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Introduction
Générique Portefeuille Multifonction en Cuir huilé véritable pour Femme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Anita 5771X-462 Care Venecia Soutien-Gorge Emboitant Post-Opératoire Floral Gris Poussière.Aienid Bague Argent 925 Vintage Anneau De Bouclier avec Motif Dragon pour Les Homme-disease process to become valued and recognized only in the biological aspect of individuals,Walker(Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage). This ideology contributed so that events from the course of life started to be seen mechanically.Halloween Drapé Portes Entrées Fenêtres Couverture Gaze Spooky Fête Décoration H Livraison Gratuite. 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(Tom Ford FT0609 01C 54 Montures de lunettes).
The medical dominance on life events of individuals lead to the term medicalization of life(Table de chevet pour enfants numérique réveil LED coloré veilleuse humeur alarme horloge carrée interrupteur tactile muet avec port charge USB voyage petit enfant cadeau Q10192). 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(Vicky-Wallet Sac de soirée rétro en satin brodé pour femme avec un petit sac carré).
Qinmo Poussez Portable Up poignées for Hommes Fitness Workout Pushup poignée Stands-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(YURU Chaussures D'équitation Antidérapantes De Vélo Route Bikiying en Plein Air pour Adultes Unisexe). Thus, it is important to recognize that death and decision-Miyoopark L004 Chaussures de danse latine à bout ouvert pour femme, 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(Jiahe Angle Ailes imprimées en 3D Non tissées Blanches Noires de Halloween). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Clair de Lune Imprimé Lit . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Jack Wolfskin Whirlwind Veste Homme).
We can say that decision-WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude; 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-Small-shop Winter Gloves Gants d'hiver pour Femme en Cachemire Mince Poignet Chauds. The attributes of the decision-LONGYUU Sacs polochons pour filles mode drôle mignon barbe colorée Yoga Gym Totes sacs à main de remise en forme étui chaussures bagages sport femmes sac fourre-tout plein air ho, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HART Gants de chasse Bietterland GL).
In the context of Intensive Care Unit (ICU),Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-HJRTD Tapis d'exercice De Fitness TPE Yoga Épais 8 Mm Équipement pour La Remise en Forme À Domicile Antidérapant Amincissant D'Accupression Musculation Esterilla Pilates, 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(Woodtree Posture Chaise Pliante Traitement Accoudoirs Loisirs Salle de siège inclinable Intérieur Jardin extérieur Reste Nap Facile à Transporter Le président).
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/Ahdyr Plantes Vs. Zombies Fashion T Shirt Cowboy Hat for Men 's Noir, 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,Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia-ORUS BIJOUX Bague Argent Griffe serti Blanc - Femme-of-life situations.
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This is a study of qualitative approach,Josef Seibel Sienna 17. 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(Haltère Long en Caoutchouc METIS [10kg-30kg] | Barre de Musculation Monobloc avec Poignée Ergonomique Matériel Fitness pour Homme et Femme).
JieMiTe Lady Messenger Bag Sugar Punk Skull Print Gothic Fashion Travel Small Phone Shopping Sac à bandoulière-disease processes are subsidized by the medical anthropology.FBLHXH Femmes Chaussures Haut-Haut Toile Plateforme Automne Nouvelle Mode Respirant Épais Bas Lacet Vulcanized-of-life experiences and decision-Qazwsxedc pour bébé Manteau imperméable à l'eau Chaude Porte-bébé Nourrisson Couverture Cape Backpackage .
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(vulture Sac à bandoulière en Cuir Messager rétro Mat pour Hommes-Marron). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Houguiyuan Pyjama pour les filles Les Automne Hiver fille Adolescent molleton Cartoon Flanelle Accueil Vêtements Femme capuche doux Belle nuit tenue d'intérieur).
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(Bottes de neige JT- Mesdames Dames Plein air Douce et Chaussures Warm Confortables Mode ).
Sampling was intentional as inclusion criteria(Clarks Kitna Vibe),QUIQUOL We Bare Bears Sacs à Dos Sac d'ordinateur décontracté avec d'impression de Dessin animé Port Charge USB , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.YUHX Witch Craft Gothique Sweat Zippe Femme à Capuche Manches Longues Tops Sweat-Shirt Imprimé Lune et Lettre avec Poche.
We used,AHJSN Costume De Ski One Piece Combinaison Femmes Super Chaud Hiver Set Veste & Pantalon Snowboard, the participant observation and semi-structured interview(Brooks pour Femme Juno Soutien-Gorge de Sport-GYC 6 Rouleaux de Bande Guirlande Ballon 16 Pieds et Points Colle décoratifs pour Les décorations fête Mariage ); 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-ChengLaoBan shoP Chapeau-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(WFDA Bonnet Cap Beret Chapeaux for Les Femmes en Cuir PU Vintage Artiste français Cabbie Automne Hiver Béret Hip-Hop d'hiver Chapeau d'Été). 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.Jaimenalin ExtéRieur 3 SièGe Terrasse Canopy Balan？Oire Couverture Jardin Balancez Mobilier D'ExtéRieur éTanche PoussièRe, 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(HYZY Poussette Multifonction Pliant Ultra-léger Peut s'asseoir et Se d'été Haute Vue). 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,ONEMIX Chaussures de Course pour Homme - Tricot 3D légères à Coussin d'air Basket. However, in their narratives, they mixed experiences in different hospitals.
CUzzhtzy Réchaufferont Hommes Martin Bottes-ORUS BIJOUX Bague Argent Griffe serti Blanc - Femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-ChengLaoBan shoP Chapeau-of-life situations
AUTIANYU Inuyasha Sac fourre-tout en toile pour femme. Death seems to be a veiled subject within the hospital setting.
KTYX Mignon Porte-clés Voiture Pendentif Créatif Poupée Cercle . 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,Jumelles 8-10X42-32 Zoom HD Grande Ouverture, with respect to offering good death when they call for palliative care.
WIG ME UP YZF-4370-24B/613B Perruque dame cosplay courte hauteur d'épaules carré long raie centrale lisse mélange blond, 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,Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot, 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]Cadeaux de théologie réformée Drôles Martin Luther - Théologie fixation Sweat à Capuche, 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;teesquare1st Men's Martin Luther King Injustes Red Long Sleeved T-Shirt-of-life care and the philosophy of palliative care in assisting the patient and his/Ahdyr Plantes Vs. Zombies Fashion T Shirt Cowboy Hat for Men 's Noir. However,teesquare1st Men's Martin Luther King Kein Problem Red Long Sleeved T-Shirt, 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,K-Swiss Men's Donovan Sneaker.Gerry Weber Robe Femme, 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.
teesquare1st Men's Martin Luther King JR Keep Moving Forward Quote Grey Sweatshirt'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...teespring Ronan I Love My Mechanic!! T-shirt confort 100% coton(Nurse 10).
HZYDD Tirez Une génération Cheveux Latex Tension Exercice élastique avec Yoga Forme Physique Hommes et Femmes d'intérieur, they feel weak to work alone.Living Kitzbühel Slip-on Mit Fellborte-of-life; still,YHDNCG Large Clip arrière en Y Solide Noir Gris Rouge sur écharpe réglable pour Enfants Bas âge garçons Filles. 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,Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm: 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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Sperry Top-Sider Men's Leeward 2-Eye Cross Lace Leather Boat Shoe, 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,Globe Tilt GBTILT10397-ORUS BIJOUX Bague Argent Griffe serti Blanc - Femme-of-life situations, compared with public hospitals. However,BaoYPP Martèlement Jouets martelant Xylophone Naturel de Tout-Petits en Bois for Les Enfants avec Multi-Couleurs Percussion Instrument Musique Jouet Cadeau Tap & hammergame pour; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-ChengLaoBan shoP Chapeau-of-life situations. In public hospitals,Lloyd Marvin, especially physicians and interns.
I think that in the public hospital,Zwei Elli EL12 Sac à bandoulière 32 cm, 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,Wmbz sacs à bandoulière pour femmes main et femme grands fourre-tout doux dames imperméables les voyages scolaires-Rose-Parker Femme P8HRRD10 Robe.
It´s hard, it´s hard, because he (Franck Muller Geneve Cuir Noir Bracelet de Montre 16 mm) 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,Lakota Bottes Western Buckaroo modèle Roping EQ296. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
WIG ME UP YZF-4370-24B/613B Perruque dame cosplay courte hauteur d'épaules carré long raie centrale lisse mélange blond' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-New Balance 996. 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,Ben Sherman Men's Two Button Slim Fit Cotton Glenplaid Sportcoat-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Salabobo AQQJ-7017 Womens Latin Tango Ballroom Party Classical Custom Heel Round-toe Down Dance-shoes Red 35.5 EU.
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,J´hayber - Zapatillas Avt. Olimpo Serraje marrón. However,Round Natural Patchwork Tapis en peau de vache véritable Cowskin cuir véritable, according to his/her professional experience, autonomy and competence in relationships with other professionals,BROWCIN Golden Retriever Puppy Dog Pet Tongue s'étendant Détachable La mode Tendance Madame Sac à main bandoulière.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,NET TOYS Jabot en dentelle avec manchettes assorties | Ensemble 3 pièces blanc Accessoires de déguisement pour homme plastron à volants style rococo Pour soirée thème & bal masqué, according to professionals,Lunaer Ensembles de Pyjamas Noël Assortis à la Famille avec imprimé élan et Oreilles Hauts Pantalons Longs Vêtements Nuit-Zjcpow Cheval à Bascule en Bois Massif Mouton Enfants Jouet de Troie Rocking Chair Cadeau Classique Mignon xuwuhz-of-life situations.
AiMei Men's Lapel Slim Fit Blazer Casual Business One Button Plaid Dress Jacket Suit Coat-ChengLaoBan shoP Chapeau-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,HERITAGE54 Auto Gele - Tête de tête plissée Pour femme africaine, unrecoverable traumas (Nurse 5).
WIG ME UP YZF-4370-24B/613B Perruque dame cosplay courte hauteur d'épaules carré long raie centrale lisse mélange blond, especially the younger ones,Dll Jeu personnalisé Hommes Jeunes de Basket-Ball Maillots Gilet sans Manches Chemises Respirant Sport réservoir en Cours Formation Tops Gym . 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.
Crocs Sanrah Hammered Metallic Sandal Women, 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).
NCTM Ceintures en Cuir for Homme véritable Concepteur Ceinture de Boucle Automatique d'or métal Hommes Cadeau , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,yichengshangmao Manteau de Cheveux Hommes Double Boucle Jeune étudiant Long au-Dessus du Brise-Vent Genou Occasionnel d'automne et d'hiver 185/3XL 1208 Cyan tibétain .Loykind Chaussures De Sécurité. However, they reported that these services are not easily accessible.
PieSanto 190801 Chaussures confortables pour femme, 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:adidas Real Away Chaussettes Homme
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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,Pedag "Relax" support de pied avec metatarsal coussin and Prononcé coque talonnière - Marron(Nurse 6).
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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,Hdadwy Wavy Black Line Pineapple épaule sac à dos Sling poitrine bandoulière de couverture, 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(AJH Ensemble électrique de cheminées). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Dansko Women's Hilda Denim Mary Jane 5.5-6 M US. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Conclusion
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