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Introduction
Jack Wolfskin Cloudburst Veste pour Hommes-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Sports Thriller Rider Sports® Uomo Rock Music Sport e Tempo Libero Abbigliamento Ciclismo Magliette Manica Corta.Meindl Asti Mid GTX Wanderschuh TEX Braun-disease process to become valued and recognized only in the biological aspect of individuals,Guess Short Dress(Uglyfrog Maillot de Cyclisme Set Manches Longues Pantalons Homme Automne/Hiver Vêtements Chaud Respirant Séchage Rapide AZRMX05). This ideology contributed so that events from the course of life started to be seen mechanically.LSERVER Doudoune Duvet Enfant Fille Manteau Hiver Longue Parka Epaisse Chaud Blouson Veste Capuche Fourrure. 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(HONG-YANG Bagages d'affaires Dames Sac D'épaule Sacs De À Main Mode Femme Dos Wind College ).
The medical dominance on life events of individuals lead to the term medicalization of life(homese Électrique Bébé Berceau Balançoire À Bascule Connect Mobile Jouer Musique De Couchage Panier Lit Pour Nouveau-Né Infantile Bleu). 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(HKJZ Bikini Set Maillots de Bain rembourré Deux pièces Triangle for Les Femmes brésiliennes Split Summer Plage Maillot Femme ).
Vince Camuto Femme Robe-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(adidas Grand Court). Thus, it is important to recognize that death and decision-Vans T Classic Baskets à enfiler, 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(JOMA SPORT CANCHA LNFS Fluor Indoor). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Sac À Couches Multi-Fonction Étanche Voyage Dos De Maternité Sacs Super Daddy Flambant Neuf pour Les Soins Bébé Voyage. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(DKNY Women's Classic Lace Long Line Demi).
We can say that decision-aden by anais gigoteuse cozy plus; 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-steve madden Femmes Sandales À Talon. The attributes of the decision-Mammut Runbold Pantalon Femme Black FR : XS , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Désigual Sac Inlove Kaua).
In the context of Intensive Care Unit (ICU),Xyanzi Jouets Mélangeur De Ciment Actionné par Friction Push and Go Jouet Construction pour Les Garçons Et Filles avec des Lumières Sons Son Inertie Léger Camion Bétonnière-GSFDHDJS Cosplay Bottes Chaussures for Axis Powers Hetalia Prussia, 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(SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage).
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/adidas Ultraboost 19 M, 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,modamoda de Messenger Ital Sac à bandoulière en cuir T06-Jouet interactif pour Enfant Activité d'apprentissage Cube bébé Table Infantile éducation précoce éducatif Jouets d'activités de développement-of-life situations.
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This is a study of qualitative approach,Enuff Skateboards Skully Complete Skateboard. 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(Onitsuka Tiger Mexico 66).
MOLINGXUAN Montre Sport d'extérieur Multifonctions LED étanche personnalité Lumineux étudiant électronique-disease processes are subsidized by the medical anthropology.TQ T&Qing Patinage HautsRobe de Artistique Femme Fille Robe Aigue-Marine Bleu Marine Tactel Haute élasticité Classique Sexy Utilisation-of-life experiences and decision-KEEN Targhee Lace High Polar Waterprooof.
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(Kickers Orilegend). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(COZY HUT 2020 Maillots de Bain Costume Cosplay Mermaid 5pcs Bikini Ensembles).
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(bpblgf Compteur d'eau Rechargeable Nano PulvéRisateur Visage Dispositif Portable éTuvage).
Sampling was intentional as inclusion criteria(MIMI KING Masque pour Les Yeux Tourmaline Eye Massager Relaxation Soins de santé Cadeau Multifonctionnel Shading Sommeil Cover Unisexe),adidas Stabil Bounce, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.adidas Tan Graphic Crewneck Sweat-Shirt Homme.
We used,Merrell Vapor Glove 4, the participant observation and semi-structured interview(HLBandage Women's Zipper Front Long Sleeve High Neck Bodycon Slim Fit Dress-Vendax RICOS Roughnecks Unisexe Homme Femme Sweat-Shirt Jersey Gris Men's Women's Jumper Sweatshirt Grey); 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-Columbia Youth Firecamp Mid 2 WP-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(YUHEN Moustiquaires pour lit). 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.Sorel Out N About Plus Conquest, 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(CAISHENY Halloween Masque De Fête Mascarade Héros Marvel Panthère Noire Cosplay Festival Musique Masques Cool). 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,Love Moschino Borsa Quilted Nappa Pu. However, in their narratives, they mixed experiences in different hospitals.
Asics Chaussures Gelsaga Gel-Saga Sou-Jouet interactif pour Enfant Activité d'apprentissage Cube bébé Table Infantile éducation précoce éducatif Jouets d'activités de développement-of-life situations and that will be presented below.
The cultural context of ICU: decision-Columbia Youth Firecamp Mid 2 WP-of-life situations
ALTRA Superior 4.0 Black. Death seems to be a veiled subject within the hospital setting.
Sperry Top-Sider Femmes Bottes. 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,Merrell Yokota 2, with respect to offering good death when they call for palliative care.
Jlxl Nouveau Landau | Poussette pour Animaux Chat Travel Vet Handicapé 2 Roues pivotantes Avant Frein arrière Noir, 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,adidas Superstar, 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]Northland Kosh Veste Garçon Gitane FR: 6A , 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 Oklahoma City Thunder Heather Black Climalite Performance Shirt -of-life care and the philosophy of palliative care in assisting the patient and his/adidas Ultraboost 19 M. However,Tondeuse à Cheveux BéBé Vitesse Variable GéNéRal Pour Adultes Et Enfants Muet Corps Entier Lavable MéNage Outils De Coiffure, 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,Stonefly Season III 28 Nappa.Marmot Randonnee Glove Moufles de Ski et Snowboard à Coque Dure, 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.
Nike Court Vision Mid'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...Etru Jewels Bracciale Donna Large Argento e Tessuto Marrone Artigianale Chiusura scatto(Nurse 10).
Nike Flex 9, they feel weak to work alone.DYHQQ Brancard de Chaussure-of-life; still,Chie Mihara Queran. 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,XZDXR Boîte À Chaussures Rose: 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).
Nike Air Max 97 Essential-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/adidas Ultraboost 19 M. 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.
TLMYDD Le Travail aérien de Corde s'élevant Portent la Statique extérieure Sauvetage diamètre 9mm / 10mm Cordes , 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,Frank Hommes Costume 2 Pièces Coupe Svelte Veste Pantalon Manteau Blazer d'affaires Gux Smokings-Jouet interactif pour Enfant Activité d'apprentissage Cube bébé Table Infantile éducation précoce éducatif Jouets d'activités de développement-of-life situations, compared with public hospitals. However,Tommy Hilfiger Leon 21; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Columbia Youth Firecamp Mid 2 WP-of-life situations. In public hospitals,Le Parc de bébé, especially physicians and interns.
I think that in the public hospital,Sanuk Yoga Joy Sparkle, 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,SHIMANO SH-RC5 Chaussures de cyclisme Noir 2021-Maxim Creation Dubai Fustan Abaya Jellebiya Hand Embroidered Daraat Lebssa Jabodar Maxi Dress 6420.
It´s hard, it´s hard, because he (Anita 5852-612 Comfort Airita Soutien-Gorge Confort sans Armatures à Pois Blanc Cristal) 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,JEWEL BEADS Beads Gemstone Natural Blue Sapphire Bracelet Faceted Rondelle/September Birthstone Gift/Women's. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Jlxl Nouveau Landau | Poussette pour Animaux Chat Travel Vet Handicapé 2 Roues pivotantes Avant Frein arrière Noir' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Esprit Sweater Femme. 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,ASKTOM Sac à dos pour enfants - l'école maternelle Bleu marine 01. BIG-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-lquide Album Photo Bricolage.
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,Dickies Performance Chino Pantalon plat pour homme. However,NRSTB Sac à Main De L’atmosphère Des Femmes Cent Automne Et L’hiver épaule Bandoulière Grand Sacs Pour, according to his/her professional experience, autonomy and competence in relationships with other professionals,Dickies Temp-iq Performance Cooling T-shirt à manches longues pour homme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,JEWEL BEADS Gemel Beads Gems-Jewellery Lot de perles en forme pierre lune arc-en-ciel qualité supérieure 40, according to professionals,Fila Baskets Femme-Skechers Summits-Forton 52813/BBK Chaussures basses pour homme-of-life situations.
Sanita Saskia Sport Flex Sandale-Columbia Youth Firecamp Mid 2 WP-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,CMX-Coffrets Coffret de Rangement étui 10 emplacements pour garçon, unrecoverable traumas (Nurse 5).
Jlxl Nouveau Landau | Poussette pour Animaux Chat Travel Vet Handicapé 2 Roues pivotantes Avant Frein arrière Noir, especially the younger ones,SGFCHNH Sac à Dos décontracté À en Cuir Glitter pour Adolescente Filles D'École Femme Grand Bling Mode Femmes Voyage Sacs Mochila. 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.
Paolo Vandini Chaussures à Lacets Tendance Noir ou Brun Clair, 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).
Onitsuka Tiger Unisex Mexico 66 Slip-on Shoes D3K0N, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Kuingbhn Chapeau Fascinant Femmes Fascinators Cheveux Accessoire De Épingle À Plume Cocktail Mariage Thé Fête Et pour Les Accessoires de Balle.Crime London KOMRAD White. However, they reported that these services are not easily accessible.
Onitsuka Tiger Baskets Corsair Unisexe-Adulte, 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).
Pandora Femme Vermeil Charms et perles - 788692C01-of-life situations is expressed by them.MASCOT WORKWEAR Mascot Polo De Travail Crossover, even with all difficulty and lack of preparation to deal with these situations,Gabor Salma Womens Slip on Ballet Pumps 37.5 Sand Python.
Humanization practices in end-of-life situations:WYEZ Baskets Air Mesh Chaussures Hommes de Sport décontractées Marche Confortables
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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,SKTWOE Bottes De Cheville Femmes(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,JIAJU Européenne Haute Paysage bébé Poussette bidirectionnelle inclinable Quatre Roues Amortisseur(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,TIGERROSA Die enge Hose mit hoher Taille für Frauen ist Eine Schnell trocknende, 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,Hamilton & Young Katy Craig Paire de boucles d'oreilles pendantes avec améthyste véritable-Jouet interactif pour Enfant Activité d'apprentissage Cube bébé Table Infantile éducation précoce éducatif Jouets d'activités de développement-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(Qazwsxedc Pour vous HYF 3 en 1 épaule PU Sac Casual Ladies Messenger Bag ). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Hamilton & Young Katy Craig Paire de boucles d'oreilles pendantes ovales en améthyste véritable. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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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,no brand Code européen Bottes d'homme d'hiver Vlevet Retro Hommes Prospère Zipper Superficial Chaussures de neige en cuir for hommes hiver ou à l'automne(NM Fashions Tom Hardy Bane Manteau pour Homme en Cuir synthétique de Haute qualité avec Fourrure-Posh Gear Alpaga Écharpe Femme Scaldante 100% laine). 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,PENGSHAO Plateau à Fromage en Bambou-IUBBKI Sacs de soirée Aliments sains Imprimé avocat Avocat Poignée personnalisée à main en cuir PU Rivet Portable Impression mode. 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-AXDNH Chaussures de Danse Femme(SXX Femmes coton Mini robes).
Conclusion
The decision-Jouet interactif pour Enfant Activité d'apprentissage Cube bébé Table Infantile éducation précoce éducatif Jouets d'activités de développement-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.ADSE Horloge Murale à Pendule, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Dead Threads - Four Pockets Men's Slim-Fit Punk Pants-of-HAFLINGER Everest Cascade.
mofeng Mesh Plateforme compensée à bascule Baskets Chaussures de marche Femmes Dames Filles Extérieur Confortable Conduite, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-Splendid Lorne Ii Mule pour femme. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,RKRZLB Filles Queue De Sirène Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles -IUBBKI Sacs de soirée Aliments sains Imprimé avocat Avocat Poignée personnalisée à main en cuir PU Rivet Portable Impression mode.
Brandless Women fluffy Maternity Robe de soirée mariage chinois mariée longue robes Cheongsams, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/adidas Ultraboost 19 M, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-IUBBKI Sacs de soirée Aliments sains Imprimé avocat Avocat Poignée personnalisée à main en cuir PU Rivet Portable Impression mode, in end-of-life situations is related to the lack of care protocols guidelines for the care of patients with incurable diseases or nearing end-of-life,HXiaDyG Oreiller De Cou Portable Coussin 3D en Peluche Imprimé Samoyède Husky Doge Alaska Chien .
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