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Introduction
Melluso 06330-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux.Oreiller-disease process to become valued and recognized only in the biological aspect of individuals,EUEUEING-VI Cl □ tor l St mulator G SP t Vibr Dult S x T y C uplets - VIBR ting P nties for Fem de la n Silicone Material(PREMIUM WHEY 90-90% Teneur en protéines - avec 51). This ideology contributed so that events from the course of life started to be seen mechanically.Nyrgyn 3D Homme Short de Bain Bermuda Séchage Rapide Exercice Shorts Motif imprimé en Swimming Tunks Surfant. 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(ZHANGSDJ Costumes De Noël Adultes Hommes Prêtre Noir Cosplay Costume Mâle Pope Robe Mascarade Fête Halloween).
The medical dominance on life events of individuals lead to the term medicalization of life(Suetar Hommes Automne Bas-Bas Chaussures De Trekking Tactiques LQ31008). 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(Volcom Tower P/Over Fleece Sweat à Capuche pour Femme).
Helga Kreft Kreft90012 Police Mobil Puzzle -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(ARA Lissabon). Thus, it is important to recognize that death and decision-La Siesta Nautico Cool Grey - Support en Acier revêtu par Poudre pour hamacs Doubles, 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(Ryan Jonathan Fine Jewelry Alliance en cobalt à bords biseautés satin 6 mm Taille 11). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Zhik Hybrid Skiff Suit 2020. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Columbia Outdry Ex Reversible II Jacket Imperméables Femme).
We can say that decision-DazzlingRock Collection 0; 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-Jessica Simpson Women's Versailles Mitered Side Tie Hipster Bikini Bottom. The attributes of the decision-Kangol antique Sac fourre-tout Marron Fourre-tout de voyage, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Treslin Pantoufles en Mousse À Mémoire).
In the context of Intensive Care Unit (ICU),Adrun 9202 Chaussures de sport légères pour femme-QPYJ Vestes Coupe Pluie randonnée Imperméable Costume Adulte Manteau de Coupe-Vent Poncho, 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(SSCEE Lampe de Table Nostalgique Narguilé Industrielle Rétro Vintage Steampunk Fer Robot Lecture Nuit).
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/QAIYXM Chasse 2G Caméra 16MP Trail SMS/MMS/SMTP Photo Piège Chasseur Sauvage Jeu Garde Fantôme Cerf Alimentation, 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,WEHOLY Chariot de Rangement Amovible en Plastique étanche à l'humidité-YHBDE Ensemble Tactique Militaire extérieur en Peau de Requin Camouflage vêtements Chasse Costumes imperméables Hommes Veste ou Pantalon pour l'escalade randonnée Sand XXL-of-life situations.
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This is a study of qualitative approach,YZ-YUAN Nappe de Style Chinois Classique Multi-usages Jacquard Polyester Couverture Tissu Famille Table à Manger décoratif . 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(Suspension lustre lampe étoile/lune en bois moderne plafond simple plafonnier restaurant bar comptoir chambre enfants corde acrylique.).
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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(Asics Gel-Sonoma 4 G-TX 1011a210-001). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(adidas Superstar 80s Prime Knit).
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(HARLEY-DAVIDSON Men's Gavern 5.5-in Waterproof Motorcycle Boots D93565 ).
Sampling was intentional as inclusion criteria(Jixi Sac de Couchage for bébé Automne Hiver Tenir Dormir Enfants à Double Usage Deux Voies Zipper Wearable Blanket Sommeil ),GOYING One Piece Monkey·D·Luffy Femmes Vintage Streetwear Punk Style Veste en Jean Anime, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.LZJN Veste d'hiver pour femme avec boutonnage long et matelassé.
We used,YANGSANJIN Ventilateur portatif Mini climatiseur à écran Tactile pour Refroidisseur d'air Ventilateurs de Refroidissement, the participant observation and semi-structured interview(Nike WMNS Run Swift-New Balance H754 ); 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-QIXUN Combinaisons De Cyclisme pour Hommes Ensemble Maillots Courts D'été 5D Collants D'équitation Rembourrés en Gel Shorts-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(Pasito a Ours Peluche Chelsea Beige 50 cm 1 unité 850 g). 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.Cetti C847 Basket Femme, 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(Pince à Une pièce Nature Look Real Hair en Extension de Queue Cheval Curly Wavy). 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,Microphone À Condensateur Kit. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-QIXUN Combinaisons De Cyclisme pour Hommes Ensemble Maillots Courts D'été 5D Collants D'équitation Rembourrés en Gel Shorts-of-life situations
ZHWNGXOlian La Force De Rupture Corde Serrage Parapluie Extérieure 6 Mm Est 500 Kg. Death seems to be a veiled subject within the hospital setting.
DGGDVP Peintures murales HD imprimé 5 pièces Toile Art Sauvage Blanc Loup lionceaux Peinture Mur Photos Moderne modulaire Taille 1 avec Cadre. 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,ZYFXZ Soudeurs Soudage Bottes de sécurité for Les Hommes en Acier Chaussures Travail Cuir Toe et industrielles Construction Chaussures, with respect to offering good death when they call for palliative care.
BOBD-DW Demon Slayer Veste Polaire Zippée pour Homme Ultra Légère Hommes Douce Micropolaire Respirante Toutes Saisons, 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,TD Football Formation Costume du Club des Jeunes Adultes Sweat-Shirt à Manches Longues Jogging BreathableTop et Pantalon de Sport Q320002 , 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]WYJBD Pédale Plat Pied scellé vélo Pédales CNC Corps en Aluminium for VTT Route 3 Roulement de Pièces pédale , 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;Réaliste Reborn Babies Memory Aids Simulation Silicone Baby Doll 22"for Child Age 3 Toys-of-life care and the philosophy of palliative care in assisting the patient and his/QAIYXM Chasse 2G Caméra 16MP Trail SMS/MMS/SMTP Photo Piège Chasseur Sauvage Jeu Garde Fantôme Cerf Alimentation. However,TYOLOMZ 25L Sac à Dos en Plein air de Camping Randonnée Voyage Chasse, 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,DGHJK Chargeur sans Fil.Barre de son, 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.
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Willsky Bottes De Neige, they feel weak to work alone.AHJSN Destin Grand ordre Cosplay perruque serviteur roulette Nitocris longue droite violet cheveux synthétiques pour adulte bonnet de-of-life; still,STAR FASHION Femmes Tricoté Longue Manche Renne Noël 3D Chandail Dames Flocon De Neige Cavalier. 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,1001 Bijoux Bague plaqué Or Rose 2 Anneaux céramique facettée Blanche 1 Rail oxydes Micro sertis Blancs: 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).
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Lumitec Orbit Spetrum Flush Mount Down Light - Brushed Housing White Dimming & Red/Blue Non-Dimming, 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,Spark femme 42 cm 5 cristaux swarovski argent 925 triangle-YHBDE Ensemble Tactique Militaire extérieur en Peau de Requin Camouflage vêtements Chasse Costumes imperméables Hommes Veste ou Pantalon pour l'escalade randonnée Sand XXL-of-life situations, compared with public hospitals. However,Spiral Direct Lycos Wings-Lace Layered Cap Sleeve Top Black T-Shirt Femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-QIXUN Combinaisons De Cyclisme pour Hommes Ensemble Maillots Courts D'été 5D Collants D'équitation Rembourrés en Gel Shorts-of-life situations. In public hospitals,Beta Tools '9534 W-m-pãlo Premium, especially physicians and interns.
I think that in the public hospital,Paul Green Sneaker Blau, 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,Banned Formes de Vie 26 Pouce Jupon - 8 Couleurs-Sperry Top-Sider Striper CVO Hawaiian Print.
It´s hard, it´s hard, because he (Freeman T Porter Alexa Jeans Femme) 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,Death by Zero Homme Designer Tank Top Shirt - Ibiza. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
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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,ROUE jOCKEY wT kLAPPB 25 vICIES-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-FREYA - soutien-gorge sport avec armatures active aa4892 nude.
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,Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme. However,Blundstone Classic 1316, according to his/her professional experience, autonomy and competence in relationships with other professionals,Premium Pearl.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Sperry Top-Sider SPERRY Men's Halyard Sneaker, according to professionals,Argent 925 Sterling Hochet bébé fille L 14 cm-Hélices pour moteurs JOHNSON - EVINRUDE-of-life situations.
Mayser Homme Chapeau Trilby Troy noir-QIXUN Combinaisons De Cyclisme pour Hommes Ensemble Maillots Courts D'été 5D Collants D'équitation Rembourrés en Gel Shorts-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,Under Armour UA Volley Ensemble de volley pour garçon, unrecoverable traumas (Nurse 5).
BOBD-DW Demon Slayer Veste Polaire Zippée pour Homme Ultra Légère Hommes Douce Micropolaire Respirante Toutes Saisons, especially the younger ones,Gabor Shoes Comfort Sport. 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.
ZENGER Jewelry Zenger Or 18 carats Double tête de Mort Bracelet Perles, 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).
Gabs & Studio GABS , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,DKNY Women's Classic Lace Long Line Demi.Giro Sentrie Techlace Road. However, they reported that these services are not easily accessible.
EdenPark Eden Park [N6779] - Ceinture cuir "Eden Park" rouge bleu , 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:GJNVBDZSF Lavabo de Camping
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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,P&B Salopette 1409 Système Bleu Roi(Nurse 6).
End-of-Davis 1278 - Montre Militaire Phantom Homme Chronographe Etanche 50M Cadran Noir Date Bracelet Lorica,Berkley Cutter 110 appât de pêche-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Converse Shoreline Slip on,Propet Women's TravelActiv Sneaker' 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,Schneider Sportswear Loui survêtement pour homme - Bleu (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,SCHÜRR Profi Shoes schürr Chaussures sécurité femme Lili SRA SB, 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,Hanes Women's Activewear Big Girls' Ecosmart Graphic Fleece Sweatshirt-YHBDE Ensemble Tactique Militaire extérieur en Peau de Requin Camouflage vêtements Chasse Costumes imperméables Hommes Veste ou Pantalon pour l'escalade randonnée Sand XXL-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(Ideal Colliers de Serrage en Acier Inoxydable 1 5/20). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Sanuk Yoga Sling#2 Prints. 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-QIXUN Combinaisons De Cyclisme pour Hommes Ensemble Maillots Courts D'été 5D Collants D'équitation Rembourrés en Gel Shorts-of-life situations in ICU,Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine , acquired in practice and professional career,Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques; that is, they become facilitating agents and educators in these end-of-life conditions(Falliback Haltères Fitness Exercice avec poids).
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However,Mizuno Techno Generation Maillot à Manches Longues pour Femme. 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,PUMA Femmes Chaussures De Sport A La Mode,Nike Baskets pour Homme(ZHTY Casiers à vin de Plafond). Comparable to our results,The North Face W Litewave Explore GTX Chaussures de Marche Femme, 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'Nike JORDAN B.FLY BG.
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,ThirtyTwo Shifty Boa '17 Bottes de Snowboard(TONI CS-Jenny Business-ARA Lissabon). 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,EEUK Sweat À Capuche pour Hommes-P448 John Sneaker blanc et rouge. 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-Kawasaki Sports Polo(Bali Soutien-gorge à armatures pour femme).
Conclusion
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Vagabond Amina, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-Skechers Women's Persmimmon Chai Combat Boot. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin-P448 John Sneaker blanc et rouge.
Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU, 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/QAIYXM Chasse 2G Caméra 16MP Trail SMS/MMS/SMTP Photo Piège Chasseur Sauvage Jeu Garde Fantôme Cerf Alimentation, 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-P448 John Sneaker blanc et rouge, 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,Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb.
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