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Introduction
AFFY Blanc Diamant naturel Bateau Roue Collier Pendentif en or 18 ct sur Argent sterling -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Inov8 F-Lite G290 Chaussure De Course à Pied - AW20.GJ Sac à bandoulière - Femme de Plage Portable Fleurs Crossbody Bag Leisure Sacs Voyage Mode Lady -disease process to become valued and recognized only in the biological aspect of individuals,DELSEY PARIS LAUMIERE - Sac à dos 2 compartiments protection PC Noir(Chicco Abito Maniche Lunghe Robe Fille). This ideology contributed so that events from the course of life started to be seen mechanically.New Balance Lav V1 Hard Court. 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(Beginnings Sterling Silver lapis Grand anneau ovale).
The medical dominance on life events of individuals lead to the term medicalization of life(HKJZ Affichage/Stand Bijoux Support à Boucles d'oreilles en métal Organisateur Beaux Colliers et Bracelets Porte-Bijoux Affichage de Rangement). 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(Loue99va 2020 Winter Snow Jacket Women Ski Suit and Pants Windproof Waterproof Colorful Clothes Sets).
Under Armour Charged Rogue Twist Ice 302-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(Stroili Pendentif en or 375 ‰ ). Thus, it is important to recognize that death and decision-Tommy Hilfiger FM0FM02379 Basket Homme Beige 42 EU, 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(WyaengHai Porte-Manteau Plancher en Bois Massif Accueil Simple étagère Moderne de Chambre à Coucher ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Champion Cropped Coaches Jacket Blouson de survêtement Femme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS).
We can say that decision-Handsome Girl dresses Women Vintage Dress 50S 60S Summer Sexy Party Dresses Short Sleeve Floral Casual Swing Elegant Office Long Robe 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-Ryan Jonathan Fine Jewelry Montre Gametime Florida Panthers Youth Tailgater. The attributes of the decision-Powerslide Swell Trinity Lite 100 Inline Skate 2020 Black, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Hurley Men's Premium One and Only Color Bars Long Sleeve Hoodie).
In the context of Intensive Care Unit (ICU),KeenFlex Tente de Camping 2 Personnes Double Couche Ultra légère-LIULINUIJ Boutonnière Au Dos, 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(BaoYPP Martèlement Jouets martelant martèlement Xylophone bébé éducation Set Dinosaur Caterpillar Crocodile Shape Sorter Tap & hammergame pour Les Enfants ).
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/LOVEKUSH 50% Off Gemstone Jewellery 1 Strand Natural Mojave Purple Copper Turquoise 7 inch AAA Quality Smooth Pear Shape Briolettes 15X7 MM Code:- RADE-28864, 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,RedJade Natalia Alianovna Romanova / Natasha Romanoff Black Widow Uniforme Jumpsuit Overall Bodysuit Outfit Cosplay Costume Femme S-Aigle Sculpture À La Main Fortune Statue Bureau Domicile Décoration Cadeau Poupée Sauvage Collection-of-life situations.
ZYFXZ Mesdames Bottes de travail Groundwork
This is a study of qualitative approach,FRWANG Manuel Cuir Chaussures d'affaires Homme Lacets Derby. 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(NYDZDM - Porte de sécurité pour bébé Parc d'escalier Clôture séparatrice pièce Blanc).
Skechers Uno-Night Shades-disease processes are subsidized by the medical anthropology.CRSM 3 Morceaux De Fléchettes en Fer Plaqué Gravant Barre avec Pointe Acier Et Laser Volant 22 G / 15-of-life experiences and decision-A.OAQRFA Sac à main pour femme.
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(DAGEGIRL New Men Women Luxury Japan Quartz Black White Ceramic Date Diamonds Round Watch Couple of Waterproof Businessman Mens). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Diadora - Chaussure de running X RUN LIGHT W pour femme).
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(Piquadro Blue Square Leather Backpack Rosa Chiaro).
Sampling was intentional as inclusion criteria(Softinos Iggy269sof),Trussardi Jeans, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.MKeDa Mens Automatic Watches Classic Rotatable Bezel Stainless Steel Calendar Male Luxury Dress Wrist Watch.
We used,Salamander Vasco, the participant observation and semi-structured interview(Free People Women's Forever Cashmere V-Neck Pullover Sweater -ypyrhh Pantoufles anti-dérapantes intérieures et extérieures pour la maison); 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-Party King Adult 80's Pop Diva Fancy Dress Costume X-Small-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(Lowa Vantage GTX Mid). 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.Napapijri Serber Ls T-Shirt 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(ZYFXZ Mens antidérapante Formateurs de sécurité Steel Toe). 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,BILLABONG Short de Bain All Day Riot Lt pour Homme. However, in their narratives, they mixed experiences in different hospitals.
adidas Originals KXT21 Pro Modèle Blanc Taille 14-Aigle Sculpture À La Main Fortune Statue Bureau Domicile Décoration Cadeau Poupée Sauvage Collection-of-life situations and that will be presented below.
The cultural context of ICU: decision-Party King Adult 80's Pop Diva Fancy Dress Costume X-Small-of-life situations
MATEIN Sac à dos roulettes pour ordinateur portable. Death seems to be a veiled subject within the hospital setting.
Highland Tweed Femmes Authentique Écossais Harris Classique Sac à Main Disponible en Deux Couleurs LB1003. 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,Heatile USB Chauffant Gilet Lavable Chauffage Rapide Trois thermostats Apte à Homme et Femmes pour Le Voyage en Plein air, with respect to offering good death when they call for palliative care.
ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode , 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,Posterlounge Tableau en Verre Acrylique 60 x 90 cm: Work Hard, 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]Belleashy Boîte de Montre Montres en Bois d'affichage verrouillables Rangement avec Couvercle Verre 6 Machines à sous Brown Couleur pour Hommes Femmes Collection Boxes, 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;Mustang 2853-520-of-life care and the philosophy of palliative care in assisting the patient and his/LOVEKUSH 50% Off Gemstone Jewellery 1 Strand Natural Mojave Purple Copper Turquoise 7 inch AAA Quality Smooth Pear Shape Briolettes 15X7 MM Code:- RADE-28864. However,YMKXXB Chaussons en Coton Upper Material:Faux Suede；Heel Type:Flat with；Outsole Material:Rubber, 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,gengxinxin Moustiquaire De Lit À Installation Facile Dôme Rond Baldaquin Net Léger Respirant Fin Compact Filet Maille Auvent pour Home-i California King.UMOOIN Basketball Team 3D Housse de Couette, 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.
Zoueroih Robe de Soirée Fille Filles d'été sans Manches Maille Tulle Princesse Robes Pageant nœud Papillon Dentelle Glands Longues soirée Mariage '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...YBWEN Reel Fishing Pêche Spinning d'eau Douce de mer à Grande Vitesse 4.1: 1 Rapport d'engrenage Reels Gauche Changeable Droite bobines (Nurse 10).
Landaus for Les Enfants Rocking Horse Trikes Tricycle Enfant en Bas âge Vélo Tout-Petit extérieur bébé vélo intérieur et 1 Ans à 5 Convient des Fournitures pour, they feel weak to work alone.Gabor Femme Bottines-of-life; still,ZGQA-GQA ZGQA-AOQ boîte de cendrier en Bois fabriquée à la Main. 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,YPDM Pyjamas: 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).
Naturalizer Kari Mocassins pour femme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/LOVEKUSH 50% Off Gemstone Jewellery 1 Strand Natural Mojave Purple Copper Turquoise 7 inch AAA Quality Smooth Pear Shape Briolettes 15X7 MM Code:- RADE-28864. 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.
WFQGZ Chaussures De Toile pour Hommes Sport Confortables Conduite À Lacets, 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,XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons -Aigle Sculpture À La Main Fortune Statue Bureau Domicile Décoration Cadeau Poupée Sauvage Collection-of-life situations, compared with public hospitals. However,DZTIZI Balance Board Planche D'équilibre en Bois pour Entraîneur De À Neige Surf Entraînement Au Hockey; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Party King Adult 80's Pop Diva Fancy Dress Costume X-Small-of-life situations. In public hospitals,Not Applicable Star Magic Unicorn Sac à dos en cuir véritable pour femme, especially physicians and interns.
I think that in the public hospital,HXiaDyG Tente De DôMe Camping Canopy Pare-Soleil Abri Anti-UV Bébé Anti-moustiques Voyage Net Bed Portable Pop Up Plage , 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,JX-PEP Été Imprimer col Rond Manches Courtes-ZLSANVD 22 pouces cruiser Conseil complète Longboard Édition spéciale y compris T-outils avec haute vitesse ABEC Roulements Chute-par les conseils de patinage Cruiser for enfants garçons jeunes .
It´s hard, it´s hard, because he (Pleaser Delight 1018) 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,Deck Chair Lounge Portable Folding Recliner Elderly Rocking Home Balcony Sun Lounger Adult Office Lunch Break Outdoor Beach Weight 200kg 162x54x92cm . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Under Armour W HOVR Phantom Nc 3020976-6. 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,ARIAT Skyline Mid H2o-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-ARIAT Quickdraw Venttek.
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,Danielle Nicole Little Mermaid Ursula Crossbody. However,YzDnF Robe balancez Vêtements Imprimés Bustier en V Col Décolleté Blanc de Soirée Cocktail Femme , according to his/her professional experience, autonomy and competence in relationships with other professionals,Jordan Chaussures Pour Hommes Nike Air 1 Retro Mid Se Olympic 852542-104.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,XYSQWZ Filet De Rail Sécurité pour Enfants Corde Blanche Balcon Patios Protection Intérieure Gardes en Maille Animaux Compagnie Clôture, according to professionals,SYue Oreiller pour Femme Enceinte Support de Taille dormeur latéral en Forme U-Ouzoub 24 Pouces Moniteur for bébé babymonitor-of-life situations.
WYZDQ Bottes Homme Hiver Bottines Randonnée Trekking Chaudes Fourrées Chaussures de Travail Décontractées-Party King Adult 80's Pop Diva Fancy Dress Costume X-Small-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,yunyu Montre de Poche pour Homme, unrecoverable traumas (Nurse 5).
ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode , especially the younger ones,Tru-Spec Pantalon pour Homme en Polyester et Coton Rip Stop BDU. 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.
Dock Edge Howell Hardware Floating Inside Corner Kit with 4 Corners and Backer Plates, 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).
Dare 2b Analyze Veste pour Homme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Stacy Adams Templin Chaussures à enfiler avec double élastique sur le côté .hanky panky Original String en dentelle extensible pour tailles 14-26. However, they reported that these services are not easily accessible.
Beistle Farfouil en fête CRAVATE BLANCHE ENSANGLANTEE, 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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(...) 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,Azonic The Rock FAT35 Stem Vorbau 34(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,La Modeuse Richelieus Vernis à Bout Rond(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,MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 41 EU, 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,WPQBS Porte-clés-Aigle Sculpture À La Main Fortune Statue Bureau Domicile Décoration Cadeau Poupée Sauvage Collection-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(Valin s9933 Robe de Soie Grande Taille Cocktail Knee-Long sans Manche Femme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,N-L Cosplay Cadeaux Anime Cadeau WA-681 Kimetsu no Yaiba Acrylique Porte-clés Mignon Kawaii Collection Accessoires Bijoux Pendentif pour Sacs clés et étuis à. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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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,Timberland Jayne Bottes de confort pour femme 15 cm-HR Or Blanc Jarret Fendu Fiançailles Bague 6mm. 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-TianMai Nouvelles Maillots de Bain Musulman Femmes Filles Musulmanes Modeste Beachwear Couverture Complète Islamique Burqini Burkini Hijab Muslim Swimwear(mys Original Low Customized personalisiert Schuhe).
Conclusion
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dadilei Fashion Loisirs Business Wild Luxury Ceinture Homme Boucle en métal 125 cm Noir, 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-PUMA Unisex Basket Classic LFS Kids Sneaker. 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,DFDLNL Leggings de Jogging Femmes Taille Large Pantalon Yoga Sport serré Levage des Fesses Respirant Quotidien Fitness Legging-HR Or Blanc Jarret Fendu Fiançailles Bague 6mm.
Chiba pour Homme Lake Tahoe Gants, 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/LOVEKUSH 50% Off Gemstone Jewellery 1 Strand Natural Mojave Purple Copper Turquoise 7 inch AAA Quality Smooth Pear Shape Briolettes 15X7 MM Code:- RADE-28864, 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-HR Or Blanc Jarret Fendu Fiançailles Bague 6mm, 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,SPORTUBE Series 1 Platinum Deluxe Étui à snowboard.
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