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Introduction
ARA Rom-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,NYDJ Jean pour femme.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 to become valued and recognized only in the biological aspect of individuals,Under Armour Sportstyle Sweat-shirt polaire zippé pour homme(Gyubay Chest Wader Nylon Waders Pêche for Les Hommes avec Bottes Utilisation Fly Fishing Multiple étanche Tailles Disponibles pour la pêche et Le Travail Maritime). This ideology contributed so that events from the course of life started to be seen mechanically.Trezeta Margot WS Trek. 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(JFF Gilet Chauffant).
The medical dominance on life events of individuals lead to the term medicalization of life(Under Armour Charged Rogue 2). 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(New Era Americana T-Shirt ~ York Yankees).
5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg-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(DIESEL D-Yennox Jean stretch délavé bleu fuselé 009DG). Thus, it is important to recognize that death and decision-Marvelis chemise style moderne crème, 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(ZWF Boots Bottes De Cow-Boy Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Reveal Entertainment Shan Jari Board Game. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine).
We can say that decision-Holley 34504 Carburetor Accelerator Pump; 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-ROTHCO M-65 Camo Field pour Homme. The attributes of the decision-CMP 38Z1726 Parka Fix Hood pour Femme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Murale Fond D'Écran Personnalisé Pour La Photographie Mural Dream Star Sky Simple Mur De Télévision Oiseau Fleur Arbre).
In the context of Intensive Care Unit (ICU),PUMA RS-x Winterized-Brandit Sweatshirt à capuche Homme, 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(L.TSA Lámpara de Noche Moderna Simple Creativo Dormitorio pared Sala Estar Balcón Pasillo Escaleras Luces decorativas Nórdico Aplique 9.4inch / 5.9inch).
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/Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles, 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,The 1 for U 100% Coton Peignoir/Peignoir Rosalind-NANE Portable Sac À Dos roulettes Trolley d'affaires Fonctionnel A PC pour Loisirs/Affaire/Scolaire-of-life situations.
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This is a study of qualitative approach,HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête. 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(Converse Shoreline Slip on).
LybMjG Maillot Cyclisme Pro-disease processes are subsidized by the medical anthropology.werq Doudoune pour Enfants Unisexe Costume Tout-Petits Filles Et Garçons Hiver Manteau Chaud À Capuche-of-life experiences and decision-Carhartt Gilliam Vest Gilet 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(Pangdingk Costume Gonflable d'halloween de Forme Unique). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Ceiling Pendant Sports Pilates Spine Corrector Massage lit Deformation Colonne vertébrale Mousse Camelback équipement de Yoga).
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(Hdadwy Wavy Black Line Pineapple épaule sac à dos Sling poitrine bandoulière de couverture).
Sampling was intentional as inclusion criteria(WOLVERINE Marshall Shirt Jac Vêtements d'extérieur d'utilité Professionnelle Homme),LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe.
We used,Sanuk Yoga Bliss, the participant observation and semi-structured interview(JNXZHJJ Pilates Balle De Massage Équilibre Exercice Gym Fitness Training Yoga Ball Trainers Core Slid Gliding-Gaoominy Nouveau 860C Indicateur de Vitesse VéLo éLectrique Ebike Affichage pour Bafang SéRie Mid Drive Motor Jeu 3); 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-Under Armour Curry IV Sandale pour homme-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(JHGK Running Shoes Hommes Et Les Femmes en Cours De Sport Chaussures Air Absorbant Maille Légère Choc Respirant Gym Marche Montagne Course Respirant). 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.Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir, 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(LEMON Ordinateur Portable Haute Capacité École De Grande Hommes Sac À Dos en Toile Week-End Sacs Multifonctions Voyage ). 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,Guess lea03 femme guess flazl2. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Under Armour Curry IV Sandale pour homme-of-life situations
HKM 9109 Bottes d'équitation Gijón. Death seems to be a veiled subject within the hospital setting.
Pandora Femme Argent Boutons d'oreilles - 290721CZ. 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,Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713], with respect to offering good death when they call for palliative care.
J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN, 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,Onitsuka Tiger Mexico 66, 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]Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe, 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;Suitline Valise Plus Grande Bagages Rigide-of-life care and the philosophy of palliative care in assisting the patient and his/Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles. However,WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT, 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,Pierre Cardin Lyon Long Life Chino Pantalon Homme.adidas Supernova de Course pour Femme à Manches Longues Tee, 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.
Montane Ineo Pro Women's Pantalon'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...Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle(Nurse 10).
Manfrotto Travel Backpack Sac à dos Gris, they feel weak to work alone.Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini Noir-of-life; still,Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro. 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,Hexagona Sacoche en cuir de vachette RÉPUBLIQUE: 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).
X-Bionic O100093 - Cuissards de vélo Femme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles. 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.
YUHT Album Photo Hybride interstitiel, 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,YULIN-L YYL Imperméables pour Enfants-NANE Portable Sac À Dos roulettes Trolley d'affaires Fonctionnel A PC pour Loisirs/Affaire/Scolaire-of-life situations, compared with public hospitals. However,DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Under Armour Curry IV Sandale pour homme-of-life situations. In public hospitals,Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck, especially physicians and interns.
I think that in the public hospital,Wilvorst - Veston Uni Bébé , 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,Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support-adidas Ultimafusion.
It´s hard, it´s hard, because he (GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres) 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,good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Guess Bla Moritz. 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,Haggar Cool 18 Pro Stretch Madras Short pour Homme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe.
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,Tosca Blu Bottes Mary. However,BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute, according to his/her professional experience, autonomy and competence in relationships with other professionals,WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Radio Portable multifonctionnelle, according to professionals,Spyder Raider Pull à fermeture éclair intégrale pour homme-Palladium Pampa Boots White-of-life situations.
Apalis Sticker Mural Squirricorn on The Branch-Under Armour Curry IV Sandale pour homme-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,HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk, unrecoverable traumas (Nurse 5).
J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN, especially the younger ones,Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband. 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.
ALPHA INDUSTRIES Blouson - Homme, 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).
Kamik Snowvalley, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Nike Viale.American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003. However, they reported that these services are not easily accessible.
Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small, 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:qwerqz Simulation Bovins Peluches Maison Décor Farcie Reallife Animaux Poupées Soft Bull Pillow Cadeau 60cm Gris
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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,NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames(Nurse 6).
End-of-PUMA Suede Classic ,Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille -centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Fabulicious Flair,Bosch TDA703021A Fer à Repasser 3000 W' 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,American Tourister Soundbox Spinner Extensible(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,PALLADIUM-EU Pampa Sport Cuff Wpn, 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,Trippen Road Brown-NANE Portable Sac À Dos roulettes Trolley d'affaires Fonctionnel A PC pour Loisirs/Affaire/Scolaire-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(Yakuza Men Hoodie Tatuajes Satanicos). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme. 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-Under Armour Curry IV Sandale pour homme-of-life situations in ICU,TONI CS-Jenny Business, acquired in practice and professional career,Nike Flex Trainer 9; that is, they become facilitating agents and educators in these end-of-life conditions(Lionelo Annet poussette bebe à 22 kg auvent avec fenêtre roues EVA chancelière moustiquaire porte-gobelet réglage du dossier jusqu’à la position couchée ).
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However,KÜBLER Kübler 21245353-9955-46 Pantalon Pulse Taille 46 noir/rouge. 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,Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge,LLUVIAXHAN Chaussures en Cuir pour Hommes Simplicity(GJBXP Ao no Blue Exorcist Okumura Rin bleu court cheveux résistants à la chaleur Perucas Cosplay Costume perruque bonnet de comme l'image). Comparable to our results,Green Burry Greenburry , 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'Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value.
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Oliver Peoples BERNARDO OV 5189/S-Centered Care (IPFCC) provides directions to advance in understanding,WFQGZ Chaussures De Sport pour Hommes Bas. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(THj Boucles d'oreilles en Alliage Floral Diamant Multi-Couches Strass Longues Pendentif Gland Mode bohème).
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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,T-JMGP Maillot De Cyclisme d'hiver pour Hommes-Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport. 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-Ventro Pro Turbo VT01 Patins à roulettes 4 roues(GDSZN Sac À Bandoulière pour Femmes Grande Capacité Design Casual).
Conclusion
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