acting General Secretary
Mobile: 082 328 9671
Simon Hlungwani, DENOSA President
Mobile: 082 328 9635
Facebook: DENOSA National Page
DENOSA KZN negotiates with Department on unemployed nurses in the province...
Tuesday, 09 July 2019
Calling on unabsorbed post-community service nurses to contact DENOSA office urgently
The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal has been talking with the Department of Health in the province regarding the non-absorption of the more than 250 post-community service nurses who are sitting at home while their services are desperately needed in health facilities.
Out of 260 post-community service nurses who completed their community service in December last year, 200 were absorbed during the course of this year, and 60 had not been absorbed. This number was added by 200 more nurses who completed their community service in June this year, as they too are sitting at home as the department failed to employ them. Subsequent to this, the Department issued a circular releasing nurses who wish to find employment elsewhere from the obligation of serving the department for the period equal to the one spent by the nurses while studying.
DENOSA raised serious objections to this circular as it applies a blanket approach to all affected nurses as if they all want to find their work elsewhere. There are nurses who want the department to honour its side of the contract – to employ them after completion of their studies. DENOSA met with the MEC on 2 July regarding this matter and the dire situation in health facilities caused by severe shortage of staff.
The follow-up meeting on the issue of post-community service nurses will be held this Friday between DENOSA and Human Resource Department as well as Dr Mthembu who is responsoble for colleges, to find a way of getting the nurses employed, and to amending the circular so that it can be flexible and give serve both those who wish to find work outside the department on their own to apply to do so from the department while the Department is in the process of employing them as well as acknowledge those who still want to remain in the employ of the department in the province as per the spirit of their agreement.
DENOSA would like to urge all the affected nurses to contact the DENOSA Provincial Secretary in KwaZulu-Natal, Mandla Shabangu on 072 151 5874 or 031 305 1417.
“We are in talks with the neighbouring provinces with the view of finding employment for these nurses if the department is wasting their time. We wish to submit names and CVs of the willing nurses to our DENOSA colleagues in Northern Cape before this Friday, for submission to the office of the MEC in Northern Cape,” says Mandla Shabangu.
Issued by the Democratic Nursing Organisation of South Africa in KwaZulu-Natal
For more information, contact:
Mandla Shabangu, DENOSA Provincial Secretary
Mobile: 072 151 5874
Tel: 031 305 1417
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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