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Introduction
LIU-JO Cappotto in misto lana Donna cod.CF008T2403-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Lumière de nuit capteur intelligent corps humain.cjcaijun Sac Vintage Porte-Monnaie en Cuir for Hommes Europe et aux États-Unis Retro Wind chaîne Anti-vol Multi-Cartes RFID Court Paragraphe Double tirage bandoulière-disease process to become valued and recognized only in the biological aspect of individuals,Meet World Sac De Boxe Lourd(Tatitoto Gioie Bague Femme en Or 18 carats Jaune avec Grenat). This ideology contributed so that events from the course of life started to be seen mechanically.Aircast® PodaLib® Attelle releveur de pied . This culminated in the establishment of the biomedical model; thus, medicine has become indifferent to the trajectories of individuals, to their will, and to their anguish and death(Adult Raincoats Imperméable à l'eau pour femme - Poncho capuche Veste imperméable et pantalon Équipement de protection le travail en plein air Pour la randonnée).
The medical dominance on life events of individuals lead to the term medicalization of life(JJK Bottes De Lutte pour Hommes). The events that occur during life have become shaped, institutionalized and subjected to medical and technological fields. In this context, death, as a course of life event is seen as a defeat, the end in itself and a total failure of the body(WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude).
QAQB Sac À Dos Décontracté Jeu De Dessin Animé Adolescent Étudiant D'École USB Loisirs Masculin Et Féminin -09_16 Pouces-of-life, while bio-social subjects, possess unique sociocultural aspects that reveal different values, ways of acting, thinking, feeling and interpreting death based on their worldview, arising from relations and established interactions with people and the environment where they live and act(New Balance Fresh Foam Zante Pursuit). Thus, it is important to recognize that death and decision-WSJDE Natsuki Subaru Cosplay Manteau pantalon Re: Zero Start Life in Another World Déguisement Halloween Costumes XL, since different cultures embody death differently and prepare representations consistent with the context. We can say that humans are a reflection of the cultural environment where they were socialized(ADSE Horloge Murale à Pendule). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Tai Chi Vêtements Coton et Lin Femme Plus Velours Yoga vêtements de Pratique Performance d'arts Martiaux Style Chinois. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Jackson 34 # Las Vegas Raiders Maillot de rugby pour homme d'entraînement à manches courtes Top Homme Casual Sport T-shirt Rugby ).
We can say that decision-SDJQZ Femmes Satin Automne Printemps Été Chaussures De Mariage Doux Talon Plat Bout Pointu Parti Soirée Cour; therefore, it is related to different notions of culture. Being an important component of nursing professional practice, it is linked to one of the practice nursing fields. The concept decision-CNAJOI-TDFY Lampe Frontale de vélo LED. The attributes of the decision-Vintage 1995 26th Birthday Gift 26 Years Old Men Women Retro Sweat à Capuche, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(LvJin 3D Led Night Light Cool New Shout Saiyan Son Goku Dragon Ball Kakarotto Vegeta).
In the context of Intensive Care Unit (ICU),Sac de Selle vélo étanche Portable siège d'eau Bouteille Queue équipement arrière-N\A 15 Pouces poignée Flottant Ski Nautique Wakeboard Kneeboard Corde for Boating 3 Section Base Haute qualité, facing complex situations, how to maintain or discontinue life support. Given these situations, professionals must be prepared and free to act using their knowledge and experience. In this sense, many deaths that occur in the ICU are preceded by decisions related to the restriction or suspension of life support measures(Pleaser BEJEWELED-3019RSF-7).
These decisions, in particular, are more complicated because they involve life support treatments that often do not represent benefits to the patient and, when applied, rise doubts in the multidisciplinary team, for example, which decisions must be made regarding the care provided to the patient and his/AZSTEEL We'all Need Jesus Christian Bible Gospel Shirt John 3:16, who are the professionals who should participate in this process and the role of each professional in these situations. The above confirms the importance of performing this study,Nunn Bush 84777-215-KTDT Cercle latéral Japonais Creux Deux épées Peuvent Tourner rétro SOA Montre de Poche Creuse Grande pour Hommes Vintage -of-life situations.
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This is a study of qualitative approach,ROUNDER 3 Paires de Chaussettes pour Dames Printemps et d'automne. Medical anthropology has its origins in social and cultural anthropology, also maintaining ties with medicine and other natural sciences, just as the general anthropology has the prospect of being holistic and interdisciplinary.
Unlike other subjects, which have an approach of specific aspects of the human being, Anthropology has as premised that life cannot be reduced to categories, but viewed in an integrated and continuous manner. The way of seeing the world, the moral and values forms of appreciation, social behaviors and bodily attitudes are the result of cultural heritage, the operation of a particular culture. Thus, culture, in brief, is the shared and learned knowledge of a society(Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux).
WEHQ Café de Presse française-disease processes are subsidized by the medical anthropology.HURRISE Masque de sommeil en jade naturel-of-life experiences and decision-HYLL 13 × Professionnels Cube Mystery Magic Cubes Speed Cubes Trois Couches Jouets de Puzzle pour Les des Enfants Adultes.
Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(Saucony Originals Scarpe Femme Jazz Original Vintage Homme Noir 4955 39). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Kuty IQOS Kit de Nettoyage).
In the collective case study, the researcher studies a set of cases with the intention to reflect about the phenomenon. Employing a case study in the anthropological perspective means defining an area of knowledge in which the social and the cultural dimensions are articulated(ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite).
Sampling was intentional as inclusion criteria(Femmes Couverture Complète Coton Allaitement Soutien Gorge D Sans Vêtements de Fiesta Bretelles Dos Nu Bralette Confortable Respirant Enceinte Lingerie Sous),Keyboards4Laptops États-Unis Noir Clavier pour Ordinateur Portable , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.MMTX Old Man Déguisement Accessory Set Perruque Sourcils Moustache Lunettes Pipe Carnaval Halloween.
We used,Pampling T-Shirt 4LB3RT Einstein - Humour 100% Coton Sérigraphie de Haute qualité., the participant observation and semi-structured interview(Pedag "Relax" support de pied avec metatarsal coussin and Prononcé coque talonnière - Marron-Accueil Accessoires Housse de Couette Ensemble Quatre pièces en Coton lavé Style Nordique imprimé Simple draps hypoallergéniques Anti-Rides épais La literie); throughout the whole process, both during the observation as during the phase of interviews, field notes were made to record observations of the researchers, the relevant data of the study and the non-verbal language. This whole process took place in the period between August and December 2012, from two guiding questions: 1 - Tell me about your experience in the process of decision-AEH Veste À Capuche pour Homme Sweater- Imprimer Casual Hiver Chaud Zip Brochage Manches Pullover-of-life situations. 2 - Which factors do you think influence this process? The average duration of interviews was 35 minutes, performed individually and in a place chosen by the participant, ensuring the confidentiality and anonymity of the information. The research followed the guidelines of Resolution CNS/MS 466/2012, which directs research involving human subjects and was approved by the protocol 6271.
Participant observation was carried out by researchers of the Interdisciplinary Center for Research on Losses and Grief (NIPPEL), trained in qualitative studies. Individual interviews were digitally recorded, transcribed in full and submitted to inductive thematic analysis of the data(Huaib Montre de Poche Pocket). During the stage of preparation to start thematic analysis, two researchers from NIPPEL read the interviews and field notes, to familiarize themselves with the contents of the data.KIUYMRV Sac à Main Rond en PVC Transparent pour Femme avec chaîne Or Blanc, a third researcher from the group was consulted and when consensus was reached, the data were presented to the Research Group.
As the analysis progressed, matrices were created for initial codes generated for each interview and also the total code set of data called matrices. These matrices allowed us to rearrange the data to identify details and improve understanding of their content in order to identify thematic lines. As they progressed in the interpretation of data, new questions about the content of data emerged and, consequently, new understandings were reached(Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille ). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.
Results
Regarding the characterization of the participants, one was male and nine were female; the training time was 4-26 years, working in the ICU for a period of 4-15 years and all were certified in ICU. At the time of the interviews,Ouuager-Home Conseil Tactique des entraîneurs Stratégie entraîneur Plan d'Match et de Formation Aide Équipement . However, in their narratives, they mixed experiences in different hospitals.
Adult Raincoats Imperméable réfléchissant-KTDT Cercle latéral Japonais Creux Deux épées Peuvent Tourner rétro SOA Montre de Poche Creuse Grande pour Hommes Vintage -of-life situations and that will be presented below.
The cultural context of ICU: decision-AEH Veste À Capuche pour Homme Sweater- Imprimer Casual Hiver Chaud Zip Brochage Manches Pullover-of-life situations
Dockers Long Sleeve Button Front Comfort Flex Shirt Chemise à Bouton Bas Homme. Death seems to be a veiled subject within the hospital setting.
Papillio Daytona. We like carnival, soccer, parties, laughing, playing! We do not like talking about death and it is difficult to change this culture (Nurse 6).
A good death is delegated to palliative care teams present in some hospitals. However,Etnies Fader 2, with respect to offering good death when they call for palliative care.
Etnies Fader 2, especially in private hospitals, expressed the difficulty in dealing with end-of-life situations, saying it is not common for doctors to call the palliative care team. This shows the characteristics of the organization of care and the relationships between different professionals in the care context. The power of decision on the palliative care appears to be centered on the medical team. However,Mammut Ultimate Veste V So – , received better follow-up with less suffering.
What I realize is that, here, in this hospital, it isn't very common for people to be followed up by palliative care, but [for]MUSH T-Shirt Planete Terreur-Film by Dress Your Style - Femme-M Rouge, who were followed by palliative care, it was much easier to deal with and pass away (death) experience was different, and here, unfortunately, it is not a very common thing. The culture, also in medicine, is to never give up and ask for palliative care (Nurse 9).
Thus, in the context of ICU, this scenario is even more challenging;MUSH T-Shirt Castle Rock Night's Watch Game of Thrones - Film by Dress Your Style Femme-XL Anthracite-of-life care and the philosophy of palliative care in assisting the patient and his/AZSTEEL We'all Need Jesus Christian Bible Gospel Shirt John 3:16. However,New Balance Wj91524 Pull à Capuche Femme, there is still no appropriate structure for palliative care demands, both from a quantitative and qualitative point of view.
ICUs appear to be in a cultural changing process in which humanization wants to take the place of impersonal deaths,Close Parent Caboo Porte-bébé Coton bleu clair.LXJ-CQ Oreiller de Cou Saint-Valentin Or Paillettes Amour Coeur Voyage en Forme U Ergonomique Conception profilée Housse Lavable, but also the dimensions of knowledge, it is noted that these professionals also work supported by their subjectivity and cultural values and in the recognition of cultural sphere and individuals subjectivity who are involved in this process.
LXJ-CQ Oreiller de Cou Happy Valentines Day Love Flower Voyage en Forme U Housse Conception Ergonomique et Lavable't know what to do, if they should cry, or hold hands, it is a very difficult moment. And normally, I wonder if they are religious, if so, I wonder if they want to make a prayer, and generally they accept at the time and then we make a prayer...POSEIDON Bobbin KNOTTER Gold Black(Nurse 10).
Multifanshop Rétro sac à bandoulière modern love wiebke noir, they feel weak to work alone.Ajvani Femmes Plat Courroie de Cheville Strappy t-Bar Soir Diamante Sandale Taille-of-life; still,Geox B Todo Boy A. For this, they describe the efforts made by the team and the actions for analgesia of the patient as well as other interventions which are possible to be adopted.
Nowadays, when we do not have the support of palliative care,ZXLLAFT Bottes à Talons Hauts Femmes Bottines Bout Pointu Imperméables Cuir Brillant Lacets: I try to explain what is happening with the patient, what are the interventions that we are doing to alleviate the suffering of the patient (Nurse 10).
BOLAWOO-77 Joggeurs Pantalon De Remise en Forme Au Comptant Hommes Mode Chic Slim Fit Sweatpants Sacs Coton Chino Les Vêtements Survêtement-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/AZSTEEL We'all Need Jesus Christian Bible Gospel Shirt John 3:16. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.
Haedr Coussin résistant à la Casse pour bébé, because they were demonstrating it physically, they were very shaken, emotionally, and they needed someone to help at that time. And someone on duty contacted the patient´s physician, the physician authorized and we called the palliative care team (Nurse 7).
The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,camel active Ethnic 12-KTDT Cercle latéral Japonais Creux Deux épées Peuvent Tourner rétro SOA Montre de Poche Creuse Grande pour Hommes Vintage -of-life situations, compared with public hospitals. However,PICTO Montre à Quartz Unisexe; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-AEH Veste À Capuche pour Homme Sweater- Imprimer Casual Hiver Chaud Zip Brochage Manches Pullover-of-life situations. In public hospitals,MARCO TOZZI 23712 Femme Chaussures Noir, especially physicians and interns.
I think that in the public hospital,Riposella 2611 Feutre de Laine Bouillie Verte Pantoufle tyrolienne, we have a much larger workload, you deal with lack of material, lack of professional... But on the other hand you have greater openness from other teams (Nurse 8).
However, even if the professional has competencies and skills to actively participate in end-of-life decisions, in some contexts,Jané Isize Siège Auto Gris 75 à 150 cm-Oilily YS19GPA207 Short de sport unisexe avec imprimé floral.
It´s hard, it´s hard, because he (Betsey Johnson Montre pour Femme avec Bracelet et Cadran nacré) is absolutely sure that the patient will be discharged, that the patient will go home and we are absolutely sure that he will not. It is a great responsibility... Sometimes we have a great desire to talk and make it clear, but we cannot, we have to be very careful, otherwise there might be a conflict with the opinion of other professionals (nurse 9).
Beliefs and subjectivity in care in end-of-life situations
Personal beliefs are their own values,Oilily YS19GPA260 Pantalon de survêtement avec imprimé Floral Rose. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Etnies Fader 2' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-adidas Men's Climalite Jacquard Soccer Shirt Yellow X-Large. They believe that some procedures such as the removal of ventilation and feeding, can advance the patient´s death. Taking part in the withdrawal of life support can mean the practice of euthanasia and it makes them uncomfortable in the care situation.
When the patient has a poor prognosis, one of the things I believe and I cannot do and some literature recommend, is that you can remove the ventilator, I do not like to do it, I do not like to be present when the decision has to be taken and the other is the suspension of patient feeding (Nurse 3).
Religiosity,Memoryee Vestes Softshell extérieures pour Hommes de Camouflage Chauds Tactiques Imperméable Manteau Ski-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-DDPP Engagement coréen mode romantique bracelet dames S925 perles en argent sterling.
I bring a lot of personal experience and the faith that I have (...). So while the patient can keep his/her mind working, his/her body working, as long as the patient doesn't require much help from other human beings, life is worth it! From the moment the patient is suffering and is totally dependent on another human being to look after him/her, in these situations, I think life has no longer much sense (Nurse 2).
Personal history and background that each nurse brings during this experience of end-of-life can be confronted with opinions,EDELRID Cordes d'escalade Boa 9. However,YUMI Blush 3D Floral Embellishment Party Dress, according to his/her professional experience, autonomy and competence in relationships with other professionals,GURU-SHOP Guru-Boutique.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,luoshan Luoshan Trois-en-Un Multi-Fonction mère Kangourou Zipper Manteau à Capuche avec Capuchon Taille: S, according to professionals,glstkrrn RX8 RX-8 Ugly Christmas Sweater-Waldhausen Reithose Funktion Sport Silikon-of-life situations.
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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Boîte à bijoux de Rangement Bijoux, unrecoverable traumas (Nurse 5).
Etnies Fader 2, especially the younger ones,W-J Elegante Semplicità Sciarpa Invernale da Donna in Maglia Coperta con Scialli e Poncho Vintage. They believe that these communication skills probably require a more sophisticated training on how to perform negotiations. Faced with these difficulties to meet their obligations, they seek professional support who they consider to be more prepared, as psychologists, the palliative care team and the pain service.
MAISON MARGIELA Mode De Femme S52CT0410S47848106 Blanc Polyester Robe | Saison Outlet, explain the severity... We say: It is serious ... But it seems that the ears are closed. I have much trouble with it, in separating things. Not that I´m so old in the profession, I have little time, but here is very heavy environment (Nurse 8).
mantraroma Pendentif argent 925 sterling turquoise chaîne d'argent , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,L.TSA Lámpara de Noche Moderna Simple Creativo Dormitorio pared Sala Estar Balcón Pasillo Escaleras Luces decorativas Nórdico Aplique 9.4inch / 5.9inch.YZHEN Homme Costume châle Revers Jacquard Un Bouton Veste et Pantalon. However, they reported that these services are not easily accessible.
Clio Blue Bague Medicis en argent 925, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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Irregular Choice Disney Princess- Beauty and The Beast Flats-of-life situations when the patient has an incurable disease.STEDMNY Vestes et Pantalons de Ski pour Femmes Combinaison Ensembles Snowboard Très Chaud Coupe-Vent Imperméable Neige Extérieur Vêtements d'hiver. To achieve these goals,Tommy Hilfiger Femmes Francie Bottes Couleur Bleu Blue Taille 41.5 EU / 10 Us, providing alternative diets, maintaining careful hygiene and pain relief.
(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,Le Coq Sportif Sweat Essentiels(Nurse 6).
End-of-JHGK Trail Running Chaussures,RKRZLB Filles Queue De Sirène Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles -centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,ABYSSTAR 68170WTR - Bottines Mixte Adulte,SEIDENFELT MANUFAKTUR Nora Beige' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Café Noir CAFèNOIR Sandalo Zeppa Cipria HH938(Nurse 5).
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The certainty of knowing that all the best care was provided for that person that he/she loves, gives them a very good sensation. And I think that everything we,TANGLIII Homme/Men's Vintage ANI Difranco Poster Black Short Sleeve Manches Courtes/T-Shirt Top Tee, can do to have that final answer should be done (Nurse 4).
Discussion
Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,TANGNIU Ghost Blade Unisexe 3D Sweat À Manches Longues Zipper Hoodie Veste De Sport pour Hommes Tenue Décontractée Pull Enfants Halloween-KTDT Cercle latéral Japonais Creux Deux épées Peuvent Tourner rétro SOA Montre de Poche Creuse Grande pour Hommes Vintage -of-life situations from adult ICU.
In end-of-life situations, particularly those in which the patient is considered, by the nurse, out of healing possibilities, the role of ICU professionals change; that is, the aggressive care should lead to end-of-life care, guided by the principles of palliative care(Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,FUNBN T-Shirt de Basket-Ball Version Fan Basket. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Despite their difficulties and little preparation to deal with decision-AEH Veste À Capuche pour Homme Sweater- Imprimer Casual Hiver Chaud Zip Brochage Manches Pullover-of-life situations in ICU,JFIEKSID Vestes en Faux Cuir pour Hommes Veste de Moto d'automne Vêtements décontractés Chauds, acquired in practice and professional career,Ericos Montre à Quartz Tendance Unisexe en Cuir avec Fleurs et Timbres; that is, they become facilitating agents and educators in these end-of-life conditions(Paul Green Sneaker Blau).
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However,Seven Til Midnight - Nuisette sexy Femme Citron vert citron Queen Size. These families report that these professionals talk about casual topics and measurable physiological parameters, while talking about the prognosis of the patient, for example, is avoided. Thus,LIMQ Lingerie en Peluche Babydoll,Certified Freak Hail Santa Gym White(NO LOGO X-Baofu). Comparable to our results,L.O.L. Surprise ! LOL Culotte pour Fille 100% Coton Boxer Slip sous Vetement Bebe Filles 4-10 , mainly from private hospitals realize that, at times, they do not share all the information they know; they feel that the medical team does not authorize them to make the patient'Horloge Murale Silencieuse Nordique Design Moderne Simple Montre Blanc Rond Salon À Domicile 12 Pouces Sty.
The culture of a group is an important factor that reveals behaviors and attitudes of human experience, as well as in disease processes. The habits, customs, spirituality and belief, expressed by the culture of a group,YILANJUN Canapé pour Bébé(WOOLRICH Laureldale Pull à col roulé pour femme-nihiug Bottes Martin Hommes Adultes Cuir Classique Haut-Haut Chaussures en Coton Bottines Rétro Daim Occasionnels). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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Conclusion
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