Bioaccumulation and trophic transfer of total mercury through the aquatic food webs of an African sub-tropical wetland system.

Anthropogenic activities, including combustion of fossil fuels, coal, and gold mining, are significant sources of mercury (Hg) emissions into aquatic ecosystems. South Africa is a major contributor to global Hg emissions (46.4 tons Hg in 2018), with coal-fired power stations as the main source. Atmospheric transport of Hg emissions is the dominant cause of contamination, especially on the east coast of southern Africa where the Phongolo River Floodplain (PRF) is located. The PRF is the largest floodplain system in South Africa, with unique wetlands and high biodiversity, and provides essential ecosystem services to local communities who rely on fish as a protein source. We assessed the bioaccumulation of Hg in various biota, the trophic positions and food webs, as well as the biomagnification of Hg through the food webs in the PRF. Elevated Hg concentrations were found in sediments, macroinvertebrates and fish from the main rivers and associated floodplains in the PRF. Mercury biomagnification was observed through the food webs, with the apex predator tigerfish, Hydrocynus vittatus, having the highest Hg concentration. Our study shows that Hg in the PRF is bioavailable, accumulates in biota and biomagnifies in food webs.

Caring for Terminal AIDS Patients: the Experiences of Caregivers in a Palliative Care Institution

This research focused on the lived experiences of caregivers working with AIDS patients; particularly patients who die from this disease whilst resident in a formal institution. A qualitative; exploratory; descriptive; and contextual research design with a phenomenological approach to inquiry was utilised. Thirteen unstructured interviews; which were audio-taped; were conducted with caregivers working full-time in a formal institution caring for patients who are dying from AIDS. The transcribed interviews were analysed using Tesch's method of descriptive analysis (in Creswell 1994:115). One central theme emerged; namely that in their daily duty (at their place of work); caregivers experienced various challenges as a result of having to deal with the death of their patients suffering from AIDS; and five sub-themes were formulated from further analysis. The five subthemes were: Caregivers experienced emotional challenges in caring for patients dying of AIDS; Caregivers experienced a difference in death and dying of adults as apposed to children; Caregivers experienced the rationalisation of death and dying differently; Caregivers experienced that faith in God give them strength to cope with death and dying; Caregivers experienced caring for patients as fulfilling and meaningful to them despite the sadness of death and dying. The participants face the death of their patients daily; from a disease that causes untold suffering to the patients; family members and to the caregivers themselves; who wish they could prevent the anguish; the pain and the inability of the medical profession to do more than they are at present towards curing this disease. They described their emotional experiences; which included the various challenges that they face as a result of having to deal with the death and dying of their patients suffering from AIDS. The information shared by these participants formed the foundation of the broad guidelines that were developed in order to provide support for such caregivers

The Experiential World of the Oncology Nurse

In her1 experiential world; the oncology nurse experiences unique; challenging and rewarding relationships in a multidimensional; dynamic way. The aim of this study was to describe; from her viewpoint and perspective; how she experiences and reacts to this world. Through this study the researcher wants the oncology nurse's voice to be heard; the richness of her story acknowledged and the derived data to be applied to the benefit of the field of oncology. In-depth; unstructured phenomenological interviews provided the saturated data from which the uniqueness of the world of the oncology nurse unfolded as the uniqueness of the oncology patients and their world emerged clearly. Findings show that the oncology nurse; attending to the cancer patients and their family; experiences many different relationships. The uniqueness of the oncology nurse-patient relation-ship is described as unlike any other nurse-patient relationship. The challenging interpersonal relationships with management and other members of the multiprofessional team; as experienced from the perspective of the oncology nurse; are also highlighted. Furthermore; a unifying intrapersonal relationship with the self was identified. This enables the oncology nurse to be both on the giving and receiving end of the intensely emotional environment she works in; explaining; at least partly; the high job satisfaction that permeated the interviews in this study. Recommendations for nursing practice; education and research were formulated

Registered nurses' experience of the withdrawal of treatment from the critically ill patient in an intensive care unit.

In this article the results of research undertaken to explore and describe the experience of Registered Nurses regarding the withdrawal of treatment from the critically ill patient in an Intensive Care Unit (ICU), are discussed. Withdrawal of treatment from a critically ill patient in an Intensive Care Unit (ICU) is a very traumatic experience for all those involved. The Registered Nurse has the most contact with all those who are involved throughout the process. This raises questions regarding how the nurse experiences the withdrawal of treatment, and about guidelines that can be developed to accompany the nurse during the process of treatment withdrawal. The study was qualitative, descriptive, exploratory, descriptive and contextual in nature. Data was gathered by means of phenomenological interviews conducted by the researcher. Trustworthiness was ensured through the implementation of Guba's model (in Krefting 1991: 214). The following themes were identified: 1. The relationships the nurse develops with individuals involved in the process of treatment withdrawal. 2. The inner moral conflict experienced by the nurse relating to the ethical aspects of withdrawal of treatment. The focus of this article is on the discussion of these experiences of the registered nurses. Based on the identified themes, guidelines were developed to accompany the nurse during the process of withdrawal of treatment.

A self-management model towards professional maturity for the practice of nursing.

A theory-generative, qualitative, explorative, descriptive and contextual research design for theory generation was used to develop a self-management model towards professional maturity for the practice of nursing. It became evident throughout the research study that the final year nursing students needed to become independent in the management of their practice. Classification of main concepts self and management was made according to the methods of theory generation of Mc Kenna (1998), Walker and Avant (1995), Chinn and Kramer (1995) and Dickoff, James and Wiedenbach (1968). Dickoff, James and Wiedenbach's (1968:422) survey list was utilized to classify the concepts of the model. Concluding relationship statements were inferred through deductive analysis and synthesis after each concept was conceptualized. The relationship statements provided a basis for the model description. A description is given of the model evaluation utilizing the criteria of Chinn and Kramer (1995:119). To ensure trustworthiness of the study, Guba's model in Krefting (1991:215) was utilized. Guba's four criteria for trustworthiness were ensured, namely truth value, applicability, consistency and neutrality. The researcher, throughout the study, considered ethical issues discussed in the previous article, as were the recommendations and limitations.

Accompaniment needs of nursing students related to the dying patient.

Nurse educators are responsible for accompanying students towards becoming capable, competent professional nurses who are a credit to themselves, their patients, colleagues and profession. Student nurses need, therefore, to be taught to render comprehensive nursing care to patients in all stages of their lives, including when they are dying. Being confronted with human suffering and death is challenging and traumatic. Those exposed to such events on a daily basis need to have a solid foundation of self preservation to see past the pain of suffering and to bring light and hope to those in need. A young student nurse will only experience positive growth and development in these circumstances if she is also cared for and guided with understanding. The researcher utilized a qualitative, explorative, descriptive and contextual design based on the phenomenological approach to enquiry. The following question was asked at the beginning of each unstructured phenomenological interview: "How was if for you to care for a dying or deceased patient?" The central theme identified that student nurses experience turmoil in their different relationships in their accompaniment of the dying patient. Guidelines based on the central theme and sub-themes that emerged from raw data, as well as literature, are offered as strategies to promote/enhance optimal accompaniment of student nurses caring for the dying patient.

Experiences of final year nursing students in their preparedness to become registered nurses.

The objectives of this study were: firstly, to explore and describe the experiences of final year nursing students relating to how they experience their preparedness to fulfil the role of professional nurse; secondly, to explore and describe the experiences of novice professional nurses in the role of professional nurse; finally, to generate a model which will assist the final year nursing student to become a professional nurse. A theory-generative, qualitative, explorative, descriptive and contextual research design was utilized to reach the objectives of the study. Results indicated that final year nursing students experience a lack of confidence to take on the responsibilities of professional nursing. The results are displayed in table form and discussed in the article. This abstract forms part of a bigger study that addresses the professional maturity of the novice professional nurse for the practice of nursing.

In-service education and training as experienced by registered nurses.

Nursing is a dynamic profession that is subject to rapid changes in health care provision, hence the need for in-service training programmes for nurses. Newly employed registered nurses require in-service training in order to update them regarding the latest developments in nursing practice. The researcher noted that some newly appointed registered nurses were not competent in all aspects relating to their tasks. This could have been due to a knowledge deficit relating to either new developments or of the procedure relating to a specific task. In some institutions newly-appointed registered nurses on probation reported not receiving in-service training for six months or longer, yet they were still expected to perform their tasks efficiently. The objectives of the study were to, firstly, explore and describe the experiences of registered nurses regarding in-service training programmes in their institutions and, secondly, to make recommendations to Nursing Service Managers relating to the development of effective in-service training programmes in their institutions. A qualitative, exploratory, descriptive design was implemented. Data was analysed using Tesch's descriptive approach (in Creswell, 1994:155). Two main themes emerged, namely that registered nurses experienced in-service training programmes as inadequate and reacted negatively towards them. This article focuses on the experiences of registered nurses relating to in-service training programmes, as well as the formulation of guidelines to assist nursing service managers in the development of effective in-service training programmes.

Accompaniment needs of first year nursing students in the clinical learning environment.

The clinical learning environment creates many opportunitics for student learning and the development of critical competencies in the nursing profession. The learning that takes place in this environment, however, confronts the first year nursing student with challenges that are absent from the classroom situation and causes the student to experience a significant amount of uncertainty and anxiety. The study revealed that the students experience uncertainty due to the lack of opportunities to develop competence in providing nursing care. The contributing factors towards this experience are: unavailability and inaccessibility of staff due to time constraints; shortage and/or absence of equipment to fulfil nursing duties and meet the needs of patients; conflict in the expectations of nursing school personnel and clinical nursing personnel in hospitals, as well as a lack of awareness among senior professionals of the needs and problems of first year nursing students in the clinical health care environment. Furthermore the students experienced the nature of the clinical learning programme as disrupting the continuity in patient care learning experiences, and the guidance and support by nursing personnel in the clinical learning environment as inadequate. The aim of this study was to reflect the importance of effective accompaniment by tutors/mentors, personnel in the clinical environment and any other person involved in the education of the first year nursing student, to prepare and enable him/her to become a knowledgeable, safe, competent nursing practitioner.

The clinic supervisory system as experienced by nurse supervisors.

A lack of proper monitoring and supervision of clinics in the King William's Town Health District (Eastern Cape) was highlighted by members of the public in the local newspaper, The Daily Dispatch, during 1999. A clinic audit conducted by the Health Information Unit of the King William's Town Health District further revealed the inadequacies of clinic supervision in this district. This article describes the qualitative study that was conducted with the aim of optimising clinic supervision in this health district. The study brought to light two issues that appear to be paramount in ensuring optimal clinic supervision. These are: The importance of formal and informal preparation of clinic supervisors for the supervisory role The support system that the clinic supervisors require to perform their duties effectively. The focus of this article will be on the discussion of the research findings as well as guidelines that were developed to optimise clinic supervision.

Syphilis, sex and crack cocaine: images of risk and morality.

A new epidemic of syphilis in the Portland, Oregon metropolitan region mirrors a national trend in the United States. The epidemic is centered in urban areas, is associated with heterosexual transmission, and disproportionately affects people of color, especially African-Americans. The epidemic has been linked to sexual activity among users of crack cocaine, and particularly to the practice of trading sex and crack. Here, we report an analysis of in-depth interviews of 40 respondents, of whom 31 have used crack cocaine, 12 have experience as professional sex workers (prostitutes), and 12 are confirmed recent syphilis cases or their sexual contacts. These respondents confirm that sexual activity involving multiple anonymous partners often takes place within the context of crack cocaine use. They also describe sexual activity among more casual users of the drug. But respondents present themselves as having maintained an adherence to common American values regarding cleanliness, mortality, and sexual behavior. They speak of choosing sex partners according to whether a prospective partner 'looks clean.' This image of cleanliness goes beyond simple bodily hygiene, and into the realm of judgement about moral character. A person is more likely to be judged clean if he or she is known to come from a nice family, has a pleasant demeanor, or appears concerned about self-control. Such people are seen as fundamentally decent, and therefore less likely to have syphilis, a disease associated with deterioration, tearing down, dirtiness and disordering. Thus, respondents use conceptions of cleanliness and morality in constructing definitions of high- and low-risk sexual behavior, as they negotiate a life that endangers their sense of moral control. In doing this, they invoke beliefs and values central to the dominant culture surrounding them. This points to the limits of defining crack cocaine users, and other communities of drug users, as being culturally different from the rest of us.