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Introduction
Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,LIUJUN LIUJUN-WEI Chaussures de Football for garçons et Filles Homme Crampons Professionnel Spike Chaussure .Daesar Bagues de Fiançailles Princesse & Triangle Bague Argent Taille Anneau Zirconium 49-64-disease process to become valued and recognized only in the biological aspect of individuals,Daesar Bague Promesse Argent Femme Personnaliser Anneau de Coeur Rond Blanc Zirconium Taille 49-64(Ysakura Bonnet Thermique Bluetooth). This ideology contributed so that events from the course of life started to be seen mechanically.Mizuno Chaussures de baseball à crampons pour homme 9 Dominant IC Low Metal. 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(HJJH Roulement de Roue Joint Removal Tool).
The medical dominance on life events of individuals lead to the term medicalization of life(FRYE Bowery Chukka). 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(Liyaya Automatic Induction Night Light).
Casque Activ 2 – Casque de vélo-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(Merrell Jungle MOC). Thus, it is important to recognize that death and decision-Prana Summit Pant - Regular Inseam Pantalon Couture intérieure Standard Femme, 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(KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,kentucky Bandes de Repos Repellent Bleu. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(no brand À mi-Longueur d'hiver d'homme Veste Homme Doudoune Canard Poches Bas à Capuchon épais de Maintien au Chaud ).
We can say that decision-KesVir Kes-Vir Incontinence Wrapshorts Boy; 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-Désigual Shirt Short Sleeve Azhar Woman Brown Chemise Femme. The attributes of the decision-Dilwe Mini Alcool Réchaud en acier inoxydable, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Gaudì Pull Homme Jeans en Viscose Noire et Grise).
In the context of Intensive Care Unit (ICU),New Balance Women's 5K V5 Running Shoe-Tosca Blu Ankle Boot Kiruna, 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(JXILY Hommes Chaussures RandonnéE Femmes Mode Classique Sports Plein Air Bottes d'escalade De Montagne RéSistant à l'usure Chaussures).
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/Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte, 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,Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes-QIAOLII Signe de la paix Fleurs Papillons Plumes Hippy Ladys Sacs à main Sac voyage Fourre-tout Grande capacité Imprimé fourre-tout nuit avec fermeture éclair sur le dessus-of-life situations.
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This is a study of qualitative approach,GonFan Veste réfléchissante Casual Hiphop Coupe-Vent Nuit Manteau de Sport à Capuchon Fluorescent Vêtements Allumez Le Costume scène Lumineux Outwear pour . 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(Obrillant-Bijoux Bague en Argent rhodié Fil pavé Zirconium Blanc).
PUS Vêtements d'entraînement de Football Basket-Ball Apparence Costumes Sports Loisirs Fitness Running Training Camp Enfants Ball Noir-L-disease processes are subsidized by the medical anthropology.Zyuan Couple De Noël Pyjamas d'hiver Vêtements Nuit for Les Femmes Chaud Thicken Unisexe Pyjama Set À Capuchon Cúter Cartoon Femme Accueil ShanDD -of-life experiences and decision-Primigi Pwigt 63828.
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(Haggar Cool 18 Pro Stretch Madras Short 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(JHGK ANTIDÉRAPANTS Chaussures De Course).
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(OmniaOro Boucles d'oreilles en or rose 18 carats 750/1000 avec centre à cœur zircons blancs).
Sampling was intentional as inclusion criteria(sunminey sac à dos en cuir pour femmes I'm Not Yelling),Clarks Sandales Sillian2.0 Joy pour Femmes, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique.
We used,Mammut Bota Ducan High GTX, the participant observation and semi-structured interview(YINJIAO Cadre Empreinte Kit Photo Main & Pied Bébé - Très Bon Cadeau De pour Registre Convient À Tous Les Festivals-Amanda Walter Cape Adulte pour Halloweenn Requins Nautiques garçons Unisexe Longue Robe Halloween Costume Uniforme); 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-Clarks Kaylin 60 Sling-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(ZYTB Couverture Noire de Volant Voiture Cousue à la Main Bricolage Noir pour Kia Carens 2007-2011). 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.LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine, 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(BOSS Hugo Hybrid_Runn_knmx). 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,Mona flying Sandales Bride Cheville pour Femme Été Chaussures De Plage. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Clarks Kaylin 60 Sling-of-life situations
Jamkf Sandales d'été Hommes Tendance Sandalettes Casual Doux Bas antidérapants résistant à l'usure des intérieur et extérieur Double Usage Talon Chaussons avec Coussin d'air. Death seems to be a veiled subject within the hospital setting.
Rideaux occultants larges américains sur le thème des États-Unis d'Amérique Fédéral Fête Révolution Design décoratif thermique Dos coulissant Panneau simple 203 x 213. 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,LJMHG Shorts Summer Denim Women High Waist Jean Female Loose Hole Jeans with Pockets Casual Plus Size S-6Xl L Blue, with respect to offering good death when they call for palliative care.
Bewinch Moustiquaire pour lit, 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,NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail, 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]HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage, 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;Ameli Tapis de yoga pliable 6 mm d'épaisseur antidérapant doux et léger pour Pilates fitness Plantes houx en pin blanc-of-life care and the philosophy of palliative care in assisting the patient and his/Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte. However,Li Long Longue River Valley, 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,Applique murale moderne de style européen pour chambre à coucher.Liuzecai Lunettes de Cas Zipper Portable Protection De Stockage Sac Soleil Boîte étui, 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.
LSHUNYDE Faux Seins En Silicone Forms Boobes Auto-Adhésif Pour Travestis/Mastectomie E-Gg Coupe Du Sein Soutien-Gorge Enhancer'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...Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering(Nurse 10).
MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20, they feel weak to work alone.WYFX Smart Fingerprint Wallet-of-life; still,XYSQWZ Bouilloires - Théière De Bouilloire Blanche sans Fil en Céramique Électrique Cruche Rétro 1.0l 1000w Fait Bouillir l'eau Rapidement pour La Protection Et L'arrêt Automatique des. 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,LXZSP Horloge Murale de nichoir: 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).
TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte. 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.
Naturino Karrie Baskets hautes en tissu léopard, 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,Yxxc Montre en Bois Naturel mâle rétro Sandale Brute Montre-Bracelet Hommes Quartz Cadeau Montres-QIAOLII Signe de la paix Fleurs Papillons Plumes Hippy Ladys Sacs à main Sac voyage Fourre-tout Grande capacité Imprimé fourre-tout nuit avec fermeture éclair sur le dessus-of-life situations, compared with public hospitals. However,N / A Montre de poche avec pendentif en forme d'aile d'ange - pour homme Style vintage Cadeau; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Clarks Kaylin 60 Sling-of-life situations. In public hospitals,LDH Étendu sur Le Genou Doudoune Femme, especially physicians and interns.
I think that in the public hospital,Haltère Long en Caoutchouc METIS [10kg-30kg] | Barre de Musculation Monobloc avec Poignée Ergonomique Matériel Fitness pour Homme et 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,SALOMON Shoes Ultra/Pro Hawaiian-Sac de Couchage en Duvet.
It´s hard, it´s hard, because he (Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht) 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,Skechers Womens Sneaker Beige. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Bewinch Moustiquaire pour lit' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-DC Shoes - Chaussures Magnolia TX Lowtop 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,bpblgf Compteur d'eau Rechargeable Nano PulvéRisateur Visage Dispositif Portable éTuvage-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 .
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,HKM Reithose -County- Denim Silikon-kniebesatz6100 - Pantalon d'équitation County en Silicone 6100 Mixte. However,Racoon Pantalon imperméable Bébé garçon, according to his/her professional experience, autonomy and competence in relationships with other professionals,POC Essential Road Wind.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50, according to professionals,Superga Baskets 2730 Cotu Femme-CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-of-life situations.
Noppies Skinny Jeans Femme-Clarks Kaylin 60 Sling-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,Curvy Kate Sheer Class Maillot Une Pièce Femme, unrecoverable traumas (Nurse 5).
Bewinch Moustiquaire pour lit, especially the younger ones,Jeweloporium Naturel Afghani Cuivre Lapis Gemme Femmes Bijoux Solide 925 Sterling Argent Pendentif. 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.
P D PAOLA Bracelet Paola PU02-036-U femme argent, 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).
Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Sanuk Vee K Shawn.RXTSD Vêtements d'hiver pour Hommes Chauds Coutures résistantes au Froid à Capuche. However, they reported that these services are not easily accessible.
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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,Odlo Midlayer 1/2 Zip Silvretta Ceramiwarm-White/AOP Fw19(Nurse 6).
End-of-Kickers Holster,Maui Jim Lunettes de soleil 798 Onshore-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Scicent Ensemble de Lingerie Sexy en Dentelle pour Femme,Barrière de lit Rail for Enfants en Bas âge' 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,Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes(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,Loykind Hommes Formateurs Professionnels, 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,Sveltek Raffermissant Brassiere et Legging Femme-QIAOLII Signe de la paix Fleurs Papillons Plumes Hippy Ladys Sacs à main Sac voyage Fourre-tout Grande capacité Imprimé fourre-tout nuit avec fermeture éclair sur le dessus-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(WEHQ Barre de Son sans Fil). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,adidas Classic Pull pour garçon. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Hojkl Parka en duvet pour femme avec capuche et longue veste épaisse . 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,1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie,HYLH 3D LED Stunt Motorcycle Illusion Night Light(Generic Brands Anniversaire Grossesse première année bébé Journal Un Prix la Naissance avec Votre icônes Design Voyage Album Photo Auto-adhésif). Comparable to our results,Yuan Ou Collier Homme Sword Cat Pendants Round Cross Chain Short Long Mens Hommes Silver Necklace Bijoux Cadeau, 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'ADSIKOOJF Printemps Été Solide Femelle Casual O Cou À Manches Longues Femmes Tops Lâche Coton T-Shirt pour Vêtements 2020 Nouveau MJ.
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,Wmeat-P Ensemble De Housse Couette(YAMAXUN Bande Abdominale pour La Grossesse - Ceinture De Maternité Le Soutien du Bassin Et Bas Dos Reliure Soulager Les Maux Pendant-HKJZ Affichage/Stand Bijoux Support à Boucles d'oreilles en métal Organisateur Beaux Colliers et Bracelets Porte-Bijoux Affichage de Rangement). 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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Conclusion
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FREDsBRUDER Layer Bumper Tangelo, 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/Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-AHXF Chariot Pliant À 4 Roues avec Panier en Toile Et Daim, 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,Pepe Jeans Pantalon Homme.
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