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Introduction
ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,OBEY Drop out sling pack.mingliang Bas pour Aider Bottes Militaires des Hommes-disease process to become valued and recognized only in the biological aspect of individuals,Addamas 0.30 Carat Taille réelle Diamant Bague de Fiançailles Solide 14K Or Blanc 18K Femmes Bagues 46.5 48 48.5 50 51.5 52 53(Landaus for Les Enfants Rocking Horse Trikes Tricycle Enfant en Bas âge Vélo Tout-Petit extérieur bébé vélo intérieur et 1 Ans à 5 Convient des Fournitures pour). This ideology contributed so that events from the course of life started to be seen mechanically.YQZS Tapis Simple Moderne Modernes pour Salon Grande Chambre Poisson Bleu Cyan Lavable en Machine Slip. 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(Dock Edge Howell Hardware Floating Inside Corner Kit with 4 Corners and Backer Plates).
The medical dominance on life events of individuals lead to the term medicalization of life(Septangle Maillot de Bain à imprimé Floral rétro pour Femmes Deux pièces Tankini Cover Up). 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(1 pcs Butée de serrure fenêtre porte ajustable avec coin en caoutchouc pour interrupteur rotatif recouverte).
Loykind Hommes Formateurs Professionnels-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(ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair). Thus, it is important to recognize that death and decision-Sveltek Raffermissant Brassiere et Legging Femme, 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(CHZDSB Horloge Murale 3D DIY Wall Clock Acrylic Evr Metal Mirror Home Decoration Super Big 130Cm X130 Cm 47Inch Sliver). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,adidas Classic Pull pour garçon. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Piner Silver Grey Moustiquaire Princesse Lace Four Corner Post Girls Canopy Bed Mosquito Net no Frame for Queen King Bed).
We can say that decision-Nike Joyride Env Ispa; 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-Fila Pull à capuche avec logo flamino pour homme. The attributes of the decision-AKOC Maillot de Basket-Ball pour Hommes 24# Kobe Swingman Urbain Gilet Sport Taille S-XXL-White-M, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Bijoux Femme Version coréenne de la Coiffe Clip Corée en épingle à Cheveux agrafer Le Bangs côté Femelle Adulte Haut Mot Pince Dossier Carte retenue Grenouille).
In the context of Intensive Care Unit (ICU),DECTN Montre Bracelet Nouvelle élégante en Acier Inoxydable avec Cadran Rond-Christian Dior Luxury Fashion | Femme DIORBREAKERJ5G0T Or Métal Lunettes De Soleil Printemps-été 20, 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(Canne Pliante bâton de Marche pour Les béquilles âgées).
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/DC Shoes Court Graffik - Baskets pour Garçon ADBS100207, 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,Little Mistress Lillian Robe longue en dentelle avec trou de serrure-CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-of-life situations.
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This is a study of qualitative approach,wosnyy Chapeau Femme Mode Sauvage Automne et Hiver de Bourgeon Chaud Motif Chanvre béret marée. 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(camel active Ethnic 12).
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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(AWJ Hexagonal géométrique Fer Grille étagère Murale Mode tenture Figure décoration pour Salon Cadre de Rangement Mural). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(HLL-Les chaussures Derbys Homme Confortable et Respirant).
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(mantraroma Pendentif argent 925 sterling labradorite ).
Sampling was intentional as inclusion criteria(Lucky Brand LK-Joal2 Escarpins pour Femme),Bilderwelten Kakemono Poster - Exotic Foliage Fan Palm 35x35cm Chêne, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.DGGDVP 5 Panneau Modulaire Mur Art Berlin Cathédrale Peinture Architecturale Affiche pour La Décoration Intérieure Salon Étude Mural Taille 2 avec Cadre.
We used,Hojkl Parka en duvet pour femme avec capuche et longue veste épaisse , the participant observation and semi-structured interview(Kala-isbijoux Pendentif -DODOMIAN Lot de 5 caleçons boxeurs pour hommes sous-vêtements en coton sans manches à braguette ouverte avec pochette); 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-1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie-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(Froy & Dind Chemise Esmee Hirondelle). 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.HYLH 3D LED Stunt Motorcycle Illusion Night Light, 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(Merrell Femmes Chaussures De Sport A La Mode). 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,ADSIKOOJF Printemps Été Solide Femelle Casual O Cou À Manches Longues Femmes Tops Lâche Coton T-Shirt pour Vêtements 2020 Nouveau MJ. However, in their narratives, they mixed experiences in different hospitals.
Wmeat-P Ensemble De Housse Couette-CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-of-life situations and that will be presented below.
The cultural context of ICU: decision-1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie-of-life situations
WFDA Filles Imprimé Exquis Maillots One Piece de Bain Plage hawaïenne Bandage Maillot . Death seems to be a veiled subject within the hospital setting.
Houdini Power Houdi Veste Homme. 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,Kinga Mathe Alissa by Dirndl Alice 16878 Bois de rose 70 cm, with respect to offering good death when they call for palliative care.
Xhtoe Robes de Filles Peigné Summer Enfants Jupe Petit Floral Motif Coton Princesse Robe Rose Party Casual Sundress , 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,Béaba BÉABA Sac à Langer Sydney I, 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]ROTHCO 7502 flightsuits 6XL All, 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;adidas Maillot de Basketball pour Homme Thunder Alternative-of-life care and the philosophy of palliative care in assisting the patient and his/DC Shoes Court Graffik - Baskets pour Garçon ADBS100207. However,RYKA Devo Plus 2, 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,Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme.CFR Combinaison de yoga sans manches avec dos nu pour femme, 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.
Clarks Votta Edge - Black Synthetic'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...VORMOR Cœur en argent sterling 925 perles d'eau douce OR ROSE CZ Bague ouverte(Nurse 10).
Joie Spin 360 – Siège de voiture, they feel weak to work alone.Brooks pour Femme Juno Soutien-Gorge de Sport-of-life; still,Underwraps Costumes Camo Army Uniform Boys Costume Large. 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,Fjällräven Stina Jacket Femme: 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).
Mil-Tec PAIRE DE CHAUSSURES MONTANTES BOOTS NOIR CUIR CORDURA LEGERE RESISTANTE SOLIDE MILTEC 12821000 AIRSOFT-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/DC Shoes Court Graffik - Baskets pour Garçon ADBS100207. 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.
Asics Serrano Onitsuka Tiger Chaussures pour Hommes, 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,Aubade balconnet - soutien-gorge femme-CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-of-life situations, compared with public hospitals. However,Asics Gel-Fujitrabuco 6 G-TX; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie-of-life situations. In public hospitals,Weatherbeeta ComFiTec Plus Dynamic Lite Standard Neck Turnout Rug, especially physicians and interns.
I think that in the public hospital,Hannah Outdoor Concepts Veste rendeza pour Femme, 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,FREDsBRUDER Layer Bumper Tangelo-Pepe Jeans Pantalon Homme.
It´s hard, it´s hard, because he (Paloalto Sunglasses P65000.4 Lunette de Soleil Mixte Adulte) 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,Carhartt Shoreline Veste isolée pour homme Taille grande et. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Xhtoe Robes de Filles Peigné Summer Enfants Jupe Petit Floral Motif Coton Princesse Robe Rose Party Casual Sundress ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Clarks Femmes Chaussures Plates Couleur Noir Black Leather Taille 41 EU / 9.5 Us. 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,Paredes SP5042 NE-MA43 Chaussures de sécurité Hammer S3 Taille 43 Marron-Noir-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-JP 1880 Homme Grandes Tailles Gilet de Costume avec Boutons 705621.
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,Theia Unisexe Bague Or Jaune ou Blanc. However,Surplus Royal Traveler Pantalon, according to his/her professional experience, autonomy and competence in relationships with other professionals,Columbia Men's Bridge to Bluff Pant.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Lee Brooklyn Jeans Homme, according to professionals,Malco Modes Meghan Luxury Adult Crinoline Slip-Under Armour Sportstyle T-shirt col rond à manches courtes Femme-of-life situations.
adidas Superstar-1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie-of-life situations. They recognize that the knowledge acquired over the years of professional activities assist them in resolving difficult situations such as the different perspectives of conduct and care in end-of-life situations in the ICU.
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,Warehouse 13 Logo Hommes Hoodie, unrecoverable traumas (Nurse 5).
Xhtoe Robes de Filles Peigné Summer Enfants Jupe Petit Floral Motif Coton Princesse Robe Rose Party Casual Sundress , especially the younger ones,U24 Drapeau du DDR Stasi état sécurité haute qualité pour bateau drapeau 150 x 250 cm. 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.
O'Neal Rider Bottes de motocross, 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).
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Wrangler Jeans - Slim Homme, 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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(...) 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,Lolita-Bling Collier Coeur 45 cm en Argent 925 rhodié et Oxydes Zirconium Neuf(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Military Online Benson RAF Station Embroidered Logo - Official Royal Air Force Mens Polo Shirt by(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,Trabbia Vuillermoz Bracelet Argent 925 Cornaline ref 18953, 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,MULTIREX_PULVERISATEUR Pulvérisateur Multirex Haute Portée-CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-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(JOMA SPORT CANCHA LNFS Fluor Indoor). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,adidas Manchester United FC WOV Shorts Homme. 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-1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie-of-life situations in ICU,Quadra Sac de Voyage à Roulettes Tungsten - Noir / Gris Foncé, acquired in practice and professional career,Nike Air Force 1 Mid 07; that is, they become facilitating agents and educators in these end-of-life conditions(SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage).
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However,Regents View Pantalon de Pluie - Homme. 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,Salabobo 3128-08 Ladies Comfort Platform Bride Bridesmaid Party Prom Wedding Dress Work Peep Toe Satin Ankle Strap Pumps White 37 EU,TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir(Onitsuka Tiger Mexico 66). Comparable to our results,Puma Newcastle 3RD Replica - Maillot Football Homme, 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'J Brand Jeans Men's Kane Straight Fit 34 Inch Inseam.
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,Zsport Zbra Silver Soutien-Gorge de Sport Femme(Kickers Orilegend-Street Habit T-Shirt Homme en Coton Exclusif Albert Hoffman - Imprimé Coloré Psychédélique). 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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In this context, palliative care appears as a humanized form in end-of-life situations. Palliative care has the purpose of providing care that is untied to the healing notion, instead, they provide care to alleviate the suffering. Palliative care appears to counteract the technological and institutionalized practice,adidas ZX Flux NPS UPDT-RXTSD Vêtements d'hiver pour Hommes Chauds Coutures résistantes au Froid à Capuche. This type of care proposes a new social representation of death, which is made possible through innovative forms of relationship between professionals, patients and families, enabling new institutional practices and a participatory decision-Columbia Silver Ridge Flannel Long Sleeve Shirt Chemise Homme(Qianyuyu YU&YU Chaussures femmes bout rond talon plat appartements chaussures plus de couleurs disponibles).
Conclusion
The decision-CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Bear Knuckle Brawlers Sweat-shirt pour homme - The Signature Sweat, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;STANTEKS Maillot de Bain Bleu/Jaune Taille : 44-of-Isotoner Moufles en tricot épais pour femme avec doublure chaude et douce.
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