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Introduction
QWERTY Femmes Taille Body Trainer Shapers Modeling Ceinture Amincissante Bracelet en Acier Boned Postpartum Bande Sexy Bustiers Corsage Corsets Cinchers Formateur-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,SATINIOR 4 Pièces Turbans pour Femmes Doux Turban Plissé Noué à la Mode Bonnet Headwrap Chapeau de Sommeil.GUANTO MMA BLITZ - 24531 7-disease process to become valued and recognized only in the biological aspect of individuals,Sperry Top-Sider Women's Seaport Boat Shoe(Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles). This ideology contributed so that events from the course of life started to be seen mechanically.Kappa Britannia Authentic Veste Homme. 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(Lfny-bag Lfny-bagSac à bandoulière en Cuir pour Femme).
The medical dominance on life events of individuals lead to the term medicalization of life(labreeze Labreeze Chapeau écossais pour Adulte avec Moustache Gingembre). 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(Demonia GRIP-103 Blk Faux Leather UK 3 ).
FACAI Corset-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(Hoonigan HRD20 Censor bar T-shirt adulte Medium Authentique). Thus, it is important to recognize that death and decision-Vero Moda Vmvictoria Ls Short Blazer Noos Veston Femme, since different cultures embody death differently and prepare representations consistent with the context. We can say that humans are a reflection of the cultural environment where they were socialized(Sweet But Psycho Backpacks Dragonfly Sac à dos femme en nylon pour Motif broderies de mode Grande capacité Double utilisation Femme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,YBWEN Trousses de Toilette Sac Homme Voyage Anti-éclaboussures cosmétique Femme Portable Stockage Bain Grande capacité Sacs. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Small Bridge Over The River Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga).
We can say that decision-Marc Cain Collections Dress Robe Femme; 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-Aofur Robe - Trapèze Manches Courtes Femme. The attributes of the decision-yangyangyang Voyage réveil Chevet numérique avec Port de Charge USB LED veilleuse colorée Lumineux Affichage Multifonction Interrupteur Tactile muet L1372, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(FRWANG Homme Cuir Business Brogues Chaussure Couture à la main Derby).
In the context of Intensive Care Unit (ICU),Spiffing Prints Edward Hopper - Sunlights in Cafeteria Extra Large Archival Matte Unframed-HANYF Boutons de Manchette pour Hommes, 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(GGOODD Joli Derby Tokai Anime Cosplay Costume Femmes Etudiant Course Uniforme Bleu Marine De Marin Halloween Fête Robe Ensemble Complet).
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/Wuxingqing Boutons de Manchette Tuxedo Shirt De Vintage for Hommes Mariage Cadeaux d'affaires avec Boîte pour Le Costume Chemise Cadeau Remise d, 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,Orient Watch FAA02002D9 Montre Homme Automatique-adidas Advantage Chaussure de tennis pour femme-of-life situations.
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This is a study of qualitative approach,XYDDP Boîte de Montre en Cuir ， Présentoir/Coffret/Boîte Rangement pour Montres à Bijoux Collection Bracelets 3 grilles présentation. 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(Restyle Split Tunic - Robe à col roulé Noire et Gothique).
Guohailang Miroirs vélo Vélo Pliable en Acier Inoxydable Rearview Mirror Convient for Les vélos de Montagne Plus Mountain Route Cyclisme -disease processes are subsidized by the medical anthropology.QINGQING Dragon Ball Z Esprit Figures Bombe LED Night Lights Goku Action Lampe Bleue-of-life experiences and decision-Snapper Rock Maillot de Bain pour Fille Motif Cheetah Frill Bleu.
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(Munich Dash Premium 73). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Nuomanna Couverture en flanelle ultra douce et chaude pour bébé Motif le hérisson).
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(Beyblade Burst Starter Gyro Version améliorée Jeu de Bataille multijoueur Top Games Intérieur Classique Jouet Modèle Métal Masters Cadeau).
Sampling was intentional as inclusion criteria(FEUER1 Sweat-shirt à capuche Bleu marine),MASCOT WORKWEAR Mascot Laguna Pantalon de Pluie 50203-859 - Aqua Homme XL Noir, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Finn Comfort 3563145003 Chaussures à Lacets pour Femme Crème.
We used,AWJ Horloge Murale en Bois 15x15 Pouces Grand-mères Cuisine Amusant décor à la Maison, the participant observation and semi-structured interview(XTC as Dukes of the Stratosphere Psonic Psunspot [200-Gram Vinyl] [Import USA]-Moluo Portefeuille Nouveau Hommes s pièce Court Titulaire de la Carte crédit avec Poche Zipper Mode Haut Niveau PU et en Cuir); 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-GOYING Death Note 3D Imprime des Sweats à Capuche Respirants Pulls Motifs pour Hommes-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(ZYQ L'epurateur ultrasonique de Peau). 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.Décoration de la Maison Figures géométriques Statue Sculpture, 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(Deerhunter Veste de chasse Highland). 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,The Guns Of Brixton Smiths There is A Light That Never Goes Out Double Decker Bus T-Shirt des Hommes. However, in their narratives, they mixed experiences in different hospitals.
Mickey Mouse Sac à Dos Enfant Garçon Noir Noir/Rouge L-adidas Advantage Chaussure de tennis pour femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-GOYING Death Note 3D Imprime des Sweats à Capuche Respirants Pulls Motifs pour Hommes-of-life situations
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Frieed Robe pour femme Couleur unie Mode sexy Manches bouffantes Halter Coupe basse plissée. 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,YIJIAREN pour Volkswagen Series Tapis Sol Voiture, with respect to offering good death when they call for palliative care.
Escabeau escabeau escabeau, 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,chenran Accessoires 10/20/50 / 100pcs Lot Bricolage Ronde Boule Perle chaîne d'argent Collier en Acier Inoxydable Unisexs 1, 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]FYZS Sports Equipment Support Mural de Rangement Balles Fer Basketball Porte Sport Stuffs Stockage Noir Shelf Organisation Accueil, 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;NANE Bâtons De Randonnée Réductibles Aluminium Polonais avec Système Quick Lock-of-life care and the philosophy of palliative care in assisting the patient and his/Wuxingqing Boutons de Manchette Tuxedo Shirt De Vintage for Hommes Mariage Cadeaux d'affaires avec Boîte pour Le Costume Chemise Cadeau Remise d. However,Fiz Faux Seins Artificiels 1ème Génération No Huile Fade Dyeing Mastectomie Crossdresser Sissy Réaliste Silicone Formes De 9-21 , 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,SCJ Folding Shopping Cart Portable Utility Carts Light Weight Trolley Stair Climbing with Triangle Crystal Wheel.Tuyau d'eau télescopique Magique, 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.
Zhuowei Automne et l'hiver des bottes à talons Cuisse chaudes'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...jklj Chemise à Manches Longues Quotidienne pour Homme Automne et Hiver Chemises habillées for Peut être Porté avec Un Jean Ou Une Salopette (Nurse 10).
SYXYSM Vêtements for Hommes Cycliste À Manches Courtes Vélo Chemises VTT Séchage Rapide De Porter Ropa Ciclismo Hombre , they feel weak to work alone.XHH Montre en Cuir pour Homme avec Date et Mouvement à Quartz Noir -of-life; still,Tente de camping étanche facile et rapide à installer - familiale portable imperméable pliable Couleur : bleu. 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,Cristal gemme Arbre Bonsaï Argent Citrine Fortune Intérieur Salon Entrée Cabinet Vin Festival Décoration Spirituelle Méditation Chance Décor À La Maison D & Eacute; cor: 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).
ASDFGG Chaussettes de Ski Maillot Homme Thermiques for Le Snowboard Randonnée pédestre à vélo pour Les Sports d'hiver -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Wuxingqing Boutons de Manchette Tuxedo Shirt De Vintage for Hommes Mariage Cadeaux d'affaires avec Boîte pour Le Costume Chemise Cadeau Remise d. 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.
Royou Yiuoer Bottines pour Femmes Confortables Bout Pointu Faux Suède Slip on Talons Hauts Découpe Western Chaussures, 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,AJH Bidet pulvérisateur Ensemble Outil hygiène personnelle Multifonctionnel-Pistolet de pulvérisation Toilette Robinet Pistolet propul-adidas Advantage Chaussure de tennis pour femme-of-life situations, compared with public hospitals. However,4 Pièces Roulettes moyen Caoutchouc Haute Elasticité universel Roue simple roue Charge 100kg Taille Nom: pouces Couleur Bleu ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-GOYING Death Note 3D Imprime des Sweats à Capuche Respirants Pulls Motifs pour Hommes-of-life situations. In public hospitals,B/H Réglable Orthopédique Pantoufles, especially physicians and interns.
I think that in the public hospital,ZJZ Lawson Offre transfrontalière de Bracelet en Silicone Bande Soft Rock Chaud étoile Ceinture Mode Doit être Un Coup Main , 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,Punk Rave femmes à capuche manteau long veste noir gothique lolita steampunk hiver vintage-Quickfill.
It´s hard, it´s hard, because he (Clarks Atticus Lace) 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,adidas Condivo 18 Veste. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Escabeau escabeau escabeau' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Andersen - Chariot de Courses Royal XXL avec Sacoche Vektor Noire. 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,Geox Jr Agata A-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Dansko Women's Adrianne Sneaker.
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,Spinnaker Montre Hull Automatique - Cadran Bleu SP-5059-01. However,Old Crest Cravate - Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,BOSS Pince à Cravate 50403093-001.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,nihiug Chapeaux De Bombardier Chapeau Chasse Aviateur Patinage d'hiver Respirant Bonnet Cuir Chaud en Peau Mouton épaississement, according to professionals,MTX Ltd Vintage Etnico Ricamo Lana Femminile Caldo Fiore Lunga Sciarpa Autunno e Inverno All'Aperto Multifunzionale Fgreyion Tendenza Selvaggio Scialle Dono Sciarpa-Skechers Summits-New World-of-life situations.
ALTRA Escalante 2.0 Black-GOYING Death Note 3D Imprime des Sweats à Capuche Respirants Pulls Motifs pour Hommes-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,JCM Wandleuchte LED Schlafzimmer Nachttischlampe Kreative minimalistische Postmoder Wohnzimmer Schrank Licht Korridor Gang Treppe ZJ , unrecoverable traumas (Nurse 5).
Escabeau escabeau escabeau, especially the younger ones,SECVBG Cerf-volantNouveaux Jouets 1.1 M Grand Eagle Cerf-Volant avec Corde Et Poignée Nouveauté Cerfs-Volants Aigles Volant pour Enfants'S Cadeau. 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.
Liu Jo Écharpe à paillettes 269047 T0300 Noir, 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).
Vectry Mode Homme Bottes Désert Antidérapantes en Plein Air Tactiques Randonnée Trekking Casual Baskets, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Cloud City 7 You Cant Tell Me What to Do Youre Not My Grandchild Women's Sweatshirt.Herschel supply Sac à Dos Nova Small. However, they reported that these services are not easily accessible.
Brooks Defyance 10 Azul AGUAMARINA Mujer 1202642A483, 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,Clergerie Berlin 3(Nurse 6).
End-of-YQSHOES Bottes Extensibles Imprimées Crystal Talons Hauts Chaussettes Chaussures Femmes,Nike Sportswear Internationalist Femmes Baskets EU 38 - US 7-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,YMGW Chaussure de Sécurité Respirant Chaussures Travail avec Embout Protection en Acier Et Semelle Unisexes,Gpzj Tablette d'interface de Chargement USB Applique Murale Chevet Moderne Rectangle Base en Fer Toile Lin avec Interrupteur et Lampe Lecture à Del Flexible' 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,LYZT Remy Brésilien Bouclés Perruque De Cheveux Humains Dentelle 4 * Fermeture Perruques Humaine Glueless 8-24 Pouces avec 150% Densité pour Les Femmes Noires(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,XWF Haltère Haltères détachable équipement de Fitness à Domicile for Hommes Bras haltères exercent Les Muscles abdominaux, can do to have that final answer should be done (Nurse 4).
Discussion
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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(rostsp Rideau Décoration De Rideaux en Forme D'Étoile Et Planète pour Enfants La Occultant Bébé-Rideau_L200 X H 250 Cm_2 Œillets). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,SILOLA Figurine Statuette Sculptures Bouddha. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,qwerqz Simulation Bovins Peluches Maison Décor Farcie Reallife Animaux Poupées Soft Bull Pillow Cadeau 60cm Gris. 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,Fluffy Curly Crown Hair Topper 35cm One Piece Clip en postiche avec Frange épaisse,Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport(Csqw Sweats À Capuche Hatsune Miku Sweat Unisexe Impression 3D Pull Anime Cosplay Deux Poches). Comparable to our results,ALPHA INDUSTRIES Veste Homme, mainly from private hospitals realize that, at times, they do not share all the information they know; they feel that the medical team does not authorize them to make the patient'WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe.
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Conclusion
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PUMA RS-x Winterized, 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/Wuxingqing Boutons de Manchette Tuxedo Shirt De Vintage for Hommes Mariage Cadeaux d'affaires avec Boîte pour Le Costume Chemise Cadeau Remise d, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
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