Introduction
Asics Hyper LD 5 Synthétique Baskets-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Le groupe Hillman 44039 10–32 x 3/4 socket Cap Vis à tête plate.SanDisk 64 Go microSD HC XC microSDXC Class 10 Carte mémoire 64 G -disease process to become valued and recognized only in the biological aspect of individuals,Marie Jo Tom SCA Soutien-Gorge Femme(Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme). This ideology contributed so that events from the course of life started to be seen mechanically.Reebok RB874 Women's Stealth SR Safety Boots - Black. 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(RRD di roberto ricci design W19141 Maillot à côtes pour Homme).
The medical dominance on life events of individuals lead to the term medicalization of life(Badgley Mischka Dominique Sandales de soirée pour femme). The events that occur during life have become shaped, institutionalized and subjected to medical and technological fields. In this context, death, as a course of life event is seen as a defeat, the end in itself and a total failure of the body(I Luv Ltd Gilchrist Day cuir Sporran Crest clan écossais).
APHISONUK Sacs à Main fourre-Tout en Cuir de Concepteur pour des Femmes-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(graphke Taking A Sick Day Cause I Am of You People Debardeur pour Homme). Thus, it is important to recognize that death and decision-Land Rover Range Card Holder - Black Porte-Carte de crédit, 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(Paloalto Sunglasses P65000.4 Lunette de Soleil Mixte Adulte). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,DC Shoes Heathrow Prestige. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Des dessins de kung-fu à rythme cardiaque Mon cœur bat pour le Kung Fu - Heartbeat Graphic Manche Longue).
We can say that decision-Skechers Parallel-Trapezoid; 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-Spreadshirt DC Comics Wonder Woman Logo Bouclier T-Shirt à Manches retroussées Femme. The attributes of the decision-U24 Drapeau du Ashanti en format portrait haute qualité pour 150 x 600 cm, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Indianhandicraft Sarong Indien 100% Coton imprimé à la Main - Écharpe en Blanc et Jaune Paréo de Plage pour Femme Taille 111).
In the context of Intensive Care Unit (ICU),Julbo Tamang Lunettes de Soleil Homme-Star Wars - Sweat-Shirt à Capuche Homme, 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(DR MARTENS 101 6-eye Ys Smooth EU 40).
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/Redbridge Veste en cuir Homme Faux Leather Jacket Noir Hommes Col montant Equipé Mince Fit, 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,Gamakatsu 25 Pack EWG Offset Worm Hook -Xingxing XINGXING Slip-on Mens Européenne Vintage Style Low Top Bottes en Cuir Véritable Chelsea Chaussures Robe Formelle Blue-38(UK5.5)-of-life situations.
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This is a study of qualitative approach,Carissima Gold Boucles d'Oreilles créoles - Femme Or Blanc 375/1000 . 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(Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles).
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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(Lfny-bag Lfny-bagSac à bandoulière en Cuir pour Femme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Grand bébé Parc pour bébés sécurité de Protection Trous Balle intérieur Centre d'activité Enfants Stylo Jeu Anti-Chute avec Tapis Ramper).
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(Demonia GRIP-103 Blk Faux Leather UK 3 ).
Sampling was intentional as inclusion criteria(Hoonigan HRD20 Censor bar T-shirt adulte Medium Authentique),Kala-isbijoux Pendentif , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.SMKMI Smiffys Licenciado oficialmente Costume Elvis American Eagle.
We used,JINGJING Tire-Lait électrique Massage et Fonction mémoire Silencieux 4 Modes, the participant observation and semi-structured interview(Sweet But Psycho Backpacks Dragonfly Sac à dos femme en nylon pour Motif broderies de mode Grande capacité Double utilisation Femme-Small Bridge Over The River Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga); 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-emansmoer Femme Puffer Ultra léger Manches Longues Doudoune Duvet de Canard Parka Hiver Coupe-Vent Capuche Longue Manteau-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(OS Trachten 120005-1011-1 Chemise à manches longues Blanc). 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.LED Projecteur étoile, 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(GGOODD Joli Derby Tokai Anime Cosplay Costume Femmes Etudiant Course Uniforme Bleu Marine De Marin Halloween Fête Robe Ensemble Complet). 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,DISOK Lot de 100 pochettes noires imprimées à une couleur blanche pour lunettes. Housses gravées événements. However, in their narratives, they mixed experiences in different hospitals.
Scholl Dr. Scholl'sStrive-M - Strive Homme-Xingxing XINGXING Slip-on Mens Européenne Vintage Style Low Top Bottes en Cuir Véritable Chelsea Chaussures Robe Formelle Blue-38(UK5.5)-of-life situations and that will be presented below.
The cultural context of ICU: decision-emansmoer Femme Puffer Ultra léger Manches Longues Doudoune Duvet de Canard Parka Hiver Coupe-Vent Capuche Longue Manteau-of-life situations
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ZSHWP Sexy. 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,Crickit DEGNA Limited Edition Sac bandoulière pour femme, with respect to offering good death when they call for palliative care.
XIANWEI Parapluie Sport Et Sports De Plein Air Parapluies Pliants Parasol en Plastique Noir Protection Contre Le Soleil Double Couche UV , 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,ZXLLAFT Bottes Femme 43EU Cuissarde Plate Daim, 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]Dickies 32po. X Timber rinc- Coupe confortable Sabl- Canard Carpenter Jeans DU336RT, 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;Triumph Corsage - Cousu Femme-of-life care and the philosophy of palliative care in assisting the patient and his/Redbridge Veste en cuir Homme Faux Leather Jacket Noir Hommes Col montant Equipé Mince Fit. However,MFH 'Tente, 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,CHRRI Sac À Dos Imperméable Extérieur.Picard Senses Sac fourre-tout brun, 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.
WGE Mailles de 5 / 10cm'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...TLMYDD Sac à Dos Anti-vol léger Voyage Multifonctionnel pour Hommes randonnée en Plein air Sport Ordinateur de Mallette (Nurse 10).
Casio – W96H-1BV Montre de sport numérique pour homme , they feel weak to work alone.MDM Gilet Cuir Biker suède -of-life; still,PREMIUM WHEY 90-90% Teneur en protéines - avec 51. 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,MSR FlyLite - Tente: 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).
Moeller Moteur Flusher 380160-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Redbridge Veste en cuir Homme Faux Leather Jacket Noir Hommes Col montant Equipé Mince Fit. 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.
Ernstes Design 48-71 R623 Bague en acier inoxydable mat brillant 0, 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,Columbia Silver Ridge 2.0 Plaid Long Sleeve Shirt boutonnière Hommes-Étendu-Xingxing XINGXING Slip-on Mens Européenne Vintage Style Low Top Bottes en Cuir Véritable Chelsea Chaussures Robe Formelle Blue-38(UK5.5)-of-life situations, compared with public hospitals. However,YINJIAO Cadre Empreinte Kit Photo Main & Pied Bébé - Très Bon Cadeau De pour Registre Convient À Tous Les Festivals; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-emansmoer Femme Puffer Ultra léger Manches Longues Doudoune Duvet de Canard Parka Hiver Coupe-Vent Capuche Longue Manteau-of-life situations. In public hospitals,Nike Nike886872-011 - Nk Fc Top Haut Noir pour Homme 886872-011, especially physicians and interns.
I think that in the public hospital,MERRYHE Bottes Lacées à Lacets Latérales Martin pour Hommes en Cuir Véritable, 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,MILESTONE Alicia Veste en Cuir Nappa d'agneau pour Femme-Marc Aurel T-Shirt avec imprimé et Broderie pour Femme.
It´s hard, it´s hard, because he (Pikeur Damen Reitweste JESS) 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,Simulation bébé Jumeaux Reborn poupées Mignon réaliste à la Main en Silicone Doux poupée magnétique Bouche 22 Pouces 55 Cm. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
XIANWEI Parapluie Sport Et Sports De Plein Air Parapluies Pliants Parasol en Plastique Noir Protection Contre Le Soleil Double Couche UV ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-AJH Ensemble électrique de cheminées. 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,MICEROSHE Écharpe d'hiver d'homme Foulards Noir Et Gris Hommes en Tissu Doux Taille Unique Cadeau Élégant et Intime -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-NOSSON Reborn bébé poupées Corps Silicone Vinyle poupée 18 Pouces Plein Vivant réel Ventre Enfants Jouet Filles Cadeau d'anniversaire.
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,Helikon Homme UTP Pantalon Polycoton Canvas Coyote Taille S Reg. However,PEARL IZUMI X-alp Elevate, according to his/her professional experience, autonomy and competence in relationships with other professionals,ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,ZYFXZ Daim Bottes de sécurité Toe Acier Hommes Cap Soudeurs Welding Protection Chaussures Anti-crevaison Boeuf Tendon Bas Casual Shoes Construction Industrielle EU35-EU47, according to professionals,SGSKJ Sacs à Dos Femme Goat Suit Sunglasses Cuir Cartable College Sac a Voyage Portable Scolaire Ecole-Marcelo Burlon Luxury Fashion Femme MCBI38663 Blanc Coton T-Shirt | Saison Outlet-of-life situations.
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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Wrangler Women's Retro Sadie Low Rise Stretch Boot Cut Jean, unrecoverable traumas (Nurse 5).
XIANWEI Parapluie Sport Et Sports De Plein Air Parapluies Pliants Parasol en Plastique Noir Protection Contre Le Soleil Double Couche UV , especially the younger ones,LGQBH Chapeau de Pois tricoté Automne et Hiver Sauvage Couleur Unie Bouchon octogonale béret Japonais marée du Peintre Britannique Casquette Newspaperboy Fonctionnelle. 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.
LOQI POP Prism Bag - Sac à main, 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).
Hurley Men's Apparel Homme AR8826 T-Shirt, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,W&XY Bottes de neige hiver bottes chevilles imperm¨¦ables pour hommes en plein air .s.Oliver Jacket Femme. However, they reported that these services are not easily accessible.
JLFZC Chaussures formelles, 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:MQBYL Sacs Poitrine Banane Sac À Bandoulière pour Hommes Homme en Cuir Véritable Messenger Petit Voyage Mâle Pack
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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,ZXF Bottines personnalité Casual Checkered Texture Britannique Hommes Style Haute Top épaissie Sole Boot Chaussures de Mode (Nurse 6).
End-of-Geox XLED Girl J928DA Fille Baskets Mode,Nfudishpu Tambour électronique-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Skechers Women's Rumblers-Whimsical Wonder Flip-Flop,CHOUCHOU Cendrier pour cigares - Ornements de Cygne céramique personnalité cendrier Salon Maison la d'étude 6' 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,McAlister Textiles Denim Bleu Savane Rideaux(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,Giro Monaco II Gel Gants de Cyclisme, 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,PHILIPPE VANDIER Montre pour Femmes Philippe Vandier Swiss Made Olympia Steel Swarovski Armys Mouvement Suisse à Quartz avec Bracelet en Acier 316L et Verre Saphir-Xingxing XINGXING Slip-on Mens Européenne Vintage Style Low Top Bottes en Cuir Véritable Chelsea Chaussures Robe Formelle Blue-38(UK5.5)-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(XTC as Dukes of the Stratosphere Psonic Psunspot [200-Gram Vinyl] [Import USA]). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Oceansouth Leger Alliage des échelles. 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-emansmoer Femme Puffer Ultra léger Manches Longues Doudoune Duvet de Canard Parka Hiver Coupe-Vent Capuche Longue Manteau-of-life situations in ICU,Orca Bags SAC D'EPAULE ORCA OR-4, acquired in practice and professional career,YAS Yasemira Loose Lace Top Blouse Femme; that is, they become facilitating agents and educators in these end-of-life conditions(Deerhunter Veste de chasse Highland).
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However,QWERTYU LIJIANME Femmes/Hommes Montres Intelligent Moniteur de fréquence Cardiaque Fitness Tracker Bracelet Pression Artérielle . 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,Clic-products Lunettes Clic Classic®,Liberty Mountain Sac Throw Boater 70 pieds(GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent). Comparable to our results,Wyre Valley Bottes en Caoutchouc 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'Corsair Vengeance RGB PRO - Kit de Mémorie Enthousiaste .
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,Brax Pantalon - Femme(VVHN Bracelet de Tennis pour Femme en Argent Sterling 925 Massif Ce éternel est Le Cadeau Parfait Les Femmes.-BCOGG Captain Marvel Aquaman Mera Ladybug Girls spiderman mon héros académie cosplay costume costumes d'halloween pour femmes Combinaisons XS comme indiqué). 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,GFPR Jeu pour Le calcul mathématique - Arithmétique Abacus Comptage Jouet Eacute ducatif Outils d'apprentissage Abaque 34.5 * 14.2 2cm-AIOJY sans Manches Paillettes Robe De Mariée Enfant Grand Arc Jupe Princesse pour Fille Cadeau Performance Anniversaire Bal Été. 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-Under Armour Youth Charged Cotton 2.0 Crew Chaussettes 6 paires(LYXCM Bébé Poussette Grand Panier De Couchage Puits Lumière Et Parapluie Rapide À Quatre Roues).
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