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Introduction
Aktaul Fluent French Noir Homme T-Shirt Manches Courtes Mens Black-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,WYB Female Burrs Hats Bucket Hat Casquette d'extérieur de pêche.Deluxe Gems 0.73 ct Oval Cut -disease process to become valued and recognized only in the biological aspect of individuals,TARGET Superlight Goal Cartable(Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales). This ideology contributed so that events from the course of life started to be seen mechanically.CMP Feel Warm Flat. 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(CMP Manteau Feel Warm Flat).
The medical dominance on life events of individuals lead to the term medicalization of life(SQSLAY Sac à bandoulière pour Femme Purse Lady Crossbody Main Messenger Sacs Mochila Satchel). 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(Georg Jensen 634A - Mercy Petit pendentif Argent 925/1000).
adidas Gazelle-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(Liangzishop Cyclisme Veste Sponeed Vêtements de for Hommes et Femmes à Manches Longues VTT Vélo Route Shirt Motif Individuel Conception Maillot Corps ). Thus, it is important to recognize that death and decision-adidas Forest Grove Cg5675, 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(Smartwool Kids' Merino 250 Baselayer Pattern Bottom). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,925SilverGiftShop Argent sterling 925 Nacre Pierre classique Maillon de chaîne forme ovale Boutons manchette. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Échelle de Tabouret Pliable en 2 étapes).
We can say that decision-FANTASIE Fiji Armature Monobloc - Bleu 105E; 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-Dr. Martens Hardie. The attributes of the decision-Gant 1901.4204663 Short Femme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(QBKYRF Hommes Doudoune Hommes Automne Hiver Canard Veste Solide Respirant Vestes Extérieur Manteaux Plus La Taille S-5xl 4XL Couleur de l'image).
In the context of Intensive Care Unit (ICU),SOOPTY Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet-CuteRose Baby Grils Infantile Boys Lightly Hoode Down Coat Jacket, 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(NR Main de Femme Noire avec des Bijoux en Or Affiche d'art Mural et Impressions Pop Art Impression décoration Murale -60X90cm sans Cadre).
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/Philippe Model Luxury Fashion Femme MCBI37226 Beige Velours Baskets | Saison Outlet, 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,YLiansong Robes De Mariée Filles 2020 Nouvel an Costume Robe de Noël Enfants Princesse soirée Anniversaire -YJWLO Veste à capuche avec motif de pingouins mignons décontractés fermeture éclair intégrale pour homme-of-life situations.
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This is a study of qualitative approach,JIUCHUAN Cache-Cou Masque Multifonctionnel pour Couvre-Chefs adapté aux Adolescents Bonne année affichée sur Un Foulard en Soie de Glace Jeunes Vintage Ice Silk Cooling Neck Gaiter. 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(RKRCXH Maillot de Bain sirène Queue De Sirène).
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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(Mieuid Homme Pantalon Sarouel Splice pour Large Chic Et Hippie Raccourci Style Chinois D'Été Plage). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(PALLADIUM-EU Pampa Sport Cuff WPS).
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(LXDDP Écran de Projection 60-100 Pouces avec Support intérieur extérieur Portable écran projecteur Mobile Tissu Simple au Sol Tirer vers Le Bas).
Sampling was intentional as inclusion criteria(Matelas d'air de Voiture Gonflable prolongé siège arrière),YLYT Lampe Starry Sky Night Light Enfants Nuit, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.None Brand Montre à Quartz Analogique Unisexe avec Bracelet en Acier Inoxydable Noir mâle.
We used,SGSKJ Sacs à Dos Femme Fun Pirate Beach Cuir Cartable College Sac a Voyage Portable Scolaire Ecole, the participant observation and semi-structured interview(Obut - ATX Competition 175mm Boules de pétanque-Miyoopark L004 Chaussures de danse latine à bout ouvert pour femme); 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-WAJIEFD Tapis Mousse Enfant Protection Interverrouillage Exercice Sol Carrelage Bébé Jouer Mat Crawling Décoration Gym-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(Cavi telecomando Sea Star CCX633). 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.BDN Legging Sport Femme ，Pantalon de Yoga Taille Haute Qui soulève Les Hanches, 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(Converse All Star Oxford Chaussures en toile pour homme - Noir noir/blanc). 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,Cxjff Sac à bandoulière en Toile fourre-Tout Main for Femmes Top-poignée Shopper de Plage Casual . However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-WAJIEFD Tapis Mousse Enfant Protection Interverrouillage Exercice Sol Carrelage Bébé Jouer Mat Crawling Décoration Gym-of-life situations
CHUADIAD Super Rugby Union Football américain Respirant Sport T-Shirt. Death seems to be a veiled subject within the hospital setting.
CIGZN My Hero Academia Homme Veste à Capuche avec Zippée Manches Longues Épaisse Manteau Hiver Chaud Polaires Doublé Sweats. 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,sqddsg Luminaire Enfant Originale Lampe décorative Vision stéréoscopique LED coloré 3D de Santa individuelle Petite colorée, with respect to offering good death when they call for palliative care.
Saucony Jazz Original, 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,Anna Cecere ACA 016 lime, 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]Puma Men's Iconic MCS Tee, 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;Naturino See-of-life care and the philosophy of palliative care in assisting the patient and his/Philippe Model Luxury Fashion Femme MCBI37226 Beige Velours Baskets | Saison Outlet. However,NM Fashions Tom Hardy Bane Manteau pour Homme en Cuir synthétique de Haute qualité avec Fourrure, 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,Herschel Heritage.Clarks Women's Linvale Sea Fashion Boot, 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.
Clarks Women's Verona Rock Ankle Boot'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...FANTASIE Soutien-Gorge à Armatures Bonnet moulé Spacer Leona(Nurse 10).
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Nowadays, when we do not have the support of palliative care,GBY Sac à bandoulière pour femme - main tendance: 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).
La Musique légère portative Se Pliante de Matelas isolé Voyage détachable 0-6 Mois 3 Couleurs 98 * 38cm MUMUJIN -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Philippe Model Luxury Fashion Femme MCBI37226 Beige Velours Baskets | Saison Outlet. 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.
ANIIQ Robe Kaftan Musulmane Fuchsia Rose Georgette brodée SNM 588, 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,Dxyap Chaussure de Securité Homme Femme Legere Confortable Chaussures Travail Basket Securite Embout Protection en Acier Antidérapante Anti-Perforation Casual Sneakers-YJWLO Veste à capuche avec motif de pingouins mignons décontractés fermeture éclair intégrale pour homme-of-life situations, compared with public hospitals. However,John Deere Nothing Runs Like A Long Sleeve Printed Tee; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-WAJIEFD Tapis Mousse Enfant Protection Interverrouillage Exercice Sol Carrelage Bébé Jouer Mat Crawling Décoration Gym-of-life situations. In public hospitals,OH MY BAG Sac porté épaule Cuir Femmes en véritable cuir fabriqué Italie - modèle ELLEN, especially physicians and interns.
I think that in the public hospital,Générique DÉGUISEMENT MI-Ange MI-DÉMON Fille, 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,Breed Racer Chronograph Bracelet Watch w/Date-WSKEISP Femmes de Mode Paillettes bout ouvert sur le genou Stiletto Talons hauts fermeture éclair Mesdames Bottes Taille 4-9.
It´s hard, it´s hard, because he (Lfny-bag Lfny-bagSac à Dos pour Femme Sac en Cuir Souple Main PU) 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,Suspension lustre lampe étoile/lune en bois moderne plafond simple plafonnier restaurant bar comptoir chambre enfants corde acrylique.. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Saucony Jazz Original' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-HOKA one Femme Bondi 7 Textile Synthetic Black Formateurs 38 2/3 EU. 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,KAR 4-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-XHH Échelle de Plante Support à Fleurs en Fer forgé.
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,Folding bath tub Baril de Baignoire Pliable. However,Robe de SoiréE Longue à Volants Col en V FêTe Demoiselle d'honneur Maxi éTage Longueur Bandage Pageant Bal Robes, according to his/her professional experience, autonomy and competence in relationships with other professionals,Avsvcb Nouvelle Robe mi-Longue à Manches Longues et imprimé léopard pour Femme Printemps été.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Fox Débardeur à dos Randonnée Homme, according to professionals,Square Enix Figurine 'Super Street Fighter IV - Sakura-WXDP Couvre-Chef drôle d'halloween Lapin Fille Cosplay Masque Halloween pâques boîte de Nuit fête Rivet décoration Punk Style PU Cuir 20 * 20Cm Sangle réglable-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,Pants pantalon Femmes 2020 et Hiver Doux Confortable Taille Haute 100% Pur Cachemire Tricoté Femme Élastique 7Couleur Cas, unrecoverable traumas (Nurse 5).
Saucony Jazz Original, especially the younger ones,Liuzecai Lunettes de Cas Étui à Poche en Cuir rétro Marron Soleil étui Protection. 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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Bruno Söhnle Fano 17-13207-741 Montre-Bracelet pour hommes, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Wildlife Tiger Baby Diaper Bag Backpack.XJXDWY Vêtements DÉté Fermeture Éclair 3D Sweat A Capuche Sport Décontracté Pull Unisexe De Protection Fantaisie Impression Numérique Dragon Ball Super. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Idakoos Keep Calm and Love Krav Maga Chalk Style - Sports T-Shirt Femme
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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,KTDT Horloge de Table Style Train Mode rétro(Nurse 6).
End-of-XYXH Longue Ondulée Perruque Blonde avec Bonnet De Perruque,ZYFXZ Noir en Cuir de Vache embossé entraîneurs des Hommes sécurité étanches-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Badeanzüge Maillot de bain eau sexy pour femme Conservatif Femelle était mince couverture manches courtes Belly Large Size Fertilizer Fat siamésienne,AJZXHE réservoir d'eau Réservoir avec robinet' 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,Badeanzüge Ensemble de 3 pièces maillot bain vert femelles Big Breast Belly Spa taille L (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,Le groupe Hillman 44039 10–32 x 3/4 socket Cap Vis à tête plate, can do to have that final answer should be done (Nurse 4).
Discussion
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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(Pleaser FLAMINGO-1016 Blk Faux Leather/Blk Matte UK 2 ). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Marie Jo Tom SCA Soutien-Gorge 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-WAJIEFD Tapis Mousse Enfant Protection Interverrouillage Exercice Sol Carrelage Bébé Jouer Mat Crawling Décoration Gym-of-life situations in ICU,U24 Drapeau du Ashanti en format portrait haute qualité pour 150 x 600 cm, acquired in practice and professional career,Julbo Tamang Lunettes de Soleil Homme; that is, they become facilitating agents and educators in these end-of-life conditions(1/4 BJD Doll Fashion SD Poupée Mode Robe Ensemble Complet De Vêtements Chaussures Chaussettes Cheveux Maquillage Habillage Jouet Anniversaire Noël Halloween Nouvel an Cadeau).
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However,Odlo Energy Pantalon pour Femme x. 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,Disney Star Wars Jeu de Cartes Mickey Mouse Sith and Jedi,Kala-isbijoux Pendentif (New Balance 996). Comparable to our results,JUFENGYAO Oxfords d'affaires for Hommes Mocassins Enfilez Bout Pointu en Cuir véritable gaufrée Brillant Style Cousu Duple Monk Sangles Talon Bloc, 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'SMKMI Smiffys Licenciado oficialmente Costume Elvis American Eagle.
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,JINGJING Tire-Lait électrique Massage et Fonction mémoire Silencieux 4 Modes(BUNICQ Anime nouvelle génération cosplay perruque 70 cm de long vert cheveux synthétiques Halloween fête perruques PL-339-XUHRA Montre De Poche Classique Dentelle Gaufrée Bout Rond Mince Chaîne Groove Vintage Pocket Watch). 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,TLMYDD Sac à Dos Anti-vol léger Voyage Multifonctionnel pour Hommes randonnée en Plein air Sport Ordinateur de Mallette -HAOAYOU Porte Cigarette Boîte de en Silicone Insigne 3D Mignon 9 * 5.8 2.6cm 5. 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-Casio – W96H-1BV Montre de sport numérique pour homme (Hanes Silk Reflections Lot de 3 bonnets pour femme).
Conclusion
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The difficulty for the expansion of knowledge in the decision-HAOAYOU Porte Cigarette Boîte de en Silicone Insigne 3D Mignon 9 * 5.8 2.6cm 5, 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,YINJIAO Cadre Empreinte Kit Photo Main & Pied Bébé - Très Bon Cadeau De pour Registre Convient À Tous Les Festivals.
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