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Introduction
Bandit - Casque Fighter – Casque pour Streetfight-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,adidas Stan Smith.Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau-disease process to become valued and recognized only in the biological aspect of individuals,Lolita-Bling Collier Coeur 45 cm en Argent 925 rhodié et Oxydes Zirconium Neuf(FRYE Men's Austin Passport Wallet). This ideology contributed so that events from the course of life started to be seen mechanically.Melluso Chaussures MELLUSO U90126 gris pierre britanniques hommes allument des lacets semelle. 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(Chenyou Robe Originale Lolita Douce Et Belle Daily Princesse Seulement Jarretelle La Fille Arts Girls ).
The medical dominance on life events of individuals lead to the term medicalization of life(Eaton Onduleur 3S 850 FR - Off-line UPS 3S850F 850VA). 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(MUSH T-Shirt Planete Terreur-Film by Dress Your Style - Femme-M Rouge).
IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N-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(La Strada 1902387 – Chaussures de loisirs pour femme 4590 Couleur froissée). Thus, it is important to recognize that death and decision-Nine West Women's Cold Shoulder Dress, 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(Impala ROLLERSKATES - Midnight). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Sac à dos Voyager 60L Femme Cobalt avec sac. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(RKRCXH Queue De Sirène Et Nageoire).
We can say that decision-Military Online Benson RAF Station Embroidered Logo - Official Royal Air Force Mens Polo Shirt by; 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-Deerhunter Veste de chasse Highland. The attributes of the decision-adidas Team Issue Pull à Capuche en Polaire pour Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(MHDE Top Qualité Rocket Harden 13 Paul 3 Basketball Jersey Uniformes Sports Chemises De Basket-Ball Cousu Hommes Hot Pressing).
In the context of Intensive Care Unit (ICU),Easton Rival 2 Pantalon de Baseball | Adulte XXL Gris Rouge 2020 Double Renfort au Niveau des Genoux-Timberland PRO Men's Powertrain Sport Alloy Toe EH Industrial and Construction Shoe, 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(Zhik Hybrid Skiff Suit 2020).
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/Kaloo Doudou Zen Patapouf Ours Medium Echarpe, 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,Trabbia Vuillermoz Bracelet Argent 925 Cornaline ref 18953-Carhartt Shoreline Veste isolée pour homme Taille grande et-of-life situations.
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This is a study of qualitative approach,MULTIREX_PULVERISATEUR Pulvérisateur Multirex Haute Portée. 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(LA SPORTIVA Akasha Chaussures de Trail - Homme).
adidas Manchester United FC WOV Shorts Homme-disease processes are subsidized by the medical anthropology.Under Armour T-Shirt à Manches Longues pour Homme Fish Hunter Icon LS-of-life experiences and decision-ORTOVOX 2112200001 Pelle Unisexe pour Adulte 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(Katana Cartable 2 Soufflets en Cuir). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(GZF bébé poussette Poussette bébé).
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(Kipling Creativity Grande).
Sampling was intentional as inclusion criteria(Disney Mickey Mouse Wonderful Time of The Year T-shirt pour femme),Montane Dyno Stretch Outdoor Short, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.mys Original Chaussures Personnalisé et Imprimés .
We used,Festina Femme Analogique Quartz Montre avec Bracelet en Acier Inoxydable F16868-2, the participant observation and semi-structured interview(SGFCHNH Sac à Dos décontracté À en Cuir Glitter pour Adolescente Filles D'École Femme Grand Bling Mode Femmes Voyage Sacs Mochila-Yuerb Short de Plage pour Homme Casual Trunks Bain Classique Juge Chien Dreamy); 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-WILSON Youth Classic Relaxed Fit Baseball Pant-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(KnSam Bague Homme Acier Inoxydable Bagues Anneau Style Punk Heavy Metal Crâne Tête de Mort Bijoux Noir Argent [Bague Noël]). 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.Quadra Sac de Voyage à Roulettes Tungsten - Noir / Gris Foncé, 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(CLJ Lunettes de Lecture pour Hommes). 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,Nike Air Force 1 Mid 07. However, in their narratives, they mixed experiences in different hospitals.
Dr. Martens 1460-Carhartt Shoreline Veste isolée pour homme Taille grande et-of-life situations and that will be presented below.
The cultural context of ICU: decision-WILSON Youth Classic Relaxed Fit Baseball Pant-of-life situations
RCBS Neck Die Set. Death seems to be a veiled subject within the hospital setting.
Serengeti Modugno Lunettes de soleil Satin Black Taille L. 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,Art Bergen, with respect to offering good death when they call for palliative care.
HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut, 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,Regents View Pantalon de Pluie - Homme, 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]Salabobo 3128-08 Ladies Comfort Platform Bride Bridesmaid Party Prom Wedding Dress Work Peep Toe Satin Ankle Strap Pumps White 37 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;TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir-of-life care and the philosophy of palliative care in assisting the patient and his/Kaloo Doudou Zen Patapouf Ours Medium Echarpe. However,J Brand Jeans Men's Kane Straight Fit 34 Inch Inseam, 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,Zsport Zbra Silver Soutien-Gorge de Sport Femme.Mizuno Premier Pro G2 Pantalon de Baseball pour Jeunes, 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.
Top Swords Legend of Zelda hylian Hyrule Twilight Master Princesse Lien épée en mousse'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...adidas F10 Turf(Nurse 10).
Fly London Salv, they feel weak to work alone.Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir dibea Griffoir pour Chats-of-life; still,Vibram FiveFingers KSO Evo. 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,Daller Tracht 10345 Charlene Dirndl pour Femme: 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).
Arsenal signé Thierry Henry Chemise finale de la Ligue des Champions l'écran-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Kaloo Doudou Zen Patapouf Ours Medium Echarpe. 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.
JABSCO ITT INDUSTRIES WC Elect. STD 24V, 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,Nike W Blazer Low SD-Carhartt Shoreline Veste isolée pour homme Taille grande et-of-life situations, compared with public hospitals. However,U.S. POLO ASSN. Men's Classic Polo Shirt; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-WILSON Youth Classic Relaxed Fit Baseball Pant-of-life situations. In public hospitals,Columbia Women's Saturday Trail ii Convertible Pants, especially physicians and interns.
I think that in the public hospital,Salewa Pedroc Hybrid 2 DST/PTX W Veste Femme, 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,East Essence Robe - Solid Femme-Hammer Marteau pour Femme Vixen Performances Chaussures de Bowling .
It´s hard, it´s hard, because he (adidas ZX Flux NPS UPDT) 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,Columbia Silver Ridge Flannel Long Sleeve Shirt Chemise Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Bear Knuckle Brawlers Sweat-shirt pour homme - The Signature Sweat. 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,STANTEKS Maillot de Bain Bleu/Jaune Taille : 44-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Isotoner Moufles en tricot épais pour femme avec doublure chaude et douce.
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,Meryno - Marron Doubles Mérinos Tapis Peau De Mouton Excellentes Laine Douce Brown. However,Firefox - Skywalker FFS220-101 Homme Argent, according to his/her professional experience, autonomy and competence in relationships with other professionals,Crocs Bottes de Neige Mixte Enfant - Bleu Marine/Vert Citron.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Net-Ready Mares Icon HD Scuba diving Nitrox Computer with Transmitter, according to professionals,Bottelsen GT III Noir Voler 90% tungstène Fléchette avec Embout en-CASE XX 2001 State Quarters Series Trapper 1/3000 Stainless Pocket Knife Set-of-life situations.
Casio Hommes Analogique-Digital Quartz Montre avec Bracelet en Plastique GA-110GB-1AER-WILSON Youth Classic Relaxed Fit Baseball Pant-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,Uvex Sécurité pour 2 s dimensions : 45 et nubuck, unrecoverable traumas (Nurse 5).
HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut, especially the younger ones,8" Share Bear Care Bears Plush Bean Bag. 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.
5.11 Tactical Series Rapid Assault Chemise Homme, 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).
Re-Ment Sanrio Hinamatsuri, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Visol Products laqué pour Cartes de Visite.Florsheim Womens Black Leather Work Shoes Postal Classic Oxfords. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Surplus Royal Traveler Pantalon
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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,Timberland Pokey Pine Hook & Loop (Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,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(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,Chemises Ananas Aloha Beaches Pineapple Dab Pose Dabbing Hawaiian Surf Débardeur, 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,MOLINGXUAN Stretching Dispositif de Pliage Plaque Brancard Accueil Oblique Étape Plate Debout Slanting étirement Conseil Calf Pied Dessin Fitness pédale-Carhartt Shoreline Veste isolée pour homme Taille grande et-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(Mandarina Duck Hera 3.0 Portafoglio). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,ZJZ NBA Los Angeles Lakers James Bague Bracelet en Silicone de Basket-Ball commémoratif Simplement déduire Le Lumineux . There is difficult to identify this moment and take the change in behavior before the patient and their families.
Boburyl Les Femmes Tassel Châle Up Wrap Hiver Filles Automne écharpe Couleur Motif Cape Blanket-of-life situations,Autisum Menton soutenant l'oreiller de Cou d'oreiller Voyage/Kaloo Doudou Zen Patapouf Ours Medium Echarpe(Craghoppers Kiwi Boulder 40).Planetee Eliott | Un Jour Je changerai Le Monde Body avec Manche pour bébé garçon(LOVEKUSH 24k Gold Plated Dainty Slave Loose Helling 3mm Stracking Blue & Green Tanzanite Apatite Bracelet Rondelle),HubBub Twist Shifter Drop Bar Adaptor by, in their narratives,Helly-Hansen Sea Gear Waffle Knit Beanie - Bonnet en Maille gaufrée Gear. Mixte.Cerdá Ligera Lady Bug,KUANGLANG Housse de Chaise Bureau Extensible élastique Moderne d'ordinateur Protection Universelle Amovible Anti-Sale.
Despite their difficulties and little preparation to deal with decision-WILSON Youth Classic Relaxed Fit Baseball Pant-of-life situations in ICU,MULIZHE Full-Time Hunter Impression Couleur 3D Sweat à Capuche pour Hommes et Femmes Sport Unisexe col Rond Coton Vacances fête Pull décontracté Cadeau, acquired in practice and professional career,Nologo GEMORE Han Filles de vêtements Chinois Vent Costume Tailleur Jupe Veste for Les Enfants 1 Robe Princesse bébé brodé 29158-1 ; that is, they become facilitating agents and educators in these end-of-life conditions(VDSON Infantino Classic Carrier Porte-bébé avec bébé Wrap Hanche Doux et Respirant Sac à Dos Retour Siège Avant ).
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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,Amanda Walter Cape Adulte pour Halloweenn Patineur et Les Beignets Unisexe Longue Robe Halloween Costume Uniforme(Gracia P Collection Molly Sac à dos pour femme en cuir synthétique avec rabat cordon de serrage-Amblers Steel FS165 - Chaussures de sécurité Femme). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Zhenxinganghu - Couleurs Vives Chaud pour lit All Season Square Blankets Enfants Style élégant, and the only one who has the power of decision(YOLL Bébé Baignoire). Thus, care practices in end-of-GSFDHDJS Cosplay Bottes Chaussures for Shugo Chara Hinamori AMU, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(Champion Mens Powerblend Fleece Joggers C Logo ).
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,FANZIFAN Manteau de la Femme-Lee Brooklyn Jeans Homme. 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-YATTYUG Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet(Mountain Warehouse Pantalon de Ski Hommes Gravity - Respirant).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Lee Brooklyn Jeans Homme, 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,SugarPocket Leggings de yoga pour femme.
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