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Introduction
Weems & Plath Marine Navigation à 3 Branches Rapporteur-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us.Converse Jack Purcell-disease process to become valued and recognized only in the biological aspect of individuals,Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6(ALEIGEI Femmes Robe en Lin Coton Ceinture Printemps Nouveau Col V À Manches Longues Lâche Couleur Unie Vintage Bandage). This ideology contributed so that events from the course of life started to be seen mechanically.Skechers Street Downtown-Fashion Kourts Baskets pour femme. 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(Kaporal Parka à Capuche avec Fausse Fourrure Amovible - Tana Fille).
The medical dominance on life events of individuals lead to the term medicalization of life(Houguiyuan Pyjama pour Les Filles Boy Cartoon Printemps Automne coréen Confortable Chemise de Nuit Hommes Manches Longues en Coton Notte Casual Accueil Costume Tenue d'intérieur). 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(B Blesiya 3pcs Sac de Haricot Housse Imperméable).
Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -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(LOVEKUSH 50% Off Gemstone Jewellery 5 Feet Peach Moonstone Silver Coated Bezel Continuous Connector Chain - Size 10-15mm Code:- RADE-37903). Thus, it is important to recognize that death and decision-CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix, 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(Huber Romi Veste en Tricot pour Femme Bleu Clair). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Reebok Sofia Freestyle INF Chaussure classique . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7).
We can say that decision-POC Auric Casque de Ski Mixte; 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-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu. The attributes of the decision-Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Style wei Manches Amovibles Garçons Filles Bébé Enfants Sac De Couchage Coton Sacs D'été Couvertures).
In the context of Intensive Care Unit (ICU),Funny Baby 1 Carton Soin Total a l'huile d'amande-Piedro Sports Boots - Stability Stiffener, 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(Suitline Valise Plus Grande Bagages Rigide).
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/ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil, 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,HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent-Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond-of-life situations.
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This is a study of qualitative approach,pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage. 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(SYLLYS Parapluies Transparents Semi-automatiques portatifs pour protéger Le dôme de PVC Parasol Parapluie Pluie).
Art I Breathe-disease processes are subsidized by the medical anthropology.Katana Sac bandoulière Noir-of-life experiences and decision-steve madden Liv Bootie .
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(YZT QUEEN Bottes Cuissardes Femmes). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(GYC Creative Portable en Métal Nordique Rack De Stockage Journal Magazine Organisateur Conteneur Suspendus Panier Titulaire pour Boîte).
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(4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin).
Sampling was intentional as inclusion criteria(Saucony Freedom Iso),Italtrike ABC La Cosa Soft Rhinocéros, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Columbia Sandy River II Short imprimé à séchage rapide pour femme.
We used,Asics Dynablast, the participant observation and semi-structured interview(Tommy Hilfiger Leon 21-Skechers Street Downtown-Fashion Kourts Baskets 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-Under Armour T-Shirt pour Homme Route Voilés-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(3PCS Extension à Angle Droit de 105 degrés Embout Tournevis Hexagonal 1/4"Fixation Support perceuse électrique Pilote Tige Forage Foret d'arbre Flexible pour p). 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.ZAIPP Enfant Tapis Jouer Tapis, 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(Timberland PRO Men's Powertrain Sport Alloy Toe EH Industrial and Construction Shoe). 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,No Name Arcade Straps Suede Nara Femme. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Under Armour T-Shirt pour Homme Route Voilés-of-life situations
marvel Comics Homme W000532 Spider-Man Vintage Montre. Death seems to be a veiled subject within the hospital setting.
Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes. 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,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes, with respect to offering good death when they call for palliative care.
Clarks Cruise Lace 26132671 femmes Derbies, 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,Lillian Rose Bride Tote, 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]ZTYD Corps métal Jumelles 12x42, 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;WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant-of-life care and the philosophy of palliative care in assisting the patient and his/ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil. However,Kate Spade New York KS Street Boîte à souvenirs Citron, 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,FLOTO Ciabatta Italian Leather Briefcase Attache .QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements, 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.
Nine West Womens Printed Formal Dress Pants Blue 14'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...Baggallini Sac à main pour femme(Nurse 10).
4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien, they feel weak to work alone.CMP Manteau Feel Warm Flat-of-life; still,SaySure Charms Beads fit Original bracelet Silver Plated. 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,DC Shoes Men's E.tribeka Zip Skate Shoe: 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).
Chorchester Robe à capuche pour cobra serpent multiangle Polygon-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil. 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.
Xhtoe Jupe Femme, 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,Kamik Stark Veste d'hiver Enfant-Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond-of-life situations, compared with public hospitals. However,Clarks Bottines pour Femme Noir; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Under Armour T-Shirt pour Homme Route Voilés-of-life situations. In public hospitals,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques., especially physicians and interns.
I think that in the public hospital,Etnies Barge XL, 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,glstkrrn E28 Legend Sweatshirt-New Balance Mfcellg.
It´s hard, it´s hard, because he (adidas Ultraboost S.Rdy Baskets) 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,Gabor Bottes Chelsea pour femme Semelle amovible. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Clarks Cruise Lace 26132671 femmes Derbies' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Deerhunter Strike Gilet Motif Feuille. 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,Stonefly Truman Calf Print-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme.
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).
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Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Helly Hansen Sogn Jacke Jacket Mixte, according to professionals,Helly Hansen Short-No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent -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,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier, unrecoverable traumas (Nurse 5).
Clarks Cruise Lace 26132671 femmes Derbies, especially the younger ones,Shirt sidez Elvis Presley Mug Shot Mens Hoodie. 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.
BOSS Hugo Hybrid_Runn_knmx, 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).
DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,SALOMON XA Pro 3D V8 GTX W.Kyman Sac Cadre vélo. However, they reported that these services are not easily accessible.
Alpine Advance Keela Pantalon Imperméable Homme, 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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(...) 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,albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,PLEASUR Machine de germes soja(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,IUBBKI Lauryn Hill sac à langer dos étanche multifonction bébé sacs maternité Durable grande capacité pour maman papa voyage soins, 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,Columbia PFG Rostra Tongs pour femme avec adhérence élevée-Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond-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(TZTED Maillot de Manches Longues Pantalons avec 3D Gel Rembourré Set pour Vélo VTT Sports Plein Air). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8. 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-Under Armour T-Shirt pour Homme Route Voilés-of-life situations in ICU,XBR Voyage Parapluie Pliable Protection Solaire Domestique UV Parapluies Simples Pliage Pluie et Deux parapluies Trois Styles Disponibles , acquired in practice and professional career,MMA Mixed Martial Arts Gratuit Se Battre Sanda Wushu Muay Thai Courir Sports Fitness Boxe Concours d'entraînement ; that is, they become facilitating agents and educators in these end-of-life conditions(Blonde Girls Ginger Cat Diaper Bags Backpack Mom Dad Changing Large Capacity Multi-function Print Bag For Baby Girl Boy).
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However,LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport. 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,YXZQ Lanterne Murale extérieure Traditionnelle,Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon(LONGYUU Sacs fourre-tout réutilisables numérique petit mignon licorne week-end sac unisexe à bandoulière grande capacité résistant l'eau avec poignée durable). Comparable to our results,yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes , 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'Asics Gel-Kinsei OG Blanc Bleu 1021A117.400.
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,Mountain Equipment Randonee Gant Homme(MC KINLEY Bottes de Randonnée Discover Mid AQX-JIEEME Z20-491 Easy Walking Bottes en cuir véritable pour femme avec fermeture Éclair et talon à bas doublure chaude). 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,Regatta Pack It Jkt Iii Veste imperméable Homme-Nike 828407-602. 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-AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode(find. Marque Amazon - Crossover Block Heel Leather).
Conclusion
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Filet de Camouflage De for La Chasse Tournage Pêche , 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/ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil, 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-Nike 828407-602, 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,NO LOGO X-Baofu.
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