SEARCH

SEARCH BY CITATION

This paper highlights cardiovascular disease and nursing within the realm of critical care nursing in South Africa, and how it is a part of the multidisciplinary treatment of patients with cardiovascular diseases.

GEOGRAPHY AND DEMOGRAPHICS

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES

South Africa is located on the southern tip of the continent and is surrounded by about 2700 km of coastline on 3 sides. The north boarders are on Namibia, Zimbabwe, Botswana, Swaziland, and Mozambique. South Africa covers an area of approximately 4800 km2 making it slightly less than twice the size of the US state of Texas.1 The highest point is Njesuthi (3408 m above sea level) and the lowest point is the Atlantic Ocean.2 The country has a temperate climate that is relatively uniform throughout the nation and rainfall that is about one-half the world average.3

The country's government is based in 3 capitals: Cape Town (legislative capital); Pretoria (administrative capital); and Bloemfontein (judicial capital). Since 1994, the government has been a constitutional democracy2 and the African National Congress (ANC) the ruling party. The formal head of state is the president of the ANC, President Kgalema Motlanthe. South Africa has a bicameral Parliament consisting of the National Assembly (400 members) and the National Council of Provinces (90 members). South Africa's 9 provinces are home to a diverse population whose inhabitants speak 11 official and a myriad of tribal languages.

South Africa has a total population of 48.7 million people.4 Of the total population, 10% are 0–4 years of age, 20% are between the ages of 5 and 13, 40% between 14 and 34, 25% are between the ages of 35 and 65, and 5% are over the age of 65.4 Black Africans constitute the majority (79%) followed by white (9.6%), colored or mixed race (8.9%), and Indian/Asian (2.5%).4

HIV/AIDS is South Africa's primary health concern. According to Statistics South Africa, the overall HIV prevalence rate is approximately 11%, meaning 5.35 million people in South Africa may be HIV positive.4 The average age of a South African is estimated at 24.2 years and the expected lifespan for a South African at birth is estimated at 52.2 years.4 The growth rates for the South African population shows a steady decline from 1.5% between 2001 and 2002 to 0.8% between 2007 and 2008.4

HEALTH CARE SYSTEM

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES

The South African health care structure comprises of 2 health care delivery systems. The first and largest is the public sector that delivers free healthcare services to about 80% of the population. The second delivery system is the smaller but fast-growing private sector that offers health care services to the remaining 20% of the population, generally those who can afford health insurance or are covered through employment.5 Most of the country's health resources are located in the private sector. The state contributes about 40% of all expenditure on health care services in the public sector, which is under enormous pressure to deliver effective health care services. The public sector's emphasis is shifting from acute to primary health care and private hospitals have begun to take over many tertiary and specialist health services.5

CARDIOVASCULAR DISEASE

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES

Despite the high mortality rates caused by HIV/AIDS in South Africa, actuarial projections suggest that rate of chronic disease, including cardiovascular diseases, will also increase, reaching about 666 deaths per day by 2010.6 The Heart and Stroke Foundation of South Africa estimated that 195 people died per day from 1997 through 2004 because of some form of heart and blood vessel disease.6 Approximately 25% of all health expenditures are devoted to cardiovascular disease.6 South Africa is currently losing more adults aged 35 to 64 years from cardiovascular disease than are countries such as the United States and Portugal.6 The highest death rates for heart and blood vessel disease in South Africa are found in the Indian population, followed by colored people, while white and black people seem to have the lowest rates.6

CARDIOVASCULAR CARE

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES

Various single function units, such as postoperative ventilation of cardiothoracic patients, were established during the 1960s in South Africa. Dr Neil Goodwin from Sweden was head of the first of these multidisciplinary units, which opened in 1970 at the Addington Hospital in Durban.7 Today several units in South Africa still function as multidisciplinary units with some dedicated to the exclusive care of cardiovascular patients. Specialist physicians care for the cardiovascular patient in collaboration with nurses, physiotherapists, and dieticians. Depending on the health care system available to the patient, be it the public sector or the private sector, the patient follows a specific route of care. The patient in the public sectors' first contact with health care is usually with the primary health care nurse in the community clinic. The nurse is responsible for the referral of patients to specialist teams at public hospitals. Because of the limited resources of cardiovascular units in the public sector, patients are admitted on bed and staff availability in the units. In an attempt to address these critical shortages, the public sector often admits patients to private clinics for diagnostic tests and interventions such as angiograms and percutaneous transluminal angioplasty and stenting. Patients in the private sector usually consult with a general practitioner who refers complex patients to a specialist physician who has access to highly hi-tech health services (Figure).

image

Figure Figure. Provincial map of South Africa. Nations online. Available from: http://www.nationsonline.org/maps/south_africa_prov_map.jpg. Accessed November 19, 2008.

Download figure to PowerPoint

NURSING EDUCATION

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES

The pioneers of nursing education and practice were the women who cared for the pregnant wives of European settlers following their arrival in the Cape in 1652.7 Today student nurses within the South African context follow 1 of 2 formal routes in becoming registered nurses. These programs under the constituting eye of the South African Nursing Council incorporate the training of registered nurses into a 4-year diploma or degree preregistration program. Both programs lead to simultaneous registration in general nursing, psychiatric nursing, community health nursing, and midwifery.8,9

The postapartheid transformation and democratizing of South African Higher Education, procreated a policy of inclusivity,8 and great effort was put forward to ensure that nursing education became part of the mainstream of higher education in South Africa. Today various colleges and universities are accredited not only to train preregistration nurses but also to provide various postregistration courses leading to an additional qualification for the purpose of specialist nursing practice.7,10

CARDIOVASCULAR DISEASE NURSING

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES

The postregistration training of nurses in South Africa does not provide for the exclusive training of cardiovascular nurses, however, nurses receive comprehensive training in cardiovascular nursing in both the preregistration program and in the postregistration program of which critical care nursing is one. The first South African-based postbasic diploma in intensive care nursing was offered in 1966 at the Johannesburg Hospital.7 Today critical care nursing education in South Africa is provided on 2 levels, one being a postregistration diploma which is offered by nursing colleges and universities, and the other a postgraduate (masters) degree offered exclusively by universities.7Table provides an overview of the differences between the 2 levels of qualifications and indicates that the only distinction between the 2 levels can be found in the research component.

Table Table. Postregistration Diploma vs Postgraduate Degree in Critical Care Nursing Education in South Africa
Postregistration diplomaDuration of studyPostgraduate degree
One yearTwo years
Medical and surgical unitsClinical rotationMedical and surgical units
Cardio-Thoracic units Cardio-Thoracic units
Trauma and neuro-surgical units Trauma and neuro-surgical units
Coronary care Coronary care
Renal dialysis (additional) Renal dialysis (additional)
Anaesthesia (additional) Anaesthesia (additional)
Burn units (additional) Burn units (additional)
No research requiredResearchRequired to conduct research under supervision in a selected specialty
Nursing dynamicsSubject contentNursing dynamics
Internal Medicine and Surgery capita selecta Internal Medicine and Surgery capita selecta
Medical and Surgical Nursing Science Medical and Surgical Nursing Science
Registration as a critical care nurseRegistration statusRegistration as a critical care nurse

THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES

To date no formal cardiovascular nursing society or organization is registered in South Africa, but the Critical Care Society of Southern Africa (CCSSA) takes on this role by offering a multidisciplinary home to doctors, nurses, and other members within the critical care team.7 As part of the CCSSA the Critical Care Nurse Forum was established in 2006. This forum sets out to lead South African critical care nurses to influence policy and so contribute to the improvement of the practice, management, and education at local, national, and regional level. The CCSSA hosts an annual conference and refresher course for its members and also contributed to the representation of South African nurses on the council of the World Federation of Critical Care Nurses.7

REFERENCES

  1. Top of page
  2. GEOGRAPHY AND DEMOGRAPHICS
  3. HEALTH CARE SYSTEM
  4. CARDIOVASCULAR DISEASE
  5. CARDIOVASCULAR CARE
  6. NURSING EDUCATION
  7. CARDIOVASCULAR DISEASE NURSING
  8. THE CRITICAL CARE SOCIETY OF SOUTHERN AFRICA
  9. REFERENCES
  • 1
    The World Factbook. 2008. South Africa. Available from: http://www.cia.gov/library/publications/theworld-factbook/print/sf.html. Accessed November 6.
  • 2
    International Marketing Council of South Africa. 2008. About South Africa. Available from: http://www.southafrica.info/about/. Accessed November 2.
  • 3
    South Africa Yearbook. Available from: http://www.gcis.gov.za/docs/publications/yearbook/index.html. Last updated November 11, 2008. Accessed November 20, 2008.
  • 4
    Statistics South Africa. Mid-year population estimates. Pretoria: Statistics South Africa. Available from: http://www.statssa.gov.za/publications/statsdownload.asp?PPN=P0302&SCH=4203. Accessed November 6, 2008.
  • 5
    International Marketing Council of South Africa. 2008. About South Africa. Available from: http://www.southafrica.info/about/health/health.htm. Accessed November 6, 2008.
  • 6
    Steyn K. The land and it's people. In: FourieJM, Ed., Heart Disease in South Africa. Cape Town, South Africa: Lifestyle Unit, Medical Research Council; 2007:728.
  • 7
    Scribante J, Schmollgruber S, Nel E. Perspectives on critical care nursing: South Africa. Connect. World Crit Care Nurs. 2004;3 (4):111115.
  • 8
    Kyriacos U, Jordan S, Van Den Heever J. The biological sciences in nursing: a developing country perspective. J Adv Nurs. 2005;52 (1):91103.
  • 9
    South African Nursing Council. South African Nursing Council Regulation 425, Government Printers, Pretoria, February 22 1985.
  • 10
    South African Nursing Council. South African Nursing Council Regulation 212, 19 February as amended by Regulation 74 of Government Printers, Pretoria, January 17, 1997.