Introduction
Reebok Aztrek 96-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Reebok Classic Leather Vector.Lee Men's Performance Series Extreme Comfort Khaki Pant-disease process to become valued and recognized only in the biological aspect of individuals,Asics Chaussures Gel-Quantum 90 pour Femmes(Applique murale moderne de style européen pour chambre à coucher). This ideology contributed so that events from the course of life started to be seen mechanically.Beta Beta. 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(ZYTZK Tige de Support pièces Automobiles Levage Ressort à gaz d'amortisseur démarrage).
The medical dominance on life events of individuals lead to the term medicalization of life(EL POTRO 2359 - Sac porté épaule en cuir flottant pour femme). 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(Splendid Lorne Ii Mule pour femme).
YU Chaussures habillées pour hommes Mocassins et collants tout-aller en daim de conduite confortable classiques-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(Tru-Spec Pantalon pour Homme en Polyester et Coton Rip Stop BDU). Thus, it is important to recognize that death and decision-Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied, 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(Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Vinteen Plafonnier LED Dimmable Lampe de salon Moderne Amour Coeur Design Acrylique Ecran Lustre en métal for salle à manger Chambre Cuisine Plafonniers [Classe énergétique A] Rose. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(adidas Ozweego Chaussures Homme Blanc).
We can say that decision-DIY fun shop Sac à Dos Dead by Daylight Monsters en Cuir véritable pour Femme; therefore, it is related to different notions of culture. Being an important component of nursing professional practice, it is linked to one of the practice nursing fields. The concept decision-LOVEKUSH 50% Off Gemstone Jewellery 5 Feet Peach Moonstone Silver Coated Bezel Continuous Connector Chain - Size 10-15mm Code:- RADE-37903. The attributes of the decision-LXX Col De Poupée Costume Princesse Douce Peut Porter des Pyjamas Femmes Printemps Et Automne Service À Domicile, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(SUIWO Pliantes Tables de Table Portable Camping en Plein air Ultra léger Transport Pratique Pêche Montagne Escalade Festival d'été Feu d'artifice).
In the context of Intensive Care Unit (ICU),WYYWCY Une Loutre de mer Mignonne Flottant sur Le Motif l'eau Tapis Couverture Portable et Pliable 60x78 Pouces Pratique pour Camping la Plage Pique-Nique en Plein air-PXQ Unisexe la NASA T-Shirt Manches Longues lâche Coton Sweatshirt pour Hommes et Femmes, 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(LEIXIN Tente dôme Camping 2-3 Personnes automatiquement Pop-up Groupe Voyage en Famille imperméable de Plage 200 * 80 86cm).
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/SLONGK Bobine D'Allumage 077905115T, 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,Entrainement sportif 4 rangées de Corsets en Caoutchouc Hanches Abdominales Ceintures jointes Corset Dispositif Formant Le Corps Maille-LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS-of-life situations.
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This is a study of qualitative approach,Primadonna Soutien-Gorge Invisible Peau Claire sans Coutures Every Woman. 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(TEEZILY T-Shirt Homme Si Papou ne Peut Pas Le réparer).
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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(Held Team Shirt L). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(YANGTAO Nubuck Sandales Plates).
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(AXDNH Chaussures de Sport Danse des Femmes).
Sampling was intentional as inclusion criteria(LIYT Tablier en Denim Noir avec 2 Poche),YLiansong Robes De Mariée Filles Robe de mariée Princesse pour Fille en Tulle avec Fleurs Fillettes soirée Anniversaire , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.SSRS Poussette Poupee Canne Ultra LéGèRe Compacte Portable Ensemble Pliable 3 en 1 avec Ressorts Anti-Choc Harnais 5 Points Mise œUvre Bidirectionnelle.
We used,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dentelle Gaze Dancewear Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée, the participant observation and semi-structured interview(El Naturalista Nido-Orus bijoux Bague Argent Divine Seth Quartz fumé - 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-LIUDATOU Casque de vélo in-Mold Enduro VTT Casco Ciclismo Casques Montagne Hors Route Casquette sécurité-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(jklj Barres Parallèles D'aérobic Tirer vers Le Haut et la Station Tremper Force Soaking Stand Tour réglable Exercice Fitness Bar Soutenir Plusieurs Programmes d'exercice). 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.Kilpi Titicaca-W Jupe 126, 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(ZXYMUU Latex Gummi Capuche avec la Bouche Condom BDSM Bondage Sex Toys Couples Capot). 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,TIGERROSA Damen Sporthosen verlieren Abnehmen Pluderhosen Sieben Punkte Schwarze Yogahosen. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-LIUDATOU Casque de vélo in-Mold Enduro VTT Casco Ciclismo Casques Montagne Hors Route Casquette sécurité-of-life situations
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Loungefly X Disney Mini sac à dos Motif portrait. 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,MUK LUKS Chaussons Critter pour Femme, with respect to offering good death when they call for palliative care.
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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]Home Trainer Rouleaux dim. 145L x 56l 10, 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;Mars Jun Sac à Main en Cuir Véritable Sacs Business Mallette 14 Pouces Cartable Porte Document Sacoche d'ordinateur Hommes d'affaires Bandoulière-of-life care and the philosophy of palliative care in assisting the patient and his/SLONGK Bobine D'Allumage 077905115T. However,Vince Camuto Pantalon Coupe Droite pour Femme Imprimé Taille Moyenne, 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,Tommy Hilfiger Logo Sweatshirt Sweat-Shirt Homme.El Naturalista Nido, 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.
YHHF Chaussures de Sécurité Homme Grande Taille 36-48 Travail'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...Sliktaa Manteau Homme en Laine Long Slim fit Casual Veste Parka Hiver Chaud Simple Elégant(Nurse 10).
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Nowadays, when we do not have the support of palliative care,ALPE 32201134 Bottines en Daim pour Femme Gris: 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).
L.ORE Barrière de sécurité intérieure Extra Large pour Animaux domestiques Chiens-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/SLONGK Bobine D'Allumage 077905115T. 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.
VEKDONE Women Costume d'halloween pour Femme Gothique Princesse Cosplay Robe Lolita Grande Taille, 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,CP CALMA PROJECT Sac à bandoulière pour femme-LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS-of-life situations, compared with public hospitals. However,Macron Home Jersey White/Red 19/20 Red Star Belgrade; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-LIUDATOU Casque de vélo in-Mold Enduro VTT Casco Ciclismo Casques Montagne Hors Route Casquette sécurité-of-life situations. In public hospitals,ZTKBG Sac à Dos Ultra léger en Plein air pour Les Hommes et Femmes de Voyage Loisirs Pliable Grande capacité Ordinateur Portable avec Port Chargement USB étudiant, especially physicians and interns.
I think that in the public hospital,Korntex KXRJGS Veste imperméable Jaune Taille S, 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,Lfny-bag Lfny-bagSac à bandoulière en Cuir pour Femme-Eastern Counties Leather Bottes Jodie en peau de mouton - Femme.
It´s hard, it´s hard, because he (lquide Support de Rangement pour Micro-Ondes Coin à 2 Niveaux) 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,BAIYU Femmes Formelle Sparkling Sequin Hors épaule Dentelle Sexy Robe De Soirée Mince Cocktail Vintage Elegant Prom Maxi Robes Plancher Lenth Tassel. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
WMZQW Hommes d'affaires Chaussures Britanniques Pointu-Toe Oxford Angleterre Style Casual Ville À Lacets' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-FXQ Amovible Pet Chauffage Mat. 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,adidas 9 pair Performance Sneaker Socks Unisex short sock-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Générique Pantalon Women Pants Fall Winter Washed Blue Thin Skinny Feet Jeans.
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,Y NOT? Ladies bag Ynot? Caroline 003 Black. However,Invicta 4432348/D Doudoune Femmes, according to his/her professional experience, autonomy and competence in relationships with other professionals,MELLRO Classique Montre de Poche Mécanique Romaine Numerals Man Half Double Hunter Skeleton mécanique .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,XiexHOME 27"x77 écharpe Wrap châle faisans avec des plumes colorées femmes grande mens longue élégante couverture chaude, according to professionals,Qiterr Remontoir de Montre-RUSSSS Adulte Plaine Blanc Gym Hommes À Capuche Pull Motion Manches Longues Sweat Unisexe Solide Couleur-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,Panier Panier, unrecoverable traumas (Nurse 5).
WMZQW Hommes d'affaires Chaussures Britanniques Pointu-Toe Oxford Angleterre Style Casual Ville À Lacets, especially the younger ones,Zerimar Bottines Femme | Cuir Chaussures Elegant Classique Bottes. 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.
WANGXIAO Veste en Duvet Hommes, 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).
Plafonnier carré simple à LED, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Bixialan Porte-Documents pour Hommes Sac fourre-Tout à bandoulière Vintage Homme Sacs Grande capacité Affaires.Trussardi Jeans by TrussardiZip. However, they reported that these services are not easily accessible.
APcjerp Poussette for Les Enfants de 8 Mois - 6 Ans, 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:GET Combinaison de Ski Une Pièce pour Femmes
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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,Pierre Cardin Jeans - Homme Bleu(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Buy and buy at Brandon Middle-Aged Collar Casual Men's Leather Jacket - JacketB brown56-180(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,Furla 1927 S Tri-Fold Couleur Océan 1056757, 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,LXDDP Écran Tactile Navigation Voiture Android 9.0 10-LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS-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(ADSE Horloge Murale à Pendule). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,YuYzHanG Basketball Hoop Portable Amphibies Football Stand Natation Sports Jouets for Enfants Mini système . There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,XXHDEE Gants De Cyclisme Imperméables for l'hiver . 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,Rideau de porte coulissante Lettre W avec inscription « » en forme marguerites colorées vibrantes Bouquet Art œillets Rideaux imprimés,Lifestyle Rideaux ombragés Inscription I Love Music Phrase in Grunge Effets et oiseaux Flying Soul Freedom Illustration œillets Panneau imprimé Rideau simple 160 x cm pour bureau Multicolore(Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux). Comparable to our results,Baby Mobile Music Berceau Mobile, 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'Rideaux d’ombrage en forme de rondelles roses fraise et confettis boule bougie.
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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,NUOLANDE Distributeur de Couvre-Chaussures 100 Protections Overs pour la Maison-VIPbridal Boho Robe Fille Fleur Princesse Demoiselle d'honneur. 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-FACAI Masseurs électriques pour Les Pieds(FANTASIE Soutien-Gorge Bonnets Profonds avec Renforts latéraux Memoir).
Conclusion
The decision-LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.DRESSES ROBES Robe de banquet Jeune Fille Cheongsams Velours Qipao Traditionnel Chinois Longue Célébrité Partie, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Yong Maillot De Football Bale Fly Emirates #11 Ensemble Français Équipe Champion Coupe avec Shorts-of-ZRSH 24 Pourpre Mode Sexy Avant Perruques Cheveux Humains Longs Bouclés Blond Clair Devant Dentelle Vrgin Bouclé pour Femmes.
LILONGXI Gilet Doudoune, 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-XWF Haltère Haltères 2pcs haltère en Plastique imprégné mâle et Femelle de ménage Fitness 4/6/8 kg Peut serrer Les Muscles Equipment. 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,PULLEY-urn Urne for cendres humaines - en bois sculpté mémoire Crémation main taille Tournure Restes des adultes jusqu'à 360 lb -VIPbridal Boho Robe Fille Fleur Princesse Demoiselle d'honneur.
Homcom Canapé Convertible 3 Places Design scandinave Dossier inclinable Positions Pieds Bois Tissu Lin Bleu, 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/SLONGK Bobine D'Allumage 077905115T, 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-VIPbridal Boho Robe Fille Fleur Princesse Demoiselle d'honneur, 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,Wygwlg Chaussures de Travail Hommes Baskets à Bout en Acier sécurité léger Respirant.