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DENOSA KwaZulu-Natal pleased to be invited by Provincial Legislature to its three-day programme of inspecting...
Tuesday, 15 October 2019
The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal is pleased by the invitation from the Health Portfolio Committee of the KwaZulu-Natal Provincial Legislature to its three-day programme of monitoring functionality of health institutions in the province starting from today.
DENOSA has long been expressing its unhappiness over the poor state of health in the province, mainly as a result of gross shortage of staff and equipment as well as poor conditions of work for health workers. Many of these areas have not been addressed by the department.
DENOSA appeals to managers of the facilities that will be visited not to hide the extent of the challenges they face. This is because, in the past, whenever facilities are visited and such visits are announced before, clinics would borrow equipment from neighbouring facilities as a way to create a cosmetic perfection and impress those doing the inspecting.
DENOSA representatives will form part of the inspections of institutions. “Nurses have always raised many challenges in the facilities that continue to pose a serious challenge to the delivery of quality of healthcare service to community members,” says DENOSA KwaZulu-Natal Provincial Secretary, Mandla Shabangu.
“Yes, there are slight improvements on some areas of concern, but there still remain many challenges that need urgent attention from the Department of Health in the province. The issue of poor staffing levels in many facilities leads to delayed service for end-users, and not to mention frustrations on both workers and patients.”
The province still has thousands of qualified nurses who are sitting at home looking for work whereas many positions remain unfilled in many health facilities.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal
For more information, contact:
Mandla Shabangu, DENOSA KZN Provincial Secretary
Mobile: 071 643 3369
DENOSA KZN analysis of an agreement on prioritizing the promotion of qualifying nurses, a year later ...
Tuesday, 15 October 2019
As the year has passed since the agreement at the provincial bargaining chamber on giving priority to promoting nurses who have gone through a bridging course to become professional nurses before advertising posts, the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal has been monitoring the implementation of this agreement and has noted that only 50% of the agreement was implemented whereas two more challenges still remain.
On 11 October 2018, the agreement with the Department of Health in KwaZulu-Natal was that the then 1200 nurses who had completed their qualification as professional nurses from being enrolled nurses would be employed as professional nurses whenever vacancies in their institutions arose and that any advertisement of such vacant posts would be retracted to give priority to qualifying nurses internally.
As of 11 October 2019, DENOSA has observed that 600 nurses were translated into professional nurse positions in line with the agreement. However, the number of qualifying nurses who are due for translation has since increased to 700 currently as more nurses have since completed their studies to become professional nurses too.
Furthermore, DENOSA has noted with great disappointment that the agreement to prioritize the absorption of the qualifying nurses to become professional nurses as soon as positions become available has not been respected and implemented by institutions in the province as they continue to advertise positions despite the presence of this agreement.
Another challenge that DENOSA noted is the moratorium on the appointment of the 600 vacant positions of enrolled nurses that were created by the promotion of the nurses who had completed their studies to become professional nurses. “This, in essence, has brought us back to exactly where we were in 2018,” says DENOSA KwaZulu-Natal Provincial Chairperson, Mandla Shabangu.
“The fact that these vacancies were never filled makes no difference because the staff numbers remain the same except for improvement of skills for those who went to school. This does not mean, however, that these nurses who went to school increased their manpower, because there were still shortage of nurses even at the professional nurse level when they went to school. It is equally important that both vacancies of enrolled nurses as well as those of professional nurses are filled,” adds Shabangu.
DENOSA calls for the lifting of this moratorium of the employment of nurses, because it is compromising the quality of healthcare services that communities receive. We hope the new HOD in the province will see the essence of hiring every necessary staff member in healthcare facilities of the province.
Issued by DENOSA in KwaZulu-Natal
For more information, contact:
Mandla Shabangu, DENOSA KZN Provincial Secretary
Mobile: 071 643 3369
DENOSA statement on International Mental Health Awareness Day: Many health professionals are also patients dy...
Thursday, 10 October 2019
As today, 10 October, is commemorated as International Mental Health Awareness Day, the Democratic Nursing Organisation of South Africa (DENOSA) would like to highlight the gloomy picture of the poor state of Mental Healthcare for South Africa as a country with more than 17 million people suffering from one form of mental illness or another, including health professionals themselves.
More concerning for DENOSA is that there are poor systems in place to deal with what has become increasing illness for South Africans, many of whom are dying in silence and further drowning in their own thoughts with little or no intervention from the healthcare system.
In Mpumalanga province, for example, there is not a single mental health institution that should be a shelter to accommodate patients suffering from mental health illnesses. Patients with mental illnesses get cared for in provinces like Gauteng, thus indicating lack of will and urgency in caring for such patients. Student nurses in Mpumalanga get their training on Psychiatry in KwaZulu-Natal.
And recently, there have been gruesome incidents of killings in the province: a mother killed her four children; a man killing his mother, and a man killed women and buried them in shallow graves.
It has taken Northern Cape over ten years to build, complete and open a mental health institution of its own in Kimberley. Ten years!
Whilst most patients suffer from this condition, the healthcare system itself is producing its own victims from amongst healthcare practitioners. Their work exposes them to traumatic experiences every day with no support structure in the form of debriefing sessions. Many nurses who work in trauma and emergency units of hospitals, because they attend to patients with gunshots and stab wounds daily, develop symptoms of depression, anxiety and other forms of mental illnesses, as these compound to their already many personal stresses.
Whereas in the past there used to be counselling services for health workers at each institution to help them cope with the stressful work, such assistance is no longer there and they are expected to act normally even after they have experienced multiple loss of patients. This develops and grows into something bigger and more serious. As a result, they find ways of taking their frustrations out by ventilating at wrong avenues like patients, doing so unconsciously.
DENOSA strongly suggests that counselling and debriefing sessions be brought back at each healthcare facility as a matter of urgency, and that innovative ways of providing assistance to health professionals through technology be prioritized.
Furthermore, government in provinces must realise and appreciate that, for them to attract healthcare specialists in their health facilities, they need to upgrade their standard so that each province has at least one tertiary healthcare institution which will support such specialists with their research work that contributes towards enriching the body of knowledge in health.
The absence of such solutions-based healthcare service creates a domino-effect whereby the existing challenges create even more patients, even in the form of healthcare professionals, who suffer from various forms of mental illness due to working under depressing conditions.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Cassim Lekhoathi, DENOSA Acting General Secretary
Mobile: 082 328 9671
Simon Hlungwani, DENOSA President
Mobile: 082 328 9635
Facebook: DENOSA National Page
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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