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DENOSA Gauteng concerned by continuing financial woes at Gauteng Health Department and calls on Treasury to ba...
Wednesday, 15 November 2017
The Democratic Nursing Organisation of South Africa (DENOSA) in Gauteng is highly concerned about the crumbling financial state of affairs at the Gauteng Department of Health, and this risks the Department and province losing quality and professional workers in large numbers due to compensation shortfalls that remain unfulfilled for long periods.
Over the past months we have witnessed the Gauteng Department of Health becoming the playground of the sheriff of the court, and bank accounts of the department being attached by the court, unpaid pay progression and incentive bonuses of workers to the tune of R829 million and a shortfall in the compensation of employees (COE) budget to the tune of R916 million.
All these are signs that the department of health is under siege and cannot cope with these challenges. DENOSA in Gauteng is concerned that all these challenges are known by Treasury and government, but they don’t seem to bother them. “But we have witnessed urgent action in the recent past to bail out state-owned enterprises such as SAA and Eskom, but there is not even a move to bail out health in this country,” says DENOSA Gauteng Provincial Chairperson, Simphiwe Gada. “It seems that the government cannot prioritise well, because it is our view that the health of our citizens is more important than an airline.”
DENOSA Gauteng would like to call on government to intervene and bail out the Gauteng Department of Health before the crisis reaches a boiling point and become irreversible, so that the department can continue to function and meet its obligations. DENOSA Gauteng equally warns government in Gauteng that if workers continue to be compromised by the current dire financial state and are not paid their incentive bonuses and pay progression, we will shut down the department of health.
Our last call is that the public must step in and put pressure onto the government to save the department of health or be ready to have a non-existent department of health that will not meet their health needs.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in Gauteng.
For more information, contact:
Simphiwe Gada, DENOSA Gauteng Provincial Chairperson
Mobile: 072 563 1923
DENOSA KZN on the viral video of a nurse at St Mary's Hospital...
Friday, 10 November 2017
The Democratic Nursing Organisation of South Africa (DENOSA) in Kwazulu-Natal would like to confirm that the nurse in the video that is going viral is its member, and that she has been placed on precautionary suspension.
As a result, the organisation is not able to make any further comment on the incident as shown in the video, as we are obliged to represent our member in the disciplinary hearing that is to take place in due course, until the matter has reached its conclusion. Commenting on it would be prejudicial.
As an organisation, however, we are concerned about the utterances made by the MEC of Health in KZN, Dr Sibongiseni Dlhomo, on the media platforms regarding this matter, which we feel may compromise this case as he has already made judgmental comments before this issue is handled in the normal departmental disciplinary processes.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal.
For more information, contact:
Mandla Shabangu, DENOSA KZN Provincial Organiser.
Mobile:071 643 3369
DENOSA Gauteng is at Thele Mogoerane Hospital in Vosloorus engaging management regarding the unrest caused by ...
Thursday, 26 October 2017
The Democratic Nursing Organisation of South Africa (DENOSA) in Gauteng has urgently deployed its provincial Treasurer who is also COSATU Provincial Treasurer, cde Thabang Sonyathi, and both regional and local leadership to engage management at Thele Mogoerane Hospital in Vosloorus regarding non-payment of the security company working at the hospital, which has since led to security workers withdrawing their labour and health workers joining in solidarity with security workers.
“DENOSA would like to inform the community, however, that their healthcare needs will be taken care of at the facility. We further make a call to community to support these security workers in their cause by holding the hospital management accountable and run the hospital effectively in the interest of the community,” says DENOSA Gauteng Chairperson, Simphiwe Gada.
“As such, nurses working in critical areas such as ICU, maternity and casualty are at work, although they work in an insecure environment and as a result it gives us great discomfort that the safety of both patients and nurses cannot be guaranteed while taking care of patients at the facility, because there is no security at work.”
In the meeting currently underway between management and workers at the hospital since this morning, DENOSA is pleading with the management to speedily pay the invoice to the security company so that operations could return to normality.
“Timeous payment of suppliers is one of the grey areas that government needs to resolve throughout the departments of health,” adds Gada. “This is one of the negative outcomes of outsourcing security function by government, because security as public servants would have been paid through PERSAL (government payment system) and none of us would be in this messy situation.”
DENOSA is also seeking urgent intervention of the MEC of Health in the province to see to it that the issue is not prolonged any longer.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in Gauteng
For more information, contact:
Simphiwe Gada, DENOSA Gauteng Provincial Chairperson
Mobile: 072 563 1923
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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