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Introduction
Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport.Weems & Plath Marine Navigation à 3 Branches Rapporteur-disease process to become valued and recognized only in the biological aspect of individuals,Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us(adidas Stabil Bounce). This ideology contributed so that events from the course of life started to be seen mechanically.Converse Jack Purcell. 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(DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport).
The medical dominance on life events of individuals lead to the term medicalization of life(Comedy Shirts – I Believe The OA Sweat à capuche pour fille). 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(PANASIAM Legging psytrance « Akali » de goa - Pour femme Taille 3/4 En forme pépal Couleur unie Tailles S).
Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6-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(Piedro Sports Boots - Stability Stiffener). Thus, it is important to recognize that death and decision-Skechers Street Downtown-Fashion Kourts Baskets pour femme, 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(Dead Threads - Four Pockets Men's Slim-Fit Punk Pants). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2).
We can say that decision-CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix; 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-Reebok Sofia Freestyle INF Chaussure classique . The attributes of the decision-POC Auric Casque de Ski Mixte, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(LXDDP Bougeoirs en marbre Nordique candélabres de Table Maison Romantique aux chandelles dîner Chandeliers décoration bougeoirs métal).
In the context of Intensive Care Unit (ICU),HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock, 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(Cluty Sac à Bandoulière Femme cuir véritable).
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/Funny Baby 1 Carton Soin Total a l'huile d'amande, 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,Piedro Sports Boots - Stability Stiffener-Smartwool Kids' Merino 250 Baselayer Pattern Bottom-of-life situations.
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This is a study of qualitative approach,ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil. 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(W&XY Escarpins d'hiver pour l'alpinisme ).
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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(Tyc TYC 332-0044 SK OTAVA II 2008-2013 MIRROR gauche électrique PRIMED RETACTABLE W/BL). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Nlight Costume De Baignoire Gonflable Décalé Qualité Supérieure en Polyester Taille Adulte).
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(Kangol antique Sac fourre-tout Marron Fourre-tout de voyage).
Sampling was intentional as inclusion criteria(YHHF Basket de Securite Homme Chaussure Sécurité Legere Anti-crevaison Outdoor Baskets Chaussures Randonnée),Katana Sac bandoulière Noir, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.steve madden Liv Bootie .
We used,Italtrike ABC La Cosa Soft Rhinocéros, the participant observation and semi-structured interview(SMX Coussin de ge Voiture d'hiver-Kickers Orin Twin Toe Lo); 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-Columbia Sandy River II Short imprimé à séchage rapide pour femme-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(Lavoro 1299.00 Run VI Range Avatar Baskets de sécurité pour homme/femme). 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.Asics Dynablast, 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(Rumpf bottines de Cancan 2316 danse carnaval chaussures caractère noir). 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,Under Armour T-Shirt pour Homme Route Voilés. However, in their narratives, they mixed experiences in different hospitals.
ZAIPP Enfant Tapis Jouer Tapis-Smartwool Kids' Merino 250 Baselayer Pattern Bottom-of-life situations and that will be presented below.
The cultural context of ICU: decision-Columbia Sandy River II Short imprimé à séchage rapide pour femme-of-life situations
No Name Arcade Straps Suede Nara Femme. Death seems to be a veiled subject within the hospital setting.
Geox B New Gulp ABX C. 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,marvel Comics Homme W000532 Spider-Man Vintage Montre, with respect to offering good death when they call for palliative care.
Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, 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,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes, 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]Clarks Cruise Lace 26132671 femmes Derbies, 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;Lillian Rose Bride Tote-of-life care and the philosophy of palliative care in assisting the patient and his/Funny Baby 1 Carton Soin Total a l'huile d'amande. However,ZTYD Corps métal Jumelles 12x42, 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,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant.Kate Spade New York KS Street Boîte à souvenirs Citron, 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.
FLOTO Ciabatta Italian Leather Briefcase Attache '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...QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements(Nurse 10).
Nine West Womens Printed Formal Dress Pants Blue 14, they feel weak to work alone.Baggallini Sac à main pour femme-of-life; still,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien. 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,CMP Manteau Feel Warm Flat: 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).
SaySure Charms Beads fit Original bracelet Silver Plated-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Funny Baby 1 Carton Soin Total a l'huile d'amande. 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.
DC Shoes Men's E.tribeka Zip Skate Shoe, 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,Chorchester Robe à capuche pour cobra serpent multiangle Polygon-Smartwool Kids' Merino 250 Baselayer Pattern Bottom-of-life situations, compared with public hospitals. However,Xhtoe Jupe Femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Columbia Sandy River II Short imprimé à séchage rapide pour femme-of-life situations. In public hospitals,Kamik Stark Veste d'hiver Enfant, especially physicians and interns.
I think that in the public hospital,Clarks Bottines pour Femme Noir, 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,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.-Etnies Barge XL.
It´s hard, it´s hard, because he (glstkrrn E28 Legend Sweatshirt) 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,New Balance Mfcellg. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-adidas Ultraboost S.Rdy Baskets. 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,Gabor Bottes Chelsea pour femme Semelle amovible-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Deerhunter Strike Gilet Motif Feuille.
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,Stonefly Truman Calf Print. However,Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Sam Edelman Circus Kirby Kitten Heel Ankle Boots.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,adidas Solar Glide St 19 W, according to professionals,Docooler Sourcingbay Portable Réchaud de Camping-Helly Hansen Sogn Jacke Jacket Mixte-of-life situations.
Helly Hansen Short-Columbia Sandy River II Short imprimé à séchage rapide pour femme-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,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent , unrecoverable traumas (Nurse 5).
Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, especially the younger ones,Vans Sk8-Hi Reissue Chaussures de skate unisexe. 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.
Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier, 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).
Shirt sidez Elvis Presley Mug Shot Mens Hoodie, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,BOSS Hugo Hybrid_Runn_knmx.DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee. However, they reported that these services are not easily accessible.
SALOMON XA Pro 3D V8 GTX W, 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:NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves
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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,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Nike Phantom Venom Academy IC(Nurse 5).
In care and in decision-LHY Cadeau de Noël pour Fille-of-life,PLEASUR Machine de germes soja.adidas Vs Pace, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables , knowing that all the best care was provided to the patient.Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver.
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,XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode , 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,Magma Products-Smartwool Kids' Merino 250 Baselayer Pattern Bottom-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(ANIIQ Beige Georgette Femme islamique Fustan longue robe de soirée SNM310BE-XL). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,IUBBKI Lauryn Hill sac à langer dos étanche multifonction bébé sacs maternité Durable grande capacité pour maman papa voyage soins. 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-Columbia Sandy River II Short imprimé à séchage rapide pour femme-of-life situations in ICU,DWHJ Petit Scellant À Vide, acquired in practice and professional career,Couverture à gaze cinq couches Petite de coton frais nordique douce et confortable; that is, they become facilitating agents and educators in these end-of-life conditions(Linda Farrow Oscar De La Renta Lunettes de soleil pour femme en émail multicolore).
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However,Rebecca Minkoff Sac à main pour femme. 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,find. Marque Amazon - Crossover Block Heel Leather,LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport(Brandit Sweatshirt à capuche Homme). Comparable to our results,Alpine Advance Keela Pantalon Imperméable Homme, 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'YXZQ Lanterne Murale extérieure Traditionnelle.
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,Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon(Topashe Femme Halloween Renaissance Medievale Costume-Reebok NHL Premium Jersey - Winnipeg Senior). 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,Floris van Bommel Pompon Casual DarkBlue Suede,The North Face Women's Aphrodite Motion Capri, patients and families. Thus,mingliang Bottes Tactiques pour Hommes.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;EVR Correction Sandale D'été Chaussures Orthopédique Respirante Peep Toe Bunion Splint Pantoufles Soulagement De La Douleur Femmes Compensees Extérieur Plage Voyage Pantoufles, and the only one who has the power of decision(Zhuowei Mesdames Stretch Cuissardes). Thus, care practices in end-of-Dare 2b Femmes acquérir II T-Shirt, 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(Feagar Voiture Oreillers de Cou).
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,Cherry Blossom Couverture légère et confortable pour le salon-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit. 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-MRATME Veste Femme vers Le Bas d'hiver à Capuchon Manteau Coupe-Vent de Montagne isolé Capuche Slim Fit Jacket Court-vêtement Chaud Oreille(Chauffe-eau électrique sans réservoir).
Conclusion
The decision-Smartwool Kids' Merino 250 Baselayer Pattern Bottom-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Regatta Pack It Jkt Iii Veste imperméable Homme, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode-of-Pepi Leti 685843716846 Couverture pour bébé Motif Minky Rose 100 x 75 cm.
MILASIA Parachutiste US Vintage Industries, 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-Under Armour Tribase Reign 2.0 Cross Trainer pour homme. 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,Anastasia Beverly Hills - Veste Courte rembourrée pour Femme-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit.
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