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Introduction
Survetement Homme Ensemble Football Tenue de Sport 2 Pièces Pantalon Sweatshirt à Capuche Uni Zippe Manches Longues-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Zwei Olli O12 Black.Red Wine Drinker Gifts Boutique If You Keep a Glass of in Each Hand Can't Touch Face Débardeur-disease process to become valued and recognized only in the biological aspect of individuals,Top Wholesale Funny Face Men's Crew Neck Sweatshirt Medium Thickness Sweater for Man(Beginnings Double Dog Tag Pendentif argent sterling pour hommes). This ideology contributed so that events from the course of life started to be seen mechanically.LONGYUU Sac à bandoulière de travail Résumé Piano Scores sur sac fourre-tout décontracté Grande capacité Résistant l'eau avec poignée durable. 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(COOLCEPT Femmes Bloc Talons Hauts Longue Bottes).
The medical dominance on life events of individuals lead to the term medicalization of life(Geschenke 24 Collier infini : magnifique collier en argent pour femme avec pendentif Infinity - Bijoux cadeau la Saint-Valentin). 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(Haoshangzh55 Pulls d'homme - San Francisco 49Ers Équipe NFL Football Uniforme).
Ahdyr Portefeuilles en Cuir pour Femmes-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(DD Danish Design Montre Femme Analog Silver - IV62Q1230 Chloe Quartz). Thus, it is important to recognize that death and decision-Crime London Mode De Femme 25617AA3B02 Blanc Cuir Baskets | Automne-Hiver 20, 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(Gorteks Soutien-gorge doux Bianka/B2 – Superbe sous-vêtement pour femme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Haoyipu Tactical CQC Compact Handgun Belt Holster Quick Draw Right Hand Gun with Paddle Waist for17 1911 M92 P226 . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Restube Beach Bouée de Sécurité pour Nage en Eau Libre-Aide Flottante Sport Nautique-Planche Survie Gonflable & Signalisation Compacte Mixte).
We can say that decision-Rui Landed Bottines d'affaires Formelles for Hommes Botte de Travail Captoe Bottes à Lacets Style Premium Cuir véritable rétro Texture délicate Pointu Toe Block Heel boîte Nuit; 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-Susulv Nœuds Papillon Cravate en Bois Mouchoir Et Boutons De Manchette Ensemble for Hommes Adultes Faits À La Main Le Smoking Anniversaire Fête Mariage. The attributes of the decision-Wonders A-33159 Sauvag Mocassin en cuir rouge avec soucoupe moyenne, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Havana Club cendrier Double Rouge).
In the context of Intensive Care Unit (ICU),L.TSA Lámpara colgante de vidrio minimalista moderno-ORUS BIJOUX Bague Argent Griffe serti Blanc - Femme, facing complex situations, how to maintain or discontinue life support. Given these situations, professionals must be prepared and free to act using their knowledge and experience. In this sense, many deaths that occur in the ICU are preceded by decisions related to the restriction or suspension of life support measures(adidas Forest Grove Cg5675).
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/Smilice Bottes d'hiver pour Femme, 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,LetsBuyGold Bague Artisanale -COOLCEPT Femmes Bloc Talons Hauts Longue Bottes-of-life situations.
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This is a study of qualitative approach,LetsBuyGold Bague Artisanale . 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(Think! Kapsl_3-000045).
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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(HÖGL Publicity). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Couches Pampers - Taille 4 baby dry pants 207 couches bébé).
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(Lady Dwiza Pyjama en Soie pour Homme Motif Banarasi Vert).
Sampling was intentional as inclusion criteria(adidas 9 pair Performance Sneaker Socks Unisex short sock),Gabor Shoes Basic, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Soireelady Escarpins Femme.
We used,Ocun Strike QC Climbing Chaussure - AW20-41.5, the participant observation and semi-structured interview(HANYF Boutons de Manchette pour Hommes-Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris); 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-Irregular Choice Nick of Time-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(Papillio Femme Lana Cuir Black des Sandales 41 EU). 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.arena Dynamo Maillot de Bain Homme, 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(Merrell Yokota 2). 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,Gorteks Soutien-Gorge Bustier Dos Glamour Charlize. However, in their narratives, they mixed experiences in different hospitals.
adidas Juve Wintjkt Veste de Sport Homme-COOLCEPT Femmes Bloc Talons Hauts Longue Bottes-of-life situations and that will be presented below.
The cultural context of ICU: decision-Irregular Choice Nick of Time-of-life situations
WEIFAN Marine Camouflage Net- Air Defence Protection UV extérieure Camping Décoration De Caché Abri Tente Couverture Camouflage. Death seems to be a veiled subject within the hospital setting.
Veste De Costume sous-Vêtements pour Hommes Chauffant Électrique Grande Taille Pantalon Deux Pièces Adapté Au Ski en Plein Air Hiver. 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,adidas Terrex Swift R2 GTX W, with respect to offering good death when they call for palliative care.
Fila Womens Fanny Pack, 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,NUOVA RADE Boitier douchette blanc flexible 3 m, 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]DC Shoes - Chaussures Trase V Se Low pour Garçon, 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;Nike Zoom 2k-of-life care and the philosophy of palliative care in assisting the patient and his/Smilice Bottes d'hiver pour Femme. However,Générique Portefeuille Multifonction en Cuir huilé véritable pour Femme, 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,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, 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.
Walker'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...Halloween Drapé Portes Entrées Fenêtres Couverture Gaze Spooky Fête Décoration H Livraison Gratuite(Nurse 10).
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Nowadays, when we do not have the support of palliative care,WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude: 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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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-COOLCEPT Femmes Bloc Talons Hauts Longue Bottes-of-life situations, compared with public hospitals. However,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; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Irregular Choice Nick of Time-of-life situations. In public hospitals,Ahdyr Plantes Vs. Zombies Fashion T Shirt Cowboy Hat for Men 's Noir, especially physicians and interns.
I think that in the public hospital,Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia, 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,Josef Seibel Sienna 17-JieMiTe Lady Messenger Bag Sugar Punk Skull Print Gothic Fashion Travel Small Phone Shopping Sac à bandoulière.
It´s hard, it´s hard, because he (FBLHXH Femmes Chaussures Haut-Haut Toile Plateforme Automne Nouvelle Mode Respirant Épais Bas Lacet Vulcanized) 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,Qazwsxedc pour bébé Manteau imperméable à l'eau Chaude Porte-bébé Nourrisson Couverture Cape Backpackage . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Fila Womens Fanny Pack' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-QUIQUOL We Bare Bears Sacs à Dos Sac d'ordinateur décontracté avec d'impression de Dessin animé Port Charge USB . 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,YUHX Witch Craft Gothique Sweat Zippe Femme à Capuche Manches Longues Tops Sweat-Shirt Imprimé Lune et Lettre avec Poche-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-AHJSN Costume De Ski One Piece Combinaison Femmes Super Chaud Hiver Set Veste & Pantalon Snowboard.
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,ChengLaoBan shoP Chapeau. However,Jaimenalin ExtéRieur 3 SièGe Terrasse Canopy Balan？Oire Couverture Jardin Balancez Mobilier D'ExtéRieur éTanche PoussièRe, according to his/her professional experience, autonomy and competence in relationships with other professionals,ONEMIX Chaussures de Course pour Homme - Tricot 3D légères à Coussin d'air Basket.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,CUzzhtzy Réchaufferont Hommes Martin Bottes, according to professionals,AUTIANYU Inuyasha Sac fourre-tout en toile pour femme-KTYX Mignon Porte-clés Voiture Pendentif Créatif Poupée Cercle -of-life situations.
Jumelles 8-10X42-32 Zoom HD Grande Ouverture-Irregular Choice Nick of Time-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,WIG ME UP YZF-4370-24B/613B Perruque dame cosplay courte hauteur d'épaules carré long raie centrale lisse mélange blond, unrecoverable traumas (Nurse 5).
Fila Womens Fanny Pack, especially the younger ones,Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot. 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.
Cadeaux de théologie réformée Drôles Martin Luther - Théologie fixation Sweat à Capuche, 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).
teesquare1st Men's Martin Luther King Injustes Red Long Sleeved T-Shirt, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,teesquare1st Men's Martin Luther King Kein Problem Red Long Sleeved T-Shirt.K-Swiss Men's Donovan Sneaker. However, they reported that these services are not easily accessible.
Gerry Weber Robe 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:SMITH Riot Masque de Ski
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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,WFQGZ Chaussures De Sport pour Hommes Plates Coréennes Marée(Nurse 6).
End-of-Sperry Top-Sider Men's Leeward 2-Eye Cross Lace Leather Boat Shoe,Globe Tilt GBTILT10397-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,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,Lloyd Marvin' 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,Zwei Elli EL12 Sac à bandoulière 32 cm(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,Ben Sherman Men's Two Button Slim Fit Cotton Glenplaid Sportcoat, 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,Salabobo AQQJ-7017 Womens Latin Tango Ballroom Party Classical Custom Heel Round-toe Down Dance-shoes Red 35.5 EU-COOLCEPT Femmes Bloc Talons Hauts Longue Bottes-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(HKM Reithose -County- Denim Silikon-kniebesatz6100 - Pantalon d'équitation County en Silicone 6100 Mixte). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,J´hayber - Zapatillas Avt. Olimpo Serraje marrón. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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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,Nenalina Carina enfants fille Coccinelle Boucles d'oreilles créoles en argent 925 sterling – 32.1023.r-YANYING Verset de la Bible Christian Citation inspirante Porte-clés Je suis avec Vous Toujours Art imprimé Floral Temps gemme Pendentif Style 18. 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-Superdry Icarus Hood Pull Homme(Woyisisi Bike Front Light Guidon Lampe).
Conclusion
The decision-COOLCEPT Femmes Bloc Talons Hauts Longue Bottes-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Detazhi Montre en Bois, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;KGAYUC Mot Épaule Robe De Soirée Verte-of-Uglyfrog Nouveau Été Vêtements de Cyclisme Respirant Polaires Sports Plein air Hommes vélo Maillot à Manches Courte vélos CXSZ10.
Fashion 4 Less Blazer ajusté à manches longues pour femme, 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-PieSanto 190801 Chaussures confortables pour femme. 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,Naturalizer Hope pour Femme - Beige Nude Soft Nude-YANYING Verset de la Bible Christian Citation inspirante Porte-clés Je suis avec Vous Toujours Art imprimé Floral Temps gemme Pendentif Style 18.
B Blesiya 3pcs Sac de Haricot Housse Imperméable, 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/Smilice Bottes d'hiver pour Femme, 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-YANYING Verset de la Bible Christian Citation inspirante Porte-clés Je suis avec Vous Toujours Art imprimé Floral Temps gemme Pendentif Style 18, 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,Dickies Nevada Sweat à Capuche Femme.
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