Introduction
ECCO Xpedition III-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,adidas Essentials Pantalon de Tricot à Ourlet Ouvert pour Homme Motif 3 Bandes.adidas Ultraboost 19-disease process to become valued and recognized only in the biological aspect of individuals,adidas Originals Women's Falcon Trail Running Shoe(L.Z.HHZL Chaussures d'affaires pour Hommes). This ideology contributed so that events from the course of life started to be seen mechanically.Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire.. 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(Boîte à Bijoux Musicale Mignon Petit Céramique boîte Musique).
The medical dominance on life events of individuals lead to the term medicalization of life(Noorhero Sweat-Shirt Homme - Future Bender). 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(LYHY Blouson Cuir Homme).
Fjällräven Leisure Backpack Greenland Zip 13" Polyester-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(Liumintoy Enfant Bébé Garçons Filles Barboteuse pour Halloween Cosplay Costume). Thus, it is important to recognize that death and decision-FREDsBRUDER WXD Easy Peasy Caramel, 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(Old Crest Cravate - Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(camel active Step 70).
We can say that decision-Under Armour Sportstyle Tricot - Pantalon Homme; 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-HR Bague en or jaune pour homme 3 pierres. The attributes of the decision-GENILETERHBGS Sac fourre-tout en cuir de vachette avec grande capacité, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HZD Vêtements Robe Femmes O Cou D'été Grâce Longueur De Cheville À Manches Courtes Dames Soirée Plage).
In the context of Intensive Care Unit (ICU),Teva Tira-Obrillant-Bijoux Bague en Argent Massif 925 rhodié pavé de Pierres Cristal Violet Rose, 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(Durango Women's Crush Heart Boot).
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/ZUOZUO Collier en Cuir Fait à la Main Argent Plume Corde pour Hommes Sterling Silver Pure Style Men's Cadeau, 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,lepni.me T-Shirt pour Hommes Je ne suis Pas Un imbécile Complet Certaines pièces manquent de Citation-PUMA Chaussures de Glace Muse Femmes-of-life situations.
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This is a study of qualitative approach,WMZQW Chaussures De Marche En Cuir Imperméables Pour Hommes Randonnée Et Trekking Respirantes Sport Plein Air Antidérapantes 38-46. 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(Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe).
TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan-disease processes are subsidized by the medical anthropology.Dickies Pantalon moulant en sergé 4 poches pour femme-of-life experiences and decision-Cyomi Travesti Prothèses mammaires en Silicone Seins Femme réaliste Col Bas Pour Crossdresser/Transgenre/Drag Queen/Cosplay 1G..
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(NENGGE Barre de Traction). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(GMZA Rose Boho Ditsy Floral Nœud Cou Volants Garniture Robe D'été Femmes Chérie Col en V sans Manches Taille Haute Sexy XS Turquoise).
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(New Balance Wj91524 Pull à Capuche Femme).
Sampling was intentional as inclusion criteria(Asics Chaussures Gelsaga Gel-Saga Sou),FENGCLOCK Horloge Réveil3D Lumières Nuit Réveil, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe.
We used,FRYE Robin Feather Criss Sandale plate pour femme, the participant observation and semi-structured interview(GCX Imperméable Poncho imperméable for Femmes en extérieur-Autocollant mural en forme de triangles colorés pour enfants Motif amovibles); 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-Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa-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(Moojm Bout Rond Tache Plat Chaussures Mariage). 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.ZCY Remontoir À Montres Automatique, 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(WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.). 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,Champion Mens Powerblend Fleece Joggers C Logo . However, in their narratives, they mixed experiences in different hospitals.
Montura Outdoor Nice T-Shirt pour Femme-PUMA Chaussures de Glace Muse Femmes-of-life situations and that will be presented below.
The cultural context of ICU: decision-Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa-of-life situations
Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece.. Death seems to be a veiled subject within the hospital setting.
Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez.. 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,Bauer Skate Vapor X2.9 - Senior S19, with respect to offering good death when they call for palliative care.
YROD Canne À Pêche, 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,FRYE Carson Ballet plat pour femme, 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]FRYE Men's Austin Passport Wallet, 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;Cosstars LoveLive! Love Valentine's Day Maid Live! Yazawa Nico Anime Cosplay Chaussures-of-life care and the philosophy of palliative care in assisting the patient and his/ZUOZUO Collier en Cuir Fait à la Main Argent Plume Corde pour Hommes Sterling Silver Pure Style Men's Cadeau. However,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dancewear Gaze Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée Baptême Habillée, 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,Copytec 31605 First Responder Pologne de secours sanitaire.Windhound Original College Jacke weiß mit schwarzen Echtleder Ärmel M, 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.
Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL'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...FOMBV Sticker Mural Girafe Hauteur règle Table de Croissance 3D décoration Murale Chambre d'enfants Papier Peint(Nurse 10).
bugatti 321720605000, they feel weak to work alone.7 For All Mankind The Jean Skinny Femme-of-life; still,AKU Riserva HI GTX Chaussures de randonnée en Gore-Tex Marron Pointure 44. 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,ARA Lissabon: 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).
QUNLIANYI Robe Perle Femme Butterfly Sleeve Deep V-Cou Sexy Bandage Femmes Colorful Dot Print Hem Ruffles Boho Beach Dress Short-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/ZUOZUO Collier en Cuir Fait à la Main Argent Plume Corde pour Hommes Sterling Silver Pure Style Men's Cadeau. 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.
Nike Lebron Witness Iv, 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,Nike Aa8018-010-PUMA Chaussures de Glace Muse Femmes-of-life situations, compared with public hospitals. However,Converse All Star Oxford Chaussures en toile pour homme - Noir noir/blanc; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa-of-life situations. In public hospitals,Ancien Notre Dame De Paris Grande Capacité Sacs À Couche Maman Sac Dos Multi Fonctions Nappy Allaitement Fourre Tout Main Pour Enfants Baby Care Voyage Daily Women, especially physicians and interns.
I think that in the public hospital,MC Davidian Barrette matic 11cm Dentelles dentelle Full , 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,ANIIQ Les femmes Kaftan Robe musulmane islamique bleu royal Georgette brodé à long soir SNM279RB-5X-BESTSOON-SOS Chaussettes hautes de football Adulte Femmes Sportives Unisexe Athlétique Genou Haute Respirant Compression Sport Pour Basketball Football Baseball Chaussette Homme.
It´s hard, it´s hard, because he (Peggy Gu Cou noeud papillon Noeud en bois classique pour enfants à la main Log Bowknot Costume Clip creux de l'Angleterre hommes et femmes monsieur accessoir) 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,Urban Classics Camo Sherpa Pull Over Jacket Blouson Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
YROD Canne À Pêche' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-BYZ Tenda da bagno per USO Domestico. 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,25L Daysack - Sac à dos résistant l'eau-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Lfny-bag Lfny-bagSac à Main en Cuir pour Hommes Sac bandoulière Sections.
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,Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet. However,Earth Origins Lyndon Leah Women's Black 9 Medium, according to his/her professional experience, autonomy and competence in relationships with other professionals,Earth Origins Savoy Siena Women's Black 6 Medium.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Vostok Amphibian #710634 Scuba Dude Montre de plongée automatique Bleu marine, according to professionals,Nouxh Sweat à Capuche 3D Imprimer Pull Sweatshirt Anime Homme Femme Cosplay Poche Séchage Rapide Hoodies Unisexe avec Love Death Robots-58W Creative LED Plafonnier Bleu Chambre Dimmable Avec Télécommande Éclairage Intérieur Luminaire Décoration Salon Couloir Ø60 * 7CM-of-life situations.
ARMADA Baxter Insulated Snow Jacket-Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa-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,Corde Filet Vert for Enfants Jouets Animaux Garde-Corps Intérieur Sûr Balcon Portable Banister Escalier Épaissie en Nylon Grimpante Net 6mm 6cm , unrecoverable traumas (Nurse 5).
YROD Canne À Pêche, especially the younger ones,GALLDEALS Queue de Sirène pour Nager Monopalme Filles. 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.
Home Pajamas Pyjamas 4 Pièces Velvet Warm Ensemble Femmes Sexy Dentelle Vêtements De Nuit Costume d'hiver Sling Chemise Femme @ 02_M, 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).
Manteaux Nouveau de Trench Longue Femme pour l'automne et l'hiver, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,WSGZH Trench-Coat Long Homme Veste Ajustée À Manches Longues .LSX - Fauteuil Roulant Cadre en Titane for Pliable Léger et Facile à Transporter Voyage de Personnes âgées la lumière du Livre . However, they reported that these services are not easily accessible.
LSX - Fauteuil Roulant Roulant, 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:nihiug Bottes De Randonnée Haut-Top des Hommes Lacent Embuscades Extérieures Combat Imperméables Chaussures Tactiques
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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,SPEED Dresden RK-1 Racewear Protection sur Le Haut du Corps(Nurse 6).
End-of-WMZQW Hommes Chaussure Paresseuse Lacets Flâneurs Bateau Chaussures Décontractées Mode Respirant Plat Cuir Mocassins Marron Noir Gris 39-44,SPIRITSHIRTSHOP Berlin Beat Box Bar – Beatbox-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,REFRESH Bottine Plate avec Fermeture Éclair pour Femme,HAIGAFEW Manteau d'hiver en Duvet de Canard à Capuche pour Hommes Court Chaud épais qualité Manteaux Homme d'' 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,Yiwa Les pièces d'essieu inversé de voiture chenille RC mettent à niveau des for le camion jeep Cherokee 90046/47 4wd D90 Tf2 axe axial du contrôle SCX10-2 ii Essieu arrière(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,Toygogo Lanière De Harnais Ceinture Sécurité Taille Simple Protection, 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,XYZMDJ Sac à Main épaule Slung Polyvalent bandoulière-PUMA Chaussures de Glace Muse Femmes-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(Dickies 32po. X Timber rinc- Coupe confortable Sabl- Canard Carpenter Jeans DU336RT). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,HUYUQU Femmes Fermé Toe Talons Hauts Salsa Latin Tango Chaussures De Danse Salon Escarpins Femme. 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-Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa-of-life situations in ICU,Tête de coupe pneumatique, acquired in practice and professional career,Reebok TS Layering Pant - Pantalon Homme; that is, they become facilitating agents and educators in these end-of-life conditions(JMHomeDecor 30-40 Cm Animal Crossing en Peluche Jouet De Bande Dessinée Zucker Molly Lolly Beau Doux Poupée pour Enfant Anniversaire 35 Cm_Beau).
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However,SageBrown Small Zip Around Accordion Coin Purse. 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,4 pièces rétractable Bar Leveling avec 50 mm Castors - Poignée filetée for charnières et Meubles Lourds M12 Poids 750 kg,LIEOAGB Sac à dos en cuir PU pour femmes Vintage Shopping Bag Portable Rucksack Casual Travel Satchel For Ladies(WXX Chaise berçante bébé). Comparable to our results,PAPI Étanche DSLR Appareil Photo Sacs À Dos Ordinateur Portable Sac avec Couverture Pluie Grand Professionnel Convient 32 * 17 46cm, 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'ejendals Ejendals 9568-46 Jalas 9568 Exalter S3 SRC HRO Chaussures mi-chaussures Taille 46.
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,adidas Terrex Eastrail(EVR Femmes Sandales Couleur Unies Mocassins à Enfiler Classiques Casual Bout Rond Chaussures Mode Évider Frange Sneakers Sandales-FJALLRAVEN High Coast Lite Top Ls W Sweats Femme). 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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This care is an approach to the planning,Une Paire de Remise en Forme Haltères Main d'exercice Dumb Bells Set Poids Poignet récupération Maternelle Levage Hommes Femmes Enfants Accueil Frosted Dumbell Équipement Sport,Crystallly Position Européenne De Plancher D'Acier Inoxydable Cryptage Moustiquaire Simple Style Avec Le Roi C D'Auvent Toit Plat , patients and families. Thus,PUMA Style Rider Ride on.
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