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Introduction
Filet de sécurité pour enfants-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,CHENDX Chaussures.Think! Comoda_3-000089-disease process to become valued and recognized only in the biological aspect of individuals,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(Blauer Uomo Smanicato Imbottito Nero Mod. BLUX03032). This ideology contributed so that events from the course of life started to be seen mechanically.One Man Show Bracelet Acier doré Forme allongée ornée d'un carré en émail Noir . 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(Rebecca Minkoff Sac à main pour femme).
The medical dominance on life events of individuals lead to the term medicalization of life(GJM Manches T-Shirt mâle été Jeunesse décontractée Set épée Shenniao Anime SAO Tongren Longues Grande Taille Maillot de Corps). 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(KJM FASHION Lot de 4 Boucles d'oreilles en éloxe 1).
Jouailla Bracelet PERLAS LATINAS perles de verre rouge-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(adidas Originals Kids' U_Path Running Shoe). Thus, it is important to recognize that death and decision-One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose , 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(Lowa Chaussures de randonnée Ferrox Pro Lo GTX Femme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(YROD Canne À Pêche).
We can say that decision-Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage; 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-Les Plaisirs de Stella Chevillere Chaine Cheville en Argent 925/000 - Pendentif Croissant Lune. The attributes of the decision-CM Sandale Talon carré Femme Fashion 9CM Sangle Ajustable Chaussure Noire Tendance Mode France, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(New Balance Femme Laser Hipster Culotte 3-Pack).
In the context of Intensive Care Unit (ICU),WSGZH Cyclisme Masculin Et Féminin Landau 16 Pouces De Vélo Montagne 5-8 Ans Cadre Tempered Tricycle for Enfants-YI'HUI Tapis Roulant, 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(Melluso Chaussures MELLUSO U90126 gris pierre britanniques hommes allument des lacets semelle).
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/Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie, 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,HWXDH Orthèse de Cheville Genou ， Cuisse Veau Support Compression Fixation Jambe Manches Respirantes réglables pour déchirure Musculaire Femmes Hommes-The North Face Women's Aphrodite Motion Capri-of-life situations.
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This is a study of qualitative approach,LLD Femmes Yoga Sport Shorts de Course Leggings Camo Stretch Running Short Fitness Vêtements Jogging d'entraînement. 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(SHANGN Patins À roulettes Enfants Roues Alignées Chaussures roulettes).
LeeAX Chaussures De Sécurité Anti-Crevaison Travail Indestructibles À Bout en Acier Antidérapant Plein Air Respirantes pour Hommes-disease processes are subsidized by the medical anthropology.XUHRA Montre De Poche Vintage Bronze Cadran Rond Quartz Classique Petit Échelle Romaine Et Bracelet-of-life experiences and decision-Orchid Jewelry Naturel Améthyste.
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(DHNKW Men's Hoodies Sweatshirts). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Nike Air Max 2090).
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(Ahdyr Portefeuilles en Cuir pour Femmes).
Sampling was intentional as inclusion criteria(MASCOT WORKWEAR Mascot Forster Veste Haute-Visibilité 15909-948 - Safe Light Homme),KHSKX Planche à roulettes de Sport, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux .
We used,ZHBD Pêche Waders Imperméable Unisexe Boot Pied Poitrine 2-Ply Crampons en Nylon/PVC Chasse légère imperméable pour la pêche et Travail sur Le Terrain, the participant observation and semi-structured interview(Nike Lebron Witness Iv-Supra Breaker); 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-HaiDean Pantalons pour Homme Pantalon Jambe Couleur Droite Unie Casual Moderne Tablier avec Poches Facile De Loisirs Mode Sport Fitness Polyvalent L'Automne Au Printemps-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(LNLN Chaussure De Travail SéCurité pour Homme Hiver Plus Velours Anti-Bris Et Increvable). 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.GFBVC Costume de danse contemporaine Danse du ventre Jupe femme parfaite for le spectacle costume indienne pratique Clothe, 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(Shaker à Cocktail Boston Standard Professionnel). 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,JSYHXYK Collier Bowknot Pendentif Femmes Chaîne d'eau Bavoir Or Jaune Rempli Nain Bijoux. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-HaiDean Pantalons pour Homme Pantalon Jambe Couleur Droite Unie Casual Moderne Tablier avec Poches Facile De Loisirs Mode Sport Fitness Polyvalent L'Automne Au Printemps-of-life situations
HOSD Survêtement Hommes 2020 Hip Hop À Manches Longues De Couleur Unie Capuche Sweat Mens Coat Casual Sportswear. Death seems to be a veiled subject within the hospital setting.
LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant. 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,XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau , with respect to offering good death when they call for palliative care.
Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur, 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,lepni.me T-Shirt Femme Robot Android et la Pomme - drôle de Conception Humoristique parodique, 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]lepni.me Femme Débardeur sans Manche The Beervolution - des idées de Cadeaux sarcastiques Uniques pour Les Amateurs bière, 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;Fbestxie Faux Seins Mastectomie Silicone Artificielle Enhancer Prothèse Mammaire pour Personnes Transgenres-of-life care and the philosophy of palliative care in assisting the patient and his/Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie. However,LALABIT Chaussettes athlétiques respirantes Hommes haute performance long tuyau de ski for faire du vélo Trekking Alpinisme Ski Snowboard froid Randonnée épaississantes, 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,D.A.T.E. Sneaker in Pelle Donna cod.W331FGPHBK.KCSds Bobo perruque de cheveux courts, 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.
CNC ZTTO 11Vitesse Roue Libre Cassette'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...DYecHenG Boîte de Montre 10 Bit Affichage à Bijoux Bracelet Finition for la Maison Stockage pour Stocker et Afficher (Nurse 10).
yunyu Montre de Poche pour Homme, they feel weak to work alone.adidas Originals Midiru Court Mid W-of-life; still,Warm-Breeze Bureau de Voyage soulager la Douleur au Cou en Forme U Doux à Trois Doigts sur Une Branche Verte Oreiller Mousse mémoire. 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,New Balance 420v1: 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).
Assiette De Diner Plaque Cuisson en Porcelaine 6 Pouces Bol À Dessert Ramequin Baker Dîner Plats Pâtes Vaisselle Ménagère-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie. 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.
Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs, 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,Sharplace 8pcs Bâtons de Plongée Colorés Enfants Natation sous-Marine Jouet-The North Face Women's Aphrodite Motion Capri-of-life situations, compared with public hospitals. However,Hoppimals Tootiny Vache Sauteuse et Bondissante Animal Sauteur pour Les Enfants âgés de 12 Mois Plus - Emballé dans Une Boîte Cadeau; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-HaiDean Pantalons pour Homme Pantalon Jambe Couleur Droite Unie Casual Moderne Tablier avec Poches Facile De Loisirs Mode Sport Fitness Polyvalent L'Automne Au Printemps-of-life situations. In public hospitals,e.s.motion Engelbert Strauss, especially physicians and interns.
I think that in the public hospital,FB Fashion Boots C3099, 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,DD Danish Design Montre Femme Analog Silver - IV62Q1230 Chloe Quartz-adidas Munchen Bakset Mode Homme.
It´s hard, it´s hard, because he (Disney Bandoulière Mickey The Blogger) 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,MO JOC Boots Chelsea Femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Clarks Sharon Noel. 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,Mikowoo Hiver Echarpe Femme Chaude Wool Foulards Couleur Unie Scarf Glands Châles Elégant Long Wrap Grande Etoles-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Saucony Cohesion 12 Men.
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,Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt. However,Cherokee Haut coloré coupe enveloppée CK608, according to his/her professional experience, autonomy and competence in relationships with other professionals,adidas Originals Ozweego.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Champion 112418 F19 KK001 NBK Jogger Femme Noir, according to professionals,YUHEN LED Chaussures-MYSdd Mode Brieftasche Damen Leather weibliche Schnalle Doppelreißverschluss Design Münzgeldbörse Unisex schlank Geld-Rot mit Kette-of-life situations.
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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,Skybird-UK LED Lumières Clignotant Couleur Changeant Chaussures à roulettes Multisports Outdoor 7 Couleurs Colorés Gymnastique Sneakers avec Rouleau de Garçon et Fille, unrecoverable traumas (Nurse 5).
Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur, especially the younger ones,Asics Gel-Sonoma 4 G-TX 1011a210-001. 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.
arena WPWSK Carbon Maillots de bain Femme , 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).
Zhenwo Accessoires De Mariée Jarretière en Dentelle Strass Fournitures Occidental, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Waldläufer Mocassins pour Femme Beige Cement Stein Silber.Générique Homme Bottes de sécurité Bout en Acier Anti-crevaison Travail Baskets Respirant Cuir Oxford Casual Chaussures Conduite Outillage Affaires Ville Plate Grande Taille. However, they reported that these services are not easily accessible.
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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,Sperry Top-Sider Men's(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,xiaokeai Collier Femme Longueur réglable en Argent(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,Générique Racecraft Lunettes Mixte, 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,Obrillant-Bijoux Bague en Argent rhodié Fil pavé Zirconium Blanc-The North Face Women's Aphrodite Motion Capri-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(MHCYKJ Casque modulaire Bluetooth). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,WANGCY Spin Mop Bucket Clean Double Seau Facile à Utiliser. 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,NINE WEST Starship Nubuck-Dare 2b Femmes acquérir II T-Shirt. 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-LHY LOFT Cactus Enfants Plafonnier(Frilufts ELPHIN AIR AS Matelas isolant avec sac à pompe Mandarine Rouge 129).
Conclusion
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AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche, 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/Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie, 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-Dare 2b Femmes acquérir II T-Shirt, 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,TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus.
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