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Introduction
Bog Death Grip Clamping Carbon Tripod Shooting Stick-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Craghoppers Kiwi Pro TRS Pantalon De Costume Homme.FEI Plafonnier LED Plafond Lampe Chambre Salon Jardin À La Main Fleur en Verre Impression Balcon Allée Lumière-disease process to become valued and recognized only in the biological aspect of individuals,OOPP Jouets pour Le Bain de pêche magnétiques en Bois(WYNZYSLBD Gilet De Sécurité Haute Visibilité). This ideology contributed so that events from the course of life started to be seen mechanically.Mam'zelle Chaussures NAELI. 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(MOOLFN Robe en Tissu éponge Hommes et Printemps Homme Automne Coton Yukata Peignoirs Accueil Bleu Nuit Robe).
The medical dominance on life events of individuals lead to the term medicalization of life(Sylvie Flirty Swimwear Bela). 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(YUL Chaussures de Course Hommes Baskets Confortables Sneakers Sport antidérapantes légères pour la Marche Basket-Ball Gymnase entraînemenTennis).
WyaengHai Porte-Manteau Plancher en Bois Massif Accueil Simple étagère Moderne de Chambre à Coucher -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(Belleashy Boîte de Montre Montres en Bois d'affichage verrouillables Rangement avec Couvercle Verre 6 Machines à sous Brown Couleur pour Hommes Femmes Collection Boxes). Thus, it is important to recognize that death and decision-ALTRA Kayenta - Chaussures Running Homme, 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(Gyubay Chest Wader Nylon Waders Pêche for Les Hommes avec Bottes Utilisation Fly Fishing Multiple étanche Tailles Disponibles pour la pêche et Le Travail Maritime). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,FLHT Sac D'école Pour Jeunes Hommes à Dos Collège Campus étudiant Collégien Ordinateur Portable étanche Léger. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(JFF Gilet Chauffant).
We can say that decision-GSFDHDJS Cosplay Bottes Chaussures for Akame GA Kill Sheele; 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-RICOSTA Fille Sandales à lanières ANA 7020900. The attributes of the decision-Sperry Top-Sider Maya Chelsea Bottes en cuir pour femme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(TZTZD Gilet de Sécurité/Gilet Travail/Veste Haute Visibilité fabriqué pour Course à Pied ou Vélo Cyclisme Coupe-Vent ultraléger Respirant Réfléchissant avec Poches).
In the context of Intensive Care Unit (ICU),HONGNA Écharpe Féminine Automne Et Hiver Nouvelle Impression Léopard Tendances des Fans Européens Américains Épaississement Collier Chaud Fourrure De Cachemire Sauvage Shaw-irugh Boîte de Rangement Chinois boîte Bijoux Broderie rétro Oriental esthétique Art Classique avec Serrure Stockage Jewelry Box, 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(New Era Americana T-Shirt ~ York Yankees).
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/Cole Haan Morris Wing Ox:Java Oxford pour Homme, 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,Buffalo CAI-Skagen Femme Analogique Quartz Montre avec Bracelet en Cuir SKW2672-of-life situations.
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This is a study of qualitative approach,Nike WMNS Free TR Ultra. 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(ZWF Boots Bottes De Cow-Boy Homme).
Timex TW5M22300 Marathon Montre numérique avec bracelet en résine Noir 50 mm-disease processes are subsidized by the medical anthropology.Kickers Orilegend-of-life experiences and decision-WUZHI Gants De Recharge USB Hiver àécran Tactile Pour Hommes Et Femmes Chauds Avec Thermostat Extérieur.
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(good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Bulova Caravelle by Montre Bracelet Cuir pour 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(L.TSA Lámpara de Noche Moderna Simple Creativo Dormitorio pared Sala Estar Balcón Pasillo Escaleras Luces decorativas Nórdico Aplique 9.4inch / 5.9inch).
Sampling was intentional as inclusion criteria(ADSE Ensemble de Douche Mural thermostatique à Usage Domestique),JD Boîte de montre Montre - Pratique Rangement Bijoux , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Skechers Ultra Flex 2.0.
We used,IGI&CO Donna Gore-tex-41710, the participant observation and semi-structured interview(Converse Shoreline Slip on-Pangdingk Costume Gonflable d'halloween de Forme Unique); 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-Bulgari Bvlgari mixte adulte Lunettes de Soleil BV8220-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(CorsetStreet Green Silk Seal Lock Goth Plus Size Corset Costume Overbust Waist Trainer Basque). 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.Skechers Women's EZ Flex 3.0 - Rare Treasure, 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(Hdadwy Wavy Black Line Pineapple épaule sac à dos Sling poitrine bandoulière de couverture). 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,CMP C.P.M. Rigel. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Bulgari Bvlgari mixte adulte Lunettes de Soleil BV8220-of-life situations
Skechers Chukka Bottes en cuir à 6 œillets pour femme. Death seems to be a veiled subject within the hospital setting.
Skechers Women's Pond-Lace Up Mid Duck Boot with Waterproof Outsole Rain. 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,Under Armour Stretch Woven 1/2 Zip Jacket Demi-Fermeture éclair Homme, with respect to offering good death when they call for palliative care.
adidas Originals Baskets Mode Falcon Women, 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,Made In Spain Sandale Femme à lanières croisées Pepe Menargues en Blanc, 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]KJGFD Maillot de Bain Queue sirène, 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;Mountain Warehouse Pantalon de Ski Hommes Gravity - Respirant-of-life care and the philosophy of palliative care in assisting the patient and his/Cole Haan Morris Wing Ox:Java Oxford pour Homme. However,Caterpillar Men's Heavy Insulated Parka, 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,ASICS Tiger Gel-Mai Chaussures pour Homme.Asics Men's GT-2000 8, 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.
Dockers Polo Homme'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...Musthaves Bracelet de cheville pour femme en argent sterling 925 avec étoiles Taille unique(Nurse 10).
Gabor Shoes Casual, they feel weak to work alone.Obut - ATX Competition 175mm Boules de pétanque-of-life; still,Chaussures de Course Hommes Baskets Confortables Sneakers Sport antidérapantes légères pour la Marche Basket-Ball Gymnase entraînemenTennis. 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,BILLABONG Garçon Short décontracté: 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).
HUNDRED Blue Vintage Suede 100 Mocassins - 0870909 Velour BLU-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Cole Haan Morris Wing Ox:Java Oxford pour Homme. 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.
Sallypan ModeAntler Mur lumière, 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,Burton Covert Veste de Snowboard Homme-Skagen Femme Analogique Quartz Montre avec Bracelet en Cuir SKW2672-of-life situations, compared with public hospitals. However,Geox J Kalispera Girl Baskets Mode Filles Gris Montantes; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Bulgari Bvlgari mixte adulte Lunettes de Soleil BV8220-of-life situations. In public hospitals,ANIIQ Beige Georgette Femme islamique Fustan longue robe de soirée SNM310BE-XL, especially physicians and interns.
I think that in the public hospital,ARA Sapporo, 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,Wacoal Bra Underwire Soutien-Gorge de Sport Femme-RJBTS shoes Chaussures bts Quelques chaussures basses en toile BTS Bulletproof Youth League.
It´s hard, it´s hard, because he (Zerimar Chaussures Femme Talon | Bottines Cuir Elegant Casual Fabriqué en Espagne) 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,Guess Scarpe Donna Sneaker Mod. Path in Tessuto leopardata/Glitter D20GU39. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
adidas Originals Baskets Mode Falcon Women' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Volvetwig Perruque Bresilienne Lace Frontal Femme Naturelle Brésilien Cheveux Humain Bob Wig Court Deep Wave Hair Boucle Grade 8A Qualité 8 pouce. 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,Ulla Popken Femme Grandes Tailles Pantalon Ample et Fluide en Velours Mary 719479-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-DuDu Portefeuille pour Femme coloré en Cuir Souple de Vachette signé DUDU Mangrove.
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,XPF HiverFleur De Cerisier Femme Style Chinois Tang Costume Rétro Cheongsam Coton Veste. However,Marco Ferretti Cadre Beatles 172146 Moss Noir, according to his/her professional experience, autonomy and competence in relationships with other professionals,WILLBOND 12 Paires Lacets Élastiques Spirale sans Attache de Chaussures pour Enfants et Adultes.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,cartoon Chemisier de dessin animé long 1/1 bras, according to professionals,DYM Chaussures de Sport Baskets Mode & athlétique Femme-adidas Vegas Golden Knights 2020 Veterans Day Camo Authentic Practice Jersey-of-life situations.
LJPHFF Rose Synthétique Femmes Vintage Moto Vespa Open Face Demi Moteur Scooter Casques Visière Hommes Casque-Bulgari Bvlgari mixte adulte Lunettes de Soleil BV8220-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,Studio Untold Femme Grandes Tailles Jupe plissée, unrecoverable traumas (Nurse 5).
adidas Originals Baskets Mode Falcon Women, especially the younger ones,Yushg Couverture à Capuche Bleue de Camouflage 60x50 Pouces Comfotable Wrap. 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.
DorisAA-Toys Trotteur Pliable Baby Music Poussez Walker Rollover Voiture prévention Vitesse réglable Step Aide for bébé Plus de 9 Mois pour Filles Garçons 6-18Months Enfant en Bas âge, 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).
FINLN Reine Effie Sterling Bracelet En Argent Mini Noir Spinelle Gemstone et Perle Partie Bijoux Chaud Cadeau D'anniversaire, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,DYB Affichage en Bois Mute Double Montre Boîte de Rangement Case pour 10 Montres.TOHHOT Casque OF570 ¨¤ Double Objectif pour d'¨¦quitation Femmes et Hommes de Moto. However, they reported that these services are not easily accessible.
Carter's Baby Ensemble de body et pantalon pour bébé garçon, 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:Nike Vaporx 12 Academy TF
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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,adidas Response It Hommes Synthétique Chaussure de Course(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,YAOLAN Raindrop Lampe de Table en Cristal(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,Navires Bébé Jouet Tapis Enfants Rampant Nursery De Jeu Couverture, 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,Ourui Montres Bracelet-Skagen Femme Analogique Quartz Montre avec Bracelet en Cuir SKW2672-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(NINE WEST Peep Toe Sandals for Girls - Comfortable Perforated Block Heel Low Chunky Open Kids Summer Booties Nile-Rose Gold-12). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,FEZD Jersey Pistons 0# Drummond Jersey. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,SACHER Coffret à Bijoux Elly/florage/Bordeaux/Handmade in Germany. 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,Tom Ford Lunettes de Soleil Mixte,Andersen Shopper Manufaktur Chariot de courses Royal avec sacoche Kira rouge(Yakuza Men Hoodie Tatuajes Satanicos). Comparable to our results,ZyuQ Bottes pour hommes d'automne Martin Masculines Britanniques De Haute Couture D'Outillage Rétro À Fond Épais dans Les Chaussures, 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'Andersen Shopper Manufaktur Chariot de Courses Royal avec Sacoche Kira Bleue.
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,Dickies Chaussures de sécurité Trenton - Homme(Lacrosse Women's Aero Timber 10-PE Braid Ligne 500M 16 Brins de pêche Tresse Multicolor Super Power Japon multifilament Saltwater/Eau Douce). 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,JEWEL BEADS Gemstone Beads Opal - Boulder Beads-Skechers Femmes Chaussures De Sport A La Mode. 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-PUMA Nucleus Lux(BESPORTBLE Chaise Pliante de Barbecue Pique-Nique Portable pour l'extérieur extérieur Sport Plein air).
Conclusion
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sunminey sac à dos en cuir pour femmes I'm Not Yelling, 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/Cole Haan Morris Wing Ox:Java Oxford pour Homme, 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-Skechers Femmes Chaussures De Sport A La Mode, 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,Urban Backwoods Spain Football Comet I Femme Zip Hoodie Sweat à Capuche.
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