Introduction
Parcs pour Tout-Petits-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,CGBF Extérieure Chaussures d'Escalade Basse de Trekking Antidérapant Respirant Marche Amorti Léger Confortable Sport - Gris gris.Trespass Qikpac Female Jacket Vestes coupe-pluie Femme -disease process to become valued and recognized only in the biological aspect of individuals,Joyara Bague Femme 14 ct Or Blanc 0.35 Rond Saphir Rose Millgrain 1/3(Protest Filles Maillots de Bain 2 pièces Sandle 20-2 JR). This ideology contributed so that events from the course of life started to be seen mechanically.Joyara Bague Femme 9 ct Or Blanc 0.25 Rond Vert Emeraude 5 Pierres 1/4. 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(Ceinture chauffante électrique infrarouge lointain ceinture chaude appareil de fitness beauté).
The medical dominance on life events of individuals lead to the term medicalization of life(Rieker 41743 Femme Escarpins à Sangle). 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(HONGYU Sac à Dos de randonnée).
Reebok Workout Plus-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(Herschel supply Sac à Dos Nova Small). Thus, it is important to recognize that death and decision-Joyara Bague Femme 18 ct Or Blanc Diamants 0.25 Noir Coeur 1/4, 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(XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Josef Seibel Chance 39. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(1yess Randonnée en Plein air Camping Batterie de Cuisine avec poignée).
We can say that decision-Geox B New Flick B; 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-Geox D Nebula C. The attributes of the decision-PUMA Chaussures de Glace Muse Femmes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Coghlan de Bungee Étendoir Linge W/Mousqueton Pinces à Séchage).
In the context of Intensive Care Unit (ICU),Dachstein Ramsau 2.0 Gore-TEX Chaussure-New Balance Fresh Foam Zante Pursuit, 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(Safety 1st Lot de 45 prises courant ultra transparentes).
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/Columbia WAYFINDER FLIP Sandales de sport pour 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,Jack Pyke Gilet sans Manches Countryman - pour Homme Polaire Thermique-RENJIANFENG Les Femmes Blanches À Manches Longues Crop Top Chauve-Souris Fermeture Glissière Col Semi-Ouvert Sweat-Shirt Casual en Vrac Blouse Chemises pour Dames-of-life situations.
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This is a study of qualitative approach,nihiug Bottes De Randonnée Haut-Top des Hommes Lacent Embuscades Extérieures Combat Imperméables Chaussures Tactiques. 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(AZSTEEL Native American Lives Matter Indigenous Peoples' Day Pullover Hoodie | Black Novelty Unisex Lightweight).
nihiug Bottes De Randonnée Hommes Imperméable à l'eau Léger High Rise Lace Up Outdoor Grande Taille Chaussures en Plein Air-disease processes are subsidized by the medical anthropology.Jack Wolfskin Womens/Ladies Gravity Flex Shield Fitness Trainers-of-life experiences and decision-Under Armour Polo rehaussé pour 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(RVCA South Eastern Trunk pour Homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(TIZORAX Sac à main en cuir synthétique avec poignée sur le dessus pour femme Motif ethno tribal).
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(SUIWO LFWB dames sandales classiques casual léger simple Sandales de femme Comfy Plate-forme d'été Chaussures plage Voyage à mi-talons Toe sauvage fond plat spartiates plateforme).
Sampling was intentional as inclusion criteria(Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck),Kamik Raindrops, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Roxy Rock Peak - Veste matelassée déperlante pour Femme ERJJK03250.
We used,TEN POINTS Carina, the participant observation and semi-structured interview(Champion Sweat à Capuche en Laine Polaire pour Homme-no!no! Anti-Pluie Surchaussures); 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-DC Shoes Heathrow-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(Clarks Women's Addiy Sharilyn Fashion Boot). 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.Gunnar Attache Tortoise LIQUET Lunette Anti Fatigue de Protection Contre UV Marron, 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(GLXDDB Rétro Industriel Loft Pendentif Lumières Birdcage Lumière Creative Vintage Lampe en Fer Luminaire pour Café Restaurant Bar Salon Allée Lustre A). 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,Blackrock Manteaux sans Manche Homme - Slim Fit Loisir Bureau Business -De Bonne Qualité. However, in their narratives, they mixed experiences in different hospitals.
Tommy Hilfiger Cora C-NK Sweatdress Ls Robe Femme-RENJIANFENG Les Femmes Blanches À Manches Longues Crop Top Chauve-Souris Fermeture Glissière Col Semi-Ouvert Sweat-Shirt Casual en Vrac Blouse Chemises pour Dames-of-life situations and that will be presented below.
The cultural context of ICU: decision-DC Shoes Heathrow-of-life situations
Kickers Bonbon. Death seems to be a veiled subject within the hospital setting.
Nike Magista Onda AG. 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,Mizuno Tc-02, with respect to offering good death when they call for palliative care.
ECCO Biom Terrain, 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,ECCO Xpedition III, 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]ECCO Xpedition III, 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;adidas Essentials Pantalon de Tricot à Ourlet Ouvert pour Homme Motif 3 Bandes-of-life care and the philosophy of palliative care in assisting the patient and his/Columbia WAYFINDER FLIP Sandales de sport pour homme. However,adidas Ultraboost 19, 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,adidas Originals Women's Falcon Trail Running Shoe.Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire., 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.
Fjällräven Leisure Backpack Greenland Zip 13" Polyester'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...FREDsBRUDER WXD Easy Peasy Caramel(Nurse 10).
Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S, they feel weak to work alone.Under Armour Sportstyle Tricot - Pantalon Homme-of-life; still,HR Bague en or jaune pour homme 3 pierres. 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,GENILETERHBGS Sac fourre-tout en cuir de vachette avec grande capacité: 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).
Teva Tira-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Columbia WAYFINDER FLIP Sandales de sport pour 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.
Obrillant-Bijoux Bague en Argent Massif 925 rhodié pavé de Pierres Cristal Violet Rose, 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,ZUOZUO Collier en Cuir Fait à la Main Argent Plume Corde pour Hommes Sterling Silver Pure Style Men's Cadeau-RENJIANFENG Les Femmes Blanches À Manches Longues Crop Top Chauve-Souris Fermeture Glissière Col Semi-Ouvert Sweat-Shirt Casual en Vrac Blouse Chemises pour Dames-of-life situations, compared with public hospitals. However,lepni.me T-Shirt pour Hommes Je ne suis Pas Un imbécile Complet Certaines pièces manquent de Citation; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-DC Shoes Heathrow-of-life situations. In public hospitals,WMZQW Chaussures De Marche En Cuir Imperméables Pour Hommes Randonnée Et Trekking Respirantes Sport Plein Air Antidérapantes 38-46, especially physicians and interns.
I think that in the public hospital,TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan, 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,Dickies Pantalon moulant en sergé 4 poches pour femme-Cyomi Travesti Prothèses mammaires en Silicone Seins Femme réaliste Col Bas Pour Crossdresser/Transgenre/Drag Queen/Cosplay 1G..
It´s hard, it´s hard, because he (FENGCLOCK Horloge Réveil3D Lumières Nuit Réveil) 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,IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
ECCO Biom Terrain' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-FRYE Robin Feather Criss Sandale plate pour 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,Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-ZCY Remontoir À Montres Automatique.
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,Champion Mens Powerblend Fleece Joggers C Logo . However,Montura Outdoor Nice T-Shirt pour Femme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece..
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez., according to professionals,Bauer Skate Vapor X2.9 - Senior S19-YROD Canne À Pêche-of-life situations.
FRYE Carson Ballet plat pour femme-DC Shoes Heathrow-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,FRYE Men's Austin Passport Wallet, unrecoverable traumas (Nurse 5).
ECCO Biom Terrain, especially the younger ones,Cosstars LoveLive! Love Valentine's Day Maid Live! Yazawa Nico Anime Cosplay Chaussures. 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.
YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dancewear Gaze Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée Baptême Habillée, 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).
Copytec 31605 First Responder Pologne de secours sanitaire, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Windhound Original College Jacke weiß mit schwarzen Echtleder Ärmel M.Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:FJXQCY Peignoir en Satin pour Femme
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,Nike Aa8018-010(Nurse 6).
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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,Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet, 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,Earth Origins Lyndon Leah Women's Black 9 Medium-RENJIANFENG Les Femmes Blanches À Manches Longues Crop Top Chauve-Souris Fermeture Glissière Col Semi-Ouvert Sweat-Shirt Casual en Vrac Blouse Chemises pour Dames-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(Natori Women's Power Yogi Contour Convertible Sport Bra). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Earth Origins Savoy Siena Women's Black 6 Medium. 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-DC Shoes Heathrow-of-life situations in ICU,Home Pajamas Pyjamas 4 Pièces Velvet Warm Ensemble Femmes Sexy Dentelle Vêtements De Nuit Costume d'hiver Sling Chemise Femme @ 02_M, acquired in practice and professional career,Manteaux Nouveau de Trench Longue Femme pour l'automne et l'hiver; that is, they become facilitating agents and educators in these end-of-life conditions(Tuyau d'eau télescopique Magique).
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However,The fairy Brève Solide Pull et Jupe Costume Automne Hiver Surdimensionné Chauve-Souris Manches Pulls Tricot 2 Pièces Ensemble. 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,SAKURAM Couvre-Chaussures ImperméAbles Bottes De Pluie en Silicone Lavables Et RéUtilisables ModèLes pour Hommes Femmes avec des éLastiques à Long Tube,Clicked Figure d'action Accessoires Costume De Mariage Fleurs Sexy pour Poupées Figurines Femme 1/6(wxl&gz Leggings De Remise en Forme pour Femmes Poches Sexy Patchwork Taille Haute Élasticité Push Up Legging Polyester Femme D Livraison Gratuite). Comparable to our results,7 For All Mankind The Jean Skinny Femme, 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'DONDUP Pantalon Jambe Droite Quadro. P586A432-XXX913 TG.
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,SPEED Dresden RK-1 Racewear Protection sur Le Haut du Corps(Wsreyj Ciel De Lit Moustiquaire Filleprincesse Hanging Round Lace Canopy Bed Netting Comfy Dome Mosquito Net -B_60 * 270Cm-Nebulus Former T1313 Veste de survêtement). 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,O'NEILL Bar-à-Plage Shorts Hybrides Chino pour Hommes-Tongnian Twisted Wonderland Deuce Spade Femmes Hommes Uniforme Tenue Chemises Veste Pantalon Ceinture Et Accessoires Halloween Carnaval Cosplay. 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-Lapdesks GGJIN Mascarade soirée cosplay perruque tout prêt Styled Buns Jaune Cheveux longs Jeu de rôle Perruques(BTNEEU Compagnon Portefeuille Femme Grande Capacite Porte Monnaie en Cuir PU).
Conclusion
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DAGEGIRL Top Hommes Femmes Lady Montre en Acier Inoxydable Japonais Quartz Saphir Argent Noir Blanc Diamants Montres AAA, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/Columbia WAYFINDER FLIP Sandales de sport pour homme, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
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