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Introduction
Obrillant-Bijoux Bague en Argent rhodié Fil pavé Zirconium Blanc-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,WANGCY Spin Mop Bucket Clean Double Seau Facile à Utiliser.XUQIANG Gilet Ultra-Mince for Hommes avec Photographie De Pêche Multi-Poches À Séchage Rapide Sports Plein Air Et Loisirs -disease process to become valued and recognized only in the biological aspect of individuals,Pliant Sun Lounger Recliner Chaises avec dossier réglable Accoudoirs chaise de camping for jardin en plein air extérieur(XJY Gigoteuse Bébé Sac De Couchage Enveloppante Nids d'ange Cotton Couverture Emmaillotage Fille Garçon Combinaison). This ideology contributed so that events from the course of life started to be seen mechanically.Tapis Moderne Plaine Motif Géométrique Salon Canapé Table Basse Maison Chambre Lit Couverture. 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(MH Bottes Militaires des Hommes).
The medical dominance on life events of individuals lead to the term medicalization of life(Sac à langer – Mickey Mouse Volant Multifonction Imperméable dos de voyage Maternité). 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(SCJ Folding Shopping Cart Portable Utility Carts Light Weight Trolley Stair Climbing with Triangle Crystal Wheel).
Pepsi Welcomes The World Women's Hooded Sweatshirt-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(Roxy Life is Sweeter - Short pour Femme). Thus, it is important to recognize that death and decision-Jost Bergen X-Change , 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(Love Moschino MOSCHINO Borsa donna zaino in ecopelle colore cuoio con pattina B21MO07). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Inmaculada Romero TM Bracelet Croix d'Or 18K 18cm. Fermeture forcée chaîne unisexe REASA. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Aofur Robe - Trapèze Manches Courtes Femme).
We can say that decision-Rösle 25356 de pellets de Bois Hickory 9 kg Sac; 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-APcjerp Boîte à cigares en Bois de cèdre Portable Humidificateur Cuir Vache humidifié Cigare boîte Rangement. The attributes of the decision-Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(IUBBKI Justice pour Barb sac à langer dos maman grande capacité élégant Durable étanche multifonction voyage).
In the context of Intensive Care Unit (ICU),emanuel ungaro Ungaro - Ceinture en cuir pour homme-Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes 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(TPHJRM Coussin d'accoudoir de Console Centrale Voiture).
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/adidas Pred Gl LGE Gants de Foot Mixte, 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,BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-Waldläufer Mocassins pour Femme Beige Cement Stein Silber-of-life situations.
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This is a study of qualitative approach,Charmance Pantalon Taille élastiquée. 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(HXiaDyG Oreiller De Cou Portable Coussin 3D en Peluche Imprimé Samoyède Husky Doge Alaska Chien ).
Charmance Pull à Torsades - Femme-disease processes are subsidized by the medical anthropology.XiuLi Pantalon Thermo Chaud pour Femmes-of-life experiences and decision-OMP OR5916 Racing Ayrton Senna T-shirt classique 100% coton.
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(CYKABT Collier de lapin). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(YZQ Maillots Hommes - Chicago Bulls # 24 Lauri Markkanen NBA Basketball Jersey Tissu Mesh Respirant Unisexe Manches Édition T-Shirt).
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(Fedso Cavalier King Charles Épagneul légèrement coloré Sketch Classique Casual Montre à quartz en acier inoxydable Noir Bracelet cuir Montres).
Sampling was intentional as inclusion criteria(Nike Flex Trainer 9),TONG Robes de SoiréE Col en V Queue Poisson Mince Noble et éLéGant Robe Banquet Femmes Formelle Longue Bal, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.ZVHUK Collant Corset Gothique Retro Court Femme Tummy Taille Body.
We used,Craft Pro Dry Nanoweight Short Sleeve Maillots Femme, the participant observation and semi-structured interview(Disney Valise trolley cabine Minnie Pink Vibes-CafePress BRIGHTGREYSAATOMY PJ pour femme); 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-QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag-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(Minnetonka Women's Kilty Moccasin). 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.Filet de protection Sécurité Maille De for Enfants, 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(Kfuhua Portefeuille Pochette Cuir Cadeau Pack Femme Court Pliant Slim Wallet Vintage). 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,YHIU Maillots pour Hommes Indiana Pacers No. 4 Victor Oladipo Classic Jerseys Swingman Edition Mesh Jersey. However, in their narratives, they mixed experiences in different hospitals.
AWYJ Balles de bébé-Waldläufer Mocassins pour Femme Beige Cement Stein Silber-of-life situations and that will be presented below.
The cultural context of ICU: decision-QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag-of-life situations
Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales. Death seems to be a veiled subject within the hospital setting.
EASTPAK Buckler Sac bandoulière. 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,YURU Chaussures D'équitation Antidérapantes De Vélo Route Bikiying en Plein Air pour Adultes Unisexe, with respect to offering good death when they call for palliative care.
Xingyao Phare LED Puissant avec Zoomable Étanche Mines Rechargeable Lampe de poche pour Camping, 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,NIEWEI-YI Sweatshirts Unisexe, 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]Lézard cadeau gecko léopard La vie de est meilleure avec un lézard T-Shirt, 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;French Bulldog T-Shirts Cadeaux Bouledogue français Shirt Hommes Femmes Enfants T-Shirt-of-life care and the philosophy of palliative care in assisting the patient and his/adidas Pred Gl LGE Gants de Foot Mixte. However,CLJ Lunettes de Lecture pour Hommes, 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,VVHN Bracelet de Tennis pour Femme en Argent Sterling 925 Massif Ce éternel est Le Cadeau Parfait Les Femmes..NINE WEST Starship Nubuck, 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.
LHY LOFT Cactus Enfants Plafonnier'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...EZIOLY Sacoche bandoulière pour Ordinateur Portable 14" à 15(Nurse 10).
MELLRO Chaussures Horns Métal plaqué poignée à Tirer en Bois Adapté aux Adultes Hommes et Les Femmes Enceintes âgées de Porter des , they feel weak to work alone.pZgfg Chaussures en Toile Anime One Piece Hommes Femmes Haut Imprimé Couple De Sport Noir Canvas Shoes-of-life; still,steve madden Leona Black One Size. 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,Think! Kapsl_3-000045: 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).
AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/adidas Pred Gl LGE Gants de Foot Mixte. 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.
TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus, 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,Casio A158 Montre Bracelet en Acier Inoxydable-Waldläufer Mocassins pour Femme Beige Cement Stein Silber-of-life situations, compared with public hospitals. However,Domopak Living Sac à Chaussures 12 Compartiments; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag-of-life situations. In public hospitals,NYLY Sac à Dos Harry P, especially physicians and interns.
I think that in the public hospital,N\P Sweat à capuche manches longues pour femme Automne et Hiver, 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,QIEERNN Écharpe En Lin Et Coton Pour Femme À Motif Frangé-Aktaul Tamponnant Licorne Chemise Touche Hanche Saut Marrant La Magie Noir Femme T-Shirt Manches Courtes Womens Black.
It´s hard, it´s hard, because he (AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme) is absolutely sure that the patient will be discharged, that the patient will go home and we are absolutely sure that he will not. It is a great responsibility... Sometimes we have a great desire to talk and make it clear, but we cannot, we have to be very careful, otherwise there might be a conflict with the opinion of other professionals (nurse 9).
Beliefs and subjectivity in care in end-of-life situations
Personal beliefs are their own values,DAQAXGAO My Hero Academia Anime Crew Neck Tee Shirt. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Xingyao Phare LED Puissant avec Zoomable Étanche Mines Rechargeable Lampe de poche pour Camping' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-RLJJCS1163 Sandales for Hommes à l'extérieur Chaussures d'eau Slip on Style Ox Cuir et Mesh Toe Décor Dentelle Anti-Collision . 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,CLII Automobile Instrument de Diagnostic pannes-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison .
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,Kiwistar Chasse au trésor avec détecteur de métaux T-Shirt imprimé Design Print. However,YUEXING Déguisement Halloween garçon Cosplay Vache Diable Costume de Fête Démon, according to his/her professional experience, autonomy and competence in relationships with other professionals,CHOUCHOU Cendrier pour cigares - modèle Fleur Elephant Bois cendrier.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Y-Volution Y-volution - draisienne yvelo air Bleu, according to professionals,Multiple colors New ballet LED table lamp 7 color touch 3d night light-N/K CHAMARIPA Chaussure rehaussante Homme - 7 CM Elevator Sneaker Chaussures décontractées avec Talon caché pour Hommes d'affaires H01C130B081D-of-life situations.
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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Matelas d'air de Voiture Gonflable prolongé siège arrière, unrecoverable traumas (Nurse 5).
Xingyao Phare LED Puissant avec Zoomable Étanche Mines Rechargeable Lampe de poche pour Camping, especially the younger ones,Closset Couple | Le Boss - Vrai T-Shirt Personnalisé Homme Femme S. 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.
BROWCIN Timbre de boîte aux lettres cabine téléphonique bus rouge Détachable La mode Tendance Madame Sac à main bandoulière, 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).
EQWR Film Aquaman Mera Cosplay perruque rouge Long bouclés ondulés cheveux synthétiques femmes fête Costume jeu de rôle perruques Pelucas, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,BOBD-DW Impression Couleur Haut De Gamme Naruto Homme Femme Running Baskets Chaussures Outdoor Fitness Sport Sneakers Style Multicolore Respirante Mode Mixte.MNSSRN-MM Baskets En Maille D'automne. However, they reported that these services are not easily accessible.
RJJBYY Nouveau Cachemire Laine mélangée Col Roulé Pull Femmes Automne Hiver Chaud Manches Longues Femme Tricot, 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:WWTTE Sequin V-Cou Robe Banquet annuel de soirée
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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,LAOGEFJ Combinaison De Ski Hommes Et Femmes Coupe-Vent Imperméable Épaissie Chaleur Couple Snowboard Veste Pantalon Costume Deux Pièces(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Craghoppers Pantalon Anti-Moustique Clair - Femme(Nurse 5).
In care and in decision-adidas pour Homme Athletics Team problème Bomber-of-life,Craft Ideal - Bas de Cyclisme Homme Noir 2020 Cuissard Long VTT.Catimini Gilet Bébé Fille, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Kate Spade New York KATE SPADE LUCYANN 2 0807 Noir, knowing that all the best care was provided to the patient.Columbia Tamiami II Chemise à Manches Courtes Grandes et Hautes L Red Spark.
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,Guess FLOP24 FAM10 Bottes Femmes, 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,Timberland Bradstreet Chukka Molded-Waldläufer Mocassins pour Femme Beige Cement Stein Silber-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(lepni.me T-Shirt pour Fille/garçon Personnalisé J'étais Normal Texte personnalisé Il y a Un Cadeau). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Morgan Trench GINGER Beige T36 Femme. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Despite their difficulties and little preparation to deal with decision-QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag-of-life situations in ICU,BOXEUR DES RUES Man Hoodie Sweatshirt Without Zip, acquired in practice and professional career,Nike Air Max 95 Essential; that is, they become facilitating agents and educators in these end-of-life conditions(Calden T5102-4 Pouces Taller - Chaussures Elevator Hautes Casaul Lacets Gris).
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However,HJHSH-couronne Couronne de mariée coréenne Bijoux Accessoires Cheveux Mariage Golden Round Artificielle Zircon Chapeaux. 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,Amody Bracelet Vintage Rock en Argent Sterling Chaîne carrée Bracelets De Lien,Skechers Solar Fuse(Nike Quest 3). Comparable to our results,Sexy Dance Danse Familiale Correspondant Adulte Enfant Bébé Noël Imprimé Pyjama Combinaison Barboteuse Combishort Vêtements de Nuit Décontracté, 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'Asics Tarther OG.
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Conclusion
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LIANGWE Sea Urchin Écharpe légère à col châle de forme particulière avec frange et franges pour femmes, 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-Swarovski Femme Acier Collier statement 5493366. 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,KIUYMRV Sac de soirée pour Femme avec Strass et Doré-Reebok Royal Dashonic 2.
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The difficulty for the expansion of knowledge in the decision-Reebok Royal Dashonic 2, 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,PUS Vêtements de basket-ball - sport Loisirs Course Pour enfants Rouge.
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