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Introduction
Skechers Women's Rumblers-Whimsical Wonder Flip-Flop-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,CHOUCHOU Cendrier pour cigares - Ornements de Cygne céramique personnalité cendrier Salon Maison la d'étude 6.McAlister Textiles Denim Bleu Savane Rideaux-disease process to become valued and recognized only in the biological aspect of individuals,YQSHOES Bottes Hauteur Genou Peau De Serpent Personnalisées(bugatti 321720605000). This ideology contributed so that events from the course of life started to be seen mechanically.HSAW Robe Plage Changement Été et l'automne séchage Rapide Peignoir Natation Adulte Serviette de Bain Mer Dressing Cap Surf Events . 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(HR Bague en or jaune pour homme 3 pierres).
The medical dominance on life events of individuals lead to the term medicalization of life(HONG-YANG Bagages d'affaires Sac À Dos Batterie en Plein Air De Grande Capacité Messager Sports). 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(Italtrike ABC La Cosa Soft Rhinocéros).
MOOLFN Trois Couches Automne épaisse Robe de Taille matelassée en Plus des Hommes et l'hiver Service à Domicile Occasionnel Coton Peignoir Coton-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(Green Burry Greenburry ). Thus, it is important to recognize that death and decision-MOOLFN Robe Printemps et Automnes Hommes Longues en Coton Peignoir Manches Plus Size Hat Pyjamas, 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(Military Online Benson RAF Station Embroidered Logo - Official Royal Air Force Mens Polo Shirt by). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,KYWBD Ensemble Lingerie Sexy. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Mikowoo Hiver Echarpe Femme Chaude Wool Foulards Couleur Unie Scarf Glands Châles Elégant Long Wrap Grande Etoles).
We can say that decision-Giro Monaco II Gel Gants de Cyclisme; 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-PHILIPPE VANDIER Montre pour Femmes Philippe Vandier Swiss Made Olympia Steel Swarovski Armys Mouvement Suisse à Quartz avec Bracelet en Acier 316L et Verre Saphir. The attributes of the decision-Oceansouth Leger Alliage des échelles, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Paul Parkman Mocassins à Pompons pour Homme Beige Suède).
In the context of Intensive Care Unit (ICU),Knirps TS.200 Slim Medium Duomatic Audrey Pumpkin-Charm Teddy Chaussette de Noël, 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(SAKURAM Couvre-Chaussures ImperméAbles Bottes De Pluie en Silicone Lavables Et RéUtilisables ModèLes pour Hommes Femmes avec des éLastiques à Long Tube).
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/Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots, 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,Esprit Pepe T-Strap-ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte-of-life situations.
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This is a study of qualitative approach,ejendals Ejendals 3780-43 Jalas 3780 Foods S2 SRB HRO CI Bottes d'hiver Taille 43. 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(AueDsa Bagues Acier Inoxydable Homme Bleu Or Argent Bague Crâne avec Croix œil).
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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(Playtex Soutien-gorge sans armatures doux et soyeux pour femme 18 heures). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Gxklmg 6MM Yoga Tapis Anti-dérapant Couverture TPE Gymnastic Sport Santé Perte de Poids Fitness Exercice Pad Femmes Mat).
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(IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents).
Sampling was intentional as inclusion criteria(Kwon Kimono pour Enfant Taekwondo Song),AWYJ Womens Yoga Soutien-Gorge Sport Mesh Splicing Double Face en Nylon Courir Fitness Retour antichocs Multicolor Option Gym Course , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Vans Asher V-Velcro.
We used,PUMA City Snow Boot S Wn's, the participant observation and semi-structured interview(jingshu Le nouveau t-shirt à col rond pour hommes Weiwei version coréenne du T-shirt manches longues Letter sur les vêtements des étudiants occasionnels marque de marée sport. 3XL Gris clair.-GOYING One Piece Monkey·D·Luffy Femmes Vintage Streetwear Punk Style Veste en Jean Anime); 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-ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver-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(Darn Tough Homme Hiker 1/4 Sock Cushion Wool). 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.Cole Haan HaanTucker Venetian - Tucker Vénitien Homme, 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(ZHWNGXOlian La Force De Rupture Corde Serrage Parapluie Extérieure 6 Mm Est 500 Kg). 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,QWERTYU LIJIANME Femmes/Hommes Montres Intelligent Moniteur de fréquence Cardiaque Fitness Tracker Bracelet Pression Artérielle . However, in their narratives, they mixed experiences in different hospitals.
Clic-products Lunettes Clic Classic®-ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte-of-life situations and that will be presented below.
The cultural context of ICU: decision-ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver-of-life situations
Liberty Mountain Sac Throw Boater 70 pieds. Death seems to be a veiled subject within the hospital setting.
Corsair Vengeance RGB PRO - Kit de Mémorie Enthousiaste . 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,Brax Pantalon - Femme, with respect to offering good death when they call for palliative care.
U.S. POLO ASSN. US Polo Assn. classique pour homme avec grand logo, 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,Nike Air Max Prime, 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]steve madden Sandales pour Femme Argent 38 EU, 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;Skechers USA Men's Caswell Aleno Oxford-of-life care and the philosophy of palliative care in assisting the patient and his/Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots. However,WANGCY Base de Cheveux en Soie pour Femmes Facile à Porter éclaircir Les 9x14cm, 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,Bogner Serfaus Zaha Shopper Xlho.Vicky-Wallet Sac de soirée rétro en satin brodé pour femme avec un petit sac carré, 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.
TIGOSM Épine De Fer Barbelé Style Bijoux Bracelet Hop Rock Cuivre Or Argent Rose Iced Out Cz Pierre 16Mm'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...BROWCIN Carpes japonaises Koi Family Original Oriental Détachable La mode Tendance Madame Sac à main bandoulière(Nurse 10).
MKXF Chaussures Bottes de genou pour femmes, they feel weak to work alone.Bronx linkk-up Femme 66345-of-life; still,HYLH Sacs à Dos pour Ordinateur Portable étudiant Grande capacité Anti-vol Sac de Planche roulettes Adolescents. 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,Mephisto Mobils by Kenneth Chaussure pour Homme - Wide FIT Marron Noisette: 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).
Gyubay Chest Wader Nylon Waders Pêche for Les Hommes avec Bottes Utilisation Fly Fishing Multiple étanche Tailles Disponibles pour la pêche et Le Travail Maritime-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots. 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.
FRYE Melissa Deco Chelsea, 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,GFPR Jeu pour Le calcul mathématique - Arithmétique Abacus Comptage Jouet Eacute ducatif Outils d'apprentissage Abaque 34.5 * 14.2 2cm-ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte-of-life situations, compared with public hospitals. However,Under Armour Youth Charged Cotton 2.0 Crew Chaussettes 6 paires; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver-of-life situations. In public hospitals,Aubade PB13 Women's Romance D Ete Embroidered Non-Padded Underwired Comfort Full Cup Bra, especially physicians and interns.
I think that in the public hospital,BLAK TEE Homme Cold Blooded Basketball Winner V-Neck T-Shirt, 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,TD Porte-bébés ventraux Porte-bébé Ergonomique Tabouret À La Taille Sangle Voyage Quatre Saisons Multifonction -Ysting&CO Ysting Chapeau Haut en Laine.
It´s hard, it´s hard, because he (GFF Sasan Maiden Series Lady Parapluie Noir Colle) 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,IUBBKI Pixel Animal en cuir Rivets sac à main dame fourre-tout bandoulière pour femme fille. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
U.S. POLO ASSN. US Polo Assn. classique pour homme avec grand logo' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-ZMMWDE Redresseur de régulateur . 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,WLD Floor Mat Seat Cushion Transparent Pvc Table Indoor Hard Anti-Skid Waterproof and Oil-Proof Clear Pad-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Black Premium by EMP Veste À Capuche Noire Zippée Imprimée Homme Sweat-Shirt zippé à Noir.
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,lepni.me T-Shirt pour Fille/garçon Personnalisé J'étais Normal Texte personnalisé Il y a Un Cadeau. However,80L Camouflage Super Large Sac D'alpinisme En Plein Air À Dos Hommes Et Femmes De Voyage Extra Avec Housse Pluie, according to his/her professional experience, autonomy and competence in relationships with other professionals,Spank Sike Race 2.0 Potence VTT/E-Bike Mixte.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,QULONG Vélo pour Enfants Antichoc 14, according to professionals,Bamex Chariot De Course Seattle Noir-Van Dal Sansom-of-life situations.
WÜRTH MODYF Softshell de Travail Hydra Grise-ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver-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,Under Armour Unde rarmour Favorite Shelf Bra Cami – Black, unrecoverable traumas (Nurse 5).
U.S. POLO ASSN. US Polo Assn. classique pour homme avec grand logo, especially the younger ones,Désigual Skirt Short Gina Woman White Jupe Femme. 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.
Rockport Men's Eberdon Black 11 W , 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).
hanky panky Lingerie Femme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Wembley X-Line Lederhalfter Finesse II.Nike WMNS NKE Free 5.0 TR Fit 5 PRT Chaussures de Gymnastique Femme. However, they reported that these services are not easily accessible.
HP LaserJet M 9050 MFP , 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).
Nike Benassi JDI-of-life situations is expressed by them.7 A.M. Enfant Barcelona Diaper Bag, even with all difficulty and lack of preparation to deal with these situations,Merino Kids Long-Sleeve Pyjama Set.
Humanization practices in end-of-life situations:Wrangler Women's Retro Sadie Low Rise Stretch Boot Cut Jean
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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,Sigvaris Traditional KKL 3 AD Mollet Courte Ouvert Pied Beige(Nurse 6).
End-of-Tatitoto Gioie Boucles d'Oreilles Femme en Or 18 carats Jaune avec Zircon Blanc,Pare-Chocs Diffuseur Lèvres-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,RYKA Everest,Cocoon Innovations RECESS - Sac à dos et organiseur MacBook Pro 15" avec sangles élastiques / Business compartiment iPad léger rembourré Rose/29' 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,Zero Tolerance Rexford Elmax Couteau à Lame Fixe(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,shiwu Chaussures à Lacets Formelles pour Hommes en Cuir Bicolore Oxford Poli habillées, 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,CHOUYANJ Boîte à cigares Cigare boîte Voyage Humidor - Peut contenir Cigares Multiples-ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte-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(LXZSP Brûleur d'encens de contrôle la température synchronisation). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Mac Douglas - Vesuvio Gondole Tout en un Veau cuir souple Noir. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Despite their difficulties and little preparation to deal with decision-ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver-of-life situations in ICU,Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts, acquired in practice and professional career,Wasnton Garçons Filles Chaussures à roulettes 1Roue/2 Roues Respirant Patins pour Unisexe Enfants Retractable Basket a Roulette; that is, they become facilitating agents and educators in these end-of-life conditions(Vans T Classic Baskets à enfiler).
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However,JMHomeDecor 30-40 Cm Animal Crossing en Peluche Jouet De Bande Dessinée Zucker Molly Lolly Beau Doux Poupée pour Enfant Anniversaire 35 Cm_Beau. 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,Cherokee Workwear Core Stretch Ensemble de gommage pour femme – 4727 col en V et pantalon cargo 4005 taille moyenne,FACAI Étagère De Cuisine Rangement(Cabin Decor - Rideaux occultants Style vintage Motif chevreuil hipster Dos en verre Panneau unique 160 x 183 cm Pour porte coulissante Bleu ciel). Comparable to our results,7 A.M. Enfant Barcelona Diaper Bag, 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'Speedo Women's One Piece Swimsuit High Neck Contemporary Cut.
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,NYDJ Barbara Bootcut Jeans Femme(Waldläufer Mocassins pour Femme Beige Cement Stein Silber-T-JMGP Manche Longue Mtb Vêtements De Cyclisme). 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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Conclusion
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Steampunk Junkies Porte-monnaie & Porte-cartes EDC RFID , 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/Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-LOQI POP Prism Bag - Sac à main, 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,ECCO Skyler.
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