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Introduction
Walker Valentin Chapeau IBHT Femmes Cap Plein Air Scarf points imprimés style décontracté Pare-soleil extensible respirant Yoga chaud cou sommeil Couvre-chef ST Nouveau-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,WEM Plafonnier LED carré ultra-mince moderne à intensité variable avec télécommande 3000K-6000K Éclairage pour enfants de chambre coucher Acrylique Abat-jour blanc Garçon Fille Chambre L.Metal.CH 2133.47 Montre chronographe pour homme avec date 47 mm et bracelet en cuir beige-disease process to become valued and recognized only in the biological aspect of individuals,Yctze Volant de bateau(Geox Mariele Mid 26 Escarpin Classique pour Femme Talon 2 cm). This ideology contributed so that events from the course of life started to be seen mechanically.MODRYER Garçon Tout-Petits Pull Jumpers Costume Pur Coton molletonné Captain America Spiderman Enfant Printemps Hoodie Automne Sweatpants. 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(MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Centrale Voiture).
The medical dominance on life events of individuals lead to the term medicalization of life(QLCY-78OI Mode Le mode 14 pouces Brief Hommes Messenger Bag multifonction portable multi-fonctionnelle Casual). 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(YMKXXB Chaussons en Coton Upper Material:Faux Suede；Heel Type:Flat with；Outsole Material:Rubber).
XLAHD Relogio De Bolso Hommes Femmes Montre de Poche à Quartz Creux Phoenix boîtier sculpté avec chaîne Cadeau noël-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(SALOMON Wings Pro 2). Thus, it is important to recognize that death and decision-Bermnn Pikachu de LED Ménage Plafonnier Simple Chevet Plafond Lumières étude Chambre Lustre for Salon Salle à Manger Vestiaire Couloir Aisle d'enfant Kindergarten, 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(yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Marc New York by Andrew Men's Bergen Ultra Stretch Packable Jacket. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Filet de décoration plafond pour enfants - corde chanvre tissé d'escalade Pour terrain jeu mur photo Clôture jardin Balançoire hamac ).
We can say that decision-SWIMS Mocassins en Dentelle Stride pour Hommes; 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-Bohrcraft perçage Craft 41550302000 masch. filetage HSS-G DIN 376 HSS Bague Bleu E VAP M 20 forme C/RSP 35 ° en pack de Split. The attributes of the decision-BERSAGLIO MOBILE BATTENFELD Holster - ÉTUI pour Pistolet Sig Sauer P226 BM, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Desigual Hindi Dancer Stud - Leggings Danseur Hindi. Femme).
In the context of Intensive Care Unit (ICU),Powerslide R4 Trinity Rollers-HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine, 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(RKRZLB Filles Queue De Sirène Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles ).
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/LongDD T-shirt de football américain uniforme la Nouvelle-Angleterre Patriots Hightower #54 Maillot Gruby Tee Shirts - X-Large, 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,LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS-AWJ Barre d'appui de Douche-of-life situations.
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This is a study of qualitative approach,Cwypxl Santiag Femmes Western PU Botte Cowboy Talon Casual Chic Cowgirl Boots Haute Chaussures Chelsea Pointu à imprimé Serpent Couleur mélangée. 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(ASKTOM Sac à dos pour enfants - l'école maternelle Bleu marine 01. BIG).
Delavi Self Medication T-Shirt Femme Noir Women's Black-disease processes are subsidized by the medical anthropology.HAIK Route Pédale Auto-Verrouillage à Double Face Multi-Angle léger de Verrouillage Lollipop Equitation Pédales Vélo -of-life experiences and decision-ACEACE Nouvelle Femme Sexy Danse du Ventre Costume Set Indien Professionnel Robe Lady vêtements de Porter Pratique/Performance 4 Couleurs .
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(YATTYUG Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(WEHOLY Sonnette Avant Cloche Style Industriel Européen Rétro Jardin Nostalgique en Fonte Manuelle Fer Forgé Clochettes À Main Maison Suspendue Décoration Murale).
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(PUMA S XT nuageux Chaussure gris 359 135 02).
Sampling was intentional as inclusion criteria(JEWEL BEADS Gemel Beads Gems-Jewellery Lot de perles en forme pierre lune arc-en-ciel qualité supérieure 40),GET Combinaison de Ski Une Pièce pour Femmes, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.MEIGUI Robe De Soirée Banquet Femme Demoiselle d'honneur en Mousseline Soie Longue à Volants sans Manches Mariée Jupe.
We used,VIPbridal Boho Robe Fille Fleur Princesse Demoiselle d'honneur, the participant observation and semi-structured interview(YAS Yasemira Loose Lace Top Blouse Femme-Disney Petite Serviette de Minnie Mouse Rose Point Blanc Jet¡§?e sur Barboteuse ); 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-PUMA TSUGI Disc-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(Theia Bague Or Blanc et Jaune 9ct Forme Ruban Confort 0.04ct Deux Diamants Ronds Sertis en Chaîne 5&7mm). 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.Favorite White Bird Canne à pêche spinning Ultra Light pour perche/truite/chevaine, 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(Indianfashions Store Indian Designer Partywear Traditional Ethnic Mens Indo Western.). 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,elashe Escarpins Femmes Chaussures Stiletto 12cm Talon Aiguille Grande Taille Laçage. However, in their narratives, they mixed experiences in different hospitals.
PUMA Roma Basic-AWJ Barre d'appui de Douche-of-life situations and that will be presented below.
The cultural context of ICU: decision-PUMA TSUGI Disc-of-life situations
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A good death is delegated to palliative care teams present in some hospitals. However,ZIYOU Argent Sterling 925 avec Pierre Porte-Bonheur Charms pour Bracelet Pandora Joyeux Anniversaire 12 Couleurs Jan- DEC élégant Fit la Plupart des Bracelets européens, with respect to offering good death when they call for palliative care.
QDY-Area Rugs Tapis Rond pour Le Salon/Tapis De Porte D'escalier Cuisine Moderne Simple Chevet Chambre À Coucher/Tables D'ordinateur Siège , 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,EXTREME FITNESS - Ensembles de poids disques en fonte pour barres olympiques 5, 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]Roxy Snow Junior's Surface Zip Through Top, 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;COMPRESSPORT Winter-socken Chaussettes Homme-of-life care and the philosophy of palliative care in assisting the patient and his/LongDD T-shirt de football américain uniforme la Nouvelle-Angleterre Patriots Hightower #54 Maillot Gruby Tee Shirts - X-Large. However,Kask Utopia Casque vélo Adulte Unisexe, 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,Hotter Glove.Reebok Aztrek 96, 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.
Reebok Classic Leather Vector'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...Lee Men's Performance Series Extreme Comfort Khaki Pant(Nurse 10).
Asics Chaussures Gel-Quantum 90 pour Femmes, they feel weak to work alone.Beta Beta-of-life; still,YU Chaussures habillées pour hommes Mocassins et collants tout-aller en daim de conduite confortable classiques. 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,Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied: 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).
Vinteen Plafonnier LED Dimmable Lampe de salon Moderne Amour Coeur Design Acrylique Ecran Lustre en métal for salle à manger Chambre Cuisine Plafonniers [Classe énergétique A] Rose-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/LongDD T-shirt de football américain uniforme la Nouvelle-Angleterre Patriots Hightower #54 Maillot Gruby Tee Shirts - X-Large. 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.
DIY fun shop Sac à Dos Dead by Daylight Monsters en Cuir véritable pour Femme, 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,LOVEKUSH 50% Off Gemstone Jewellery 5 Feet Peach Moonstone Silver Coated Bezel Continuous Connector Chain - Size 10-15mm Code:- RADE-37903-AWJ Barre d'appui de Douche-of-life situations, compared with public hospitals. However,LXX Col De Poupée Costume Princesse Douce Peut Porter des Pyjamas Femmes Printemps Et Automne Service À Domicile; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-PUMA TSUGI Disc-of-life situations. In public hospitals,WYYWCY Une Loutre de mer Mignonne Flottant sur Le Motif l'eau Tapis Couverture Portable et Pliable 60x78 Pouces Pratique pour Camping la Plage Pique-Nique en Plein air, especially physicians and interns.
I think that in the public hospital,PXQ Unisexe la NASA T-Shirt Manches Longues lâche Coton Sweatshirt pour Hommes et Femmes, 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,SLONGK Bobine D'Allumage 077905115T-Entrainement sportif 4 rangées de Corsets en Caoutchouc Hanches Abdominales Ceintures jointes Corset Dispositif Formant Le Corps Maille.
It´s hard, it´s hard, because he (Primadonna Soutien-Gorge Invisible Peau Claire sans Coutures Every Woman) 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,TK Total Three 3.1 Accelerate Crosse de hockey 2020/20. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
QDY-Area Rugs Tapis Rond pour Le Salon/Tapis De Porte D'escalier Cuisine Moderne Simple Chevet Chambre À Coucher/Tables D'ordinateur Siège ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-adidas Originals Baskets Mode 3MC X Truth Never Told. 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,TAZAN Mocassins De Conduite pour Hommes Plat-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-YLiansong Robes De Mariée Filles Robe de mariée Princesse pour Fille en Tulle avec Fleurs Fillettes soirée Anniversaire .
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,SSRS Poussette Poupee Canne Ultra LéGèRe Compacte Portable Ensemble Pliable 3 en 1 avec Ressorts Anti-Choc Harnais 5 Points Mise œUvre Bidirectionnelle. However,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dentelle Gaze Dancewear Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée, according to his/her professional experience, autonomy and competence in relationships with other professionals,LIUDATOU Casque de vélo in-Mold Enduro VTT Casco Ciclismo Casques Montagne Hors Route Casquette sécurité.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Kilpi Titicaca-W Jupe 126, according to professionals,TIGERROSA Damen Sporthosen verlieren Abnehmen Pluderhosen Sieben Punkte Schwarze Yogahosen-PUMA Baskets Wired Knit-of-life situations.
EDELWEISS Chaîne d'Ancre Ronde en Or Jaune 750 585 333-2-PUMA TSUGI Disc-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,Loungefly X Disney Mini sac à dos Motif portrait, unrecoverable traumas (Nurse 5).
QDY-Area Rugs Tapis Rond pour Le Salon/Tapis De Porte D'escalier Cuisine Moderne Simple Chevet Chambre À Coucher/Tables D'ordinateur Siège , especially the younger ones,MUK LUKS Chaussons Critter pour Femme. 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.
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Portable Butane Stove Burner - Taille Unique, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Home Trainer Rouleaux dim. 145L x 56l 10.Mars Jun Sac à Main en Cuir Véritable Sacs Business Mallette 14 Pouces Cartable Porte Document Sacoche d'ordinateur Hommes d'affaires Bandoulière. However, they reported that these services are not easily accessible.
Vince Camuto Pantalon Coupe Droite pour Femme Imprimé Taille Moyenne, 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,WENZHEN Sac à Dos The North Face(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Macron Home Jersey White/Red 19/20 Red Star Belgrade(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,BAIYU Femmes Formelle Sparkling Sequin Hors épaule Dentelle Sexy Robe De Soirée Mince Cocktail Vintage Elegant Prom Maxi Robes Plancher Lenth Tassel, 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,FXQ Amovible Pet Chauffage Mat-AWJ Barre d'appui de Douche-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(Moshow Sweat à Capuche Homme Shark Whale 2 Sweatshirt). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,adidas 9 pair Performance Sneaker Socks Unisex short sock. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Trussardi Jeans by TrussardiZip. 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,APcjerp Poussette for Les Enfants de 8 Mois - 6 Ans,LAOSHIPAI Veste Femme Grande de col Fourrure pour Femmes épaissir lâche Mince Chaud Fille Mode Casual Hiver Chaude Noir S-M-L(Modèle éducatif modèle d'articulation de Hanche Chien - Anatomique d'anatomie articulaire Nerf Jambe d'os Squelette canin). Comparable to our results,El Naturalista Nido, 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'Baby Mobile Music Berceau Mobile.
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Conclusion
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Cluty Sac à Bandoulière Femme cuir véritable, 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/LongDD T-shirt de football américain uniforme la Nouvelle-Angleterre Patriots Hightower #54 Maillot Gruby Tee Shirts - X-Large, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
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