More patients at risk of being killed by intruders in health facilities due to poor safety ...

Media statement
 
Tuesday, 14 January 2020
 
As more and more patients get killed by intruders in our health facilities, the Democratic Nursing Organisation of South Africa (DENOSA) is saddened to forewarn that more patients are likely to fall victims of shootings and attacks inside the country's health facilities due to poor safety and security. 
 
This warning is in the context of the recent shooting and killing of a 47-year-old patient at Clairwood Hospital south of Durban on Friday evening.
 
This will be the case for many patients, of course, unless the National Department of Health comes up with a concrete plan on strengthening the safety in our health facilities across the country, as the current outsourcing of security has proven to be a great disaster.
 
Many armed intruders gain entry in our health facilities with great ease and they cause damage successfully and disappear without any trace. 
 
Frankly, DENOSA is tired of saying the same thing whenever incidents of this nature occur. This has resulted in low morale amongst health workers in health facilities as they work fearfully.
 
DENOSA has said it many times that, because security is such a critical service in health facilities, the following are non-negotiables:
 
A) In-sourcing of security services; 
 
B) Boom gates installation in all facilities;
 
C) Functional metal detectors for security personnel at all the gates; 
 
D) Installation of CCTV cameras on various fronts with functional monitoring screens;
 
E) Installation of panic buttons in all sections of the facilities.
 
Currently, almost all of these prerequisites are non-existent, and that is why there is escalation of security breaches in facilities which lead to both patients and health workers becoming victims.
 
The National Department of Health has been quiet on this critical issue, and has left provinces to fumble, often at the expense of patients livelihoods.
 
End 
 
Issued by DENOSA 
 
For more information, contact:
 
Cassim Lekhoathi, DENOSA Acting General Secretary 
 
Mobile: 082 328 9671
 
Simon Hlungwani, DENOSA President
 
Mobile: 082 328 9635
 
Website: www.denosa.org.za 
 
Facebook: DENOSA National Page 
 
Twitter: @DENOSAORG 

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DENOSA Congratulates 2019 matriculants and urges them to be careful of bogus colleges as they seek tertiary e...

Media statement 
 
The Democratic Nursing Organisation of South Africa (DENOSA) congratulates the 2019 matriculants for passing their Matric exams with a higher rate. Also, we congratulate the teachers for their dedication as well as the Department of Education for the support that it provided to teachers.
 
In particular, DENOSA congratulates children of nurses who were amongst those that wrote Matric exams, for we understand how emotional this journey of preparing for their exams may have been a lonely one for them as their parents work long hours in health facilities caring for patients. 
 
This journey may have been more lonely for those matriculants whose parents are single parents who have taken a pledge of service that says the total care of their patients will be their first consideration. 
 
These positive 2019 Matric Results are an indication of the dedication of the current youth to education and their commitment to their future. 
 
DENOSA would like to encourage the matriculants to also consider nursing as part of their career choices. There may be challenges with the absorption of nurses into the public health facilities, but this does not take away the reality that the country still needs more nurses to care for patients in our health facilities, both rural and urban. It is a challenge that needs visionary leadership to solve instantly. Signs shown by Health MEC in Gauteng, Dr Bandile Masuku, to solve such challenges in Gauteng inspire hope and should inspire other MECs to do the same.
 
This year has been declared by World Health Organization (WHO) as the International Year of the Nurse and Midwife. DENOSA has pledged its commitment to ensuring that nurses voice is heard on its challenges, even if this means gate-crashing meetings of the powers-that-be, as long as that will be advocating for patients (community) and the nursing profession.
 
Lastly, DENOSA would like to caution the group of 2019 matriculants to be extra-vigilant when seeking tertiary education opportunities during this time of the year, as there are bogus colleges that will emerge and offer them programmes which are not accredited.
 
In the case of nursing, there are fly-by-night nursing schools that offer nursing programmes which are not accredited. Many young people fall victims to these scams. We urge parents and matriculants to ensure that the institutions they intend to register with are legitimate ones. They can confirm their legitimacy, before paying, by phoning the Department of Higher Education and Training to double-check if they are legitimate schools or colleges.
 
For those who would be doing nursing, they can double-check if the institutions they intend to register with are legitimate ones by phoning the South African Nursing Council (SANC), which is the regulatory body for nursing. They can call: 012 420 1000.
 
DENOSA would like to wish all those who have passed all the best. Those who have not made it, they must not lose hope and prepare themselves better because the journey towards a career is a long one. 
 
End 
 
Issued by DENOSA
 
For more information, contact: 
 
Cassim Lekhoathi, Acting General Secretary.
Mobile: 082 328 9671
 
Simon Hlungwani, DENOSA President
Mobile: 082 328 9635
 
Tel: 012 343 2315 
 
 
Facebook: DENOSA National Page
 
Twitter: @DENOSAORG

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DENOSA KZN statement on the incident involving a pregnant woman in Zululand on Wednesday...

Media statement 
 
The Democratic Nursing Organisation of South Africa notes the incident that took place involving a pregnant woman who was assisted by a taxi driver in Zululand in Wednesday. 
 
We note the statements made on social media and issuing of statement by the department attacking nurses without hearing the true story of what transpired in the situation
 
As nurses, we feel offended that a perception is created out there that any one can become a nurse.
 
The year 2020 has been declared as the International Year of the Nurse and Midwife by the World Health Organization and we expect all those involved in the health system to praise nurses when due and not only to comment about nurses when negative incidences occured.
 
We do not condone any unprofessional behaviours in the health system but let us praise when it is due and discourage wrong behaviour when it occurs.
 
The Department of Health has failed nurses in that over the years it has been failing to deal with gross shortage in the department, but nurses have been holding the forte to service our communities without fail. The same department has never openly showed appreciation towards them for working under unbearable conditions. 
 
We urge those in the leadership of the department to respect processes without judging those involved without facts having been established first.
 
We are still investigating the matter as the nursing organisation to get to the bottom of the incident where a taxi driver ended up assisting the mother to deliver the baby.
 
End 
 
Issued by DENOSA in KwaZulu-Natal
 
For more information, contact:
 
Mandla Shabangu, DENOSA Provincial Secretary 
 
Mobile: 071 643 3369

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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

         
August 2019

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