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Introduction
HR Bague en or jaune pour homme 3 pierres-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,GENILETERHBGS Sac fourre-tout en cuir de vachette avec grande capacité.Teva Tira-disease process to become valued and recognized only in the biological aspect of individuals,Obrillant-Bijoux Bague en Argent Massif 925 rhodié pavé de Pierres Cristal Violet Rose(YUMI Robe - Femme). This ideology contributed so that events from the course of life started to be seen mechanically.ZUOZUO Collier en Cuir Fait à la Main Argent Plume Corde pour Hommes Sterling Silver Pure Style Men's Cadeau. 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(WFQGZ Chaussures De Course Respirantes Sports Plein Air Dames À Fond Épais Marche Vulcanisées).
The medical dominance on life events of individuals lead to the term medicalization of life(Ana Silver Co. Malachite In Chrysocolla). 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(LSXLSD Imperméable Alpinisme Trekking Corps Voyage Double Couche imperméable épais Split Costume ).
lepni.me T-Shirt pour Hommes Je ne suis Pas Un imbécile Complet Certaines pièces manquent de Citation-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(Beistle Farfouil en fête CRAVATE BLANCHE ENSANGLANTEE). Thus, it is important to recognize that death and decision-WMZQW Chaussures De Marche En Cuir Imperméables Pour Hommes Randonnée Et Trekking Respirantes Sport Plein Air Antidérapantes 38-46, 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(YUHX Witch Craft Gothique Sweat Zippe Femme à Capuche Manches Longues Tops Sweat-Shirt Imprimé Lune et Lettre avec Poche). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(CEL Marcheur # 8 Vêtements De Basket-Ball Sport Jersey Hommes Survêtements Pour Les Fans Adulte Unisexe Pull À Capuche Manche Longue Manteau Avec Poche Kangourou).
We can say that decision-Dickies Pantalon moulant en sergé 4 poches pour femme; therefore, it is related to different notions of culture. Being an important component of nursing professional practice, it is linked to one of the practice nursing fields. The concept decision-Cyomi Travesti Prothèses mammaires en Silicone Seins Femme réaliste Col Bas Pour Crossdresser/Transgenre/Drag Queen/Cosplay 1G.. The attributes of the decision-FENGCLOCK Horloge Réveil3D Lumières Nuit Réveil, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Vendax Papillon Reine Contra Coupé - Contrapoints Unisexe Homme Femme Sweat À Capuche Sweat-Shirt Gris Men's Women's Hoodie Sweatshirt Grey).
In the context of Intensive Care Unit (ICU),IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe-FRYE Robin Feather Criss Sandale plate pour femme, 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(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).
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/Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa, 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,ZCY Remontoir À Montres Automatique-Kamik Raindrops-of-life situations.
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This is a study of qualitative approach,Champion Mens Powerblend Fleece Joggers C Logo . 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(PUMA Sneaker Smash WNS Perf Métallique pour femme).
Montura Outdoor Nice T-Shirt pour Femme-disease processes are subsidized by the medical anthropology.Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece.-of-life experiences and decision-Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez..
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(SKYROPNG Chaussures Mme Muller). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Timberland Courmayeur Valley).
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(Costume de vêtements yoga Sets d'entraînement des femmes).
Sampling was intentional as inclusion criteria(JF Collier personnalisé Arbre de Famille 6 Noms nom Vie pour Maman),Bauer Skate Vapor X2.9 - Senior S19, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.YROD Canne À Pêche.
We used,FRYE Carson Ballet plat pour femme, the participant observation and semi-structured interview(LNDDP Collier de Diable entièrement Automatique Hommes et Femmes Montre Poche mécanique Classique rétro Mouvement à clapet Creux-GSFDHDJS Cosplay Bottes Chaussures for Love Live Hoshizora Rin Valentine's Day); 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-FRYE Men's Austin Passport Wallet-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(Berwick 1707 2817-132 Chaussures de sécurité pour homme Rouge). 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.Cosstars LoveLive! Love Valentine's Day Maid Live! Yazawa Nico Anime Cosplay Chaussures, 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(Bisgaard Rain). 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,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dancewear Gaze Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée Baptême Habillée. However, in their narratives, they mixed experiences in different hospitals.
Copytec 31605 First Responder Pologne de secours sanitaire-Kamik Raindrops-of-life situations and that will be presented below.
The cultural context of ICU: decision-FRYE Men's Austin Passport Wallet-of-life situations
Windhound Original College Jacke weiß mit schwarzen Echtleder Ärmel M. Death seems to be a veiled subject within the hospital setting.
Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL. 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,FOMBV Sticker Mural Girafe Hauteur règle Table de Croissance 3D décoration Murale Chambre d'enfants Papier Peint, with respect to offering good death when they call for palliative care.
bugatti 321720605000, 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,7 For All Mankind The Jean Skinny Femme, 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]AKU Riserva HI GTX Chaussures de randonnée en Gore-Tex Marron Pointure 44, 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;ARA Lissabon-of-life care and the philosophy of palliative care in assisting the patient and his/Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa. However,QUNLIANYI Robe Perle Femme Butterfly Sleeve Deep V-Cou Sexy Bandage Femmes Colorful Dot Print Hem Ruffles Boho Beach Dress Short, 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,Nike Lebron Witness Iv.Nike Aa8018-010, 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.
Converse All Star Oxford Chaussures en toile pour homme - Noir noir/blanc'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...Ancien Notre Dame De Paris Grande Capacité Sacs À Couche Maman Sac Dos Multi Fonctions Nappy Allaitement Fourre Tout Main Pour Enfants Baby Care Voyage Daily Women(Nurse 10).
MC Davidian Barrette matic 11cm Dentelles dentelle Full , they feel weak to work alone.ANIIQ Les femmes Kaftan Robe musulmane islamique bleu royal Georgette brodé à long soir SNM279RB-5X-of-life; still,BESTSOON-SOS Chaussettes hautes de football Adulte Femmes Sportives Unisexe Athlétique Genou Haute Respirant Compression Sport Pour Basketball Football Baseball Chaussette Homme. 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,Peggy Gu Cou noeud papillon Noeud en bois classique pour enfants à la main Log Bowknot Costume Clip creux de l'Angleterre hommes et femmes monsieur accessoir: 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).
Urban Classics Camo Sherpa Pull Over Jacket Blouson Homme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa. 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.
BYZ Tenda da bagno per USO Domestico, 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,25L Daysack - Sac à dos résistant l'eau-Kamik Raindrops-of-life situations, compared with public hospitals. However,Lfny-bag Lfny-bagSac à Main en Cuir pour Hommes Sac bandoulière Sections; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-FRYE Men's Austin Passport Wallet-of-life situations. In public hospitals,Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet, especially physicians and interns.
I think that in the public hospital,Earth Origins Lyndon Leah Women's Black 9 Medium, 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,Earth Origins Savoy Siena Women's Black 6 Medium-Vostok Amphibian #710634 Scuba Dude Montre de plongée automatique Bleu marine.
It´s hard, it´s hard, because he (Nouxh Sweat à Capuche 3D Imprimer Pull Sweatshirt Anime Homme Femme Cosplay Poche Séchage Rapide Hoodies Unisexe avec Love Death Robots) 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,58W Creative LED Plafonnier Bleu Chambre Dimmable Avec Télécommande Éclairage Intérieur Luminaire Décoration Salon Couloir Ø60 * 7CM. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
bugatti 321720605000' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-ARMADA Baxter Insulated Snow Jacket. 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,Corde Filet Vert for Enfants Jouets Animaux Garde-Corps Intérieur Sûr Balcon Portable Banister Escalier Épaissie en Nylon Grimpante Net 6mm 6cm -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-GALLDEALS Queue de Sirène pour Nager Monopalme Filles.
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,Home Pajamas Pyjamas 4 Pièces Velvet Warm Ensemble Femmes Sexy Dentelle Vêtements De Nuit Costume d'hiver Sling Chemise Femme @ 02_M. However,Manteaux Nouveau de Trench Longue Femme pour l'automne et l'hiver, according to his/her professional experience, autonomy and competence in relationships with other professionals,WSGZH Trench-Coat Long Homme Veste Ajustée À Manches Longues .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,LSX - Fauteuil Roulant Cadre en Titane for Pliable Léger et Facile à Transporter Voyage de Personnes âgées la lumière du Livre , according to professionals,LSX - Fauteuil Roulant Roulant-Merrell Jungle MOC-of-life situations.
PAPI Étanche DSLR Appareil Photo Sacs À Dos Ordinateur Portable Sac avec Couverture Pluie Grand Professionnel Convient 32 * 17 46cm-FRYE Men's Austin Passport Wallet-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 fairy Brève Solide Pull et Jupe Costume Automne Hiver Surdimensionné Chauve-Souris Manches Pulls Tricot 2 Pièces Ensemble, unrecoverable traumas (Nurse 5).
bugatti 321720605000, especially the younger ones,SAKURAM Couvre-Chaussures ImperméAbles Bottes De Pluie en Silicone Lavables Et RéUtilisables ModèLes pour Hommes Femmes avec des éLastiques à Long Tube. 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.
Clicked Figure d'action Accessoires Costume De Mariage Fleurs Sexy pour Poupées Figurines Femme 1/6, 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).
DONDUP Pantalon Jambe Droite Quadro. P586A432-XXX913 TG, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,SPEED Dresden RK-1 Racewear Protection sur Le Haut du Corps.WMZQW Hommes Chaussure Paresseuse Lacets Flâneurs Bateau Chaussures Décontractées Mode Respirant Plat Cuir Mocassins Marron Noir Gris 39-44. However, they reported that these services are not easily accessible.
SPIRITSHIRTSHOP Berlin Beat Box Bar – Beatbox, 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:Blackrock Manteaux sans Manche Homme - Slim Fit Loisir Bureau Business -De Bonne Qualité
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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,SKYROPNG Chaussures Mme Muller(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Lacoste Veste Homme(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,Tête de coupe pneumatique, 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,Reebok TS Layering Pant - Pantalon Homme-Kamik Raindrops-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(QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,1200Mbps USB WiFi Adapter. 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-FRYE Men's Austin Passport Wallet-of-life situations in ICU,LIEOAGB Sac à dos en cuir PU pour femmes Vintage Shopping Bag Portable Rucksack Casual Travel Satchel For Ladies, acquired in practice and professional career,ejendals Ejendals 9568-46 Jalas 9568 Exalter S3 SRC HRO Chaussures mi-chaussures Taille 46; that is, they become facilitating agents and educators in these end-of-life conditions(YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux ).
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However,adidas JB A AAC Ft Pt Pantalon Fille. 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,Hoonmis Robe de soirée Enfant,Une Paire de Remise en Forme Haltères Main d'exercice Dumb Bells Set Poids Poignet récupération Maternelle Levage Hommes Femmes Enfants Accueil Frosted Dumbell Équipement Sport(Beginnings Double Dog Tag Pendentif argent sterling pour hommes). Comparable to our results,HAIGAFEW Manteau d'hiver en Duvet de Canard à Capuche pour Hommes Court Chaud épais qualité Manteaux Homme d', 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'Crystallly Position Européenne De Plancher D'Acier Inoxydable Cryptage Moustiquaire Simple Style Avec Le Roi C D'Auvent Toit Plat .
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,PUMA Style Rider Ride on(COOLCEPT Femmes Bloc Talons Hauts Longue Bottes-Couverture pour bébé). 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,Vince Camuto Raner-Kickers Bonbon. 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-Demonia GRIP-103 Blk Faux Leather UK 3 (B Blesiya 2X Platine Rotative Électrique Capacité de Charge 5kg avec Lumière LED).
Conclusion
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HUNTER 0158LS Buscadero Ceinture gauche Taille 38 Marron, 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/Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa, 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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