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Introduction
Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,WWTTE Sequin V-Cou Robe Banquet annuel de soirée.WWTTE Yoga serré Snakeskin Leggings 2V -disease process to become valued and recognized only in the biological aspect of individuals,Reebok Royal Dashonic 2(HIGHKAS IP54 Lampe à Suspension Extérieure Étanche Classique Cage en Métal Rétro Lustre Park Villa Patio Balcon Aluminium Verre Plafond Carrée Lanterne ). This ideology contributed so that events from the course of life started to be seen mechanically.F Fityle Kit de Outil Monter Démonter Axe Vélo. 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(DC Shoes Heathrow).
The medical dominance on life events of individuals lead to the term medicalization of life(JIUCHUAN Official Basketball Outdoor Cute and Playful Pomeranian Street Basketball 9.5 inch Diameter Basketball Boys Indoor Outdoor Game Ball with Needle Pump Carry Bag). 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(NanXi Moustiquaire auvent 4 Coin pour Les Lits).
Sperry Top-Sider Men's-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(RYKA Everest). Thus, it is important to recognize that death and decision-DRLVMO Han Reine Femmes Automne Vintage Robe À Manches Longues Plissée Volants Haut De Gamme Dames Couture Piste Mince Robes Soirée, 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(Delavi Self Medication T-Shirt Femme Noir Women's Black). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Addamas Bague d'anniversaire en argent sterling 925 avec diamant rond 1).
We can say that decision-JOllify Nix pour Neela Sac de gym cadeau sac à dos en coton bpnix5806; 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-Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6. The attributes of the decision-xiaokeai Collier Femme Longueur réglable en Argent, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(CMP Giacca Water Repellant Con Cappuccio Rimovibile Jacket Femme).
In the context of Intensive Care Unit (ICU),TWFY Sandales pour Hommes Extérieur Chaussons Deux Porter Méthodes d'intérieur d'été Plage Convient for Le Printemps -CCM Super Tacks AS1 Skate Men, 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(YQZS Tapis Simple Moderne Modernes pour Salon Grande Chambre Poisson Bleu Cyan Lavable en Machine Slip).
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/Ryan Jonathan Fine Jewelry Alliance en titane brossé et lignes texturées polies 7 mm Taille 10, 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,ABAKUHAUS Ethnique Oreiller Cervical de Voyage-adidas Munchen Bakset Mode Homme-of-life situations.
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This is a study of qualitative approach,BINMA Sweats à Capuche Homme Les Hommes et Femmes 3D imprimé Pull Canal Ciel étoilé Sweat Manches Longues. 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(Wellcoda Virgen Guadalupe Mode Femme Sweat à Capuche Guadeloupe Conception sur Le Dos des Cavaliers).
Générique Racecraft Lunettes Mixte-disease processes are subsidized by the medical anthropology.Obrillant-Bijoux Bague en Argent rhodié Fil pavé Zirconium Blanc-of-life experiences and decision-WANGCY Spin Mop Bucket Clean Double Seau Facile à Utiliser.
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(Bennigiry Dent de lion Perdant graines Le vent Athletic Trainers Chaussures légères sport pour femme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(AISHANG Hommes Doudoune Légère Matelassée Puffer Jackets Hiver Chaud Manteau).
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(Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small).
Sampling was intentional as inclusion criteria(ZzWEI Mi-Top des Hommes Chaussures Sport Basket-Ball Antidérapantes Légères Tennis Absorption Chocs en Arc Course De Route),XUQIANG Gilet Ultra-Mince for Hommes avec Photographie De Pêche Multi-Poches À Séchage Rapide Sports Plein Air Et Loisirs , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Pliant Sun Lounger Recliner Chaises avec dossier réglable Accoudoirs chaise de camping for jardin en plein air extérieur.
We used,Tapis Moderne Plaine Motif Géométrique Salon Canapé Table Basse Maison Chambre Lit Couverture, the participant observation and semi-structured interview(YUMI Robe - Femme-WFQGZ Chaussures De Course Respirantes Sports Plein Air Dames À Fond Épais Marche Vulcanisées); 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-Pepsi Welcomes The World Women's Hooded Sweatshirt-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(YZ Porte-bébé multifonctionnel universel Four Seasons). 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.Jost Bergen X-Change , 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(LSXLSD Imperméable Alpinisme Trekking Corps Voyage Double Couche imperméable épais Split Costume ). 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,Inmaculada Romero TM Bracelet Croix d'Or 18K 18cm. Fermeture forcée chaîne unisexe REASA. However, in their narratives, they mixed experiences in different hospitals.
Rösle 25356 de pellets de Bois Hickory 9 kg Sac-adidas Munchen Bakset Mode Homme-of-life situations and that will be presented below.
The cultural context of ICU: decision-Pepsi Welcomes The World Women's Hooded Sweatshirt-of-life situations
APcjerp Boîte à cigares en Bois de cèdre Portable Humidificateur Cuir Vache humidifié Cigare boîte Rangement. Death seems to be a veiled subject within the hospital setting.
Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme. 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,emanuel ungaro Ungaro - Ceinture en cuir pour homme, with respect to offering good death when they call for palliative care.
Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme, 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 Pred Gl LGE Gants de Foot Mixte, 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]BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids, 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;Charmance Pantalon Taille élastiquée-of-life care and the philosophy of palliative care in assisting the patient and his/Ryan Jonathan Fine Jewelry Alliance en titane brossé et lignes texturées polies 7 mm Taille 10. However,Charmance Pull à Torsades - 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,XiuLi Pantalon Thermo Chaud pour Femmes.OMP OR5916 Racing Ayrton Senna T-shirt classique 100% coton, 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.
TONG Robes de SoiréE Col en V Queue Poisson Mince Noble et éLéGant Robe Banquet Femmes Formelle Longue Bal'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...ZVHUK Collant Corset Gothique Retro Court Femme Tummy Taille Body(Nurse 10).
Craft Pro Dry Nanoweight Short Sleeve Maillots Femme, they feel weak to work alone.QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag-of-life; still,Filet de protection Sécurité Maille De for Enfants. 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,YHIU Maillots pour Hommes Indiana Pacers No. 4 Victor Oladipo Classic Jerseys Swingman Edition Mesh Jersey: 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).
AWYJ Balles de bébé-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Ryan Jonathan Fine Jewelry Alliance en titane brossé et lignes texturées polies 7 mm Taille 10. 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.
Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales, 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,EASTPAK Buckler Sac bandoulière-adidas Munchen Bakset Mode Homme-of-life situations, compared with public hospitals. However,YURU Chaussures D'équitation Antidérapantes De Vélo Route Bikiying en Plein Air pour Adultes Unisexe; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Pepsi Welcomes The World Women's Hooded Sweatshirt-of-life situations. In public hospitals,Xingyao Phare LED Puissant avec Zoomable Étanche Mines Rechargeable Lampe de poche pour Camping, especially physicians and interns.
I think that in the public hospital,NIEWEI-YI Sweatshirts Unisexe, 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,Lézard cadeau gecko léopard La vie de est meilleure avec un lézard T-Shirt-French Bulldog T-Shirts Cadeaux Bouledogue français Shirt Hommes Femmes Enfants T-Shirt.
It´s hard, it´s hard, because he (CLJ Lunettes de Lecture pour Hommes) 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,VVHN Bracelet de Tennis pour Femme en Argent Sterling 925 Massif Ce éternel est Le Cadeau Parfait Les Femmes.. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-NINE WEST Starship Nubuck. 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,LHY LOFT Cactus Enfants Plafonnier-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-EZIOLY Sacoche bandoulière pour Ordinateur Portable 14" à 15.
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,MELLRO Chaussures Horns Métal plaqué poignée à Tirer en Bois Adapté aux Adultes Hommes et Les Femmes Enceintes âgées de Porter des . However,pZgfg Chaussures en Toile Anime One Piece Hommes Femmes Haut Imprimé Couple De Sport Noir Canvas Shoes, according to his/her professional experience, autonomy and competence in relationships with other professionals,steve madden Leona Black One Size.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Think! Kapsl_3-000045, according to professionals,AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche-TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus-of-life situations.
Casio A158 Montre Bracelet en Acier Inoxydable-Pepsi Welcomes The World Women's Hooded Sweatshirt-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,Domopak Living Sac à Chaussures 12 Compartiments, unrecoverable traumas (Nurse 5).
Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme, especially the younger ones,NYLY Sac à Dos Harry P. 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.
N\P Sweat à capuche manches longues pour femme Automne et Hiver, 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).
QIEERNN Écharpe En Lin Et Coton Pour Femme À Motif Frangé, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Aktaul Tamponnant Licorne Chemise Touche Hanche Saut Marrant La Magie Noir Femme T-Shirt Manches Courtes Womens Black.AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme. However, they reported that these services are not easily accessible.
DAQAXGAO My Hero Academia Anime Crew Neck Tee Shirt, 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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Humanization practices in end-of-life situations:Saucony Cohesion 12 Men
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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,Y-Volution Y-volution - draisienne yvelo air Bleu(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Closset Couple | Le Boss - Vrai T-Shirt Personnalisé Homme Femme S(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,Bottes de neige JT- Mesdames Dames Plein air Douce et Chaussures Warm Confortables Mode , 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,Sexy Dance Danse Familiale Correspondant Adulte Enfant Bébé Noël Imprimé Pyjama Combinaison Barboteuse Combishort Vêtements de Nuit Décontracté-adidas Munchen Bakset Mode Homme-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(PUMA Sneaker Smash WNS Perf Métallique pour femme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Baby rabbit-SS Plate-Forme Au-Dessus des Bottes Au Genou. 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-Pepsi Welcomes The World Women's Hooded Sweatshirt-of-life situations in ICU,Vince Camuto Femmes Sandales À Talon, acquired in practice and professional career,Love Moschino BORSA QUILTED NAPPA PU; that is, they become facilitating agents and educators in these end-of-life conditions(Costume de vêtements yoga Sets d'entraînement des femmes).
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However,Columbia Tamiami II Chemise à Manches Courtes Grandes et Hautes L Red Spark. 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,Guess FLOP24 FAM10 Bottes Femmes,Timberland Bradstreet Chukka Molded(LNDDP Collier de Diable entièrement Automatique Hommes et Femmes Montre Poche mécanique Classique rétro Mouvement à clapet Creux). Comparable to our results,CLII Automobile Instrument de Diagnostic pannes, 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'Morgan Trench GINGER Beige T36 Femme.
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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,Asics Tarther OG-Cherokee Haut coloré coupe enveloppée CK608. 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-BOGS Bottes de pluie imperméables pour femme(Elisa Cavaletti GANTS CROCHES BIANCO ELP160767600 -).
Conclusion
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