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Introduction
Cakunmik Raquettes à Neige Plus la Taille des Plates Dames Bottes de Laine Coton-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Global Vision Lunettes de Soleil Nouvelle Attitude.NIHAOA Cravate de Mode Clip Costume Joker Red Deep Blue Hommes et Blanc Motif décoratif Chasse au Sol Noeud Papillon -disease process to become valued and recognized only in the biological aspect of individuals,Mdsgfc Hommes Chaussures Mode Chaud Hiver Bottes Automne Cuir Pour Homme Haut Top Toile Casual(HXiaDyG Oreiller De Cou Portable Coussin 3D en Peluche Imprimé Samoyède Husky Doge Alaska Chien ). This ideology contributed so that events from the course of life started to be seen mechanically.Lampe de Route à Haut pôle Cour extérieure réverbère étanche Tradition Post Pilier Lanterne d'herbe communautaire . 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(CYKABT Collier de lapin).
The medical dominance on life events of individuals lead to the term medicalization of life(New Balance Men's Roav V1 Fresh Foam Walking Shoe). 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(Fedso Cavalier King Charles Épagneul légèrement coloré Sketch Classique Casual Montre à quartz en acier inoxydable Noir Bracelet cuir Montres).
Walker Valentin Chapeau IBHT Femmes Cap Plein Air Scarf points imprimés style décontracté Pare-soleil extensible respirant Yoga chaud cou sommeil Couvre-chef ST 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(Nike Flex Trainer 9). Thus, it is important to recognize that death and decision-WEM Plafonnier LED carré ultra-mince moderne à intensité variable avec télécommande 3000K-6000K Éclairage pour enfants de chambre coucher Acrylique Abat-jour blanc Garçon Fille Chambre L, 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(Disney Valise trolley cabine Minnie Pink Vibes). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Metal.CH 2133.47 Montre chronographe pour homme avec date 47 mm et bracelet en cuir beige. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(CafePress BRIGHTGREYSAATOMY PJ pour femme).
We can say that decision-Yctze Volant de bateau; 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-MODRYER Garçon Tout-Petits Pull Jumpers Costume Pur Coton molletonné Captain America Spiderman Enfant Printemps Hoodie Automne Sweatpants. The attributes of the decision-XLAHD Relogio De Bolso Hommes Femmes Montre de Poche à Quartz Creux Phoenix boîtier sculpté avec chaîne Cadeau noël, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Asics Men's Gel-BND Sportstyle Shoes).
In the context of Intensive Care Unit (ICU),Bermnn Pikachu de LED Ménage Plafonnier Simple Chevet Plafond Lumières étude Chambre Lustre for Salon Salle à Manger Vestiaire Couloir Aisle d'enfant Kindergarten-Marc New York by Andrew Men's Bergen Ultra Stretch Packable Jacket, 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(Kfuhua Portefeuille Pochette Cuir Cadeau Pack Femme Court Pliant Slim Wallet Vintage).
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/SWIMS Mocassins en Dentelle Stride pour Hommes, 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,Bohrcraft perçage Craft 41550302000 masch. filetage HSS-G DIN 376 HSS Bague Bleu E VAP M 20 forme C/RSP 35 ° en pack de Split-My Fair Lady Pure Saree pour Femmes Kanchipuram Kanjivaram Brocade Pattu Sari Handmétier à main Banarasi Soie Tussar Silk Mysore-of-life situations.
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This is a study of qualitative approach,BERSAGLIO MOBILE BATTENFELD Holster - ÉTUI pour Pistolet Sig Sauer P226 BM. 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(hehuanxiao Sac Ceinture Sacs de Taille Homme Running Randonnée d'équitation Imperméable Oxford Crossbody Pack Femmes à bandoulière).
Powerslide R4 Trinity Rollers-disease processes are subsidized by the medical anthropology.HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine-of-life experiences and decision-LongDD T-shirt de football américain uniforme la Nouvelle-Angleterre Patriots Hightower #54 Maillot Gruby Tee Shirts - X-Large.
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(Bike Combinaisons Cyclistes d'été à Manches Longues pour Hommes Le vélo de Plein air). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(LPudding La nouvelle mode de rue européens et américains foulards musulmans couleur unie foulard arabe hijab vent national).
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(YXZQ Accueil Deco Suspension Creative Lustre Globe Métal Creux Rétro Plafonnier).
Sampling was intentional as inclusion criteria(MTX Ltd Vintage Etnico Ricamo Lana Femminile Caldo Fiore Lunga Sciarpa Autunno e Inverno All'Aperto Multifunzionale Fgreyion Tendenza Selvaggio Scialle Dono Sciarpa),LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Cwypxl Santiag Femmes Western PU Botte Cowboy Talon Casual Chic Cowgirl Boots Haute Chaussures Chelsea Pointu à imprimé Serpent Couleur mélangée.
We used,Delavi Self Medication T-Shirt Femme Noir Women's Black, the participant observation and semi-structured interview(lepni.me T-Shirt pour Fille/garçon Personnalisé J'étais Normal Texte personnalisé Il y a Un Cadeau-DOUCAL'S Chaussures - Noir); 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-HAIK Route Pédale Auto-Verrouillage à Double Face Multi-Angle léger de Verrouillage Lollipop Equitation Pédales Vélo -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(L@YC Chaussures pour femme à talons hauts et sangle de cheville bout pointu fermé talon haut | Taille 36 38). 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.ACEACE Nouvelle Femme Sexy Danse du Ventre Costume Set Indien Professionnel Robe Lady vêtements de Porter Pratique/Performance 4 Couleurs , 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(Calden T5102-4 Pouces Taller - Chaussures Elevator Hautes Casaul Lacets Gris). 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,GET Combinaison de Ski Une Pièce pour Femmes. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-HAIK Route Pédale Auto-Verrouillage à Double Face Multi-Angle léger de Verrouillage Lollipop Equitation Pédales Vélo -of-life situations
VIPbridal Boho Robe Fille Fleur Princesse Demoiselle d'honneur. Death seems to be a veiled subject within the hospital setting.
PUMA TSUGI Disc. 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,Favorite White Bird Canne à pêche spinning Ultra Light pour perche/truite/chevaine, with respect to offering good death when they call for palliative care.
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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]Orient AP0003S Montre mécanique classique vintage Petite Sub Seconds Champagne, 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;FB Fashion Boots 14902-of-life care and the philosophy of palliative care in assisting the patient and his/SWIMS Mocassins en Dentelle Stride pour Hommes. However,ZIYOU Argent Sterling 925 avec Pierre Porte-Bonheur Charms pour Bracelet Pandora Joyeux Anniversaire 12 Couleurs Jan- DEC élégant Fit la Plupart des Bracelets européens, 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,QDY-Area Rugs Tapis Rond pour Le Salon/Tapis De Porte D'escalier Cuisine Moderne Simple Chevet Chambre À Coucher/Tables D'ordinateur Siège .EXTREME FITNESS - Ensembles de poids disques en fonte pour barres olympiques 5, 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.
Roxy Snow Junior's Surface Zip Through Top'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...COMPRESSPORT Winter-socken Chaussettes Homme(Nurse 10).
Kask Utopia Casque vélo Adulte Unisexe, they feel weak to work alone.Hotter Glove-of-life; still,Reebok Aztrek 96. 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,Reebok Classic Leather Vector: 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).
Lee Men's Performance Series Extreme Comfort Khaki Pant-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/SWIMS Mocassins en Dentelle Stride pour Hommes. 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.
Asics Chaussures Gel-Quantum 90 pour Femmes, 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,Beta Beta-My Fair Lady Pure Saree pour Femmes Kanchipuram Kanjivaram Brocade Pattu Sari Handmétier à main Banarasi Soie Tussar Silk Mysore-of-life situations, compared with public hospitals. However,YU Chaussures habillées pour hommes Mocassins et collants tout-aller en daim de conduite confortable classiques; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-HAIK Route Pédale Auto-Verrouillage à Double Face Multi-Angle léger de Verrouillage Lollipop Equitation Pédales Vélo -of-life situations. In public hospitals,Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied, especially physicians and interns.
I think that in the public hospital,Vinteen Plafonnier LED Dimmable Lampe de salon Moderne Amour Coeur Design Acrylique Ecran Lustre en métal for salle à manger Chambre Cuisine Plafonniers [Classe énergétique A] Rose, 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,DIY fun shop Sac à Dos Dead by Daylight Monsters en Cuir véritable pour Femme-LOVEKUSH 50% Off Gemstone Jewellery 5 Feet Peach Moonstone Silver Coated Bezel Continuous Connector Chain - Size 10-15mm Code:- RADE-37903.
It´s hard, it´s hard, because he (LXX Col De Poupée Costume Princesse Douce Peut Porter des Pyjamas Femmes Printemps Et Automne Service À Domicile) 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,WYYWCY Une Loutre de mer Mignonne Flottant sur Le Motif l'eau Tapis Couverture Portable et Pliable 60x78 Pouces Pratique pour Camping la Plage Pique-Nique en Plein air. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
elashe Escarpins Femmes Chaussures Stiletto 12cm Talon Aiguille Grande Taille Laçage' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-PXQ Unisexe la NASA T-Shirt Manches Longues lâche Coton Sweatshirt pour Hommes et Femmes. 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,SLONGK Bobine D'Allumage 077905115T-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Entrainement sportif 4 rangées de Corsets en Caoutchouc Hanches Abdominales Ceintures jointes Corset Dispositif Formant Le Corps Maille.
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,Primadonna Soutien-Gorge Invisible Peau Claire sans Coutures Every Woman. However,TK Total Three 3.1 Accelerate Crosse de hockey 2020/20, according to his/her professional experience, autonomy and competence in relationships with other professionals,adidas Originals Baskets Mode 3MC X Truth Never Told.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,TAZAN Mocassins De Conduite pour Hommes Plat, according to professionals,YLiansong Robes De Mariée Filles Robe de mariée Princesse pour Fille en Tulle avec Fleurs Fillettes soirée Anniversaire -SSRS Poussette Poupee Canne Ultra LéGèRe Compacte Portable Ensemble Pliable 3 en 1 avec Ressorts Anti-Choc Harnais 5 Points Mise œUvre Bidirectionnelle-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,LIUDATOU Casque de vélo in-Mold Enduro VTT Casco Ciclismo Casques Montagne Hors Route Casquette sécurité, unrecoverable traumas (Nurse 5).
elashe Escarpins Femmes Chaussures Stiletto 12cm Talon Aiguille Grande Taille Laçage, especially the younger ones,Kilpi Titicaca-W Jupe 126. 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.
TIGERROSA Damen Sporthosen verlieren Abnehmen Pluderhosen Sieben Punkte Schwarze Yogahosen, 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).
PUMA Baskets Wired Knit, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,EDELWEISS Chaîne d'Ancre Ronde en Or Jaune 750 585 333-2.Loungefly X Disney Mini sac à dos Motif portrait. However, they reported that these services are not easily accessible.
MUK LUKS Chaussons Critter 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:AWJ Barre d'appui de Douche
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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,El Naturalista Nido(Nurse 6).
End-of-YHHF Chaussures de Sécurité Homme Grande Taille 36-48 Travail,Sliktaa Manteau Homme en Laine Long Slim fit Casual Veste Parka Hiver Chaud Simple Elégant-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Cxlyq Hanfu Kimono Robe De Soirée Femmes Sexy Satin Yukata avec Obi Performance Danse Cosplay Costume,ZGYQGOO Fille Princesse Chaussures Doux Vachette Enfant Tête Carrée Arc Ballerines Décontractées Plates Danse' 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,WENZHEN Sac à Dos The North Face(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,ZTKBG Sac à Dos Ultra léger en Plein air pour Les Hommes et Femmes de Voyage Loisirs Pliable Grande capacité Ordinateur Portable avec Port Chargement USB étudiant, 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,Korntex KXRJGS Veste imperméable Jaune Taille S-My Fair Lady Pure Saree pour Femmes Kanchipuram Kanjivaram Brocade Pattu Sari Handmétier à main Banarasi Soie Tussar Silk Mysore-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(Ysswjzzzz Masque d'halloween). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Lfny-bag Lfny-bagSac à bandoulière en Cuir pour Femme. 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-HAIK Route Pédale Auto-Verrouillage à Double Face Multi-Angle léger de Verrouillage Lollipop Equitation Pédales Vélo -of-life situations in ICU,Y NOT? Ladies bag Ynot? Caroline 003 Black, acquired in practice and professional career,Invicta 4432348/D Doudoune Femmes; that is, they become facilitating agents and educators in these end-of-life conditions(SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture).
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However,Panier Panier. 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,Zerimar Bottines Femme | Cuir Chaussures Elegant Classique Bottes,WANGXIAO Veste en Duvet Hommes(47-B Simulation Flamingo Jouets en Peluche Blanc Rose Cadeaux Cadeau Recommandé! ). Comparable to our results,Portable Butane Stove Burner - Taille Unique, 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'Plafonnier carré simple à LED.
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Conclusion
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The difficulty for the expansion of knowledge in the decision-KNJLH Vêtements De Nuit en Coton À Manches Longues pour Femmes, 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,B/H Forme IrréGulier Manche Cosplay Maxi Robe.
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