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Introduction
adidas Ultraboost S.Rdy Baskets-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Gabor Bottes Chelsea pour femme Semelle amovible.Deerhunter Strike Gilet Motif Feuille-disease process to become valued and recognized only in the biological aspect of individuals,Stonefly Truman Calf Print(GOYING One Piece Monkey·D·Luffy Femmes Vintage Streetwear Punk Style Veste en Jean Anime). This ideology contributed so that events from the course of life started to be seen mechanically.Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme. 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(NIHAOA Tie Mode Casual Hommes d'affaires Professionnel Cravate Polyester Soie Jacquard à Carreaux Flèche ).
The medical dominance on life events of individuals lead to the term medicalization of life(Etnies Scout). 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(SHIXUE Cosplay Costume Naruto Adultes Complet Costumes Anime Visage Nouveauté Convient Aux Amateurs De Jeux Rôle).
Sam Edelman Circus Kirby Kitten Heel Ankle Boots-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(Rocket Dog Sadea). Thus, it is important to recognize that death and decision-adidas Solar Glide St 19 W, 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(CNAJOI-TDFY Lampe Frontale de vélo LED). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Docooler Sourcingbay Portable Réchaud de Camping. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(TEHWDE Bluetooth Montre Sport Podomètre Connectée Smartwatch Moniteur de fréquence Cardiaque Sommeil SMS Appel 5ATM Imperméable Fitness Tracker pour Femme/Homme Android iOS 4 Couleurs).
We can say that decision-Helly Hansen Sogn Jacke Jacket Mixte; 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-Helly Hansen Short. The attributes of the decision-No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(A.S.98 AS 98 Bottines à Talons en Cuir ref_48076 Rouge).
In the context of Intensive Care Unit (ICU),Vans Sk8-Hi Reissue Chaussures de skate unisexe-Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier, 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(CLII Automobile Instrument de Diagnostic pannes).
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/Shirt sidez Elvis Presley Mug Shot Mens Hoodie, 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,BOSS Hugo Hybrid_Runn_knmx-Clarks Cruise Lace 26132671 femmes Derbies-of-life situations.
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This is a study of qualitative approach,DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee. 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(WRJY Poussette pour bébé).
SALOMON XA Pro 3D V8 GTX W-disease processes are subsidized by the medical anthropology.Kyman Sac Cadre vélo-of-life experiences and decision-Alpine Advance Keela Pantalon Imperméable Homme.
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(Sweat À Capuche Streetwear Homme Brodé Grue Fleur De Pêche Caractère Chinois Coton Décontracté Mode Fleurs). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(STZYY Vestes de Pluie imperméables Costumes Ensembles d'imperméables Imperméable électrique Moto Anti-tempête).
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(Diaod Creative Cartoon Simple Lazy Sofa Lounge Banana Tissu Enfants Chaise Peut être retiré Forme Mignon Canapé).
Sampling was intentional as inclusion criteria(YKJ Anime Cosplay Chaussures Femme Masquerade Bottes en Cuir Blanc Version Bas Personnalisée Heeled),Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes .
We used,NINE WEST Brodie cuir Femme, the participant observation and semi-structured interview(STAR FASHION Femmes Tricoté Longue Manche Renne Noël 3D Chandail Dames Flocon De Neige Cavalier-Nisdsgd Men's Hoodies Sweatershirt); 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-Scanstrut APT-LB-01-Support antenne 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(TYXTYX SèChe-Chaussures éLectrique). 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.Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature, 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(Lowa Renegade GTX Mid). 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,Sekonda Montre bracelet - Femme 2157.27. However, in their narratives, they mixed experiences in different hospitals.
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-Clarks Cruise Lace 26132671 femmes Derbies-of-life situations and that will be presented below.
The cultural context of ICU: decision-Scanstrut APT-LB-01-Support antenne Blanc-of-life situations
X-Toy 1/72 Fighter Modèle en Plastique. Death seems to be a veiled subject within the hospital setting.
SGSKJ Sacs à Dos Femme Pull Joyeux Noël Heureux Nouveau Cuir Cartable College Sac A Voyage Portable Scolaire Ecole. 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,Nike Phantom Venom Academy IC, with respect to offering good death when they call for palliative care.
LHY Cadeau de Noël pour Fille, 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,PLEASUR Machine de germes soja, 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]adidas Vs Pace, 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;Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables -of-life care and the philosophy of palliative care in assisting the patient and his/Shirt sidez Elvis Presley Mug Shot Mens Hoodie. However,Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver, 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,XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode .Magma Products, 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.
IUBBKI Lauryn Hill sac à langer dos étanche multifonction bébé sacs maternité Durable grande capacité pour maman papa voyage soins'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...Columbia PFG Rostra Tongs pour femme avec adhérence élevée(Nurse 10).
TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8, they feel weak to work alone.Timberland Chaussures - Grantly Chukka A12IA brown-of-life; still,Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir. 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,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée: 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).
SWEETQT Activités Intérieures Legging Sport Femme Pantalon Yoga Femmes Mode Exercices Leggings Gym Pilates Fibre Elastique Pantalons XL-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Shirt sidez Elvis Presley Mug Shot Mens Hoodie. 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.
DWHJ Petit Scellant À Vide, 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,Couverture à gaze cinq couches Petite de coton frais nordique douce et confortable-Clarks Cruise Lace 26132671 femmes Derbies-of-life situations, compared with public hospitals. However,XBR Voyage Parapluie Pliable Protection Solaire Domestique UV Parapluies Simples Pliage Pluie et Deux parapluies Trois Styles Disponibles ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Scanstrut APT-LB-01-Support antenne Blanc-of-life situations. In public hospitals,MMA Mixed Martial Arts Gratuit Se Battre Sanda Wushu Muay Thai Courir Sports Fitness Boxe Concours d'entraînement , especially physicians and interns.
I think that in the public hospital,Lowa Chaussures de randonnée Ferrox Pro Lo GTX Femme, we have a much larger workload, you deal with lack of material, lack of professional... But on the other hand you have greater openness from other teams (Nurse 8).
However, even if the professional has competencies and skills to actively participate in end-of-life decisions, in some contexts,ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité-Under Armour Tribase Reign 2.0 Cross Trainer pour homme.
It´s hard, it´s hard, because he (Rebecca Minkoff Sac à main 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,find. Marque Amazon - Crossover Block Heel Leather. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
LHY Cadeau de Noël pour Fille' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport. 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,YXZQ Lanterne Murale extérieure Traditionnelle-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon.
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,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400. However,Mountain Equipment Randonee Gant Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Under Armour Essential.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,WOCTP Outdoor bag, according to professionals,Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste-Clarks Kinzie Light-of-life situations.
Floris van Bommel Pompon Casual DarkBlue Suede-Scanstrut APT-LB-01-Support antenne Blanc-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,The North Face Women's Aphrodite Motion Capri, unrecoverable traumas (Nurse 5).
LHY Cadeau de Noël pour Fille, especially the younger ones,mingliang Bottes Tactiques pour Hommes. 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.
EVR Femmes Sandales Couleur Unies Mocassins à Enfiler Classiques Casual Bout Rond Chaussures Mode Évider Frange Sneakers Sandales, 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).
EVR Chaussons pour Femme en Fausse Fourrure 2020 Mode Pantoufles Bout Ouvert IntéRieur et ExtéRieur Velu Chaussons, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,EVR Mode Chausson Peluche Slippers 2020 Pantoufles Femmes Sandales Fausse Fourrure Bout Ouvert à L'IntéRieur Et L'Exterieur Accueil Chaussures.EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:FLOTO Ciabatta Italian Leather Briefcase Attache
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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,MILASIA Parachutiste US Vintage Industries(Nurse 6).
End-of-Anastasia Beverly Hills - Veste Courte rembourrée pour Femme,Peak Mountain Doudoune Femme ARES-Marine-XL-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,teesquare1st Men's Martin Luther King Jr - Darkness Grey Sweatshirt,Filet de Camouflage De for La Chasse Tournage Pêche ' 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,NO LOGO X-Baofu(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,Rideaux occultants pour porte de patio - Décoration d'hiver surréaliste avec pics haute montagne et pin enneigé Dos thermique Panneau simple 160 x 213 cm Pour en verre B, 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,One Man Show Bracelet Acier doré Forme allongée ornée d'un carré en émail Noir -Clarks Cruise Lace 26132671 femmes Derbies-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(Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Jouailla Bracelet PERLAS LATINAS perles de verre rouge. 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-Scanstrut APT-LB-01-Support antenne Blanc-of-life situations in ICU,YI'HUI Tapis Roulant, acquired in practice and professional career,Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie; that is, they become facilitating agents and educators in these end-of-life conditions(TIGOSM 10Mm Trombone Iced Out Cubic Zircon Bracelet Or Argent Personnalité Hop Bijoux Pour Hommes Femmes).
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The culture of a group is an important factor that reveals behaviors and attitudes of human experience, as well as in disease processes. The habits, customs, spirituality and belief, expressed by the culture of a group,GFBVC Costume de danse contemporaine Danse du ventre Jupe femme parfaite for le spectacle costume indienne pratique Clothe(ProCook - Cocotte Faitout Ronde 24cm / 4-Merrell Boys' Moab 2 Low LACE Hiking Shoe). 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,adidas Originals Midiru Court Mid W-Nine West Womens Printed Formal Dress Pants Blue 14. 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-Warm-Breeze Bureau de Voyage soulager la Douleur au Cou en Forme U Doux à Trois Doigts sur Une Branche Verte Oreiller Mousse mémoire(ASICS Soutien-Gorge à Fermeture Éclair pour Femme).
Conclusion
The decision-Clarks Cruise Lace 26132671 femmes Derbies-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.New Balance 420v1, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Assiette De Diner Plaque Cuisson en Porcelaine 6 Pouces Bol À Dessert Ramequin Baker Dîner Plats Pâtes Vaisselle Ménagère-of-Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs.
Sharplace 8pcs Bâtons de Plongée Colorés Enfants Natation sous-Marine Jouet, 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-Orchid Jewelry Naturel Améthyste. 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,Hoppimals Tootiny Vache Sauteuse et Bondissante Animal Sauteur pour Les Enfants âgés de 12 Mois Plus - Emballé dans Une Boîte Cadeau-Nine West Womens Printed Formal Dress Pants Blue 14.
e.s.motion Engelbert Strauss, 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/Shirt sidez Elvis Presley Mug Shot Mens Hoodie, 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-Nine West Womens Printed Formal Dress Pants Blue 14, 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,FB Fashion Boots C3099.
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