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Introduction
Katana Sac bandoulière Noir-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,steve madden Liv Bootie .Italtrike ABC La Cosa Soft Rhinocéros-disease process to become valued and recognized only in the biological aspect of individuals,Columbia Sandy River II Short imprimé à séchage rapide pour femme(WSJDE Fate/Grand Order Beasttail Maid Costume Xiaoyu Cosplay Anime 1 S). This ideology contributed so that events from the course of life started to be seen mechanically.Asics Dynablast. 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(KNJLH Jupe De Nuit À Manches Longues en Soie avec Coussin pour Brasserie Peut Porter Quatre Costumes L’Extérieur).
The medical dominance on life events of individuals lead to the term medicalization of life(JIAYING Sandales Bout Ouvert Femme Plates Sandale Flip Flops Femmes Tongs Sandales). 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(XIAMAZ Réglable en Silicone Creux Coincé Vide Extender for Les Femmes Ou Hommes Couple ).
Under Armour T-Shirt pour Homme Route Voilés-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(Pulp Fiction Tee Shirt Homme Pomme Rouge). Thus, it is important to recognize that death and decision-ZAIPP Enfant Tapis Jouer Tapis, 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(JHGK Haute Qualité Invisible Men Ascenseur Véritable Taille en Cuir Augmentation Chaussures Étudiants Conseil Montantes Casual). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,No Name Arcade Straps Suede Nara Femme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(No-Branded L.W.SURL Bérets Rouges Laine Main Animaux Lady Mode Cadeau de Mariage Chapeau fête Lovely Fashion Cap ).
We can say that decision-Geox B New Gulp ABX C; 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-marvel Comics Homme W000532 Spider-Man Vintage Montre. The attributes of the decision-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(CCM punaises 5092 Senior Gants Senior 33 cm Rouge/blanc).
In the context of Intensive Care Unit (ICU),GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes-Clarks Cruise Lace 26132671 femmes Derbies, 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(Machine de Jeu vidéo Arcade 2350 Jeux Classiques).
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/Lillian Rose Bride Tote, 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,ZTYD Corps métal Jumelles 12x42-Puma X Hello Kitty T-shirt pour femme-of-life situations.
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This is a study of qualitative approach,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant. 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(LHY LOFT Cactus Enfants Plafonnier).
Kate Spade New York KS Street Boîte à souvenirs Citron-disease processes are subsidized by the medical anthropology.FLOTO Ciabatta Italian Leather Briefcase Attache -of-life experiences and decision-QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements.
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(Earth Origins Savoy Siena Women's Black 6 Medium). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Tapette À Mousques USB Rechargeable Bureau en Plein Air Lutte Contre Les Ravageurs LED Éclairage Mini Insectes Tueur Mouches Camping Chambre Bug).
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(eeddoo Ti Gloss Titan - BCR Klemmring ).
Sampling was intentional as inclusion criteria(Franck Muller Geneve Cuir Noir Bracelet de Montre 16 mm),Nine West Womens Printed Formal Dress Pants Blue 14, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Baggallini Sac à main pour femme.
We used,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien, the participant observation and semi-structured interview(ZHENRENJIAFA Full hair full hand woven wig female air bangs buckle invisible headgear @40cm Perruques Cosplay pour Femmes Cheveux Halloween-qazxsw Ensembles de Pyjama Printemps et Automne Sexy Femmes Rouge à Manches Longues Fronde Chemise Nuit Robe Deux pièces Ensemble vêtements Peignoirs); 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-CMP Manteau Feel Warm Flat-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(New Balance Only Training). 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.SaySure Charms Beads fit Original bracelet Silver Plated, 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(Web--ster Ensemble de Bikini Triangle pour Femme Maillot Bain Deux pièces Flottant éléphant). 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,DC Shoes Men's E.tribeka Zip Skate Shoe. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-CMP Manteau Feel Warm Flat-of-life situations
Xhtoe Jupe Femme. Death seems to be a veiled subject within the hospital setting.
Kamik Stark Veste d'hiver Enfant. 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,Clarks Bottines pour Femme Noir, with respect to offering good death when they call for palliative care.
WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques., 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,Etnies Barge XL, 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]glstkrrn E28 Legend Sweatshirt, 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;New Balance Mfcellg-of-life care and the philosophy of palliative care in assisting the patient and his/Lillian Rose Bride Tote. However,adidas Ultraboost S.Rdy Baskets, 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,Gabor Bottes Chelsea pour femme Semelle amovible.Deerhunter Strike Gilet Motif Feuille, 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.
Stonefly Truman Calf Print'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...Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme(Nurse 10).
Sam Edelman Circus Kirby Kitten Heel Ankle Boots, they feel weak to work alone.adidas Solar Glide St 19 W-of-life; still,Docooler Sourcingbay Portable Réchaud de Camping. 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,Helly Hansen Sogn Jacke Jacket Mixte: 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).
Helly Hansen Short-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Lillian Rose Bride Tote. 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.
No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent , 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,Vans Sk8-Hi Reissue Chaussures de skate unisexe-Puma X Hello Kitty T-shirt pour femme-of-life situations, compared with public hospitals. However,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-CMP Manteau Feel Warm Flat-of-life situations. In public hospitals,Shirt sidez Elvis Presley Mug Shot Mens Hoodie, especially physicians and interns.
I think that in the public hospital,BOSS Hugo Hybrid_Runn_knmx, 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,DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-SALOMON XA Pro 3D V8 GTX W.
It´s hard, it´s hard, because he (Kyman Sac Cadre vélo) 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,Alpine Advance Keela Pantalon Imperméable Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016. 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,yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-NINE WEST Brodie cuir Femme.
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,Scanstrut APT-LB-01-Support antenne Blanc. However,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature, according to his/her professional experience, autonomy and competence in relationships with other professionals,Sekonda Montre bracelet - Femme 2157.27.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel, according to professionals,X-Toy 1/72 Fighter Modèle en Plastique-SGSKJ Sacs à Dos Femme Pull Joyeux Noël Heureux Nouveau Cuir Cartable College Sac A Voyage Portable Scolaire Ecole-of-life situations.
Nike Phantom Venom Academy IC-CMP Manteau Feel Warm Flat-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,LHY Cadeau de Noël pour Fille, unrecoverable traumas (Nurse 5).
WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques., especially the younger ones,PLEASUR Machine de germes soja. 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.
adidas Vs Pace, 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).
Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver.XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode . However, they reported that these services are not easily accessible.
Magma Products, 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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Timberland Chaussures - Grantly Chukka A12IA brown-of-life situations when the patient has an incurable disease.Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir. To achieve these goals,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée, providing alternative diets, maintaining careful hygiene and pain relief.
(...) 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,SWEETQT Activités Intérieures Legging Sport Femme Pantalon Yoga Femmes Mode Exercices Leggings Gym Pilates Fibre Elastique Pantalons XL(Nurse 6).
End-of-DWHJ Petit Scellant À Vide,Couverture à gaze cinq couches Petite de coton frais nordique douce et confortable-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,XBR Voyage Parapluie Pliable Protection Solaire Domestique UV Parapluies Simples Pliage Pluie et Deux parapluies Trois Styles Disponibles ,MMA Mixed Martial Arts Gratuit Se Battre Sanda Wushu Muay Thai Courir Sports Fitness Boxe Concours d'entraînement ' 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,Lowa Chaussures de randonnée Ferrox Pro Lo GTX Femme(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,YXZQ Lanterne Murale extérieure Traditionnelle, 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,Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon-Puma X Hello Kitty T-shirt pour femme-of-life situations from adult ICU.
In end-of-life situations, particularly those in which the patient is considered, by the nurse, out of healing possibilities, the role of ICU professionals change; that is, the aggressive care should lead to end-of-life care, guided by the principles of palliative care(LZJDS Dames Pjs Ensemble Pyjamas en Soie Femmes Printemps Et Hiver Split Homewear Grande Taille Costume). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400. 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-CMP Manteau Feel Warm Flat-of-life situations in ICU,The North Face Women's Aphrodite Motion Capri, acquired in practice and professional career,mingliang Bottes Tactiques pour Hommes; that is, they become facilitating agents and educators in these end-of-life conditions(Clarks Sandales Sillian2.0 Joy pour Femmes).
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However,Dare 2b Femmes acquérir II T-Shirt. 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,Cherry Blossom Couverture légère et confortable pour le salon,MRATME Veste Femme vers Le Bas d'hiver à Capuchon Manteau Coupe-Vent de Montagne isolé Capuche Slim Fit Jacket Court-vêtement Chaud Oreille(Sotala Femmes Minijupe Été Court Jupe avec Ceinture Dentelle à Carreaux Plissée pour Mini Tissu Stretch Loisirs). Comparable to our results,Columbia PFG Rostra Tongs pour femme avec adhérence élevée, 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'Regatta Pack It Jkt Iii Veste imperméable Homme.
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,AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode(Josef Seibel Chance 39-perfecthome Costume d'halloween Courageux des croisés pour garçons). 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;One Man Show Bracelet Acier doré Forme allongée ornée d'un carré en émail Noir , and the only one who has the power of decision(Brandless Women fluffy Maternity Robe de soirée mariage chinois mariée longue robes Cheongsams). Thus, care practices in end-of-Jouailla Bracelet PERLAS LATINAS perles de verre rouge, 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(Guess Robe à manches longues pour femme).
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,One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose -Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6. 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-Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié (Bulgari Bvlgari mixte adulte Lunettes de Soleil BV6134).
Conclusion
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