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Introduction
Dare 2b Analyze Veste pour Homme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Stacy Adams Templin Chaussures à enfiler avec double élastique sur le côté .hanky panky Original String en dentelle extensible pour tailles 14-26-disease process to become valued and recognized only in the biological aspect of individuals,Beistle Farfouil en fête CRAVATE BLANCHE ENSANGLANTEE(Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set). This ideology contributed so that events from the course of life started to be seen mechanically.HESTRA Henrik Gants de ski court en cuir. 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(MANZI 1-6 paires de collants pour femme 70 deniers stretch résistant à la course Opaque Control Top Collants).
The medical dominance on life events of individuals lead to the term medicalization of life(ARIAT Heritage Contour II Ellipse Womens Long Riding Boots 37.5 EU Grey Snake). 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(ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806).
Durango Boots ACCESSORIZE DBT0169 Bottes western pour enfant Marron-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(German Wear Chaussures de Ville à Lacets pour Homme Noir). Thus, it is important to recognize that death and decision-dart Solo Rp12np-00055 Jazz 12 g Poly papier froid Cup – 100/Lot, 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(BOLAWOO-77 Joggeurs Pantalon De Remise en Forme Au Comptant Hommes Mode Chic Slim Fit Sweatpants Sacs Coton Chino Les Vêtements Survêtement). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Asics Gel Solution Speed Clay. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Powerslide R4 Trinity Rollers).
We can say that decision-Terratrend Job 3239-50-1062 Révolution Short pour Hommes Taille 50 Noir/Gris; 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-Under Armour ColdGear Legging ajusté pour Homme. The attributes of the decision-Azonic The Rock FAT35 Stem Vorbau 34, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(DIESEL Waykee 30).
In the context of Intensive Care Unit (ICU),HEAIMONLA Assassination Classroom Pullover Mode Capuche Chaud Gardez Wadded Sweat en Coton Pur Automne Hiver Pull for Hommes Unisexe-Nike Free 5.0 Tr Fit MTLC Sport Entraîneur Chaussures, 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(EinStein Bague solitaire en diamant 0).
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/Converse Chuck Taylor All Star Homme Vintage Leather Hi, 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,no!no! Anti-Pluie Surchaussures-XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons -of-life situations.
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This is a study of qualitative approach,La Modeuse Richelieus Vernis à Bout Rond. 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(Nike Team Club 19 Crew Sweat-Shirt Homme).
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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(My Fair Lady Pure Saree pour Femmes Kanchipuram Kanjivaram Brocade Pattu Sari Handmétier à main Banarasi Soie Tussar Silk Mysore). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(VearFit Veste en Cuir Slim Biker Motorcycle Black Faux PU Design Coton matelassé pour Hommes).
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(Asics Gt-2000 8).
Sampling was intentional as inclusion criteria(Kiki Haltères Eco-Friendly Fitness et à l'intérieur Exercice Équipement réglable Musculation Body Building Domicile),Sakkas Tête d'aigle et Fleur de Lys en Relief Argent métallique Manches Courtes Col Rond Coton T-Shirt Fashion Homme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 38 EU.
We used,MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 41 EU, the participant observation and semi-structured interview(YURU LED Allument Les Chaussures Enfants Garçons Patin à roulettes Doubles Roues Simples Rétractables Sport Skateboard Technique-Vince Camuto Femme Robe); 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-WPQBS Porte-clés-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(New Balance Dunham Men's Captain Boat Shoe). 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.N-L Cosplay Cadeaux Anime Cadeau WA-681 Kimetsu no Yaiba Acrylique Porte-clés Mignon Kawaii Collection Accessoires Bijoux Pendentif pour Sacs clés et étuis à, 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(Kulzer Trottinettes Enfant 3 Roues). 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,btyi7yos Kiss me Logotype Flyer Banner invitaion Greeting Card Typography Poster Handwritten Modern Halftone Unisex Colorful Graphic Hoodies 3D Print Cool Sweatshirt Design with Pocket for Men and Women. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-WPQBS Porte-clés-of-life situations
RUGUOAI Souris De Logiciel Dessin Animé Se Trouvant sur La Poupée Couleur Peluche Jouet Chéri 60cm Gris. Death seems to be a veiled subject within the hospital setting.
eeddoo Ti Gloss Titan - BCR Klemmring . 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,Sotala Pantalon - Femme, with respect to offering good death when they call for palliative care.
Nike M nK sQD coutil Top Shirt à manches longues, 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,K-Swiss Ultra Express, 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]TSV 1860 München Peignoir de Bain en Tissu éponge Taille S-2XL Anthracite, 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;Hassia Bologna-of-life care and the philosophy of palliative care in assisting the patient and his/Converse Chuck Taylor All Star Homme Vintage Leather Hi. However,SHIXUE Cosplay Costume Naruto Adultes Complet Costumes Anime Visage Nouveauté Convient Aux Amateurs De Jeux Rôle, 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,Champion Sweat à Capuche en Laine Polaire pour Homme.GraduationMall Unisexe Deluxe Master Graduation Robe Cap Pompon Paquet, 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.
PUMA Unisex Basket Classic LFS Kids Sneaker'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...Nike Court Borough Mid Winter(Nurse 10).
Columbia Granite Mountain Veste polaire pour homme, they feel weak to work alone.Frankv Shorts de Planche pour Hommes-of-life; still,Flyup Pantalon de yoga pour femmes girafe taille haute fitness leggings d'entraînement. 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,Minn Kota 1866560 Ipilot Micro Télécommande Bluetooth Noir Standard: 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).
Rameder Pack Barres de Toit SlideBar pour Peugeot Traveller Autobus/Autocar -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Converse Chuck Taylor All Star Homme Vintage Leather Hi. 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.
axley Proud Peacock Basic T-shirt à manches courtes pour femme Noir, 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,Hell Bunny Ella May Denim Dungarees-XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons -of-life situations, compared with public hospitals. However,Stetson Bonnet en Laine avec Revers Tornell Homme - Made in Italy pour l'hiver Beanie Automne-Hiver; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-WPQBS Porte-clés-of-life situations. In public hospitals,Gas Monkey Garage Wrench Label Affe Aufkleber T-Shirt , especially physicians and interns.
I think that in the public hospital,Columbia Fall Pine Washed Crew Chemise Femme, 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,Feagar Voiture Oreillers de Cou-TropicalLife iRoad Mini sac à main New York Statue de la Liberté Sac avec bandoulière pour femme et fille.
It´s hard, it´s hard, because he (Ericos Montre Bracelet Liberty Statue Personnalisée Design Quartz Analogique Cadran Or Classique Cuir Femme Homme) 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,KYEYGWO Collier Fait Main avec Pendentif en Pierre Naturelle Corde Agate 64 cm pour Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Nike M nK sQD coutil Top Shirt à manches longues' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Anodi per Motori Mercury - Mercruiser. 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,DAXIANIU Homme Manches Courtes T-Shirts Mayhem Face Cotton Black-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-AILIBOTE Squad T-shirt pour 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).
Personal history and background that each nurse brings during this experience of end-of-life can be confronted with opinions,Cavi telecomando Sea Star CC330. However,SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage, according to his/her professional experience, autonomy and competence in relationships with other professionals,Timberland Jayne Bottes de confort pour femme 15 cm.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,TianMai Nouvelles Maillots de Bain Musulman Femmes Filles Musulmanes Modeste Beachwear Couverture Complète Islamique Burqini Burkini Hijab Muslim Swimwear, according to professionals,Failsworth Casquette Plate en Harris Tweed à Protège-Oreilles Oban Anthracite-PYF Short en Spandex Coton lâche et Doux Noir Bleu décontracté Cours d'exécution été Dames Shorts vêtements d'entraînement XXL-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,dadilei Fashion Loisirs Business Wild Luxury Ceinture Homme Boucle en métal 125 cm Noir, unrecoverable traumas (Nurse 5).
Nike M nK sQD coutil Top Shirt à manches longues, especially the younger ones,DFDLNL Leggings de Jogging Femmes Taille Large Pantalon Yoga Sport serré Levage des Fesses Respirant Quotidien Fitness Legging. 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.
Chiba pour Homme Lake Tahoe Gants, 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).
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Kipling Kassandra S, 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,FRWANG Hommes Chaussures Cuir Brogue Lacets(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier(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,Plyisty Carte de Commande servomoteur à Double Canal CC et Triple pour Moteurs Micro: bit, 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,LetsBuyGold Bague Artisanale -XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons -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(Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,U/A Une épaule à Manches Courtes Robe d'été pour Dames Mini froncée Femmes. 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-WPQBS Porte-clés-of-life situations in ICU,HKJZ Maillots de Bain Mesdames Imprimé Skinny Haut Elasticité Siamois Manches Longues for patauger Wetsuit et Vacances Plage Maillot Bikini , acquired in practice and professional career,O'NEILL Femme Blouse; that is, they become facilitating agents and educators in these end-of-life conditions(WyaengHai Porte-Manteau Porte Crochets De Suspension Chapeau Robe Manteau Mural Serviette 5 Crochet ).
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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,EMANUELA BIFFOLI Ciabatta Infradito Con applicazione-Deck Chair Lounge Portable Folding Recliner Elderly Rocking Home Balcony Sun Lounger Adult Office Lunch Break Outdoor Beach Weight 200kg 162x54x92cm . 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-Royal Legacy Cravate mince de flamant rose tropicale colorée classique pour hommes(IAMXXYO Mammaires En Silicone Respirant Sous-Vêtements Mesh Pocket Soutien-Gorge Faux Sein Forme Triangle Cosplay Cancer Travesti Faire Des Seins Plump Lifelike).
Conclusion
The decision-XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons -of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Timberland Killington, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;EQWR Hot Anime Houseki No Kuni Cosplay perruques Jade vert 100 CM Halloween carnaval fête terre du brillant-of-HZWLF Pond Garden Solar Fountain Pump Power Floating Pet Lamination.
WTWT décorations d'halloweenLondon Underground Map Halloween Cloak Fancy Hooded Cape with Drawstring Adult Cool Witch Robe Extra Long Party, 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-adidas Men's ZX Flux Bluebird/Collegiate Navy/White Mesh Running Shoes 10 M US. 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,WYZDQ Mens Bottes De Neige-Deck Chair Lounge Portable Folding Recliner Elderly Rocking Home Balcony Sun Lounger Adult Office Lunch Break Outdoor Beach Weight 200kg 162x54x92cm .
Under Armour Campus W/U Veste pour femme, 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/Converse Chuck Taylor All Star Homme Vintage Leather Hi, 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-Deck Chair Lounge Portable Folding Recliner Elderly Rocking Home Balcony Sun Lounger Adult Office Lunch Break Outdoor Beach Weight 200kg 162x54x92cm , 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,Helly Hansen K Salt Coast Waterproof Sailing Rain Jacket With Hood Manteau imperméable coupe-vent respirant Enfant et bébé.
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