DENOSA response to President Ramaphosa’s maiden SONA, especially on health commitments ...

Media statement  

Monday, 19 February 2018 

The Democratic Nursing Organisation of South Africa (DENOSA) notes the maiden State of the Nation Address by President Cyril Ramaphosa that he delivered on a Friday under a calm environment for the first time in a very long time. 

DENOSA particularly notes the undertaking made by the president on the health front, particularly the need to realise Universal Health Coverage (UHC) for all South Africans in the form of the National Health Insurance (NHI), whose Bill will be tabled in Parliament soon. 

DENOSA is hopeful that, after many years of undertaking by former President during SONAs, President Ramaphosa will be able to make follow-up on the commitments he has made of visiting state institutions, talking to heads about the need to accelerate service delivery. DENOSA urges the President to seriously look at the underlying causes of what is slowly becoming poor service delivery – the absence of or broken tools of trade and shortage of staff and shortage of critical equipment in the case of health facilities. These are some of the issues we had raised to him during our 20th anniversary celebrations in Pretoria on 5 December 2016. 

We had remained hopeful that his predecessor, former President Jacob Zuma, would live by his words of the 2011 SONA where he undertook to revitalize and refurbish 201 previously closed nursing colleges nation-wide. Not a single college had opened until he left office. And the health demands, in the meantime, are on the increase due to growing population figures as well as increase in the number of immigrants that come to South Africa for greener pastures. DENOSA’s concern is that these are not matched by any plan to increase the intake of nursing students so that queues in health facilities could not become longer by the day as they are currently. 

While it is a good and commendable move that government will be committing to increasing the initiation of HIV positive people into the country’s Anti-Retroviral Treatment (ART) by 2 million in the next two years to a total of 5 million by year 2020, DENOSA is highly concerned that this ambition is not matched by a slight increase in the intake of students to do nursing so that overtime shortage of nurses in facilities is addressed. DENOSA warns that the country could be a victim of its own success in that increasing patients into ART without hiring more nurses will lead to high default rate, because many patients are turned away in many clinics due to long queues and the fact that there are few nurses. 

We hope the President will look into this matter so that it is not business as usual, as have been the case over the years. 

Nurses’s shouts of #ThumaMina (SendMe) are overshadowed by this severe shortage of nurses and equipment in our health facilities. NHI will still need more nurses, which we are not increasing the intake of their production today. This will catch the country badly if President is not looking into it. That is why DENOSA is hopeful that this area will be looked into by Finance Minister in his budget speech on Wednesday. 

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 

Sibongiseni Delihlazo, DENOSA Communications Manager

Mobile: 072 584 4175 

Website: www.denosa.org.za

Facebook: DENOSA National Page 

Twitter: @DENOSAORG

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DENOSA calls for a stop of operations at Sibanye Stillwater mines until health and safety risks are eliminate...

Media statement 

Thursday, 8 February 2018 

Following yesterday’s death of two miners at Kloof Mine, the Democratic Nursing Organisation of South Africa (DENOSA) would like to call on the departments of Minerals Resources and Labour to temporarily stop operations at Sibanye Stillwater mines until all health and safety concerns are relooked and inspected thoroughly. 

 

The death of the two miners follows right on the heels of another near-death of 955 miners from the same mining company’s Beatrix Mine in the Free State, which could not operate its generators soon after electricity outage in the area.  It took Eskom to fix its power for the miners to be rescued after a day. 

DENOSA is in solidarity with its sister union, the Union of Mineworkers (NUM), in calling for improvement of health and safety measures in mining operations, so that miners are not made to sell their lives. We call for the investigation into this incident to be speeded up so that corrective measures are taken as soon as possible.    

Health facilities throughout the country are faced with a major challenge of shortage of health workers. Carelessness of mining companies on health and safety threaten to worsen this situation, and that is why the naughty ones must be called to order. 

It cannot be correct that an uncaring mining company, which Sibanye Stillwater has proven to be, is allowed to plunge mineworkers into death traps on a regular basis. Today’s incident is living proof that profit comes before the health and safety of workers. 

Both the departments of Mineral Resources and Labour must ensure that companies they give licences to do mining operations in South Africa are socially responsible at all times, otherwise many households risk losing bread-winners because of the careless behaviour of mining companies.

DENOSA would like to remind mining companies that there is no second chance to a life that has been lost! Therefore mining must not be done at the expense of miners’ livelihoods. 

Maybe it is time the Mining Indaba erected a Wall of Shame where names of mining companies that still undermine the issue of health and safety are placed, if it will take that for them to shake up. 

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 

Sibongiseni Delihlazo, DENOSA Communications Manager 

Mobile: 072 584 4175 

Website: www.denosa.org.za

Facebook: DENOSA National Page 

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DENOSA to hold CEC meeting from 21 to 23 February in Pretoria ...

MEDIA ALERT 

The Democratic Nursing Organisation of South Africa (DENOSA) will be holding its Central Executive Committee (CEC) meeting from 21-23 February 2018 at Arcadia Hotel (515 Johannes Ramokhoase Street) in Pretoria. 

The meeting will be held under the theme: Strengthening organizational unity and cohesion for optimal member servicing.

The CEC will be attended by 180 delegates, and is constituted by Provincial Executive Committees (PECs). It will be assessing the performance and progress of the organisation.   

Day One (21 February) will see guest speakers from the South African Nursing Council, the Department of Health, Department of Public Service and Administration, the ANC, South African Communist Part and COSATU addressing delegates. Also on Day One, DENOSA President, Simon Hlungwani, will deliver the Political Report.  

Members of the media are cordially invited to attend Day One of the DENOSA Central Executive Committee meeting and report on it. 

Proceedings on Day One will commence at 14h00 (21 February 2018) and finish at 18h00.  

Day Two of the meeting will be an entirely closed session, which will deal with Organisational and Financial reports as well as Break-Away Commissions. 

Day Three of the meeting will deal with report-back of commissions to Plenary, leading to CEC Declarations between 12h00 and 13h00. 

The media is invited to attend from 12h00 on Day Three as it will be an open session. 

DENOSA President will deliver closing speech at the meeting before delegates depart on Friday 23 February. 

End 

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

For more information, contact:

Sibongiseni Delihlazo, DENOSA Communications Manager 

Mobile: 072 584 4175 

Website: www.denosa.org.za

Twitter: @DENOSAORG

Facebook: DENOSA National Page 

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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

         
November 2017

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