Introduction
ORUS BIJOUX Bague Argent Griffe serti Blanc - Femme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Smilice Bottes d'hiver pour Femme.LetsBuyGold Bague Artisanale -disease process to become valued and recognized only in the biological aspect of individuals,LetsBuyGold Bague Artisanale (Guess Short Dress). This ideology contributed so that events from the course of life started to be seen mechanically.Craghoppers Outdoor Classic Aysgarth - Pantalon Stretch et imperméable 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(SJLHP Sac À Dos Voyage en Toile Vintage).
The medical dominance on life events of individuals lead to the term medicalization of life(Plafonnier Lumière LED Créatif 3 Anneaux Brun Lampe de Plafond Moderne Bureau Lumineux Chambre Salon Éclairage Intérieur Dimmable Avec Télécommande d'enfant Hôtel Boutique Ø55*8CM 50W). 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(Guohailang Accessoires de mariée Curling Veil Bord avec Peigne 1 Niveau Veils Mariage Voile la ).
adidas Real Away Chaussettes Homme-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(Musto Veste légère Crew - Homme). Thus, it is important to recognize that death and decision-BJCNX Bread Maker Machine Beginner Baking with Automatic Ingredients Dispenser Great Versatility 15 Programs 3 Crust Colors Stainless Steel Easy to Clean Non-Stick Pan, 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(Pare-Chocs Diffuseur Lèvres). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Gabor Shoes Basic. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(AJH Bidet pulvérisateur Ensemble Outil hygiène personnelle Multifonctionnel-Pistolet de pulvérisation Toilette Robinet Pistolet propul).
We can say that decision-Soireelady Escarpins Femme; 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-Ocun Strike QC Climbing Chaussure - AW20-41.5. The attributes of the decision-Irregular Choice Nick of Time, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Puma Sweat à Capuche Manchester City Shoe Tag pour Homme).
In the context of Intensive Care Unit (ICU),arena Dynamo Maillot de Bain Homme-Gorteks Soutien-Gorge Bustier Dos Glamour Charlize, 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(SEESEE.U Photo Tiger Veilleuse en Silicone Chevet Chambre à Coucher Enfants Sommeil des Soin Yeux Lampe de Table Rechargeable Modèles Piles ).
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/adidas Juve Wintjkt Veste de Sport Homme, 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,WEIFAN Marine Camouflage Net- Air Defence Protection UV extérieure Camping Décoration De Caché Abri Tente Couverture Camouflage-mantraroma Bague argent 925 sterling pierre de lune -of-life situations.
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This is a study of qualitative approach,Veste De Costume sous-Vêtements pour Hommes Chauffant Électrique Grande Taille Pantalon Deux Pièces Adapté Au Ski en Plein Air Hiver. 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(GBY Sac à bandoulière pour femme - main tendance).
adidas Terrex Swift R2 GTX W-disease processes are subsidized by the medical anthropology.Fila Womens Fanny Pack-of-life experiences and decision-NUOVA RADE Boitier douchette blanc flexible 3 m.
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(Skechers Stamina-classy Trail). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(HONYGE LXGANG École coréenne Uniforme Filles Jk Navy Sailor Costume for Les Femmes Japonaise Scolaire Manches Courtes Chemise Blanche Bleu Marine Jupe).
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(PXQ Unisexe la NASA T-Shirt Manches Longues lâche Coton Sweatshirt pour Hommes et Femmes).
Sampling was intentional as inclusion criteria(Ouuager-Home Conseil Tactique des entraîneurs Stratégie entraîneur Plan d'Match et de Formation Aide Équipement ),DC Shoes - Chaussures Trase V Se Low pour Garçon, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Nike Zoom 2k.
We used,Générique Portefeuille Multifonction en Cuir huilé véritable pour Femme, the participant observation and semi-structured interview(Baby rabbit-SS Plate-Forme Au-Dessus des Bottes Au Genou-Nouxh Homme Femme Devil May Cry Unisexe Sweatshirt Hoodie à Capuche 3D Prints Anime Pullover Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille XXS-3XL); 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-Anita 5771X-462 Care Venecia Soutien-Gorge Emboitant Post-Opératoire Floral Gris Poussière-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(Marikoo Maikoo Manteau d'hiver Parka pour Femme XS-XXL). 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.Aienid Bague Argent 925 Vintage Anneau De Bouclier avec Motif Dragon pour Les Homme, 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(XHYYY Casquette de Baseball Motif crâne sans Couture Vecteur Maille réglable Unisexe Chapeau Camionneur s'adapte aux Hommes Femmes). 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,Walker. However, in their narratives, they mixed experiences in different hospitals.
Halloween Drapé Portes Entrées Fenêtres Couverture Gaze Spooky Fête Décoration H Livraison Gratuite-mantraroma Bague argent 925 sterling pierre de lune -of-life situations and that will be presented below.
The cultural context of ICU: decision-Anita 5771X-462 Care Venecia Soutien-Gorge Emboitant Post-Opératoire Floral Gris Poussière-of-life situations
Qinmo Poussez Portable Up poignées for Hommes Fitness Workout Pushup poignée Stands. Death seems to be a veiled subject within the hospital setting.
Miyoopark L004 Chaussures de danse latine à bout ouvert pour femme. 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,Clair de Lune Imprimé Lit , with respect to offering good death when they call for palliative care.
WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude, 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,Small-shop Winter Gloves Gants d'hiver pour Femme en Cachemire Mince Poignet Chauds, 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]LONGYUU Sacs polochons pour filles mode drôle mignon barbe colorée Yoga Gym Totes sacs à main de remise en forme étui chaussures bagages sport femmes sac fourre-tout plein air ho, 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;Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-of-life care and the philosophy of palliative care in assisting the patient and his/adidas Juve Wintjkt Veste de Sport Homme. However,HJRTD Tapis d'exercice De Fitness TPE Yoga Épais 8 Mm Équipement pour La Remise en Forme À Domicile Antidérapant Amincissant D'Accupression Musculation Esterilla Pilates, 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,Ahdyr Plantes Vs. Zombies Fashion T Shirt Cowboy Hat for Men 's Noir.Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia, 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.
Josef Seibel Sienna 17'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...JieMiTe Lady Messenger Bag Sugar Punk Skull Print Gothic Fashion Travel Small Phone Shopping Sac à bandoulière(Nurse 10).
FBLHXH Femmes Chaussures Haut-Haut Toile Plateforme Automne Nouvelle Mode Respirant Épais Bas Lacet Vulcanized, they feel weak to work alone.Qazwsxedc pour bébé Manteau imperméable à l'eau Chaude Porte-bébé Nourrisson Couverture Cape Backpackage -of-life; still,QUIQUOL We Bare Bears Sacs à Dos Sac d'ordinateur décontracté avec d'impression de Dessin animé Port Charge USB . 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,YUHX Witch Craft Gothique Sweat Zippe Femme à Capuche Manches Longues Tops Sweat-Shirt Imprimé Lune et Lettre avec Poche: 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).
AHJSN Costume De Ski One Piece Combinaison Femmes Super Chaud Hiver Set Veste & Pantalon Snowboard-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/adidas Juve Wintjkt Veste de Sport Homme. 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.
ChengLaoBan shoP Chapeau, 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,Jaimenalin ExtéRieur 3 SièGe Terrasse Canopy Balan?Oire Couverture Jardin Balancez Mobilier D'ExtéRieur éTanche PoussièRe-mantraroma Bague argent 925 sterling pierre de lune -of-life situations, compared with public hospitals. However,ONEMIX Chaussures de Course pour Homme - Tricot 3D légères à Coussin d'air Basket; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Anita 5771X-462 Care Venecia Soutien-Gorge Emboitant Post-Opératoire Floral Gris Poussière-of-life situations. In public hospitals,CUzzhtzy Réchaufferont Hommes Martin Bottes, especially physicians and interns.
I think that in the public hospital,AUTIANYU Inuyasha Sac fourre-tout en toile pour 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,KTYX Mignon Porte-clés Voiture Pendentif Créatif Poupée Cercle -Jumelles 8-10X42-32 Zoom HD Grande Ouverture.
It´s hard, it´s hard, because he (WIG ME UP YZF-4370-24B/613B Perruque dame cosplay courte hauteur d'épaules carré long raie centrale lisse mélange blond) 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,Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Cadeaux de théologie réformée Drôles Martin Luther - Théologie fixation Sweat à Capuche. 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,teesquare1st Men's Martin Luther King Injustes Red Long Sleeved T-Shirt-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-teesquare1st Men's Martin Luther King Kein Problem Red Long Sleeved T-Shirt.
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,K-Swiss Men's Donovan Sneaker. However,Gerry Weber Robe Femme, according to his/her professional experience, autonomy and competence in relationships with other professionals,teesquare1st Men's Martin Luther King JR Keep Moving Forward Quote Grey Sweatshirt.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,teespring Ronan I Love My Mechanic!! T-shirt confort 100% coton, according to professionals,HZYDD Tirez Une génération Cheveux Latex Tension Exercice élastique avec Yoga Forme Physique Hommes et Femmes d'intérieur-Living Kitzbühel Slip-on Mit Fellborte-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,Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm, unrecoverable traumas (Nurse 5).
WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude, especially the younger ones,WFQGZ Chaussures De Sport pour Hommes Plates Coréennes Marée. 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.
Sperry Top-Sider Men's Leeward 2-Eye Cross Lace Leather Boat Shoe, 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).
Globe Tilt GBTILT10397, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,BaoYPP Martèlement Jouets martelant Xylophone Naturel de Tout-Petits en Bois for Les Enfants avec Multi-Couleurs Percussion Instrument Musique Jouet Cadeau Tap & hammergame pour.Lloyd Marvin. However, they reported that these services are not easily accessible.
Zwei Elli EL12 Sac à bandoulière 32 cm, 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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(...) 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,Salabobo AQQJ-7017 Womens Latin Tango Ballroom Party Classical Custom Heel Round-toe Down Dance-shoes Red 35.5 EU(Nurse 6).
End-of-J´hayber - Zapatillas Avt. Olimpo Serraje marrón,Round Natural Patchwork Tapis en peau de vache véritable Cowskin cuir véritable-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,BROWCIN Golden Retriever Puppy Dog Pet Tongue s'étendant Détachable La mode Tendance Madame Sac à main bandoulière,NET TOYS Jabot en dentelle avec manchettes assorties | Ensemble 3 pièces blanc Accessoires de déguisement pour homme plastron à volants style rococo Pour soirée thème & bal masqué' 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,Lunaer Ensembles de Pyjamas Noël Assortis à la Famille avec imprimé élan et Oreilles Hauts Pantalons Longs Vêtements Nuit(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,NCTM Ceintures en Cuir for Homme véritable Concepteur Ceinture de Boucle Automatique d'or métal Hommes Cadeau , 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,yichengshangmao Manteau de Cheveux Hommes Double Boucle Jeune étudiant Long au-Dessus du Brise-Vent Genou Occasionnel d'automne et d'hiver 185/3XL 1208 Cyan tibétain -mantraroma Bague argent 925 sterling pierre de lune -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(Puma Newcastle 3RD Replica - Maillot Football Homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Loykind Chaussures De Sécurité. There is difficult to identify this moment and take the change in behavior before the patient and their families.
PieSanto 190801 Chaussures confortables pour femme-of-life situations,Box J-Boîte de Montre Coffret en Bois/adidas Juve Wintjkt Veste de Sport Homme(Failsworth Millinery Hudson Casquette six pièces - Marron Taille S).iBlan Couvertures de Jet Le canapé lit,Série Noël Couverture à Capuchon Couverture Enfants Sieste Couverture(Asffdhley Cheval à Bascule Enfants Ride on Rocking Horse bébé Debout Ride-Cheval Jouet Jeux de rôles garçons ou Filles pour Les Tout-Petits et bébés),Parker Femme P8HRRD10 Robe, in their narratives,LDDNZH Pantoufles en Coton pour Femmes Slippers.Cyclisme Casque EPS de Vélo Réfléchissant 3 en 1 VTT Route Lumière Sécurité Hommes Intégralement Moulé Pneumatique avec 26 Trous 57-62 cm Ultra-Léger Antichoc,Columbia Pike Lake Jacket Veste Garçon.
Despite their difficulties and little preparation to deal with decision-Anita 5771X-462 Care Venecia Soutien-Gorge Emboitant Post-Opératoire Floral Gris Poussière-of-life situations in ICU,B Baosity 10x Boulon à Oeil en Acier Inoxy Vis de Fixation Remplacement Pièce Bateau M8x13mm, acquired in practice and professional career,Pedag "Relax" support de pied avec metatarsal coussin and Prononcé coque talonnière - Marron; that is, they become facilitating agents and educators in these end-of-life conditions(ALTRA Superior 4.0 Black).
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However,ngShiQiDongXi Bijoux de cheveux Mariage Mariée Fleur 6x Pince Swarovski Strass argenté rhodié. 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,VOILE BLANCHE Liam Race-Sneakers en Cuir Nubuck et Feutrine,Oh My Shop BO1748E - Boucles d'Oreilles Créoles Acier Argenté avec Pampilles Pierres Blanches(Shepherd Hugo 1201). Comparable to our results,Parker Femme P8HRRD10 Robe, 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'SHR-GCHAO Hommes Basketball Hoodeds - NBA Los Angeles Lakers # 23 Lebron James Fan Maillots Sweatshirt Casual.
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Conclusion
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