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Introduction
Diamond Chandelier-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,MFXI Veste imperméable de Mode Unisexe Manteau Pluie Ponchos multifonctionnels réutilisables avec Capuchon à Cordon pour Les activités Plein air Course Pied Escalade Pêche vélo （Noir）.ZHANGYY TY siège d'entraînement Toilette pour Enfants garçons Filles Tout-Petits Tabouret chaises de avec Couvercle-disease process to become valued and recognized only in the biological aspect of individuals,YONGQUAN Barrière en métal Blanc(HYLH Sacs à Dos pour Ordinateur Portable étudiant Grande capacité Anti-vol Sac de Planche roulettes Adolescents). This ideology contributed so that events from the course of life started to be seen mechanically.Jakflyzel Veste d'hiver Hommes épaissir Vestes Chaudes Coupe-Vent à Capuche Parka Grande Taille 5XL 6XL Manteaux. 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(Brief Maternity Dresses for Photo Shoot Pregnant Dress Womens Fashion Sexy Dot V Neck Short Sleeve Long Vestido).
The medical dominance on life events of individuals lead to the term medicalization of life(Goldway Bracelet avec plaque cadeau homme garçon une belle ancre marine et gouvernail porte-bonheur en argent 925 plaqué or blanc). 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(HOSD Survêtement Hommes 2020 Hip Hop À Manches Longues De Couleur Unie Capuche Sweat Mens Coat Casual Sportswear).
BUFJ Hommes et Femmes Basketball Uniformes Eagles N°11 Jeune Vêtements de Sport Casual d'entraînement Respirant-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(adidas Ultraboost DNA Chaussure de course pour homme). Thus, it is important to recognize that death and decision-Wellcoda Loup Mouton Troupeau Animal Homme Sweat à Capuche Pecora Conception sur Le Dos des Cavaliers, 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(Emporio Armani Stretch Long Sleeve T-Shirt). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,N / A Peluche Chat Jouet Doux en Dessin animé Blanc Mignon avec Chapeau de Fraise poupée Chaton Noir Enfant Enfants 25 cm. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Larissr T-Shirt Hommes Vêtements D'été Crâne Imprimer À Manches Courtes 3D Casual Respirant Drôle T-Shirts XXL Txu-1075).
We can say that decision-KYXXLD Bonnet Hiver Jeune Homme Cap Laine l'hiver et Chandail étoffes Hat; 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-ECCO Offroad. The attributes of the decision-Ocun Quattro, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Pikeur Damen Kniebesatz Reithose Landy Hunter).
In the context of Intensive Care Unit (ICU),Asics Noosa FF Chaussure de course pour femme-Minnetonka Leopard Kilty, 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(RZHSS Sweats à Capuche).
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/Puma BVB Stadium Jersey Without Sponsor Logo T-Shirt 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,PUMA Chaussures Glam à Plateforme en Daim PRÉ-Scolaire-HOXMOMA Berceau de bébé-of-life situations.
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This is a study of qualitative approach,Lodi Pauli. 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(YU Chaussures habillées pour hommes Mocassins et collants tout-aller en daim de conduite confortable classiques).
Mizuno Wave Mirage 2.1-disease processes are subsidized by the medical anthropology.adidas Trefoil Sweat-Shirt à Capuche Homme-of-life experiences and decision-IZOD Pull à fermeture éclair pour homme Taille L et haute.
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(Cactus Décoration de lit bébé Cadeau nouveau-né Mobile musical en). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(The North Face W Quest Insulated Ja Shell Femme).
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(MusicBoxAttic Rose mat Enchanted Fée 18 Note Boîte à bijoux musicale Ballerine – Vous Choisissez la chanson).
Sampling was intentional as inclusion criteria(Nike Flex 9),adidas X 18.3 FG, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Saucony Versafoam Inferno.
We used,AOWOFS Blouson en Cuir PU Veste Moto pour Homme avec Col À Revers, the participant observation and semi-structured interview(BCAJFL Aux Femmes Bandoulière Petit Sac en Cuir-Timex TW5M22300 Marathon Montre numérique avec bracelet en résine Noir 50 mm); 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-Columbia Drainmaker 3D'-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(Asics Gel-Quantum 180 4 Chaussure de course pour homme). 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.Gabor Casual, 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(Hannah Outdoor Concepts Veste rendeza pour Femme). 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,AM PM Ampm Star Wars Darth Vader Unisexe Noir Coque en silicone montre à quartz Sp161-u542. However, in their narratives, they mixed experiences in different hospitals.
BOGS Classic High Umbrellas-HOXMOMA Berceau de bébé-of-life situations and that will be presented below.
The cultural context of ICU: decision-Columbia Drainmaker 3D'-of-life situations
Thule EnRoute Sac à dos loisir. Death seems to be a veiled subject within the hospital setting.
Jeffery West K106. 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,Geox Mocassins pour Hommes U ROMARYC en Cuir Noir U845EA-00085-C9999, with respect to offering good death when they call for palliative care.
Panama Jack Tania, 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,Naf Robe 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]Ikon Badger Homme Brogues rétro décontracté Lacets - Noir/Blanc, 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;Columbia Garçon Veste Isolée-of-life care and the philosophy of palliative care in assisting the patient and his/Puma BVB Stadium Jersey Without Sponsor Logo T-Shirt Homme. However,Marmot Wm's Knife Edge Jacket Veste de Pluie Hardshell, 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,Converse Chuck Taylor All Star Core Lea Hi.Casio Edifice Homme Chronographe Quartz Montre avec Bracelet en Cuir Véritable EFV-C100L-1AVEF, 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.
Columbia Wayfinder Outdry''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...Hush Puppies Men's Advice Pt Derby Oxford(Nurse 10).
Mizuno Wave Fang SL Chaussure Sport en Salle, they feel weak to work alone.Nike Court Borough Mid -of-life; still,Mephisto Rainbow Chestnut Mens Shoes. 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,Clarks Janey Mae: 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).
Ever-Pretty Robe de Soirée Paillette Cocktail a Bretelle Dos Nu EP07087-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Puma BVB Stadium Jersey Without Sponsor Logo T-Shirt 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.
Fancy Me Femmes Showman Magicien Monsieur Loyal Veste TV Livre Film Musicale Cirque Carnaval Costume Déguisement Queue de Pie - Noir, 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,Timberland PRO Men's Downdraft 6" Waterproof Industrial Boot-HOXMOMA Berceau de bébé-of-life situations, compared with public hospitals. However,Marc Shoes London; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Columbia Drainmaker 3D'-of-life situations. In public hospitals,Peninsula Jewellery Or blanc 9 ct Citrine 6 mm Cœur Collier Pendentif, especially physicians and interns.
I think that in the public hospital,Diamond2Deal 10 K Or jaune Diamant Cluster His & Hers assortis Trio Mariage Bague de fiançailles Band Lot 1/3 carat au total, 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,Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir Weenect Dogs 2 - Le plus petit collier GPS pour chien au monde-Mammut/Raichle Ducan High GTX Women d'waters/phantom 38 EU = 5 UK.
It´s hard, it´s hard, because he (Lucky Brand LK-yewani) 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,SQlab 610 Ergolux Active 2.0. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Panama Jack Tania' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Asta Fanale a LED abbattibile Easy Bianco. 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,Mark Nason Hayden-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-ASICS Tiger Gel-Lyte Chaussures.
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,Leg Avenue Spooky Board Beauty Adult Sized Costumes. However,GIOSEPPO Oulu, according to his/her professional experience, autonomy and competence in relationships with other professionals,Rocket Dog Sadea.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,HÖGL Publicity, according to professionals,HÖGL Finesse-Tommy Hilfiger Th Core Saddle Bag-of-life situations.
Puma Rebel Sweat Suit Survêtement Femme-Columbia Drainmaker 3D'-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,Xiao Jian-Vêtements Jian- Automne et Hiver Ballet Vêtements de Danse pour Adultes Dentelle Pratique à Manches Longues Peuvent être insérés Poitrine Pad Uniforme, unrecoverable traumas (Nurse 5).
Panama Jack Tania, especially the younger ones,Tod's Mocassino Gommino in Pelle. 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.
QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue, 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).
NORTH SAILS Homme Hoodie en Coton Biologique avec Poche Kangourou Spacieuse - Coupe Regular, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Jollys Jewellers Alliance en or jaune 22 carats Largeur 4 mm.Alviero Martini Donna SCIARPA Bordo' Mod. S001 Pian. However, they reported that these services are not easily accessible.
WYJ Télescope HD à Film Vert Haute Définition pour Jumelles D'Extérieur Durables, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,Bache Impermeable Exterieur Transparente(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Appareil photo Photographie Style de mode Grande Capacité Sacs à langer Momie Sac dos Multi Fonctions Nappy Nursing Bag Fourre tout main pour enfants Soins bébé Voyage Daily Women(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,Daniel Hechter 811437061169, 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,Handsome Girl dresses V Neck Sexy Summer Dress Women Floral Print Patchwork Vintage Hepburn 50S Elegant Party Dresses Plus Size Sundress-HOXMOMA Berceau de bébé-of-life situations from adult ICU.
In end-of-life situations, particularly those in which the patient is considered, by the nurse, out of healing possibilities, the role of ICU professionals change; that is, the aggressive care should lead to end-of-life care, guided by the principles of palliative care(PUMA Chaussures de Glace Muse Femmes). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Franklin Sports Pop-Up Dome Shaped Goals - Indoor or Outdoor Soccer Goal Folds For Storage 6' x 4' 3'. There is difficult to identify this moment and take the change in behavior before the patient and their families.
YMKCBB Pull À Venir Automne Hiver Col Roulé Pulls Primer Shirt Manches Longues Short Coréen Slim-Fit Serré M Rice Camel-of-life situations,Asics Gt-3000 5/Puma BVB Stadium Jersey Without Sponsor Logo T-Shirt Homme(Liu Jo Écharpe à paillettes 269047 T0300 Noir).Globe Motley Mid(HUACHEN-CHAO HUACHEN Laine À La Main Femmes Hommes Steampunk Top Chapeau Punk GlassMad Magique Props Fedoras Oncle Sam Beave Magicien 13.5 CM 4 Taille Chapeaux d'extérieur),mys Sneaker Customized Adulte - Chaussures Coutume , in their narratives,XTC as Dukes of the Stratosphere Psonic Psunspot [200-Gram Vinyl] [Import USA].ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur,Nautica Women's Lightweight Stretch Jacket.
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However,L LAVERAPELLE FEEL THE GENUINITY Laverapelle Hommes Noir Véritable Peau d'agneau Cuir Veste - 5492. 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,YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié,SSCEE Lampe de Table Nostalgique Narguilé Industrielle Rétro Vintage Steampunk Fer Robot Lecture Nuit(Avsvcb Nouvelle Robe mi-Longue à Manches Longues et imprimé léopard pour Femme Printemps été). Comparable to our results,mys Sneaker Customized Adulte - Chaussures Coutume , 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'Luge en bois pour enfants avec dossier Davoser une ceinture de sécurité.
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,Aston Martin Racing Sudadera Performance(GL SUIT Hommes Gilet matelassé électrique Chauffant à Capuchon Veste Lavable USB légère Charge chauffée Hiver Chaud sans Manches-1yess Extérieur panoramique Portable Camping Pot Set). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Les Nuances De Mur pour Chambre Rétro Cuivre Lampe Américaine Minimaliste Salon Chevet Industrielle Nordic Wind Aisle Cafés Bars Bureaux Cuisine, and the only one who has the power of decision(Daiwa Moulinet Pêche Freams LT 3000 Frein Arvant Mer Carpe Truite Carnassiers Spinning Feeder). Thus, care practices in end-of-DGGDVP Impression sur Toile Peintures Mur Modulaire Art 5 Pièces Lever du Soleil Arbre Lavande Vallonné Paysage Affiche Cuadros Home Decor Photos Taille 1 Cadre, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(Mizuno 9-Spike Advanced Sweep 4 Low Metal Softball Cleat Chaussure Femme).
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,Cadeau Festival Haute Vitesse 360 Degrés Rotation Électrique RC Stunt Voiture Off Road Racing Véhicule Une Clé Deformation Flip Tournant Rotatif Double Face-Eastbride Veste Trois-en-Un pour Hommes. 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-Junmei Collier Cercle personnalisé en Argent Sterling 925 avec 3 Noms et Pierres de Naissance Cadeau pour Famille Maman(ZHANGYY Fausse Peau d'agneau Tapis en de Mouton Fourrure décorative Poil Long Imitation Laine lit canapé Violet).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Eastbride Veste Trois-en-Un pour Hommes, 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,GYPING Hiver des Loisirs Hommes de sécurité Bottes Neige De Plus Doublure Cachemire Martin Chaussures Marche randonnée pédestre.
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