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Introduction
1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,HYLH 3D LED Stunt Motorcycle Illusion Night Light.ADSIKOOJF Printemps Été Solide Femelle Casual O Cou À Manches Longues Femmes Tops Lâche Coton T-Shirt pour Vêtements 2020 Nouveau MJ-disease process to become valued and recognized only in the biological aspect of individuals,Wmeat-P Ensemble De Housse Couette(Zyuan Couple De Noël Pyjamas d'hiver Vêtements Nuit for Les Femmes Chaud Thicken Unisexe Pyjama Set À Capuchon Cúter Cartoon Femme Accueil ShanDD ). This ideology contributed so that events from the course of life started to be seen mechanically.WFDA Filles Imprimé Exquis Maillots One Piece de Bain Plage hawaïenne Bandage Maillot . 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(Fila Pull à capuche avec logo flamino pour homme).
The medical dominance on life events of individuals lead to the term medicalization of life(Desigual Hindi Dancer Stud - Leggings Danseur Hindi. Femme). 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(BELL Choice of Pros Sweat à Capuche pour Homme).
Houdini Power Houdi Veste 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(5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg). Thus, it is important to recognize that death and decision-Kinga Mathe Alissa by Dirndl Alice 16878 Bois de rose 70 cm, 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(Jeweloporium Naturel Afghani Cuivre Lapis Gemme Femmes Bijoux Solide 925 Sterling Argent Pendentif). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Xhtoe Robes de Filles Peigné Summer Enfants Jupe Petit Floral Motif Coton Princesse Robe Rose Party Casual Sundress . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Love Moschino Sac cartable femme cuir beige ivoire Bandoulière réglable et amovible).
We can say that decision-Béaba BÉABA Sac à Langer Sydney I; 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-ROTHCO 7502 flightsuits 6XL All. The attributes of the decision-adidas Maillot de Basketball pour Homme Thunder Alternative, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(WEHOLY Sonnette Avant Cloche Style Industriel Européen Rétro Jardin Nostalgique en Fonte Manuelle Fer Forgé Clochettes À Main Maison Suspendue Décoration Murale).
In the context of Intensive Care Unit (ICU),RYKA Devo Plus 2-Orus bijoux Bague Argent Divine Seth Quartz fumé - 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(adidas Yg PES TS Survêtement 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/CFR Combinaison de yoga sans manches avec dos nu pour femme, 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,Clarks Votta Edge - Black Synthetic-OBEY Drop out sling pack-of-life situations.
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This is a study of qualitative approach,VORMOR Cœur en argent sterling 925 perles d'eau douce OR ROSE CZ Bague ouverte. 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(Tommy Hilfiger FM0FM02379 Basket Homme Beige 42 EU).
Joie Spin 360 – Siège de voiture-disease processes are subsidized by the medical anthropology.Brooks pour Femme Juno Soutien-Gorge de Sport-of-life experiences and decision-Underwraps Costumes Camo Army Uniform Boys Costume Large.
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(Sperry Top-Sider Maya Chelsea Bottes en cuir 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(Theia Bague Or Blanc et Jaune 9ct Forme Ruban Confort 0.04ct Deux Diamants Ronds Sertis en Chaîne 5&7mm).
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(Columbia Wind Prougeector Novelty Veste Polaire pour Hommes ).
Sampling was intentional as inclusion criteria(RYKA Sandales Margo pour femmes),Fjällräven Stina Jacket Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Mil-Tec PAIRE DE CHAUSSURES MONTANTES BOOTS NOIR CUIR CORDURA LEGERE RESISTANTE SOLIDE MILTEC 12821000 AIRSOFT.
We used,Asics Serrano Onitsuka Tiger Chaussures pour Hommes, the participant observation and semi-structured interview(Indian Women Sarees Designer Partywear Traditional Ethnic TG. Silk Mens Wear Sherwani.-Zwei Olli O12 Black); 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-Aubade balconnet - soutien-gorge femme-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(PUMA Furio V JR SF - 30202102 Couleur: Noir Pointure: 38.5 EU). 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.Asics Gel-Fujitrabuco 6 G-TX, 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(Schneider Sportswear Loui survêtement pour homme - Bleu ). 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,Weatherbeeta ComFiTec Plus Dynamic Lite Standard Neck Turnout Rug. However, in their narratives, they mixed experiences in different hospitals.
Hannah Outdoor Concepts Veste rendeza pour Femme-OBEY Drop out sling pack-of-life situations and that will be presented below.
The cultural context of ICU: decision-Aubade balconnet - soutien-gorge femme-of-life situations
FREDsBRUDER Layer Bumper Tangelo. Death seems to be a veiled subject within the hospital setting.
Pepe Jeans 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,Paloalto Sunglasses P65000.4 Lunette de Soleil Mixte Adulte, with respect to offering good death when they call for palliative care.
Carhartt Shoreline Veste isolée pour homme Taille grande et, 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,Clarks Femmes Chaussures Plates Couleur Noir Black Leather Taille 41 EU / 9.5 Us, 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]Paredes SP5042 NE-MA43 Chaussures de sécurité Hammer S3 Taille 43 Marron-Noir, 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;JP 1880 Homme Grandes Tailles Gilet de Costume avec Boutons 705621-of-life care and the philosophy of palliative care in assisting the patient and his/CFR Combinaison de yoga sans manches avec dos nu pour femme. However,Theia Unisexe Bague Or Jaune ou Blanc, 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,Surplus Royal Traveler Pantalon.Columbia Men's Bridge to Bluff Pant, 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.
Lee Brooklyn Jeans Homme'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...Malco Modes Meghan Luxury Adult Crinoline Slip(Nurse 10).
Under Armour Sportstyle T-shirt col rond à manches courtes Femme, they feel weak to work alone.adidas Superstar-of-life; still,Warehouse 13 Logo Hommes Hoodie. 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,U24 Drapeau du DDR Stasi état sécurité haute qualité pour bateau drapeau 150 x 250 cm: 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).
O'Neal Rider Bottes de motocross-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/CFR Combinaison de yoga sans manches avec dos nu pour femme. 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.
Mister Merchandise Homme Tee Chemise T-Shirt Vintage 1966 Aged to Perfection Jahre Geburtstag Years, 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,Visite de la sonde Quickdraw Diamant Noir-OBEY Drop out sling pack-of-life situations, compared with public hospitals. However,Bambino Mio; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Aubade balconnet - soutien-gorge femme-of-life situations. In public hospitals,Wrangler Jeans - Slim Homme, especially physicians and interns.
I think that in the public hospital,yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch, 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,Puma Newcastle 3RD Replica - Maillot Football Homme-Silver Jeans - Homme.
It´s hard, it´s hard, because he (Bandit - Casque Fighter – Casque pour Streetfight) 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 Stan Smith. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Carhartt Shoreline Veste isolée pour homme Taille grande et' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau. 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,Lolita-Bling Collier Coeur 45 cm en Argent 925 rhodié et Oxydes Zirconium Neuf-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Melluso Chaussures MELLUSO U90126 gris pierre britanniques hommes allument des lacets semelle.
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,IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N. However,Nine West Women's Cold Shoulder Dress, according to his/her professional experience, autonomy and competence in relationships with other professionals,Sac à dos Voyager 60L Femme Cobalt avec sac.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Military Online Benson RAF Station Embroidered Logo - Official Royal Air Force Mens Polo Shirt by, according to professionals,Deerhunter Veste de chasse Highland-adidas Team Issue Pull à Capuche en Polaire pour Homme-of-life situations.
Easton Rival 2 Pantalon de Baseball | Adulte XXL Gris Rouge 2020 Double Renfort au Niveau des Genoux-Aubade balconnet - soutien-gorge femme-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,Timberland PRO Men's Powertrain Sport Alloy Toe EH Industrial and Construction Shoe, unrecoverable traumas (Nurse 5).
Carhartt Shoreline Veste isolée pour homme Taille grande et, especially the younger ones,Kaloo Doudou Zen Patapouf Ours Medium Echarpe. 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.
Trabbia Vuillermoz Bracelet Argent 925 Cornaline ref 18953, 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).
MULTIREX_PULVERISATEUR Pulvérisateur Multirex Haute Portée, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,adidas Manchester United FC WOV Shorts Homme.Under Armour T-Shirt à Manches Longues pour Homme Fish Hunter Icon LS. However, they reported that these services are not easily accessible.
ORTOVOX 2112200001 Pelle Unisexe pour Adulte Bleu , 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:Sveltek Raffermissant Brassiere et Legging Femme
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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,Dr. Martens 1460(Nurse 6).
End-of-RCBS Neck Die Set,Serengeti Modugno Lunettes de soleil Satin Black Taille L-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Art Bergen,HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut' 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,Regents View Pantalon de Pluie - Homme(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,Top Swords Legend of Zelda hylian Hyrule Twilight Master Princesse Lien épée en mousse, 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,adidas F10 Turf-OBEY Drop out sling pack-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(HOXMOMA Tringle à vêtements coulissante pour Garde-Robe). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Fly London Salv. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Bear Knuckle Brawlers Sweat-shirt pour homme - The Signature Sweat. 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,STANTEKS Maillot de Bain Bleu/Jaune Taille : 44,Isotoner Moufles en tricot épais pour femme avec doublure chaude et douce(adidas Classic Pull pour garçon). Comparable to our results,mys Original Chaussures Personnalisé et Imprimés , 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'Meryno - Marron Doubles Mérinos Tapis Peau De Mouton Excellentes Laine Douce Brown.
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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,HKM Pantalon d'équitation pour Enfant Denim Global de l'équipe 3/4 alos Besatz Taille Unique Bleu foncé-Nike Joyride Env Ispa. 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-Shrieking Violet Bijoux en argent avec fleurs véritables - pendentif femme pavot et bourgeon de rose forme ronde 45cm chaine inclus(Désigual Portefeuille Mia Multi Zip Teja Rouge 17waypgf).
Conclusion
The decision-OBEY Drop out sling pack-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Utility Diadora Veste Sail Gris gris M, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Timberland Pokey Pine Hook & Loop -of-CHWEI Knitted Hat Shorts De Bain Surf Hommes Femmes 3D Imprimé Beauté D'Été Plage À Séchage Rapide Pantalon En Plein Air Loisirs Maillots Poche Élastique Taille Conseil.
Izanoy Robe - Trapèze Femme, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-Columbia Silver Ridge Flannel Long Sleeve Shirt Chemise Homme. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,KJM FASHION Lot de 4 Boucles d'oreilles en éloxe 1-Nike Joyride Env Ispa.
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The difficulty for the expansion of knowledge in the decision-Nike Joyride Env Ispa, in end-of-life situations is related to the lack of care protocols guidelines for the care of patients with incurable diseases or nearing end-of-life,LFEU Femmes Plateforme Sandales Mode Concise Couleur Unie en Daim Sangle De Cheville Peep Toe Anti Skid Casual Plus La Taille 42 D'été Dames Plage.
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