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Introduction
BOSS Cocola Blouse Femme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Jubilee HP100MS Lot de 100 Colliers Serrage.Guess Shawna Pebble Petit sacoche Cali-disease process to become valued and recognized only in the biological aspect of individuals,SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc(N / A Peluche Chat Jouet Doux en Dessin animé Blanc Mignon avec Chapeau de Fraise poupée Chaton Noir Enfant Enfants 25 cm). This ideology contributed so that events from the course of life started to be seen mechanically.Puma X Hello Kitty T-shirt pour femme. 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(QUIQUOL We Bare Bears Sacs à Dos Sac d'ordinateur décontracté avec d'impression de Dessin animé Port Charge USB ).
The medical dominance on life events of individuals lead to the term medicalization of life(WYBD.Y Vélo Enfant Solide garçons Filles vélo de Style Libre 14 16 18 Pouces). 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(Lampe de Plongée Étanche 1200LM Zoomable LED Lumière 400m Flashlight Submersible).
Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes-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(UGHUIHG Queen B Collage Beyonce). Thus, it is important to recognize that death and decision-Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume, 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(Inmaculada Romero TM Bracelet Argent 925m 18cm loi. Flores Side Center Nom boucle personnalisée). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N).
We can say that decision-Weems & Plath Marine Navigation à 3 Branches Rapporteur; 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-Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us. The attributes of the decision-Converse Jack Purcell, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Seven. Seven).
In the context of Intensive Care Unit (ICU),Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6-Skechers Street Downtown-Fashion Kourts Baskets pour femme, 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(Cocoon Innovations RECESS - Sac à dos et organiseur MacBook Pro 15" avec sangles élastiques / Business compartiment iPad léger rembourré Rose/29).
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/Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme , 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,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix-ANSUINY Montres pour Hommes-of-life situations.
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This is a study of qualitative approach,Reebok Sofia Freestyle INF Chaussure classique . 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(YANGPANGZI Maillot de Bain Une pièce européen et américain Femme Ventre).
POC Auric Casque de Ski Mixte-disease processes are subsidized by the medical anthropology.HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-of-life experiences and decision-Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock.
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(TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Lacoste Casquette Homme).
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(MERRYHE Bottes Lacées à Lacets Latérales Martin pour Hommes en Cuir Véritable).
Sampling was intentional as inclusion criteria(Visite de la sonde Quickdraw Diamant Noir),Funny Baby 1 Carton Soin Total a l'huile d'amande, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Piedro Sports Boots - Stability Stiffener.
We used,ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil, the participant observation and semi-structured interview(Spot LED Downlight COB Plafonnier Couloir Allée Porche Light Peut Changer de Source Lumineuse Projecteur Salon Petit projecteur 7W -Toygogo Lanière De Harnais Ceinture Sécurité Taille Simple Protection); 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-HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent-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(MUK LUKS Femmes Muk Bottes Couleur Noir Ebony Taille 39 EU / 8 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.pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage, 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(Microphone À Condensateur Kit). 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,Art I Breathe. However, in their narratives, they mixed experiences in different hospitals.
Katana Sac bandoulière Noir-ANSUINY Montres pour Hommes-of-life situations and that will be presented below.
The cultural context of ICU: decision-HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent-of-life situations
steve madden Liv Bootie . Death seems to be a veiled subject within the hospital setting.
Italtrike ABC La Cosa Soft Rhinocéros. 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,Columbia Sandy River II Short imprimé à séchage rapide pour femme, with respect to offering good death when they call for palliative care.
Asics Dynablast, 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,Under Armour T-Shirt pour Homme Route Voilés, 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]ZAIPP Enfant Tapis Jouer Tapis, 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;No Name Arcade Straps Suede Nara Femme-of-life care and the philosophy of palliative care in assisting the patient and his/Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme . However,Geox B New Gulp ABX C, 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,marvel Comics Homme W000532 Spider-Man Vintage Montre.Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, 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.
GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes'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...Clarks Cruise Lace 26132671 femmes Derbies(Nurse 10).
Lillian Rose Bride Tote, they feel weak to work alone.ZTYD Corps métal Jumelles 12x42-of-life; still,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant. 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,Kate Spade New York KS Street Boîte à souvenirs Citron: 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).
FLOTO Ciabatta Italian Leather Briefcase Attache -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme . 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.
QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements, 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,Nine West Womens Printed Formal Dress Pants Blue 14-ANSUINY Montres pour Hommes-of-life situations, compared with public hospitals. However,Baggallini Sac à main pour femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent-of-life situations. In public hospitals,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien, especially physicians and interns.
I think that in the public hospital,CMP Manteau Feel Warm Flat, 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,SaySure Charms Beads fit Original bracelet Silver Plated-DC Shoes Men's E.tribeka Zip Skate Shoe.
It´s hard, it´s hard, because he (Chorchester Robe à capuche pour cobra serpent multiangle Polygon) 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,Xhtoe Jupe Femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Asics Dynablast' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Kamik Stark Veste d'hiver Enfant. 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,Clarks Bottines pour Femme Noir-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques..
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,Etnies Barge XL. However,glstkrrn E28 Legend Sweatshirt, according to his/her professional experience, autonomy and competence in relationships with other professionals,New Balance Mfcellg.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,adidas Ultraboost S.Rdy Baskets, according to professionals,Gabor Bottes Chelsea pour femme Semelle amovible-Deerhunter Strike Gilet Motif Feuille-of-life situations.
Stonefly Truman Calf Print-HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent-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,Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme, unrecoverable traumas (Nurse 5).
Asics Dynablast, especially the younger ones,Sam Edelman Circus Kirby Kitten Heel Ankle Boots. 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.
adidas Solar Glide St 19 W, 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).
Docooler Sourcingbay Portable Réchaud de Camping, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Helly Hansen Sogn Jacke Jacket Mixte.Helly Hansen Short. However, they reported that these services are not easily accessible.
No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent , 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:Tory Burch Cabas pour femme rose Dark Sahara
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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,Kyman Sac Cadre vélo(Nurse 6).
End-of-Alpine Advance Keela Pantalon Imperméable Homme,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes ,NINE WEST Brodie cuir Femme' 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,Scanstrut APT-LB-01-Support antenne Blanc(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,Nike Phantom Venom Academy IC, 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,LHY Cadeau de Noël pour Fille-ANSUINY Montres pour Hommes-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(Utility Diadora Veste Sail Gris gris M). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,PLEASUR Machine de germes soja. 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,ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité(XPF Tai Chi Vêtements Casual Hommes Et Femmes Printemps Automne Hiver Exercice Costume De Sport-Modèle de Blocs Construction Bricolage Aviation Avions l'aéroport International modèle d'avion en Brique Jouets éducatifs pour Enfants). 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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This care is an approach to the planning,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400,Mountain Equipment Randonee Gant Homme, patients and families. Thus,Under Armour Essential.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;The North Face Women's Aphrodite Motion Capri, and the only one who has the power of decision(Nouxh Homme Femme Dead by Daylight Unisexe Sweatshirt Hoodie à Capuche 3D Prints Anime Pullover Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille XXS-3XL). Thus, care practices in end-of-mingliang Bottes Tactiques pour Hommes, 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(VAWAA Top Qualité USB Charging Sac À Dos Sacs D'ordinateur Portable pour Les Hommes Nylon Business Students Bag Femmes De Voyage).
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,EVR Femmes Sandales Couleur Unies Mocassins à Enfiler Classiques Casual Bout Rond Chaussures Mode Évider Frange Sneakers Sandales-YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme. 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-EVR Chaussons pour Femme en Fausse Fourrure 2020 Mode Pantoufles Bout Ouvert IntéRieur et ExtéRieur Velu Chaussons(Saucony Women Fastwitch 9 Competition Running Shoe Shoes Neon Orange - White).
Conclusion
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