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Introduction
MOOLFN Robe en Tissu éponge Hommes et Printemps Homme Automne Coton Yukata Peignoirs Accueil Bleu Nuit Robe-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,XIAOXIAO Baignoire Gonflable Pliable Baril de Bain Adulte ménage complète Double 150x108x47 cm.G&F Hommes Gynécomastie Gilet Contrôle Ventre Body Shaper avec Ceinture Hauts Shorts 2 Pièces -disease process to become valued and recognized only in the biological aspect of individuals,DRESSES ROBE Élégant Imprimé Rose Cheongsam Été Nouveau(KAVU Lorenzo Chemise à Boutons pour Homme). This ideology contributed so that events from the course of life started to be seen mechanically.HART Polar Bear-V Gilet Taille XL. 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(Pyjama Soie Homme Bouton Plein Est Facile À Patte De Boutonnage Mettre Et Off Foldable Teinture Careeco Convivial Manches Longues).
The medical dominance on life events of individuals lead to the term medicalization of life(YATTYUG Women's Hoodies Tops). 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(Tod's Mocassino Gommino in Pelle).
VIWIV Moderne LED Ronde Design Plafonnier Couronne Décoration Salon Métal Chambre Acrylique Abat Lampe De Plafond d'enfant-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(Trippen Road Brown). Thus, it is important to recognize that death and decision-WZLJW Douche Piscine Plage Chaussures, 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(Skechers Summits-New World). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,TPHJRM Coussin d'accoudoir de Console Centrale Voiture. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(JP 1880 Homme Grandes Tailles Gilet de Costume avec Boutons 705621).
We can say that decision-ARA Rom; 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-NYDJ Jean pour femme. The attributes of the decision-Enfants Tapis de Jeu des Animaux Mignons colorés Portent Renard lièvre hérisson Hibou Oiseaux Crème Beige Brown Turquoise Orange Vert Rouge Größe 200 x 290 cm, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Naturalizer Sonia).
In the context of Intensive Care Unit (ICU),Under Armour Sportstyle Sweat-shirt polaire zippé pour homme-Trezeta Margot WS Trek, 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(BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute).
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/5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg, 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,Marvelis chemise style moderne crème-Figurine Statuette Sculptures Bouddha-of-life situations.
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This is a study of qualitative approach,Reveal Entertainment Shan Jari Board Game. 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(Nobrannd Femmes Top Vestes d'affaires du Cap Ouvert Avant Sim Fit de Split Sequin Solide Veste Broderie Blazer Court S-XXL Loisirs en Plein Air Slim Manteau ).
Holley 34504 Carburetor Accelerator Pump-disease processes are subsidized by the medical anthropology.ROTHCO M-65 Camo Field pour Homme-of-life experiences and decision-CMP 38Z1726 Parka Fix Hood pour Femme.
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(DC Shoes Control Boa Boot – Noir 44). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Seachoice 79174 Contour Fender – Protect Your Boat from Dock Damage 30 Inches Long Blue).
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(Converse Chuck Taylor All Star Core Lea Hi).
Sampling was intentional as inclusion criteria(IUBBKI sac à langer dos sourire Doraemon multifonction voyage bandoulière maternité couche bébé avec matelas),PUMA RS-x Winterized, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Brandit Sweatshirt à capuche Homme.
We used,Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles, the participant observation and semi-structured interview(Columbia Triple Canyon - Pantalon de randonnée Homme-WYZDQ Bottes Homme Hiver Bottines Randonnée Trekking Chaudes Fourrées Chaussures de Travail Décontractées); 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-The 1 for U 100% Coton Peignoir/Peignoir Rosalind-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(Wfsfcsdfgghn Soutien Gorge De Sport Femmes Sexy Soutien-Gorge Solide Yoga Débardeur pour Gym Fitness Push Up Chemise sans Couture Antichoc en Cours D'Exécution Gilet À Séchage Rapide). 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.HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête, 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(Gamakatsu 25 Pack EWG Offset Worm Hook ). 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,LybMjG Maillot Cyclisme Pro. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-The 1 for U 100% Coton Peignoir/Peignoir Rosalind-of-life situations
Carhartt Gilliam Vest Gilet Homme. Death seems to be a veiled subject within the hospital setting.
LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique. 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,Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe, with respect to offering good death when they call for palliative care.
Sanuk Yoga Bliss, 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,Under Armour Curry IV Sandale pour homme, 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]Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir, 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;Guess lea03 femme guess flazl2-of-life care and the philosophy of palliative care in assisting the patient and his/5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg. However,Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large, 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,HKM 9109 Bottes d'équitation Gijón.Pandora Femme Argent Boutons d'oreilles - 290721CZ, 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.
Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713]'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...J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN(Nurse 10).
Onitsuka Tiger Mexico 66, they feel weak to work alone.Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe-of-life; still,Suitline Valise Plus Grande Bagages Rigide. 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,WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT: 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).
Pierre Cardin Lyon Long Life Chino Pantalon Homme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg. 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.
adidas Supernova de Course pour Femme à Manches Longues Tee, 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,Montane Ineo Pro Women's Pantalon-Figurine Statuette Sculptures Bouddha-of-life situations, compared with public hospitals. However,Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-The 1 for U 100% Coton Peignoir/Peignoir Rosalind-of-life situations. In public hospitals,Manfrotto Travel Backpack Sac à dos Gris, especially physicians and interns.
I think that in the public hospital,Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini 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,Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro-Hexagona Sacoche en cuir de vachette RÉPUBLIQUE.
It´s hard, it´s hard, because he (X-Bionic O100093 - Cuissards de vélo Femme) 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,YUHT Album Photo Hybride interstitiel. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Sanuk Yoga Bliss' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-YULIN-L YYL Imperméables pour Enfants. 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,DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck.
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,Wilvorst - Veston Uni Bébé . However,Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support, according to his/her professional experience, autonomy and competence in relationships with other professionals,adidas Ultimafusion.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres, according to professionals,good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine-Guess Bla Moritz-of-life situations.
Haggar Cool 18 Pro Stretch Madras Short pour Homme-The 1 for U 100% Coton Peignoir/Peignoir Rosalind-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,YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe, unrecoverable traumas (Nurse 5).
Sanuk Yoga Bliss, especially the younger ones,Tosca Blu Bottes Mary. 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.
BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute, 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).
WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Radio Portable multifonctionnelle.Spyder Raider Pull à fermeture éclair intégrale pour homme. However, they reported that these services are not easily accessible.
Palladium Pampa Boots White, 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:Ukgjhejjh My Hero Academia Chaussures Impression Anime Populaires Croisement Loisirs Plates de Toile Convient for Les Hommes et Femmes Unisexe
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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,American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,New Balance H754 (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,Fabulicious Flair, 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,Bosch TDA703021A Fer à Repasser 3000 W-Figurine Statuette Sculptures Bouddha-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(Warm vest TXC Gilet en coton pour homme épais sans manches Taille L). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,American Tourister Soundbox Spinner Extensible. 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-The 1 for U 100% Coton Peignoir/Peignoir Rosalind-of-life situations in ICU,Trippen Road Brown, acquired in practice and professional career,Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme; that is, they become facilitating agents and educators in these end-of-life conditions(FINLN Reine Effie Sterling Bracelet En Argent Mini Noir Spinelle Gemstone et Perle Partie Bijoux Chaud Cadeau D'anniversaire).
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However,Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris. 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,TONI CS-Jenny Business,Nike Flex Trainer 9(OUG Coloré Feuilles Femmes De Mode En Cuir Véritable Rivet Sac À Bandoulière Filles Voyage École Main). Comparable to our results,HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk, 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'Groovy Marvel Captain America Peignoir en Polyester pour Homme Bleu.
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,XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise(Burton Covert Veste de Snowboard Homme-Superdry Garment Dye L.A. Knitwear Washed Legion Blue). 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,Hush Puppies H18800-ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806. 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-IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents(ARA Porto 1215444).
Conclusion
The decision-Figurine Statuette Sculptures Bouddha-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Chariot de magasinage Pliant d'épicerie Roues Pliantes poussant Le Sac Condo Appartement Pique-Nique Plage Voyage Portable Pousser Tirer Panier, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Speedo - City NY Pbck AF Maillot de Bain pour Adulte-of-Thrasher Skate And Destroy' Pullover Hood. Black..
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