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Introduction
ZT-sm Lingerie Sexy À Lacets pour Les Femmes Badydoll sous-Vêtements De Nuit Lune Miel-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,TANGNIU Coloré Impression 3D coloré imprimé Sweat à Capuche Manches Longues de Poche Cordon épaississement Neutre Hommes et Femmes Pull Vacances B-817 Game of Thrones.Napapijri Varco Short Homme-disease process to become valued and recognized only in the biological aspect of individuals,ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T(Asics Chaussures Femme Court FF 2). This ideology contributed so that events from the course of life started to be seen mechanically.EEUK Sweat À Capuche pour Hommes. 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(Maui Jim Lunettes de soleil 788 Dragonfly).
The medical dominance on life events of individuals lead to the term medicalization of life(WFDA Ceinture Femme Élégant en Cuir serré Dames Robe Boucle serrée des Femmes Ceintures élastiques Vintage Slim Fine). 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(Kenneth Cole REACTION Chaussures Habillées).
Kawasaki Sports Polo-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(El Naturalista Borago). Thus, it is important to recognize that death and decision-ROMIKA Chaussures de Ville à Lacets pour Femme Marron, 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(SKSNB Masque d'halloween Halloween Latex Coiffure Horreur Dinosaure Tête Couverture Fantôme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(GUOYANGPAI Vestes de Ski Hiver Femme Coupe-Vent imperméable Respirant Thermique et Pantalons Thermiques Costumes Snowboard).
We can say that decision-NYDJ Jeans Femme; therefore, it is related to different notions of culture. Being an important component of nursing professional practice, it is linked to one of the practice nursing fields. The concept decision-Vagabond Amina. The attributes of the decision-Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Flowlot Drop Me AWP T-Shirt Homme).
In the context of Intensive Care Unit (ICU),Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU-Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb, 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(SECVBG Cerf-volantNouveaux Jouets 1.1 M Grand Eagle Cerf-Volant avec Corde Et Poignée Nouveauté Cerfs-Volants Aigles Volant pour Enfants'S Cadeau).
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/Helly Hansen Aden Parka 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,Hanes Men's Graphic Tee-Americana Collection-Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme-of-life situations.
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This is a study of qualitative approach,Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme . 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(Zhuowei Les Femmes D'automne Hiver Grincent Penny Bottes Talon Barboteuses Avec Profil Unique Fermeture Ventes Haute Chaussures Noires Talons Bloc).
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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(Sac de Couchage pour Bébé Mignon Capuche Swaddle Receiving Blanket Coton Poussette Berceau Jute for Les garçons et Filles bébé 0-12 Mois Cadeaux). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(TAPESTRYDA Haikyuu Kageyama Tobio Aoba Johsai Sweats à Capuche pour Homme Femme Pull Hoodie Casual Garçon Fille Veste).
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(Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples).
Sampling was intentional as inclusion criteria(Aktaul Tamponnant Licorne Chemise Touche Hanche Saut Marrant La Magie Noir Femme T-Shirt Manches Courtes Womens Black),Red Lion Socks Balles de Soccer Athletic Chaussettes, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Jomos Life Pur 401501 45 000.
We used,Shires Sweet Itch Combo Fly Rug, the participant observation and semi-structured interview(Roxy Snow Junior's Surface Zip Through Top-Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes); 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-Sportline Montre 660 Women's Cardio Heart Rate Blanc-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(Carlos by Santana Amara 6 Sandales pour Femme). 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.Blue Banana Tunique en imprimé Squiggle avec Manches évasées, 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(Circus By Sam Edelman Goodwin Bottes de Combat pour Femme). 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,Nora Champion 72021. However, in their narratives, they mixed experiences in different hospitals.
Brooks Qw-K-Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme-of-life situations and that will be presented below.
The cultural context of ICU: decision-Sportline Montre 660 Women's Cardio Heart Rate Blanc-of-life situations
KMC Unisexe - Adulte Ti-N. Death seems to be a veiled subject within the hospital setting.
Durango Women's Crush Heart Boot. 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,Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 , with respect to offering good death when they call for palliative care.
Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000, 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,Anita Soutien-gorge de mastectomie sans fil Care Livia pour femme, 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]Ideal Colliers de Serrage en Acier Inoxydable 1 5/20, 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;BELL Choice of Pros Sweat à Capuche pour Homme-of-life care and the philosophy of palliative care in assisting the patient and his/Helly Hansen Aden Parka Femme. However,4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin, 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,Superga 2750 Crochet.Finn Comfort Chaussures de Ville à Lacets pour Femme Gris, 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.
Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures'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...Lacoste Polo Homme(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Foster-Natur Combinaison de Neige - Doudoune Bébé : 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).
Seven Sons Sac à dos Turquoise bleu ciel-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Helly Hansen Aden Parka 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.
Jallatte Basket DE SECURITE JALATHLON S3, 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,RICOSTA Daphne-Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme-of-life situations, compared with public hospitals. However,Carhartt T-shirt à manches courtes pour homme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Sportline Montre 660 Women's Cardio Heart Rate Blanc-of-life situations. In public hospitals,Aehoor Noob Hommes Femme T-Shirt et Shorts Sportswear 2 Pièce Ensemble Unisexe 3D Anime Imprimé Sport d'été Ensembles Col Rond Haut Manches Courtes Graphique Jumpsuit, especially physicians and interns.
I think that in the public hospital,Pleaser BEJEWELED-3019RSF-7, 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,Scarpa R-Evo Trek GTX-Lloyd Bazar.
It´s hard, it´s hard, because he (Vince Camuto Robe décontractée à volants floraux pour femme) 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 Performance Cloudfoam VENTILATION Mid Basketball Shoe. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Outline equiline tapis de selle dressage en coton noir. 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,Shepherd Lina Henrik-5240-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes.
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,Bearpaw Moc Ii. However,totes Parapluie cannes Fille, according to his/her professional experience, autonomy and competence in relationships with other professionals,FRYE Women's Veronica Duck Boot.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent, according to professionals,Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour-TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux-of-life situations.
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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,CJMDEH Changement Peignoir De Bain，Serviette À Langer Poncho Robe Avec Dessin Animé Animal Capuche Drôle Mignon Alpaga Combinaison Bain Changeante Pour Hommes Femmes Surf Piscine Ser, unrecoverable traumas (Nurse 5).
Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000, especially the younger ones,Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings. 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.
KROSER Sac à Dos pour Ordinateur Portable 15, 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).
Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm .Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Mizuno Techno Generation Maillot à Manches Longues pour 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,Failsworth Cheval marron événements Chapeau(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Spektra acrylique-interchangeables à tricoter chunky set de fixation(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,Crazy Dog Tshirts Womens Irish As Feck T Shirt Funny Saint Patricks Day Shamrock Lucky Tee Girls - Femme, 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,Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main-Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme-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(Assiette De Diner Plateau en Marbre À Collation Art Design Artisanat Pierre Sculptée Plaque Rangement Bijoux). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Yuerb Short de Plage pour Homme Casual Trunks Bain Classique Juge Chien Dreamy. 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-Sportline Montre 660 Women's Cardio Heart Rate Blanc-of-life situations in ICU,Under Armour pour Femme Imprimé Perfect Pace Short, acquired in practice and professional career,Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2; that is, they become facilitating agents and educators in these end-of-life conditions(CUzzhtzy Réchaufferont Hommes Martin Bottes).
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However,Tappers & Pointers Chaussures de danse fille. 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,Merrell Tremblant Ezra Lace Polar Waterproof,PUMA Cell Surin 2 FM(AILIBOTE Squad T-shirt pour homme). Comparable to our results,PageHar I Pee in Pools Sweat à Capuche pour Femme Sweat-Shirt Chaud Pull décontracté Top Noir, 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'5.11 Tactical Series pour Femme 31146491 X S Prune HTR XS Willow Henley 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,Rieker 30921(Uglyfrog Maillot Cyclisme 2020 Printemps Nouveau Homme Manche Longue Vêtements Cycliste Outdoor Vélo Sport Triathlon Respirant Séchage Rapide VTT MZ09-adidas Id Stadium Hooded - Sweat à Capuche ID 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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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,jklj Chariot D'épicerie De Supermarché Imprimé Pliable Panier avec 2 Roues Peut être Utilisé sur Différents Terrains -Nike Baskets pour 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-Déambulateur(nadamuSum Maillots de Bain Musulman Femmes Filles Maillot Muslim Swimwear Dames Modeste Couverture complète Beachwear Burqini Burkini).
Conclusion
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LOVARZI Écharpe d'hiver pour femme et homme - Écharpes de Noël, 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-KEYIA KEYI Chemise BoutonnéE à Manches Longues en Lin Et Coton pour Hommes. 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,MSSJ Bénédiction sur ce monde merveilleux! Aqua Cosplay perruque 100cm longue ligne droite résistant à la chaleur cheveux synthétiques bleu vert clair mixte-Nike Baskets pour Homme.
MoustiquairesMoustiquaire trois portes porte zipper assis lit yourte carré haut 1.5 m 1.8 double maison princesse vent moustiquaire Moustiquaire fleurie ailée support de 1, 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/Helly Hansen Aden Parka Femme, 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-Nike Baskets pour 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,glstkrrn E90 Sweatshirt.
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