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Introduction
Reveal Entertainment Shan Jari Board Game-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Holley 34504 Carburetor Accelerator Pump.ROTHCO M-65 Camo Field pour Homme-disease process to become valued and recognized only in the biological aspect of individuals,CMP 38Z1726 Parka Fix Hood pour Femme(YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dentelle Gaze Dancewear Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée). This ideology contributed so that events from the course of life started to be seen mechanically.PUMA RS-x Winterized. 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(Copytec 31605 First Responder Pologne de secours sanitaire).
The medical dominance on life events of individuals lead to the term medicalization of life(LOARTEE Tapis en velours corail pour chambre à coucher). 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(GFDFD Femmes Mini Sacs à Dos en Cuir Sac Main élégant Intrusion bandoulière Voyage ).
Brandit Sweatshirt à capuche Homme-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(Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe). Thus, it is important to recognize that death and decision-Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles, 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(Pants pantalon Femmes 2020 et Hiver Doux Confortable Taille Haute 100% Pur Cachemire Tricoté Femme Élastique 7Couleur Cas). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,The 1 for U 100% Coton Peignoir/Peignoir Rosalind. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Générique Homme Bottes de sécurité Bout en Acier Anti-crevaison Travail Baskets Respirant Cuir Oxford Casual Chaussures Conduite Outillage Affaires Ville Plate Grande Taille).
We can say that decision-HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête; 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-LybMjG Maillot Cyclisme Pro. The attributes of the decision-werq Doudoune pour Enfants Unisexe Costume Tout-Petits Filles Et Garçons Hiver Manteau Chaud À Capuche, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Honglimeiwujindian Écharpe Femme Womens Grand Soft Feel Wraps Foulard carré Chaud Plaid écharpe Blanket Lady Foulards Châle Long).
In the context of Intensive Care Unit (ICU),Carhartt Gilliam Vest Gilet Homme-LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique, 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(Rideaux occultants au henné - Motifs fleurs de printemps Collection traditionnelle Monochrome Dos thermique Panneau simple 132 x 213 cm Pour enfant).
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/Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe, 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,Sanuk Yoga Bliss-Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport-of-life situations.
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This is a study of qualitative approach,Under Armour Curry IV Sandale pour homme. 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(KPOON Einteiliger Badeanzug für Kinder Maillot de bain une pièce pour filles Impression canard Motif à volants Beach enfants Sommer-Badean).
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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(Waldhausen Damen Vollbesatz Reithose Ava). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(BSM Darren Anderton Maillot de football rétro signé Tottenham Hotspur avec photo).
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(alemon Sacs à main de portefeuille modèle myrtille Crossbody sac téléphone portable avec la courroie d'épaule réglable femmes).
Sampling was intentional as inclusion criteria(Mark Nason Hayden),HKM 9109 Bottes d'équitation Gijón, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Pandora Femme Argent Boutons d'oreilles - 290721CZ.
We used,Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713], the participant observation and semi-structured interview(Gabor Shoes Comfort Sport-HIGHKAS Jupe d'arbre de Flocon Neige Noël 30 Pouces); 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-J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN-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(ROMIKA Varese N 08). 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.Onitsuka Tiger Mexico 66, 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(WOLVERINE Piper Technical T-Shirt à Manches Courtes pour Femme). 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,Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe. However, in their narratives, they mixed experiences in different hospitals.
Suitline Valise Plus Grande Bagages Rigide-Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport-of-life situations and that will be presented below.
The cultural context of ICU: decision-J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN-of-life situations
WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT. Death seems to be a veiled subject within the hospital setting.
Pierre Cardin Lyon Long Life Chino Pantalon 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,adidas Supernova de Course pour Femme à Manches Longues Tee, with respect to offering good death when they call for palliative care.
Montane Ineo Pro Women's Pantalon, 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,Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle, 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]Manfrotto Travel Backpack Sac à dos Gris, 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;Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini Noir-of-life care and the philosophy of palliative care in assisting the patient and his/Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe. However,Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro, 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,Hexagona Sacoche en cuir de vachette RÉPUBLIQUE.X-Bionic O100093 - Cuissards de vélo 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.
YUHT Album Photo Hybride interstitiel'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...YULIN-L YYL Imperméables pour Enfants(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support: 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).
adidas Ultimafusion-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe. 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.
GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres, 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,good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine-Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport-of-life situations, compared with public hospitals. However,Guess Bla Moritz; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN-of-life situations. In public hospitals,Haggar Cool 18 Pro Stretch Madras Short pour Homme, especially physicians and interns.
I think that in the public hospital,YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski 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,Tosca Blu Bottes Mary-BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute.
It´s hard, it´s hard, because he (WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud ) 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,Radio Portable multifonctionnelle. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Montane Ineo Pro Women's Pantalon' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Spyder Raider Pull à fermeture éclair intégrale pour homme. 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,Palladium Pampa Boots White-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Apalis Sticker Mural Squirricorn on The Branch.
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,HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk. However,Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband, according to his/her professional experience, autonomy and competence in relationships with other professionals,ALPHA INDUSTRIES Blouson - Homme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Kamik Snowvalley, according to professionals,Nike Viale-American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003-of-life situations.
Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small-J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN-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,Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main, unrecoverable traumas (Nurse 5).
Montane Ineo Pro Women's Pantalon, especially the younger ones,Green Burry Greenburry . 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.
Under Armour Men's UA Yard Low St Sneaker, 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).
New Balance H754 , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,WOOLRICH Laureldale Pull à col roulé pour femme.German Wear Chaussures de Ville à Lacets pour Homme Noir. However, they reported that these services are not easily accessible.
NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames, 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:New Bling 14K Yellow Gold Necklace 5MM Round Flat 1MM White CZ 38 2
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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,El Naturalista Borago(Nurse 6).
End-of-Bisgaard Dora,Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche -centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants,PALLADIUM-EU Pampa Sport Cuff Wpn' 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,Trippen Road Brown(Nurse 5).
In care and in decision-Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme-of-life,Madden Girl Femmes Bottes.Columbia Wander Plus Jogger, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.gracosy Sabots Femmes Cuir, knowing that all the best care was provided to the patient.Brass Monkeys Haut Thermique - Homme.
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,Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7, 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,Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris-Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport-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(Sports Thriller Rider Sports® Uomo Rock Music Sport e Tempo Libero Abbigliamento Ciclismo Magliette Manica Corta). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,TONI CS-Jenny Business. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Craghoppers Cr165 Sport 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,Adidas Condivo d'entraînement pour homme Pantalon ,Oliver Peoples BERNARDO OV 5189/S(YOUTHUP Blazer Homme Imprimé Léger Slim Fit Veste de Costume Casual Huat Gamme au Bal). Comparable to our results,Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille , 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'WFQGZ Chaussures De Sport pour Hommes Bas.
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,Aura Cacia Ginger/Mint Mist aromathérapie(Napapijri Sweatshirt à Capuche Homme-CHZDSB YMCXXB Vêtements Enfant Filles Princesse Robe Costumes Cosplay pour Enfants Bébé Fille Dress Up Ensembles Halloween 8 1111). 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,no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable -XIAOXIAO Baignoire Gonflable Pliable Baril de Bain Adulte ménage complète Double 150x108x47 cm. 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-Flyye épaule Étui System Panel MOLLE Ranger Vert(meilun Robe Bodycon pour Femme de soirée à épaule Midi).
Conclusion
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