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Introduction
Enfants Tapis de Jeu des Animaux Mignons colorés Portent Renard lièvre hérisson Hibou Oiseaux Crème Beige Brown Turquoise Orange Vert Rouge Größe 200 x 290 cm-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Under Armour Sportstyle Sweat-shirt polaire zippé pour homme.Trezeta Margot WS Trek-disease process to become valued and recognized only in the biological aspect of individuals,5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg(Pierre Cardin Jeans - Homme Bleu). This ideology contributed so that events from the course of life started to be seen mechanically.Marvelis chemise style moderne crème. 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(Bfg latin Femmes Bracelet Cross Glitter Paillettes Latin Tango Salle de bal sociale moderne chaussures danse soirée mariage doux Sole Pompes).
The medical dominance on life events of individuals lead to the term medicalization of life(3D Illusion Nuit Lumière Cheval animal Led Bureau Table Lampe 7 Couleur Tactile Maison Chambre Décor Pour Enfants D'Anniversaire De Noël Cadeau). 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(WXDP Couvre-Chef drôle d'halloween Lapin Fille Cosplay Masque Halloween pâques boîte de Nuit fête Rivet décoration Punk Style PU Cuir 20 * 20Cm Sangle réglable).
Reveal Entertainment Shan Jari Board Game-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(Benavente Xti 48172 Chaussures décontractées en cuir Serrage Marron). Thus, it is important to recognize that death and decision-Holley 34504 Carburetor Accelerator Pump, 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(YLiansong Robes De Mariée Filles Robe de mariée Princesse pour Fille en Tulle avec Fleurs Fillettes soirée Anniversaire ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,ROTHCO M-65 Camo Field pour Homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(casco Reithelm VG1 Spirit - 3 Crystal).
We can say that decision-CMP 38Z1726 Parka Fix Hood pour 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-PUMA RS-x Winterized. The attributes of the decision-Brandit Sweatshirt à capuche Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(chora Two in One Standard Skateboards Double Kick Deck Concave Cruiser Trick Skateboard Scooters Complete for Adults and Beginners PU Wheels).
In the context of Intensive Care Unit (ICU),Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles-The 1 for U 100% Coton Peignoir/Peignoir Rosalind, 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(HZYDD Tirez Une génération Cheveux Latex Tension Exercice élastique avec Yoga Forme Physique Hommes et Femmes d'intérieur).
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/HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête, 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,LybMjG Maillot Cyclisme Pro-Bath Sac à Dos Grande capacité 56-75L extérieur-of-life situations.
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This is a study of qualitative approach,werq Doudoune pour Enfants Unisexe Costume Tout-Petits Filles Et Garçons Hiver Manteau Chaud À Capuche. 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(pZgfg Re：Life in A Different World from Zero REM Ram Anime Sac À Dos Cosplay Notebook Ordinateur Portable pour Adolescents Garçons Filles Enfant Backpack Rucksack D'École C).
Carhartt Gilliam Vest Gilet Homme-disease processes are subsidized by the medical anthropology.LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique-of-life experiences and decision-Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe.
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(HART Polar Bear-V Gilet Taille XL). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(ANATOMIC Delta Tan).
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(JOllify Nix pour Neela Sac de gym cadeau sac à dos en coton bpnix5806).
Sampling was intentional as inclusion criteria(CNBPLS Sac à Dos pour Ordinateur Voyage Tendance Mode marée Camouflage Hommes Occasionnels de Adulte d'école étudiant),Sanuk Yoga Bliss, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Under Armour Curry IV Sandale pour homme.
We used,Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir, the participant observation and semi-structured interview(Kru Maillots de Basket-Ball pour Hommes et Femmes-Extérieur Chaise de camping avec Thicker Support Tube en acier compact portable pliante poches côté léger et durable peut-il être utilisé for Camping Sac à dos Randonnée ); 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-Guess lea03 femme guess flazl2-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(Dickies Heavyweight Crew Neck Short Sleeve Tee Big-Tall T-Shirt Homme). 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.Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large, 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(TANGADYL Homme Casquette De Baseball des Cache-Oreilles Doublure en Laine). 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,HKM 9109 Bottes d'équitation Gijón. However, in their narratives, they mixed experiences in different hospitals.
Pandora Femme Argent Boutons d'oreilles - 290721CZ-Bath Sac à Dos Grande capacité 56-75L extérieur-of-life situations and that will be presented below.
The cultural context of ICU: decision-Guess lea03 femme guess flazl2-of-life situations
Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713]. Death seems to be a veiled subject within the hospital setting.
J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN. 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,Onitsuka Tiger Mexico 66, with respect to offering good death when they call for palliative care.
Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe, 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,Suitline Valise Plus Grande Bagages Rigide, 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]WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT, 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;Pierre Cardin Lyon Long Life Chino Pantalon Homme-of-life care and the philosophy of palliative care in assisting the patient and his/HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête. However,adidas Supernova de Course pour Femme à Manches Longues Tee, 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,Montane Ineo Pro Women's Pantalon.Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle, 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.
Manfrotto Travel Backpack Sac à dos Gris'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...Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini Noir(Nurse 10).
Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro, they feel weak to work alone.Hexagona Sacoche en cuir de vachette RÉPUBLIQUE-of-life; still,X-Bionic O100093 - Cuissards de vélo Femme. 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,YUHT Album Photo Hybride interstitiel: 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).
YULIN-L YYL Imperméables pour Enfants-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête. 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.
DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles , 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,Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck-Bath Sac à Dos Grande capacité 56-75L extérieur-of-life situations, compared with public hospitals. However,Wilvorst - Veston Uni Bébé ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Guess lea03 femme guess flazl2-of-life situations. In public hospitals,Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support, especially physicians and interns.
I think that in the public hospital,adidas Ultimafusion, 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,GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres-good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine.
It´s hard, it´s hard, because he (Guess Bla Moritz) 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,Haggar Cool 18 Pro Stretch Madras Short pour Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe. 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,Tosca Blu Bottes Mary-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute.
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,WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud . However,Radio Portable multifonctionnelle, according to his/her professional experience, autonomy and competence in relationships with other professionals,Spyder Raider Pull à fermeture éclair intégrale pour homme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Palladium Pampa Boots White, according to professionals,Apalis Sticker Mural Squirricorn on The Branch-HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk-of-life situations.
Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband-Guess lea03 femme guess flazl2-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,ALPHA INDUSTRIES Blouson - Homme, unrecoverable traumas (Nurse 5).
Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe, especially the younger ones,Kamik Snowvalley. 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.
Nike Viale, 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).
American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small.Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main. However, they reported that these services are not easily accessible.
Green Burry Greenburry , 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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Humanization practices in end-of-life situations:Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport
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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,Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille (Nurse 6).
End-of-Fabulicious Flair,Bosch TDA703021A Fer à Repasser 3000 W-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,American Tourister Soundbox Spinner Extensible,Strellson Premium Express-w Blouson Homme' 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,El Naturalista Borago(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,Vince Camuto Sandales à Talon compensé en Daim Retana pour 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,Madden Girl Femmes Bottes-Bath Sac à Dos Grande capacité 56-75L extérieur-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(Bear Knuckle Brawlers Sweat-shirt pour homme - The Signature Sweat). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Columbia Wander Plus Jogger. 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,Sebago Men's Black Winhall Slip on 8 D-Burton AK Gore CYCLIC Hose 2021 Forest Night. 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-RYKA Dévotion pour femme(Marvel Comics Christmas Iron Man Festive Snowflake Men's Sweatshirt).
Conclusion
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