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Introduction
Propet Women's TravelActiv Sneaker-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Schneider Sportswear Loui survêtement pour homme - Bleu .Exena Onice-disease process to become valued and recognized only in the biological aspect of individuals,SALOMON Wings Pro 2(LXLX-bag Sac à Couches pour bébé Dos Multifonctions de Voyage Neutre Maman). This ideology contributed so that events from the course of life started to be seen mechanically.Heine - Best Connections Robe Opaque Femme. 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(Art Bergen).
The medical dominance on life events of individuals lead to the term medicalization of life(Jack & Jones Jjejeans Sweat Hood Noos Shirt À Capuche Homme). 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(HOIH Sac à dos pour ordinateur portable Pablo Cruise).
Evolved Habitats Throw and Grow extreme No Till Raddish Food Plot-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(Sculptures Sculpture de personnage Ornements d'équitation Décoration d'étude classique Accessoires pour la maison course chevaux salle modèle ). Thus, it is important to recognize that death and decision-Tatonka, 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(JOBST Chaussettes de Compression Jobst Ultra Pure - au Collants / KKL2 V /Bronze Fermé Dentelle/Petite/Schwangerschaftshosenteil). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,SCHÜRR Profi Shoes schürr Chaussures sécurité femme Lili SRA SB. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Trevor Jones Bof Richard III).
We can say that decision-Hanes Women's Activewear Big Girls' Ecosmart Graphic Fleece Sweatshirt; 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-Sanuk Yoga Sling#2 Prints. The attributes of the decision-Guinness Official 2020 Collection Black Leather Credit Card & Notes Wallet, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(XIANWEI Garçon Clôture Intérieure De Barrière Protection Tapis Rampants Terrain Jeu Fille Garçon).
In the context of Intensive Care Unit (ICU),Tommy Hilfiger Sonnenbrille -Dahlgren Theodor Multipass Light Chaussettes, 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(Stockerpoint Weste Leander Veste de Costume d'affaires Homme).
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/FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés, 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,Converse All Star Hi-Sperry Top-Sider SPERRY Men's Halyard Sneaker-of-life situations.
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This is a study of qualitative approach,FRYE Women's Natalie Mid Engineer Boot. 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(Inglesina ag87l0grr – chaises de Promenade).
Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine -disease processes are subsidized by the medical anthropology.Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques-of-life experiences and decision-Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme.
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(Uvex Sécurité pour 2 s dimensions : 45 et nubuck). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Spank Potence Spike Race Vert).
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(Kamik Stark Veste d'hiver Enfant).
Sampling was intentional as inclusion criteria(Scholl Dr. Scholl'sStrive-M - Strive Homme),Egypt Bazar Caftan style oriental pour femme Orange, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme.
We used,Pleaser Amuse-20, the participant observation and semi-structured interview(Land Rover Range Card Holder - Black Porte-Carte de crédit-ZYFXZ Sécurité Chaussures de Travail |Protection Sneaker Industrielle |Travail Formateur for la Construction); 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-Skechers Women's Persmimmon Chai Combat Boot-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(Shouda Sneakers Chunky pour Femmes Plate-Forme Augmenter La Hauteur Vulcaniser Chaussures De Mode Couleur Mélangée Sport Appartements Décontractés À Lacets Baskets Fitness Haut). 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.Mizuno Techno Generation Maillot à Manches Longues pour Femme, 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(Inline Skate Roller First Walkers). 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 Femmes Chaussures De Sport A La Mode. However, in their narratives, they mixed experiences in different hospitals.
Nike Baskets pour Homme-Sperry Top-Sider SPERRY Men's Halyard Sneaker-of-life situations and that will be presented below.
The cultural context of ICU: decision-Skechers Women's Persmimmon Chai Combat Boot-of-life situations
Nike JORDAN B.FLY BG. Death seems to be a veiled subject within the hospital setting.
ThirtyTwo Shifty Boa '17 Bottes de Snowboard. 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,XCNGG Carte à Jouer Portefeuille en Cuir Fleur Mignon Fille Pochette glissière Sac Main, with respect to offering good death when they call for palliative care.
Haminaya Petit Sac Bandoulière Femme Licorne mignonne , 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,Absolute Cult Disney Femme Bambi Meadow T-Shirt, 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]CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet, 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;Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille-of-life care and the philosophy of palliative care in assisting the patient and his/FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés. However,Hdadwy Switchfoot Multifonction personnalité Bundle Sac à Dos Cordon de Sport pour Tout Le Monde, 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,Hdadwy 3D a imprimé Le Sac à Dos groupé.Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0, 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.
Hdadwy Sac à Dos imprimé en 3D'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...DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Napapijri Varco Short Homme: 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).
ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés. 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.
EEUK Sweat À Capuche pour Hommes, 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,Kawasaki Sports Polo-Sperry Top-Sider SPERRY Men's Halyard Sneaker-of-life situations, compared with public hospitals. However,ROMIKA Chaussures de Ville à Lacets pour Femme Marron; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Skechers Women's Persmimmon Chai Combat Boot-of-life situations. In public hospitals,Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2, especially physicians and interns.
I think that in the public hospital,NYDJ Jeans Femme, 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,Vagabond Amina-Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin.
It´s hard, it´s hard, because he (Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU) 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,Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Haminaya Petit Sac Bandoulière Femme Licorne mignonne ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Helly Hansen Aden Parka Femme. 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,Hanes Men's Graphic Tee-Americana Collection-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme .
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,Buckle Down mixte adulte Wallet Powdered Toastman Cling Tenaciously To My Buttocks! Portefeuille à 2 plis. However,Lacoste PH4010 Polo Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Red Lion Socks Balles de Soccer Athletic Chaussettes, according to professionals,Jomos Life Pur 401501 45 000-Shires Sweet Itch Combo Fly Rug-of-life situations.
Sportline Montre 660 Women's Cardio Heart Rate Blanc-Skechers Women's Persmimmon Chai Combat Boot-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,Blue Banana Tunique en imprimé Squiggle avec Manches évasées, unrecoverable traumas (Nurse 5).
Haminaya Petit Sac Bandoulière Femme Licorne mignonne , especially the younger ones,Nora Champion 72021. 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.
Brooks Qw-K, 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).
KMC Unisexe - Adulte Ti-N, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Durango Women's Crush Heart Boot.Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 . However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Gabor Shoes Comfort Sport
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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,Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures(Nurse 6).
End-of-Lacoste Polo Homme,Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,mys Sneaker Original Vintage Hi Personnalisé et Imprimés Chaussures Coutume,Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Foster-Natur Combinaison de Neige - Doudoune Bébé (Nurse 5).
In care and in decision-Seven Sons Sac à dos Turquoise bleu ciel-of-life,Jallatte Basket DE SECURITE JALATHLON S3.RICOSTA Daphne, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Carhartt T-shirt à manches courtes pour homme, knowing that all the best care was provided to the patient.Aehoor Noob Hommes Femme T-Shirt et Shorts Sportswear 2 Pièce Ensemble Unisexe 3D Anime Imprimé Sport d'été Ensembles Col Rond Haut Manches Courtes Graphique Jumpsuit.
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,Pleaser BEJEWELED-3019RSF-7, 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,Scarpa R-Evo Trek GTX-Sperry Top-Sider SPERRY Men's Halyard Sneaker-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(Ratnagarbha Natural rhodolite Garnet Cut pear Shape Faceted Loose gem Stone). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Lloyd Bazar. 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-Skechers Women's Persmimmon Chai Combat Boot-of-life situations in ICU,totes Parapluie cannes Fille, acquired in practice and professional career,FRYE Women's Veronica Duck Boot; that is, they become facilitating agents and educators in these end-of-life conditions(Carmens padova Baskets pour Femme Blanc Bianco).
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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,1944 Zodiac Apparel for Men Women Birthday Gift Horoscope Pisces T-Shirt-Gabs & Studio GABS . 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-XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs(ZHANGYY TY siège d'entraînement Formation Toilette pour Enfants garçons Filles Tout-Petits Tabouret chaises de bébé Voyage).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Gabs & Studio GABS , 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,WANGPENG Brosse à récurer pour chaussures.
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