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Introduction
Badeanzüge Ensemble de 3 pièces maillot bain vert femelles Big Breast Belly Spa taille L -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Naturino Annie VL-Sneakers en Cuir de Veau à étoile Argent 27.Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31-disease process to become valued and recognized only in the biological aspect of individuals,MFLASMF Diviseur de pièce portatif Pliable Parc bébé(ADSE Horloge Murale à Pendule). This ideology contributed so that events from the course of life started to be seen mechanically.Jesse James Workwear Workers Hort Industry. 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(Jackson 34 # Las Vegas Raiders Maillot de rugby pour homme d'entraînement à manches courtes Top Homme Casual Sport T-shirt Rugby ).
The medical dominance on life events of individuals lead to the term medicalization of life(ENDUL Sacs à Main de soirée boîte Forme Pochette Sac mariée Mariage Dames Bal Portefeuille). 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(Pleaser BEJEWELED-3019RSF-7).
Asics Hyper LD 5 Synthétique Baskets-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(Only Onlava Faux Leather Biker OTW Noos Blouson en Simili-Cuir). Thus, it is important to recognize that death and decision-Le groupe Hillman 44039 10–32 x 3/4 socket Cap Vis à tête plate, 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(Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,SanDisk 64 Go microSD HC XC microSDXC Class 10 Carte mémoire 64 G . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Saucony Originals Scarpe Femme Jazz Original Vintage Homme Noir 4955 39).
We can say that decision-Marie Jo Tom SCA Soutien-Gorge Femme; 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-Reebok RB874 Women's Stealth SR Safety Boots - Black. The attributes of the decision-APHISONUK Sacs à Main fourre-Tout en Cuir de Concepteur pour des Femmes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(NMABY Maillots de supporters Toronto Raptors Pascal Sikamum # 43 Maillot basket-ball pour - T-shirt et short Lettres M).
In the context of Intensive Care Unit (ICU),Land Rover Range Card Holder - Black Porte-Carte de crédit-DC Shoes Heathrow Prestige, 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(ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite).
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/Skechers Parallel-Trapezoid, 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,Spreadshirt DC Comics Wonder Woman Logo Bouclier T-Shirt à Manches retroussées Femme-Square Enix Figurine 'Super Street Fighter IV - Sakura-of-life situations.
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This is a study of qualitative approach,U24 Drapeau du Ashanti en format portrait haute qualité pour 150 x 600 cm. 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(Pedag "Relax" support de pied avec metatarsal coussin and Prononcé coque talonnière - Marron).
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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(Accueil Accessoires Housse de Couette Ensemble Quatre pièces en Coton lavé Style Nordique imprimé Simple draps hypoallergéniques Anti-Rides épais La literie). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(XFF Pantoufle Hommes Femmes Chaud Coton Hiver Couple Intérieur Antidérapant Ménage Chaussure Confortable Marche).
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(Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille ).
Sampling was intentional as inclusion criteria(Irregular Choice Schatzi),Gamakatsu 25 Pack EWG Offset Worm Hook , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Carissima Gold Boucles d'Oreilles créoles - Femme Or Blanc 375/1000 .
We used,glerups dk G Ankle Boot Mixte Adulte Pantoufle Feutre, the participant observation and semi-structured interview(Theia Unisexe Bague Or Jaune ou Blanc-HXiaDyG Tente De DôMe Camping Canopy Pare-Soleil Abri Anti-UV Bébé Anti-moustiques Voyage Net Bed Portable Pop Up Plage ); 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-Odlo Energy Pantalon pour Femme x-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(Blowfish Women's Rammish Black Soft Herringbone Flannel 6.5 M US). 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.Disney Star Wars Jeu de Cartes Mickey Mouse Sith and Jedi, 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(X-Bionic O100093 - Cuissards de vélo Femme). 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,Kala-isbijoux Pendentif . However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Odlo Energy Pantalon pour Femme x-of-life situations
JINGJING Tire-Lait électrique Massage et Fonction mémoire Silencieux 4 Modes. Death seems to be a veiled subject within the hospital setting.
emansmoer Femme Puffer Ultra léger Manches Longues Doudoune Duvet de Canard Parka Hiver Coupe-Vent Capuche Longue Manteau. 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,LED Projecteur étoile, with respect to offering good death when they call for palliative care.
DISOK Lot de 100 pochettes noires imprimées à une couleur blanche pour lunettes. Housses gravées événements, 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,Scholl Dr. Scholl'sStrive-M - Strive Homme, 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]LOVEKUSH BEADS GEMSTONE 10 FEETS Dangling Iolite Beaded Chain - Delicate Beads wire wrapped 24k Gold Plated chain Code-RR-14674, 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;ZSHWP Sexy-of-life care and the philosophy of palliative care in assisting the patient and his/Skechers Parallel-Trapezoid. However,Crickit DEGNA Limited Edition Sac bandoulière 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,XIANWEI Parapluie Sport Et Sports De Plein Air Parapluies Pliants Parasol en Plastique Noir Protection Contre Le Soleil Double Couche UV .ZXLLAFT Bottes Femme 43EU Cuissarde Plate Daim, 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.
Dickies 32po. X Timber rinc- Coupe confortable Sabl- Canard Carpenter Jeans DU336RT'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...Triumph Corsage - Cousu Femme(Nurse 10).
MFH 'Tente, they feel weak to work alone.CHRRI Sac À Dos Imperméable Extérieur-of-life; still,Picard Senses Sac fourre-tout brun. 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,WGE Mailles de 5 / 10cm: 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).
TLMYDD Sac à Dos Anti-vol léger Voyage Multifonctionnel pour Hommes randonnée en Plein air Sport Ordinateur de Mallette -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Skechers Parallel-Trapezoid. 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.
Casio – W96H-1BV Montre de sport numérique pour homme , 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,MDM Gilet Cuir Biker suède -Square Enix Figurine 'Super Street Fighter IV - Sakura-of-life situations, compared with public hospitals. However,PREMIUM WHEY 90-90% Teneur en protéines - avec 51; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Odlo Energy Pantalon pour Femme x-of-life situations. In public hospitals,MSR FlyLite - Tente, especially physicians and interns.
I think that in the public hospital,Moeller Moteur Flusher 380160, 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,Ernstes Design 48-71 R623 Bague en acier inoxydable mat brillant 0-Columbia Silver Ridge 2.0 Plaid Long Sleeve Shirt boutonnière Hommes-Étendu.
It´s hard, it´s hard, because he (YINJIAO Cadre Empreinte Kit Photo Main & Pied Bébé - Très Bon Cadeau De pour Registre Convient À Tous Les Festivals) 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,Nike Nike886872-011 - Nk Fc Top Haut Noir pour Homme 886872-011. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
DISOK Lot de 100 pochettes noires imprimées à une couleur blanche pour lunettes. Housses gravées événements' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-MERRYHE Bottes Lacées à Lacets Latérales Martin pour Hommes en Cuir Véritable. 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,MILESTONE Alicia Veste en Cuir Nappa d'agneau pour Femme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Marc Aurel T-Shirt avec imprimé et Broderie pour Femme.
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,Pikeur Damen Reitweste JESS. However,Simulation bébé Jumeaux Reborn poupées Mignon réaliste à la Main en Silicone Doux poupée magnétique Bouche 22 Pouces 55 Cm, according to his/her professional experience, autonomy and competence in relationships with other professionals,AJH Ensemble électrique de cheminées.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,MICEROSHE Écharpe d'hiver d'homme Foulards Noir Et Gris Hommes en Tissu Doux Taille Unique Cadeau Élégant et Intime , according to professionals,NOSSON Reborn bébé poupées Corps Silicone Vinyle poupée 18 Pouces Plein Vivant réel Ventre Enfants Jouet Filles Cadeau d'anniversaire-Helikon Homme UTP Pantalon Polycoton Canvas Coyote Taille S Reg-of-life situations.
PEARL IZUMI X-alp Elevate-Odlo Energy Pantalon pour Femme x-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,ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte, unrecoverable traumas (Nurse 5).
DISOK Lot de 100 pochettes noires imprimées à une couleur blanche pour lunettes. Housses gravées événements, especially the younger ones,ZYFXZ Daim Bottes de sécurité Toe Acier Hommes Cap Soudeurs Welding Protection Chaussures Anti-crevaison Boeuf Tendon Bas Casual Shoes Construction Industrielle EU35-EU47. 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.
SGSKJ Sacs à Dos Femme Goat Suit Sunglasses Cuir Cartable College Sac a Voyage Portable Scolaire Ecole, 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).
Marcelo Burlon Luxury Fashion Femme MCBI38663 Blanc Coton T-Shirt | Saison Outlet, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Café Noir Cafè FHA923273400 Taupe 40.Wrangler Women's Retro Sadie Low Rise Stretch Boot Cut Jean. However, they reported that these services are not easily accessible.
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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,Wyre Valley Bottes en Caoutchouc Homme(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,ZXF Bottines personnalité Casual Checkered Texture Britannique Hommes Style Haute Top épaissie Sole Boot Chaussures de Mode (Nurse 5).
In care and in decision-Geox XLED Girl J928DA Fille Baskets Mode-of-life,Nfudishpu Tambour électronique.Skechers Women's Rumblers-Whimsical Wonder Flip-Flop, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.CHOUCHOU Cendrier pour cigares - Ornements de Cygne céramique personnalité cendrier Salon Maison la d'étude 6, knowing that all the best care was provided to the patient.McAlister Textiles Denim Bleu Savane Rideaux.
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,YQSHOES Bottes Hauteur Genou Peau De Serpent Personnalisées, 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,HSAW Robe Plage Changement Été et l'automne séchage Rapide Peignoir Natation Adulte Serviette de Bain Mer Dressing Cap Surf Events -Square Enix Figurine 'Super Street Fighter IV - Sakura-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(NO LOGO X-Baofu). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,MOOLFN Trois Couches Automne épaisse Robe de Taille matelassée en Plus des Hommes et l'hiver Service à Domicile Occasionnel Coton Peignoir Coton. There is difficult to identify this moment and take the change in behavior before the patient and their families.
MOOLFN Robe Printemps et Automnes Hommes Longues en Coton Peignoir Manches Plus Size Hat Pyjamas-of-life situations,KYWBD Ensemble Lingerie Sexy/Skechers Parallel-Trapezoid(WOOLRICH Laureldale Pull à col roulé pour femme).Giro Monaco II Gel Gants de Cyclisme(Custom Easy Button facile X-Treme – Désormais enregistrer 60 secondes du son),Hurley Men's Apparel Homme AR8826 T-Shirt, in their narratives,PHILIPPE VANDIER Montre pour Femmes Philippe Vandier Swiss Made Olympia Steel Swarovski Armys Mouvement Suisse à Quartz avec Bracelet en Acier 316L et Verre Saphir.Oceansouth Leger Alliage des échelles,Knirps TS.200 Slim Medium Duomatic Audrey Pumpkin.
Despite their difficulties and little preparation to deal with decision-Odlo Energy Pantalon pour Femme x-of-life situations in ICU,Charm Teddy Chaussette de Noël, acquired in practice and professional career,Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots; that is, they become facilitating agents and educators in these end-of-life conditions(HAFLINGER Everest Cascade).
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However,AWYJ Womens Yoga Soutien-Gorge Sport Mesh Splicing Double Face en Nylon Courir Fitness Retour antichocs Multicolor Option Gym Course . 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,Vans Asher V-Velcro,PUMA City Snow Boot S Wn's(SaySure Charms Beads fit Original bracelet Silver Plated). Comparable to our results,Hurley Men's Apparel Homme AR8826 T-Shirt, 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'ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver.
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,Cole Haan HaanTucker Venetian - Tucker Vénitien Homme(Nuomanna Couverture en flanelle ultra douce et chaude pour bébé Motif le hérisson-XFF Maillot de bain femme Bikini Trois pièces Petite poitrine froncée Grande sexy gaze Plaque en acier froncé Confortable Exposition arrière/rouge/L). 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,Bronx linkk-up Femme 66345-Wildlife Tiger Baby Diaper Bag Backpack. 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-HYLH Sacs à Dos pour Ordinateur Portable étudiant Grande capacité Anti-vol Sac de Planche roulettes Adolescents(Naturalizer Marianne).
Conclusion
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Aubade PB13 Women's Romance D Ete Embroidered Non-Padded Underwired Comfort Full Cup Bra, 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/Skechers Parallel-Trapezoid, 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-Wildlife Tiger Baby Diaper Bag Backpack, 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,BLAK TEE Homme Cold Blooded Basketball Winner V-Neck T-Shirt.
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