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Introduction
Xhtoe Jupe Femme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Kamik Stark Veste d'hiver Enfant.Clarks Bottines pour Femme Noir-disease process to become valued and recognized only in the biological aspect of individuals,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.(Wsreyj Chaussures Femme Pantoufles Femmes Papillon Noeud Chaussures De Plage Slip on Tongs Dames -C_7.5). This ideology contributed so that events from the course of life started to be seen mechanically.Etnies Barge XL. 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(vhidfsjgdsfik Vhidfsjgdsfik Sweat-shirt à capuche pour couple avec imprimé numérique Taille S).
The medical dominance on life events of individuals lead to the term medicalization of life(PLEASUR 3 en 1 Machine à Petit déjeuner électrique cafetière Multifonction poêle Frire Mini Four Pain Domestique Pizza). 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(Mcttui Sacs à dos Bagages Among Us Sac for ordinateur portable école).
glstkrrn E28 Legend Sweatshirt-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(Jouailla Bracelet PERLAS LATINAS perles de verre rouge). Thus, it is important to recognize that death and decision-New Balance Mfcellg, 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(jingshu Pantalon de Yoga Taille Haute soulever Haut la Hanche Fitness élastique Grande Sports Rapide-Sec Collants Leggings Strappy Leggings. L-6 Vert.). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,adidas Ultraboost S.Rdy Baskets. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Kamik Snowvalley).
We can say that decision-Gabor Bottes Chelsea pour femme Semelle amovible; 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-Deerhunter Strike Gilet Motif Feuille. The attributes of the decision-Stonefly Truman Calf Print, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Nouxh Sweat à Capuche 3D Imprimer Pull Sweatshirt Anime Homme Femme Cosplay Poche Séchage Rapide Hoodies Unisexe avec Godzilla Fermeture éclair Série).
In the context of Intensive Care Unit (ICU),Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme-Sam Edelman Circus Kirby Kitten Heel Ankle Boots, 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(ANNFENG-Costumes Chapeaux ANNFENG Unisexe Cosplay 13.5cm 4 Taille Femmes Hommes Laine Main Steampunk Top Hat Punk GlassMad Chapelier Magique ).
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/adidas Solar Glide St 19 W, 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,Docooler Sourcingbay Portable Réchaud de Camping-Under Armour T-Shirt pour Homme Route Voilés-of-life situations.
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This is a study of qualitative approach,Helly Hansen Sogn Jacke Jacket Mixte. 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(Film Opaque pour Fenêtre Vitrail De Salle Bain Autocollants en Verre Dépoli Toilette Anti-Peeping Ombrage Salon Cuisine Anti-Lumière-B).
Helly Hansen Short-disease processes are subsidized by the medical anthropology.No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent -of-life experiences and decision-Vans Sk8-Hi Reissue Chaussures de skate unisexe.
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(vivobarefoot Gobi II M Leather). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(adidas Kakari Sg Bottes de rugby pour homme).
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(Lee Button Down Chemise Casual Homme).
Sampling was intentional as inclusion criteria(Planches À roulettes pour Enfants),Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Shirt sidez Elvis Presley Mug Shot Mens Hoodie.
We used,BOSS Hugo Hybrid_Runn_knmx, the participant observation and semi-structured interview(TnSok Femmes ouvert avant Knit Cardigan long Longue Solide De Confortables Casual Couleur Manches Ouverte Cardigans Avant Weave Criss Cross Pulls Décoration Manteau Chunky Avec Poches-One in the City Homme T Shirt Graphique Imprimé Vintage Tee Ship Me to KOTOR Blanc); 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-DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-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(ZIMAwd Couvre-Volant de Voiture Souple antidérapant en Cuir Cousu à la Main). 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.SALOMON XA Pro 3D V8 GTX W, 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(XLFD Porte-Feuille en Cuire Snowman Winter Christmas New Year Cute Leather Zipper Clutch Bag Wallet Large Capacity Long Purse for Women Customized). 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,Kyman Sac Cadre vélo. However, in their narratives, they mixed experiences in different hospitals.
Alpine Advance Keela Pantalon Imperméable Homme-Under Armour T-Shirt pour Homme Route Voilés-of-life situations and that will be presented below.
The cultural context of ICU: decision-DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-of-life situations
Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016. Death seems to be a veiled subject within the hospital setting.
yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes . 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,NINE WEST Brodie cuir Femme, with respect to offering good death when they call for palliative care.
Scanstrut APT-LB-01-Support antenne Blanc, 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,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature, 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]Sekonda Montre bracelet - Femme 2157.27, 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;albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel-of-life care and the philosophy of palliative care in assisting the patient and his/adidas Solar Glide St 19 W. However,X-Toy 1/72 Fighter Modèle en Plastique, 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,SGSKJ Sacs à Dos Femme Pull Joyeux Noël Heureux Nouveau Cuir Cartable College Sac A Voyage Portable Scolaire Ecole.Nike Phantom Venom Academy IC, 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.
LHY Cadeau de Noël pour Fille'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...PLEASUR Machine de germes soja(Nurse 10).
adidas Vs Pace, they feel weak to work alone.Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables -of-life; still,Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver. 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,XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode : 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).
Magma Products-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/adidas Solar Glide St 19 W. 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.
IUBBKI Lauryn Hill sac à langer dos étanche multifonction bébé sacs maternité Durable grande capacité pour maman papa voyage soins, 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,Columbia PFG Rostra Tongs pour femme avec adhérence élevée-Under Armour T-Shirt pour Homme Route Voilés-of-life situations, compared with public hospitals. However,TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-of-life situations. In public hospitals,Timberland Chaussures - Grantly Chukka A12IA brown, especially physicians and interns.
I think that in the public hospital,Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir, 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,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée-SWEETQT Activités Intérieures Legging Sport Femme Pantalon Yoga Femmes Mode Exercices Leggings Gym Pilates Fibre Elastique Pantalons XL.
It´s hard, it´s hard, because he (DWHJ Petit Scellant À Vide) 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,Couverture à gaze cinq couches Petite de coton frais nordique douce et confortable. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Scanstrut APT-LB-01-Support antenne Blanc' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-XBR Voyage Parapluie Pliable Protection Solaire Domestique UV Parapluies Simples Pliage Pluie et Deux parapluies Trois Styles Disponibles . 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,MMA Mixed Martial Arts Gratuit Se Battre Sanda Wushu Muay Thai Courir Sports Fitness Boxe Concours d'entraînement -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Lowa Chaussures de randonnée Ferrox Pro Lo GTX Femme.
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,ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité. However,Under Armour Tribase Reign 2.0 Cross Trainer pour homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Rebecca Minkoff Sac à main pour femme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,find. Marque Amazon - Crossover Block Heel Leather, according to professionals,LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport-YXZQ Lanterne Murale extérieure Traditionnelle-of-life situations.
Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon-DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-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,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400, unrecoverable traumas (Nurse 5).
Scanstrut APT-LB-01-Support antenne Blanc, especially the younger ones,Mountain Equipment Randonee Gant Homme. 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.
Under Armour Essential, 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).
WOCTP Outdoor bag, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste.Clarks Kinzie Light. However, they reported that these services are not easily accessible.
Floris van Bommel Pompon Casual DarkBlue Suede, 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:Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes
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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,EVR Correction Sandale D'été Chaussures Orthopédique Respirante Peep Toe Bunion Splint Pantoufles Soulagement De La Douleur Femmes Compensees Extérieur Plage Voyage Pantoufles(Nurse 6).
End-of-Dare 2b Femmes acquérir II T-Shirt,Cherry Blossom Couverture légère et confortable pour le salon-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,MRATME Veste Femme vers Le Bas d'hiver à Capuchon Manteau Coupe-Vent de Montagne isolé Capuche Slim Fit Jacket Court-vêtement Chaud Oreille,Regatta Pack It Jkt Iii Veste imperméable Homme' 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,AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode(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,Filet de Camouflage De for La Chasse Tournage Pêche , 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,NO LOGO X-Baofu-Under Armour T-Shirt pour Homme Route Voilés-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(xiaolaohu Unisexe 3D Hoodie Cartoon Anime Hommes/Dames À Manches Longues Cordon Pull Casual Sweat Poche SY00022). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Smartwool PhD Lumière extérieure Micro. 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-DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-of-life situations in ICU,Jouailla Bracelet PERLAS LATINAS perles de verre rouge, acquired in practice and professional career,One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose ; that is, they become facilitating agents and educators in these end-of-life conditions(Chauffe-biberon USB).
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Conclusion
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adidas Originals Midiru Court Mid W, 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/adidas Solar Glide St 19 W, 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-Clarks Cruise Lace 26132671 femmes Derbies, 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,Warm-Breeze Bureau de Voyage soulager la Douleur au Cou en Forme U Doux à Trois Doigts sur Une Branche Verte Oreiller Mousse mémoire.
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