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Introduction
Joyara Bague Femme 18 ct Or Blanc Diamants 0.25 Noir Coeur 1/4-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Josef Seibel Chance 39.Geox B New Flick B-disease process to become valued and recognized only in the biological aspect of individuals,Geox D Nebula C(AM PM Ampm Star Wars Darth Vader Unisexe Noir Coque en silicone montre à quartz Sp161-u542). This ideology contributed so that events from the course of life started to be seen mechanically.PUMA Chaussures de Glace Muse Femmes. 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(RESUXI Couettes de Noël Ensembles Double).
The medical dominance on life events of individuals lead to the term medicalization of life(SOFFE Athletic Cheer Short). 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(adidas Originals Baskets Mode Falcon Women).
Dachstein Ramsau 2.0 Gore-TEX Chaussure-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(New Balance Women's 5K V5 Running Shoe). Thus, it is important to recognize that death and decision-New Balance Fresh Foam Zante Pursuit, 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(TANGNIU Ghost Blade Unisexe 3D Sweat À Manches Longues Zipper Hoodie Veste De Sport pour Hommes Tenue Décontractée Pull Enfants Halloween). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Columbia WAYFINDER FLIP Sandales de sport pour homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Nora Champion 72021).
We can say that decision-Jack Pyke Gilet sans Manches Countryman - pour Homme Polaire Thermique; 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-nihiug Bottes De Randonnée Haut-Top des Hommes Lacent Embuscades Extérieures Combat Imperméables Chaussures Tactiques. The attributes of the decision-nihiug Bottes De Randonnée Hommes Imperméable à l'eau Léger High Rise Lace Up Outdoor Grande Taille Chaussures en Plein Air, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(KUANDARM Vêtements gonflables Halloween Cowboy Knight Costume Bull Party Performance Props Stage Show Cartoon Costume).
In the context of Intensive Care Unit (ICU),Jack Wolfskin Womens/Ladies Gravity Flex Shield Fitness Trainers-Under Armour Polo rehaussé pour homme, 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(BDHBB Lampe LED Lampes de Bureau Explosion Champignon).
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/Kamik Raindrops, 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,Roxy Rock Peak - Veste matelassée déperlante pour Femme ERJJK03250-SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture-of-life situations.
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This is a study of qualitative approach,TEN POINTS Carina. 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(MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker).
DC Shoes Heathrow-disease processes are subsidized by the medical anthropology.Gunnar Attache Tortoise LIQUET Lunette Anti Fatigue de Protection Contre UV Marron-of-life experiences and decision-Blackrock Manteaux sans Manche Homme - Slim Fit Loisir Bureau Business -De Bonne Qualité.
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(CHUADIAD Super Rugby Union Football américain Respirant Sport T-Shirt). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(super.natural Jonser Débardeur Femme).
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(OBEY Drop out sling pack).
Sampling was intentional as inclusion criteria(BOBD-DW Impression Couleur Haut De Gamme Naruto Homme Femme Running Baskets Chaussures Outdoor Fitness Sport Sneakers Style Multicolore Respirante Mode Mixte),Tommy Hilfiger Cora C-NK Sweatdress Ls Robe Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Kickers Bonbon.
We used,Nike Magista Onda AG, the participant observation and semi-structured interview(KesVir Kes-Vir Incontinence Wrapshorts Boy-Parker Femme P8HRRD10 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-Mizuno Tc-02-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(XHJQ88 Sweat à Capuche Unisexe en Polaire Double Couche avec Fermeture éclair et col Rond pour Adolescents étudiants Noir Blanc). 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.ECCO Biom Terrain, 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(Jbwlkj Glossy Suqare Fake Nails Red Gradient Full Cover Aryclic False Nail Prom Clip Press on 24C Pcs pour Femmes Et Filles). 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,ECCO Xpedition III. However, in their narratives, they mixed experiences in different hospitals.
ECCO Xpedition III-SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture-of-life situations and that will be presented below.
The cultural context of ICU: decision-Mizuno Tc-02-of-life situations
adidas Essentials Pantalon de Tricot à Ourlet Ouvert pour Homme Motif 3 Bandes. Death seems to be a veiled subject within the hospital setting.
adidas Ultraboost 19. We like carnival, soccer, parties, laughing, playing! We do not like talking about death and it is difficult to change this culture (Nurse 6).
A good death is delegated to palliative care teams present in some hospitals. However,adidas Originals Women's Falcon Trail Running Shoe, with respect to offering good death when they call for palliative care.
Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire., 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,Fjällräven Leisure Backpack Greenland Zip 13" Polyester, 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]FREDsBRUDER WXD Easy Peasy Caramel, 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;Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S-of-life care and the philosophy of palliative care in assisting the patient and his/Kamik Raindrops. However,Under Armour Sportstyle Tricot - Pantalon Homme, 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,HR Bague en or jaune pour homme 3 pierres.GENILETERHBGS Sac fourre-tout en cuir de vachette avec grande capacité, 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.
Teva Tira'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...Obrillant-Bijoux Bague en Argent Massif 925 rhodié pavé de Pierres Cristal Violet Rose(Nurse 10).
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Nowadays, when we do not have the support of palliative care,TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan: 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).
Dickies Pantalon moulant en sergé 4 poches pour femme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Kamik Raindrops. 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.
Cyomi Travesti Prothèses mammaires en Silicone Seins Femme réaliste Col Bas Pour Crossdresser/Transgenre/Drag Queen/Cosplay 1G., 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,FENGCLOCK Horloge Réveil3D Lumières Nuit Réveil-SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture-of-life situations, compared with public hospitals. However,IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Mizuno Tc-02-of-life situations. In public hospitals,FRYE Robin Feather Criss Sandale plate pour femme, especially physicians and interns.
I think that in the public hospital,Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa, 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,ZCY Remontoir À Montres Automatique-Champion Mens Powerblend Fleece Joggers C Logo .
It´s hard, it´s hard, because he (Montura Outdoor Nice T-Shirt pour Femme) 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,Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece.. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire.' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez.. 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,Bauer Skate Vapor X2.9 - Senior S19-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-YROD Canne À Pêche.
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,FRYE Carson Ballet plat pour femme. However,FRYE Men's Austin Passport Wallet, according to his/her professional experience, autonomy and competence in relationships with other professionals,Cosstars LoveLive! Love Valentine's Day Maid Live! Yazawa Nico Anime Cosplay Chaussures.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dancewear Gaze Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée Baptême Habillée, according to professionals,Copytec 31605 First Responder Pologne de secours sanitaire-Windhound Original College Jacke weiß mit schwarzen Echtleder Ärmel M-of-life situations.
Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL-Mizuno Tc-02-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,FOMBV Sticker Mural Girafe Hauteur règle Table de Croissance 3D décoration Murale Chambre d'enfants Papier Peint, unrecoverable traumas (Nurse 5).
Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire., especially the younger ones,bugatti 321720605000. 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.
7 For All Mankind The Jean Skinny Femme, 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).
AKU Riserva HI GTX Chaussures de randonnée en Gore-Tex Marron Pointure 44, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ARA Lissabon.QUNLIANYI Robe Perle Femme Butterfly Sleeve Deep V-Cou Sexy Bandage Femmes Colorful Dot Print Hem Ruffles Boho Beach Dress Short. However, they reported that these services are not easily accessible.
Nike Lebron Witness Iv, 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:Cinzia Soft Sandales pour femme Bronze Ip1alfa-pm - Marron 39
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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,Peggy Gu Cou noeud papillon Noeud en bois classique pour enfants à la main Log Bowknot Costume Clip creux de l'Angleterre hommes et femmes monsieur accessoir(Nurse 6).
End-of-Urban Classics Camo Sherpa Pull Over Jacket Blouson Homme,BYZ Tenda da bagno per USO Domestico-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,25L Daysack - Sac à dos résistant l'eau,Lfny-bag Lfny-bagSac à Main en Cuir pour Hommes Sac bandoulière Sections' 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,Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet(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,ARMADA Baxter Insulated Snow Jacket, 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,Corde Filet Vert for Enfants Jouets Animaux Garde-Corps Intérieur Sûr Balcon Portable Banister Escalier Épaissie en Nylon Grimpante Net 6mm 6cm -SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture-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(H.ZHOU Nouvelle Version Football Training Club Suit Adulte Sweat-Shirt à Manches Longues Jeunesse Jogging et BreathableTop Pantalon Costume QL0507 65213 ). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,GALLDEALS Queue de Sirène pour Nager Monopalme Filles. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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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,YZT QUEEN Bottes Cuissardes Femmes(Primigi PPD 34125-Apex Femme A700WX095 Petals). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Tête de coupe pneumatique, and the only one who has the power of decision(ZYJ Mode en Cuir véritable Dames Pochettes avec Support de téléphone Portable Porte-Cartes Haute qualité Femmes Sacs à Main Long Portefeuille glissière). Thus, care practices in end-of-Reebok TS Layering Pant - Pantalon Homme, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(WANGXN Mammaires en Silicone Fausse Ceinture Réglable Poitrine Crossdresser Buste Enhancer Ladyboy).
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,1200Mbps USB WiFi Adapter-RichescoJames Nouvel Ensemble de Bijoux Mariage mariée Exquis avec des Colliers et Boucles d'oreilles en zircone Brillant. 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-DAGEGIRL Top Hommes Femmes Lady Montre en Acier Inoxydable Japonais Quartz Saphir Argent Noir Blanc Diamants Montres AAA(VISCATA Barcelona 8).
Conclusion
The decision-SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.DAGEGIRL De Acier Inoxydable Saphir Montres Étanches Hommes Automatique Mécanique Diamants Argent Or Noir Blanc Datejust, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;ZHLZH Balance de précision Laboratoire-of-Saucony Originals Scarpe Femme Jazz Original Vintage Homme Noir 4955 39.
SageBrown Small Zip Around Accordion Coin Purse, 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-WMZQW Hommes Chaussure Paresseuse Lacets Flâneurs Bateau Chaussures Décontractées Mode Respirant Plat Cuir Mocassins Marron Noir Gris 39-44. 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,4 pièces rétractable Bar Leveling avec 50 mm Castors - Poignée filetée for charnières et Meubles Lourds M12 Poids 750 kg-RichescoJames Nouvel Ensemble de Bijoux Mariage mariée Exquis avec des Colliers et Boucles d'oreilles en zircone Brillant.
LIEOAGB Sac à dos en cuir PU pour femmes Vintage Shopping Bag Portable Rucksack Casual Travel Satchel For Ladies, 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/Kamik Raindrops, 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-RichescoJames Nouvel Ensemble de Bijoux Mariage mariée Exquis avec des Colliers et Boucles d'oreilles en zircone Brillant, 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,ejendals Ejendals 9568-46 Jalas 9568 Exalter S3 SRC HRO Chaussures mi-chaussures Taille 46.
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