DENOSA KZN welcomes the suspension of senior management at Northdale Hospital...

Media statement   
Wednesday, 05 August 2020
 
 
The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal welcomes the probe by the MEC of Health into the incident that led to the death of an elderly at Northdale Hospital's make-shift ward on the hospital's makeshift parking lot clinic and the suspension of senior management at the facility over this issue. 
 
We hope, once investigation is concluded, those responsible will face the consequences of their action and we furthermore call on the Department to cast its eyes over other institutions s well where a similar mischief by hospital management may be playing out but has not yet been caught on camera.
 
From months ago, DENOSA has received many complaints from its members and shop stewards from the same hospital over the poor manner in which the planning of the make-shift units was made, which has exposed patients to more dangers and loss of dignity. And these complaints and institutions were communicated by DENOSA to the provincial department.
 
"Many community members have expressed their anger and frustrations towards nurses at that make-shift parking lot clinic because it often get cold there by the middle of the night in that area at this time of the year, and there would be no blankets that nurses can give to patients," explains DENOSA KZN Provincial Secretary, Mandla Shabangu.
 
"And the anger caused by this poor and inconsiderate plan by management would be directed at poor nurses, who had nothing to do with it and those responsible for it would be fast asleep in their comfortable beds."
 
From as early as April this year, our shop stewards raised the serious issue of the need to separate patients who are confirmed COVID-19 cases from those who are still waiting for their results. The management had promised to do so, and the status quo remains and all patients are still under the same roof, using the same amenities and nurses are made to care for patients still awaiting their results without PPE.
 
As a result, nine nurses from one unit have contracted the virus and yet it is still business as usual.
 
The total care for patients, communities and healthcare staff is not something that is respected at the institution and the facility has actually become a danger to everybody.
 
DENOSA has issued a strict instruction to its members at the facility not to touch patients if they are not given PPE because that carelessness increases the spread of infection at a health institution that should be preventing and managing the spread of infection to patients and workers.
 
End 
 
Issued by DENOSA in KwaZulu-Natal
 
For more information, contact:
 
Mandla Shabangu, DENOSA KwaZulu-Natal Provincial Secretary
 
Cell: 071 643 3369
Tel: 031 305 1417

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DENOSA KZN calls on its members to refuse to resume work post- isolation or quarantine until they receive psy...

Media statement

Monday, 03 August 2020

 

The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal is unhappy with the slow pace in how the Department of Health is moving in dealing with the critical regulations to curb the rising infection rate amongst healthcare workers in the province.  

It is disturbing and disappointing that while we were confronted by COVID-19 since March 2020, until this date there is no workable plan on human resources, infrastructure, prioritization of patients, confusion about what type of leave our members should take when infected by the virus and to protect vulnerable employees and clear plans on psychological support.

DENOSA in KwaZulu-Natal wishes to urge our members to refuse to resume duties post- isolation or quarantine until employer provide psychological support to our members before resuming duty to deal with traumatic COVID-19 fears and stigmatization of our members.  

Furthermore, we demand that the Department of Health review and clarify the confusion about the type of leave that our members are to sign after testing positive, as well as to lead by example and put the food where their mouth is by stopping the rhetoric about health workers being important but refuse to attend to their needs.

“We demand an HR plan of the department that will ensure that when nurses are in isolation or quarantine, overtime or moonlighting is approved without forcing our members to be overburdened by the workload while their colleagues are in isolation and quarantine,” says DENOSA KZN Provincial Secretary, Mandla Shabangu.

DENOSA has written to the office of the Head of Department to get answers on the following not later than 8 August 2020:

1.       A clearly defined plan of Human Resource, to do moonlighting or overtime in all institutions with nurses in isolation or quarantine;

2.       We demand a clear circular or Standard Operation and Procedure (SOP) on psychological support of our members before reporting back to work after testing positive;

3.       We demand a clear policy or circular about precautionary measures taken by the department to reduce exposure of our members with comorbidities from infections from COVID-19.

4.       We demand that all institutions present proof of having OHS and EAP practitioners in place in all facilities.

5.       We demand that all institutions provide all nurses with N95 masks even if they are not working in designated COVID-19 units as it is clear that all wards are becoming COVID infected.

6.       We demand that COVID-19 tests for healthcare workers be prioritized to reduce turn-around time for our members to get results at least three days after testing, unlike what is happening now where our members wait up to two weeks for results exposing other health workers at work.

7.       We demand that student nurses be given the gadgets like laptops that will assist them with their learning in this current environment, because they are being disadvantaged greatly in their progress due to non-provision of these.

We believe that the department will not ignore these concerns because they are at the centre of failing or winning the fight against COVID-19.

We will be waiting for a detailed response from the Head of Department in KZN, failing which we will escalate our issues to the next level within the Department of Health.

End

Issued by DENOSA in KwaZulu-Natal

For more information, contact:

Mandla Shabangu, Provincial Secretary

Cell: 071 643 3369

Tel: 031 305 1417 

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DENOSA Gauteng welcomes the placement of Health MEC on special leave of absence...

Media statement 
 
Thursday 30th July 2020
 
The Democratic Nursing Organisation of South Africa (DENOSA) in Gauteng welcomes the placement on special leave of absence of the MEC of Health in the province, Dr Bandile Masuku, pending an investigation into procurement of PPE contracts related to management of COVID-19 in the province.
 
We hope this decision will add credibility to the processs given that the person concerned is not in his position while the investigation is ongoing and will not influence the outcome of the investigation. 
 
As a trade union, we are particularly happy that this decision is in principle in line with resolution 1 of 2003 of PSCBC on the management of disciplinary processes that is applicable to officials. It is encouraging that the same principles are applied even to a politician. 
 
We hope the investigation can be expedited so that any wrongdoing will be punished and those responsible be held accountable so that services to the community members is not hindered or interrupted in any negative way and we can all move on and focus on the covid 19 war. 
 
End.
 
Issued by DENOSA in Gauteng.
 
For more information, contact: 
 
Thabang Sonyathi, DENOSA Gauteng Deputy Provincial Chairperson.
Cell: 083 499 3729
 
Bongani Mazibuko, DENOSA Gauteng Provincial Secretary 
Cell: 071 686 9544

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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

         
February 2020

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