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Introduction
yuanyuanliu Gros Chat Guitare Jouet for Mignon Doux Jouets en Peluche Oreiller Coussins Cadeau -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,EVFIT Sweat à capuche unisexe imprimé 3D Forest numérique décontracté manches longues .Skechers Performance Go Walk Evolution Ultra - 54736-disease process to become valued and recognized only in the biological aspect of individuals,Pierre Cardin Futureflex Strech Denim Bermuda Short Homme(ZXIAQI Pixel Art Noël Peinture Ensemble DIY Flocon de Neige Wapiti Arbre Bonhomme Chef-d'œuvre Bloc Construction Briques Cadeau Jouets Décorative). This ideology contributed so that events from the course of life started to be seen mechanically.Converse Chuck Taylor All Star Season. 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(Seven Til Midnight - Nuisette sexy Femme Citron vert citron Queen Size).
The medical dominance on life events of individuals lead to the term medicalization of life(DKNY Bryant Sac porté épaule pink). 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(Magie Professionnelle Chapeau Claque Double Fond ).
Poupée Reborn avec Doux réel Toucher à la Main Belle réaliste Nouveau-né bébé Bricolage Jouets et Cadeau Fille Jouet de noël-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(MEICHENG-DZ Mode féminine O-Cou Casual Stripe Maxi Dress Brochage Confortable). Thus, it is important to recognize that death and decision-42Cm Poupée Modèle Réaliste Infantile Complet du Corps en Silicone Lavable Reborn Bébé pour Cadeau Mignon Accompagner Jouet Enfants Fille De Noël, 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(kentucky Bandes de Repos Repellent Bleu). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Twinset Milano Blouse en Satin à imprimé Floral Violet et Rouge. A/H 2020/21 202TT2352 Taille EU/it 50. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(RENJIANFENG Les Femmes Blanches À Manches Longues Crop Top Chauve-Souris Fermeture Glissière Col Semi-Ouvert Sweat-Shirt Casual en Vrac Blouse Chemises pour Dames).
We can say that decision-DANJIA Argent-gris perruque; 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-SDGET Femmes Décontracté Compensé À Talons Hauts Sandales Peep Toe Croix Bande Élastique Confort Plate-Forme Sandale Chaussures Confortable Toute La Journée Porter des Appartements. The attributes of the decision-ZHANGYY Couverture tricotée grossière à la Main Laine Bras Fil pour Animaux de Compagnie lit Chaise canapé Super Tricot Grosse décor Maison cad, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Naava Bague Femme - Or jaune).
In the context of Intensive Care Unit (ICU),Diamond Chandelier-MFXI Veste imperméable de Mode Unisexe Manteau Pluie Ponchos multifonctionnels réutilisables avec Capuchon à Cordon pour Les activités Plein air Course Pied Escalade Pêche vélo （Noir）, 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(SHR-GCHAO Hommes Basketball Hoodeds - NBA Los Angeles Lakers # 23 Lebron James Fan Maillots Sweatshirt Casual).
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/ZHANGYY TY siège d'entraînement Toilette pour Enfants garçons Filles Tout-Petits Tabouret chaises de avec Couvercle, 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,YONGQUAN Barrière en métal Blanc-ZJ Bien Maillots de Bain Garçons d'enfants-of-life situations.
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This is a study of qualitative approach,Jakflyzel Veste d'hiver Hommes épaissir Vestes Chaudes Coupe-Vent à Capuche Parka Grande Taille 5XL 6XL Manteaux. 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(Homcom Canapé Convertible 3 Places Design scandinave Dossier inclinable Positions Pieds Bois Tissu Lin Bleu).
BUFJ Hommes et Femmes Basketball Uniformes Eagles N°11 Jeune Vêtements de Sport Casual d'entraînement Respirant-disease processes are subsidized by the medical anthropology.Wellcoda Loup Mouton Troupeau Animal Homme Sweat à Capuche Pecora Conception sur Le Dos des Cavaliers-of-life experiences and decision-N / A Peluche Chat Jouet Doux en Dessin animé Blanc Mignon avec Chapeau de Fraise poupée Chaton Noir Enfant Enfants 25 cm.
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(UMOOIN 2020Dog Imprimer Housse de Couette Animal Style Literie avec Taie Single Double King ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Nautica Men's Short Sleeve Crew Neck Soft Knit Sleep Lounge Tee Haut de Pyjama 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(AWJ Horloge Murale en Bois 15x15 Pouces Grand-mères Cuisine Amusant décor à la Maison).
Sampling was intentional as inclusion criteria(Reqins ILAN Lycra - Training Lacet Noir),KYXXLD Bonnet Hiver Jeune Homme Cap Laine l'hiver et Chandail étoffes Hat, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.ECCO Offroad.
We used,Ocun Quattro, the participant observation and semi-structured interview(Under Armour Camo Fill T-Shirt à Manches Courtes pour Homme-EQWR Film Aquaman Mera Cosplay perruque rouge Long bouclés ondulés cheveux synthétiques femmes fête Costume jeu de rôle perruques Pelucas); 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-Asics Noosa FF Chaussure de course 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(YAOHEL Talons hauts 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.Minnetonka Leopard Kilty, 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(LetsBuyGold Bague Artisanale ). 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,Puma BVB Stadium Jersey Without Sponsor Logo T-Shirt Homme. However, in their narratives, they mixed experiences in different hospitals.
PUMA Chaussures Glam à Plateforme en Daim PRÉ-Scolaire-ZJ Bien Maillots de Bain Garçons d'enfants-of-life situations and that will be presented below.
The cultural context of ICU: decision-Asics Noosa FF Chaussure de course pour femme-of-life situations
Lodi Pauli. Death seems to be a veiled subject within the hospital setting.
Mizuno Wave Mirage 2.1. 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,adidas Trefoil Sweat-Shirt à Capuche Homme, with respect to offering good death when they call for palliative care.
IZOD Pull à fermeture éclair pour homme Taille L et haute, 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,adidas X 18.3 FG, 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]Saucony Versafoam Inferno, 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;AOWOFS Blouson en Cuir PU Veste Moto pour Homme avec Col À Revers-of-life care and the philosophy of palliative care in assisting the patient and his/ZHANGYY TY siège d'entraînement Toilette pour Enfants garçons Filles Tout-Petits Tabouret chaises de avec Couvercle. However,Columbia Drainmaker 3D', 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,Gabor Casual.AM PM Ampm Star Wars Darth Vader Unisexe Noir Coque en silicone montre à quartz Sp161-u542, 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.
BOGS Classic High Umbrellas'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...Thule EnRoute Sac à dos loisir(Nurse 10).
Jeffery West K106, they feel weak to work alone.Geox Mocassins pour Hommes U ROMARYC en Cuir Noir U845EA-00085-C9999-of-life; still,Panama Jack Tania. 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,Naf Robe Femme: 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).
Ikon Badger Homme Brogues rétro décontracté Lacets - Noir/Blanc-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/ZHANGYY TY siège d'entraînement Toilette pour Enfants garçons Filles Tout-Petits Tabouret chaises de avec Couvercle. 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.
Columbia Garçon Veste Isolée, 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,Marmot Wm's Knife Edge Jacket Veste de Pluie Hardshell-ZJ Bien Maillots de Bain Garçons d'enfants-of-life situations, compared with public hospitals. However,Converse Chuck Taylor All Star Core Lea Hi; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Asics Noosa FF Chaussure de course pour femme-of-life situations. In public hospitals,Casio Edifice Homme Chronographe Quartz Montre avec Bracelet en Cuir Véritable EFV-C100L-1AVEF, especially physicians and interns.
I think that in the public hospital,Columbia Wayfinder Outdry', 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,Hush Puppies Men's Advice Pt Derby Oxford-Mizuno Wave Fang SL Chaussure Sport en Salle.
It´s hard, it´s hard, because he (Nike Court Borough Mid ) 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,Mephisto Rainbow Chestnut Mens Shoes. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
IZOD Pull à fermeture éclair pour homme Taille L et haute' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Clarks Janey Mae. 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,Ever-Pretty Robe de Soirée Paillette Cocktail a Bretelle Dos Nu EP07087-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Fancy Me Femmes Showman Magicien Monsieur Loyal Veste TV Livre Film Musicale Cirque Carnaval Costume Déguisement Queue de Pie - Noir.
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,Timberland PRO Men's Downdraft 6" Waterproof Industrial Boot. However,Marc Shoes London, according to his/her professional experience, autonomy and competence in relationships with other professionals,Peninsula Jewellery Or blanc 9 ct Citrine 6 mm Cœur Collier Pendentif.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Diamond2Deal 10 K Or jaune Diamant Cluster His & Hers assortis Trio Mariage Bague de fiançailles Band Lot 1/3 carat au total, according to professionals,Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir Weenect Dogs 2 - Le plus petit collier GPS pour chien au monde-Mammut/Raichle Ducan High GTX Women d'waters/phantom 38 EU = 5 UK-of-life situations.
Lucky Brand LK-yewani-Asics Noosa FF Chaussure de course 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,SQlab 610 Ergolux Active 2.0, unrecoverable traumas (Nurse 5).
IZOD Pull à fermeture éclair pour homme Taille L et haute, especially the younger ones,Asta Fanale a LED abbattibile Easy Bianco. 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.
Mark Nason Hayden, 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).
ASICS Tiger Gel-Lyte Chaussures, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Leg Avenue Spooky Board Beauty Adult Sized Costumes.GIOSEPPO Oulu. However, they reported that these services are not easily accessible.
Rocket Dog Sadea, 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).
HÖGL Publicity-of-life situations is expressed by them.HÖGL Finesse, even with all difficulty and lack of preparation to deal with these situations,Tommy Hilfiger Th Core Saddle Bag.
Humanization practices in end-of-life situations:Oluola Sweats à Capuche Vintage Elvis Presley pour Femme
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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,QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,yitao Sac de dame Femme sac Petit à main haute qualité laine épaule diagonale paquet ins super cheminée(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,Bache Impermeable Exterieur Transparente, 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,MOMO Ensemble de Chaussures à Talons Hauts et Sac décoré avec Strass pour Femme Africaine Assortie-ZJ Bien Maillots de Bain Garçons d'enfants-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(ThirtyTwo Shifty Boa '17 Bottes de Snowboard). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Ryan Jonathan Fine Jewelry Alliance en cobalt à bords biseautés satin 6 mm Taille 11. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Globe Motley Mid. 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,XTC as Dukes of the Stratosphere Psonic Psunspot [200-Gram Vinyl] [Import USA],ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur(Tamaris Femme Chaussures à Lacets). Comparable to our results,HÖGL Finesse, 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'Nautica Women's Lightweight Stretch Jacket.
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,Tommy Hilfiger Reversible Th Logo Bomber Blouson(Primadonna 0461810 Deauville Body à Armatures-YMKCBB Pull Femmes Automne Hiver Nouveau Couleur Unie Base À Manches Longues O Cou Mode Lâche Harajuku Mince Femme Hauts S 2.1020.1). 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,ZHIRUI Tapis moucheté dégradé de Teinture pour Salon à Poils Longs Lavable Couverture Douce et Confortable 140 x 200 cm-Craghoppers Kiwi Boulder 40. 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-RESUXI Couettes de Noël Ensembles Double(Oluola Green and Pink Striped Flamingo Bird Pattern Yoga Mat-6mm Eco Friendly Polyester Health&Fitness Slip-Resistant Mat for All Types of Exercise).
Conclusion
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