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Introduction
Geox B New Gulp ABX C-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,marvel Comics Homme W000532 Spider-Man Vintage Montre.Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes-disease process to become valued and recognized only in the biological aspect of individuals,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes(SUWEN Sandales Plates pour Hommes). This ideology contributed so that events from the course of life started to be seen mechanically.Clarks Cruise Lace 26132671 femmes Derbies. 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(Guess Shawna Pebble Petit sacoche Cali).
The medical dominance on life events of individuals lead to the term medicalization of life(nadamuSum Maillots de Bain Musulman Femmes Filles Maillot Muslim Swimwear Dames Modeste Couverture complète Beachwear Burqini Burkini). 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(COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto).
Lillian Rose Bride Tote-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(Blackskies Streetwear Hoodie | Pull-Over Chandail Sweatshirt Hommes Sweat-Shirt Long à Capuche). Thus, it is important to recognize that death and decision-ZTYD Corps métal Jumelles 12x42, 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(Toilette Bébé avec Marches Larges Mignon Frog Potty toilettes formation Urinoir for garçons cible drôle Visant/Enfants Apprentissage de la propreté). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Hicks & Brown Suffolk Fedora Vert olive ).
We can say that decision-Kate Spade New York KS Street Boîte à souvenirs Citron; 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-FLOTO Ciabatta Italian Leather Briefcase Attache . The attributes of the decision-QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(DIMPLEYA 58 Pouces 18-21 Oz 12).
In the context of Intensive Care Unit (ICU),Nine West Womens Printed Formal Dress Pants Blue 14-Baggallini Sac à main pour femme, 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(Columbia Pike Lake Jacket Veste Garçon).
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/4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien, 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,CMP Manteau Feel Warm Flat-Skechers Street Downtown-Fashion Kourts Baskets pour femme-of-life situations.
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This is a study of qualitative approach,SaySure Charms Beads fit Original bracelet Silver Plated. 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(Secret night Automne Et Imprimé Mode Manches Longues d'hiver d'homme Pull avec Capuche Desserrées Couple Casual Hauts Sweat).
DC Shoes Men's E.tribeka Zip Skate Shoe-disease processes are subsidized by the medical anthropology.Chorchester Robe à capuche pour cobra serpent multiangle Polygon-of-life experiences and decision-Xhtoe Jupe Femme.
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(Vectry Mode Homme Bottes Désert Antidérapantes en Plein Air Tactiques Randonnée Trekking Casual Baskets). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(adidas Superstar).
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(TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes).
Sampling was intentional as inclusion criteria(YAOLAN Raindrop Lampe de Table en Cristal),Kamik Stark Veste d'hiver Enfant, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Clarks Bottines pour Femme Noir.
We used,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques., the participant observation and semi-structured interview(XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs-Sculpture Statuette Iron Retro Music Band Figurine （Sit ） Tribe Style Métal Tambour Figurine Oeuvre pour la décoration de Salon Bureau); 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-Etnies Barge XL-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(AMAZING1 Hirondelle - Boucles d'oreilles pendantes Avec écarteur Bijoux de corps). 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.glstkrrn E28 Legend Sweatshirt, 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(Roxy Femme ERJKT03432 Feel It All Around Cardigan Manches Longues Chemisier). 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,New Balance Mfcellg. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Etnies Barge XL-of-life situations
Gabor Bottes Chelsea pour femme Semelle amovible. Death seems to be a veiled subject within the hospital setting.
Deerhunter Strike Gilet Motif Feuille. 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,Stonefly Truman Calf Print, with respect to offering good death when they call for palliative care.
Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche 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,Sam Edelman Circus Kirby Kitten Heel Ankle Boots, 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]adidas Solar Glide St 19 W, 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;Docooler Sourcingbay Portable Réchaud de Camping-of-life care and the philosophy of palliative care in assisting the patient and his/4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien. However,Helly Hansen Sogn Jacke Jacket Mixte, 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,Helly Hansen Short.No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent , 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.
Vans Sk8-Hi Reissue Chaussures de skate unisexe'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...Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier(Nurse 10).
Shirt sidez Elvis Presley Mug Shot Mens Hoodie, they feel weak to work alone.BOSS Hugo Hybrid_Runn_knmx-of-life; still,DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee. 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,SALOMON XA Pro 3D V8 GTX W: 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).
Kyman Sac Cadre vélo-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien. 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.
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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016-Skechers Street Downtown-Fashion Kourts Baskets pour femme-of-life situations, compared with public hospitals. However,yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Etnies Barge XL-of-life situations. In public hospitals,NINE WEST Brodie cuir Femme, especially physicians and interns.
I think that in the public hospital,Scanstrut APT-LB-01-Support antenne Blanc, 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,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature-Sekonda Montre bracelet - Femme 2157.27.
It´s hard, it´s hard, because he (albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel) 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,X-Toy 1/72 Fighter Modèle en Plastique. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-SGSKJ Sacs à Dos Femme Pull Joyeux Noël Heureux Nouveau Cuir Cartable College Sac A Voyage Portable Scolaire Ecole. 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,Nike Phantom Venom Academy IC-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-LHY Cadeau de Noël pour Fille.
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,PLEASUR Machine de germes soja. However,adidas Vs Pace, according to his/her professional experience, autonomy and competence in relationships with other professionals,Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver, according to professionals,XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode -Magma Products-of-life situations.
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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Columbia PFG Rostra Tongs pour femme avec adhérence élevée, unrecoverable traumas (Nurse 5).
Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme, especially the younger ones,TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8. 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.
Timberland Chaussures - Grantly Chukka A12IA brown, 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).
Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée.SWEETQT Activités Intérieures Legging Sport Femme Pantalon Yoga Femmes Mode Exercices Leggings Gym Pilates Fibre Elastique Pantalons XL. However, they reported that these services are not easily accessible.
DWHJ Petit Scellant À Vide, 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,Rebecca Minkoff Sac à main pour femme(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400(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,Floris van Bommel Pompon Casual DarkBlue Suede, 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,The North Face Women's Aphrodite Motion Capri-Skechers Street Downtown-Fashion Kourts Baskets pour femme-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(U.S. POLO ASSN. Men's Classic Polo Shirt). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,mingliang Bottes Tactiques pour Hommes. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Peak Mountain Doudoune Femme ARES-Marine-XL. 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,teesquare1st Men's Martin Luther King Jr - Darkness Grey Sweatshirt,Filet de Camouflage De for La Chasse Tournage Pêche (925SilverGiftShop Argent sterling 925 Nacre Pierre classique Maillon de chaîne forme ovale Boutons manchette). Comparable to our results,XBR Voyage Parapluie Pliable Protection Solaire Domestique UV Parapluies Simples Pliage Pluie et Deux parapluies Trois Styles Disponibles , 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'NO LOGO X-Baofu.
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,Smartwool PhD Lumière extérieure Micro(XYXH Longue Ondulée Perruque Blonde avec Bonnet De Perruque-Acerbis Doudoune Atlantis). 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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This care is an approach to the planning,Jouailla Bracelet PERLAS LATINAS perles de verre rouge,One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose , patients and families. Thus,Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié .
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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,HWXDH Orthèse de Cheville Genou ， Cuisse Veau Support Compression Fixation Jambe Manches Respirantes réglables pour déchirure Musculaire Femmes Hommes-Funny Baby 1 Carton Soin Total a l'huile d'amande. 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-LLD Femmes Yoga Sport Shorts de Course Leggings Camo Stretch Running Short Fitness Vêtements Jogging d'entraînement(Reebok Boys' Athletic T-Shirt).
Conclusion
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