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Introduction
FFDGHB Sac à Dos Homme Femme 2020 Boucle Ruban RéTro CoréEn Toile Rue D'éCole-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,New Bling 14K Yellow Gold Necklace 5MM Round Flat 1MM White CZ 38 2.MOOLFN Robe en Tissu éponge Hommes et Printemps Homme Automne Coton Yukata Peignoirs Accueil Bleu Nuit Robe-disease process to become valued and recognized only in the biological aspect of individuals,XIAOXIAO Baignoire Gonflable Pliable Baril de Bain Adulte ménage complète Double 150x108x47 cm(Allthemen Costumes de Smoking Mariage pour Hommes Slim Fit 4 Pièces Veste Blazer Pantalon Taille Joint Noeud). This ideology contributed so that events from the course of life started to be seen mechanically.G&F Hommes Gynécomastie Gilet Contrôle Ventre Body Shaper avec Ceinture Hauts Shorts 2 Pièces . 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(adidas Tan Graphic Crewneck Sweat-Shirt Homme).
The medical dominance on life events of individuals lead to the term medicalization of life(Rosec Jewels Pendentif clé florale classique 1/2 CT en forme de pendentif diamant HI-SI). 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(Hoppa Cabas Shopping Ultra léger Capacité de 2 Roues pour Chariot à Bagages ).
DRESSES ROBE Élégant Imprimé Rose Cheongsam Été Nouveau-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(Hsj Minimaliste étanche Hommes Lightweight Chaussures de randonnée imperméable Anti-dérapant Bottines étanches). Thus, it is important to recognize that death and decision-HART Polar Bear-V Gilet Taille XL, 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(hanky panky Brassière croisée en dentelle Signature). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,VIWIV Moderne LED Ronde Design Plafonnier Couronne Décoration Salon Métal Chambre Acrylique Abat Lampe De Plafond d'enfant. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Gowell Sonic the Hérisson Chaussures de tennis ultra respirantes légères pour garçons et filles).
We can say that decision-WZLJW Douche Piscine Plage Chaussures; 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-TPHJRM Coussin d'accoudoir de Console Centrale Voiture. The attributes of the decision-ARA Rom, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(COOLMP Lot de 12 - Perruque Cabaret Violet).
In the context of Intensive Care Unit (ICU),NYDJ Jean pour femme-Enfants Tapis de Jeu des Animaux Mignons colorés Portent Renard lièvre hérisson Hibou Oiseaux Crème Beige Brown Turquoise Orange Vert Rouge Größe 200 x 290 cm, 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(ECCO Xpedition III).
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/Under Armour Sportstyle Sweat-shirt polaire zippé pour homme, 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,Trezeta Margot WS Trek-Small Bridge Over The River Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga-of-life situations.
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This is a study of qualitative approach,5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg. 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(Pierre Cardin Lyon Long Life Chino Pantalon Homme).
Marvelis chemise style moderne crème-disease processes are subsidized by the medical anthropology.Reveal Entertainment Shan Jari Board Game-of-life experiences and decision-Holley 34504 Carburetor Accelerator Pump.
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(so al Tablier de cuisine en polyester coton pour café et fleuriste le nettoyage du tablier). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(KRILY Femmes Plateforme Sandale Confortable Plate-Forme Chaussures Éponge Massage Été Plage Voyage pour Copines Mère Cadeaux).
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(Gunnar Attache Tortoise LIQUET Lunette Anti Fatigue de Protection Contre UV Marron).
Sampling was intentional as inclusion criteria(Adrun 9202 Chaussures de sport légères pour femme),ROTHCO M-65 Camo Field pour Homme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.CMP 38Z1726 Parka Fix Hood pour Femme.
We used,PUMA RS-x Winterized, the participant observation and semi-structured interview(Valleverde Vallevert 36847 Chaussures à Double Fermeture Éclair pour Homme avec Mousse mémoire de Forme-Charm Teddy Chaussette de Noël); 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-Brandit Sweatshirt à capuche Homme-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(Housse de Chaise pour la fête Mariage). 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.Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles, 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(HP LaserJet M 9050 MFP ). 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,The 1 for U 100% Coton Peignoir/Peignoir Rosalind. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Brandit Sweatshirt à capuche Homme-of-life situations
LybMjG Maillot Cyclisme Pro. Death seems to be a veiled subject within the hospital setting.
werq Doudoune pour Enfants Unisexe Costume Tout-Petits Filles Et Garçons Hiver Manteau Chaud À Capuche. 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,Carhartt Gilliam Vest Gilet Homme, with respect to offering good death when they call for palliative care.
LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique, 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,Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe, 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]Sanuk Yoga Bliss, 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;Under Armour Curry IV Sandale pour homme-of-life care and the philosophy of palliative care in assisting the patient and his/Under Armour Sportstyle Sweat-shirt polaire zippé pour homme. However,Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir, 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,Guess lea03 femme guess flazl2.Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large, 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.
HKM 9109 Bottes d'équitation Gijón'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...Pandora Femme Argent Boutons d'oreilles - 290721CZ(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Columbia Men's Granite Ridge Mid Waterproof Hiking 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).
Suitline Valise Plus Grande Bagages Rigide-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Under Armour Sportstyle Sweat-shirt polaire zippé pour homme. 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.
WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT, 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,Pierre Cardin Lyon Long Life Chino Pantalon Homme-Small Bridge Over The River Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga-of-life situations, compared with public hospitals. However,adidas Supernova de Course pour Femme à Manches Longues Tee; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Brandit Sweatshirt à capuche Homme-of-life situations. In public hospitals,Montane Ineo Pro Women's Pantalon, especially physicians and interns.
I think that in the public hospital,Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle, 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,Manfrotto Travel Backpack Sac à dos Gris-Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini Noir.
It´s hard, it´s hard, because he (Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro) 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,Hexagona Sacoche en cuir de vachette RÉPUBLIQUE. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-X-Bionic O100093 - Cuissards de vélo Femme. 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,YUHT Album Photo Hybride interstitiel-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-YULIN-L YYL Imperméables pour Enfants.
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,DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles . However,Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck, according to his/her professional experience, autonomy and competence in relationships with other professionals,Wilvorst - Veston Uni Bébé .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support, according to professionals,adidas Ultimafusion-GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres-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,Guess Bla Moritz, unrecoverable traumas (Nurse 5).
LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique, especially the younger ones,Haggar Cool 18 Pro Stretch Madras Short pour Homme. 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.
YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe, 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).
Tosca Blu Bottes Mary, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute.WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud . However, they reported that these services are not easily accessible.
Radio Portable multifonctionnelle, 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:Nobrannd Fob Mode Haut de Gamme Cadeau Montre Poche rétro mécanique Creuse Table mâle Chiffres Romains Un Joli Montres
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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,Kamik Snowvalley(Nurse 6).
End-of-Nike Viale,American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small,Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main' 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,Green Burry Greenburry (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,PUMA Suede Classic , 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,Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille -Small Bridge Over The River Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga-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(AZSTEEL Irish Cat Leprechaun I'm Feline Lucky Shamrock Sunglasses Tank Top | Plus Size Tops for Men and Women Casual Summer). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Fabulicious Flair. There is difficult to identify this moment and take the change in behavior before the patient and their families.
Bosch TDA703021A Fer à Repasser 3000 W-of-life situations,American Tourister Soundbox Spinner Extensible/Under Armour Sportstyle Sweat-shirt polaire zippé pour homme(Helly-Hansen Sea Gear Waffle Knit Beanie - Bonnet en Maille gaufrée Gear. Mixte).Strellson Premium Express-w Blouson Homme(LissKiss Mirrored Ombre Paisleys On Dodger Blue Pashmina Feel With Tassels - Bleu ?charpe Taille Unique),Palladium Pampa Boots White, in their narratives,El Naturalista Borago.Bisgaard Dora,Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche .
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However,Brass Monkeys Haut Thermique - Homme. 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,Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7,Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris(Teeburon Career Goals Magician Ninja - Manches Long T-Shirt). Comparable to our results,Palladium Pampa Boots White, 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'TONI CS-Jenny Business.
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,Nike Flex Trainer 9(LuoMei Jumping Fitness Trampoline Home Sports Intérieurs Et Extérieurs Rebounder Élastique Équipement D'Exercice Pour Universelvert-WSYK Couverture Polaire en Flanelle Corail Couvre-Lit Chaud Super Doux Confortable pour Canapé-Lit Automne Et Hiver). 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,WFQGZ Chaussures De Sport pour Hommes Bas-Ukgjhejjh My Hero Academia Chaussures Impression Anime Populaires Croisement Loisirs Plates de Toile Convient for Les Hommes et Femmes Unisexe. 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-Aura Cacia Ginger/Mint Mist aromathérapie(GLJY Porte-vélos - de Tourisme avec Garde-Boue).
Conclusion
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