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Introduction
FRYE Robin Feather Criss Sandale plate pour femme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa.ZCY Remontoir À Montres Automatique-disease process to become valued and recognized only in the biological aspect of individuals,Champion Mens Powerblend Fleece Joggers C Logo (Wuqiang 18cm tapota 3D Imprimer Jupiter Lampe). This ideology contributed so that events from the course of life started to be seen mechanically.Montura Outdoor Nice T-Shirt pour 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(Sekonda Montre bracelet - Femme 2157.27).
The medical dominance on life events of individuals lead to the term medicalization of life(Selmark Soutien-Gorge préformé Oriana Mariage Ivoire). 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(Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet).
Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece.-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(ZUOZUO Ceinture Homme Boucle Automatique Noir Longue). Thus, it is important to recognize that death and decision-Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez., 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(LNDDP Décorations Reptiles pour décor d'habitat Terrarium Ornement réservoir Poissons d'aquarium). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Bauer Skate Vapor X2.9 - Senior S19. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(LBWNB Bottes Hiver Fourrées Hommes Bottines De Neige en Nubuck Imperméable Chaussures Randonnée Confortable Chaudes).
We can say that decision-YROD Canne À Pêche; 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-FRYE Carson Ballet plat pour femme. The attributes of the decision-FRYE Men's Austin Passport Wallet, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Dogs Painting Art Head Doberman Pinscher Baby Diaper Bag Backpack).
In the context of Intensive Care Unit (ICU),Cosstars LoveLive! Love Valentine's Day Maid Live! Yazawa Nico Anime Cosplay Chaussures-YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dancewear Gaze Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée Baptême Habillée, 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(Skechers Femmes Chaussures De Sport A La Mode).
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/Copytec 31605 First Responder Pologne de secours sanitaire, 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,Windhound Original College Jacke weiß mit schwarzen Echtleder Ärmel M-ECCO Xpedition III-of-life situations.
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This is a study of qualitative approach,Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL. 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(Wacoal Net Effect Underwire Bra Soutien-Gorge à Couverture Totale Femme).
FOMBV Sticker Mural Girafe Hauteur règle Table de Croissance 3D décoration Murale Chambre d'enfants Papier Peint-disease processes are subsidized by the medical anthropology.bugatti 321720605000-of-life experiences and decision-7 For All Mankind The Jean Skinny Femme.
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(GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Heqianqian-Shoes Couvre-chaussures Imperméables Guêtres De Randonnée Durables Legging Gaiter Respirant Couvre-Jambe Haute for Enfants Trekking En Montagne Ski Marche Escalade Chasse Pour Les Jours Plu).
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(Adidas Condivo d'entraînement pour homme Pantalon ).
Sampling was intentional as inclusion criteria(HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu),AKU Riserva HI GTX Chaussures de randonnée en Gore-Tex Marron Pointure 44, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.ARA Lissabon.
We used,QUNLIANYI Robe Perle Femme Butterfly Sleeve Deep V-Cou Sexy Bandage Femmes Colorful Dot Print Hem Ruffles Boho Beach Dress Short, the participant observation and semi-structured interview(Filet de sécurité pour Enfants Cadres d'escalade Protection Enfants-Ajvani Femmes Plat Courroie de Cheville Strappy t-Bar Soir Diamante Sandale Taille); 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-Nike Lebron Witness Iv-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(Saisma Pantalon De Cyclisme D'été À Manches Courtes for Hommes Vêtements en Tissu Haute Élasticité). 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.Nike Aa8018-010, 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(ACCEY 3D stéréo haut de gamme européen bleu chambre papier peint américain rétro luxe salon TV fond ménage A1917). 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,Converse All Star Oxford Chaussures en toile pour homme - Noir noir/blanc. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Nike Lebron Witness Iv-of-life situations
MC Davidian Barrette matic 11cm Dentelles dentelle Full . Death seems to be a veiled subject within the hospital setting.
ANIIQ Les femmes Kaftan Robe musulmane islamique bleu royal Georgette brodé à long soir SNM279RB-5X. 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,BESTSOON-SOS Chaussettes hautes de football Adulte Femmes Sportives Unisexe Athlétique Genou Haute Respirant Compression Sport Pour Basketball Football Baseball Chaussette Homme, with respect to offering good death when they call for palliative care.
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, 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,Urban Classics Camo Sherpa Pull Over Jacket Blouson Homme, 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]BYZ Tenda da bagno per USO Domestico, 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;25L Daysack - Sac à dos résistant l'eau-of-life care and the philosophy of palliative care in assisting the patient and his/Copytec 31605 First Responder Pologne de secours sanitaire. However,Lfny-bag Lfny-bagSac à Main en Cuir pour Hommes Sac bandoulière Sections, 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,Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet.Earth Origins Lyndon Leah Women's Black 9 Medium, 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.
Earth Origins Savoy Siena Women's Black 6 Medium'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...Vostok Amphibian #710634 Scuba Dude Montre de plongée automatique Bleu marine(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Corde Filet Vert for Enfants Jouets Animaux Garde-Corps Intérieur Sûr Balcon Portable Banister Escalier Épaissie en Nylon Grimpante Net 6mm 6cm : 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).
GALLDEALS Queue de Sirène pour Nager Monopalme Filles-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Copytec 31605 First Responder Pologne de secours sanitaire. 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.
Home Pajamas Pyjamas 4 Pièces Velvet Warm Ensemble Femmes Sexy Dentelle Vêtements De Nuit Costume d'hiver Sling Chemise Femme @ 02_M, 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,Manteaux Nouveau de Trench Longue Femme pour l'automne et l'hiver-ECCO Xpedition III-of-life situations, compared with public hospitals. However,WSGZH Trench-Coat Long Homme Veste Ajustée À Manches Longues ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Nike Lebron Witness Iv-of-life situations. In public hospitals,LSX - Fauteuil Roulant Cadre en Titane for Pliable Léger et Facile à Transporter Voyage de Personnes âgées la lumière du Livre , especially physicians and interns.
I think that in the public hospital,LSX - Fauteuil Roulant Roulant, 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,Merrell Jungle MOC-PAPI Étanche DSLR Appareil Photo Sacs À Dos Ordinateur Portable Sac avec Couverture Pluie Grand Professionnel Convient 32 * 17 46cm.
It´s hard, it´s hard, because he (The fairy Brève Solide Pull et Jupe Costume Automne Hiver Surdimensionné Chauve-Souris Manches Pulls Tricot 2 Pièces Ensemble) 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,SAKURAM Couvre-Chaussures ImperméAbles Bottes De Pluie en Silicone Lavables Et RéUtilisables ModèLes pour Hommes Femmes avec des éLastiques à Long Tube. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
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' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Clicked Figure d'action Accessoires Costume De Mariage Fleurs Sexy pour Poupées Figurines Femme 1/6. 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,DONDUP Pantalon Jambe Droite Quadro. P586A432-XXX913 TG-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-SPEED Dresden RK-1 Racewear Protection sur Le Haut du Corps.
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,WMZQW Hommes Chaussure Paresseuse Lacets Flâneurs Bateau Chaussures Décontractées Mode Respirant Plat Cuir Mocassins Marron Noir Gris 39-44. However,SPIRITSHIRTSHOP Berlin Beat Box Bar – Beatbox, according to his/her professional experience, autonomy and competence in relationships with other professionals,REFRESH Bottine Plate avec Fermeture Éclair pour Femme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,HAIGAFEW Manteau d'hiver en Duvet de Canard à Capuche pour Hommes Court Chaud épais qualité Manteaux Homme d', according to professionals,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-YZT QUEEN Bottes Cuissardes Femmes-of-life situations.
Andrea Conti Chaussures basses en cuir à lacets pour femme-Nike Lebron Witness Iv-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,chora Cassette de brûleur poêle à gaz Portable pour Barbecue Camping en Plein air Honest, unrecoverable traumas (Nurse 5).
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, especially the younger ones,SKYROPNG Chaussures Mme Muller. 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.
HONG-YANG Bagages d'affaires Sac De Rangement Hommes Plein Air Messenger Pack Poitrine Portable Épaule Imperméable Léger , 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).
Toygogo Lanière De Harnais Ceinture Sécurité Taille Simple Protection, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,XYZMDJ Sac à Main épaule Slung Polyvalent bandoulière.HUYUQU Femmes Fermé Toe Talons Hauts Salsa Latin Tango Chaussures De Danse Salon Escarpins Femme. However, they reported that these services are not easily accessible.
Lacoste Veste Homme, 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:Fjällräven Leisure Backpack Greenland Zip 13" Polyester
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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,Reebok TS Layering Pant - Pantalon Homme(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Saucony Originals Scarpe Femme Jazz Original Vintage Homme Noir 4955 39(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,Clarks Sandales Step Cali Sand pour Femmes, 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,BaoYPP Martèlement Jouets martelant martèlement Xylophone bébé éducation Set Dinosaur Caterpillar Crocodile Shape Sorter Tap & hammergame pour Les Enfants -ECCO Xpedition III-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(Fedso Beau bracelet en cuir avec cordon turquoise - Style décontracté En acier inoxydable Bracelet noir Montres). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Jumelles # 6 x 36 - Jouet pour enfant Mini jumelles portables Télescope HD étanche en plein air. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,IUBBKI sac à main rouge et blanc vagues en cuir véritable fourre-tout rivets bandoulière poignée supérieure femmes. 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,LGLE Pyjama en satin à manches longues pour homme,Gants de boxe pour Muay Thai De haute qualité MMA Training professionnelle for les hommes femmes sac lourd en cuir infusé Gel Sparring Kickboxing Fighting Mit(Guess Short Dress). Comparable to our results,O'NEILL Bar-à-Plage Shorts Hybrides Chino pour Hommes, 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'LILONGXI Tapis.
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Conclusion
The decision-ECCO Xpedition III-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.RYKA Niah, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Beginnings Sterling Silver lapis Grand anneau ovale-of-adidas Ultraboost DNA Chaussure de course pour homme.
Beginnings Double Dog Tag Pendentif argent sterling pour hommes, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-LAA Queues de Sirène Filles Queue De Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles . The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,GLXDDB Rétro Industriel Loft Pendentif Lumières Birdcage Lumière Creative Vintage Lampe en Fer Luminaire pour Café Restaurant Bar Salon Allée Lustre A-Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S.
Bisgaard Rain, 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/Copytec 31605 First Responder Pologne de secours sanitaire, 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-Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S, 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,Superdry Applique Serif Ziphood Sweat-Shirt À Capuche Femme.
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