Introduction
Puma Men's Iconic MCS Tee-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Naturino See.NM Fashions Tom Hardy Bane Manteau pour Homme en Cuir synthétique de Haute qualité avec Fourrure-disease process to become valued and recognized only in the biological aspect of individuals,Herschel Heritage(GFF Sasan Maiden Series Lady Parapluie Noir Colle). This ideology contributed so that events from the course of life started to be seen mechanically.Clarks Women's Linvale Sea Fashion Boot. 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(LinGo Drone D'oeufs Volants Pliable 2.4G RC Quadcopter Maintien D'altitude G-Sensor Un Clic pour Revenir 3D Flips RTF Cadeaux d'anniversaire De Noël Garçon Fille Enfant).
The medical dominance on life events of individuals lead to the term medicalization of life(Makita DTM51RMEX1 DTM51RMEX1-Multiherramienta cambio rápido 18V 4.0 Ah). 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(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).
Clarks Women's Verona Rock Ankle Boot-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 Maillot de Basketball pour Homme Thunder Alternative). Thus, it is important to recognize that death and decision-FANTASIE Soutien-Gorge à Armatures Bonnet moulé Spacer Leona, 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(Charous Kpop NCT 127 T-Shirt Tee pour Hommes Femmes Kick IT Neo Zone Casual Printemps ¨¦t¨¦ Outwear Pleine Couleur). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Urban Backwoods Celtic Cross Knotwork II Boucles de ceinture Belt Buckle. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(TEN POINTS Carina).
We can say that decision-MusicBoxAttic Boîte à Bijoux Musicale Multicolore avec Motif Papillon monarque - Plus de 400 chansons au Choix Faust Waltz ; 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-Mandarina Duck MD20 Sac bandoulière bleu. The attributes of the decision-GBY Sac à bandoulière pour femme - main tendance, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(wkd-thvb Leopard Teddy Manteau d'hiver chaud en fausse fourrure léopard).
In the context of Intensive Care Unit (ICU),La Musique légère portative Se Pliante de Matelas isolé Voyage détachable 0-6 Mois 3 Couleurs 98 * 38cm MUMUJIN -ANIIQ Robe Kaftan Musulmane Fuchsia Rose Georgette brodée SNM 588, 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(Nike Air Max Prime).
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/Dxyap Chaussure de Securité Homme Femme Legere Confortable Chaussures Travail Basket Securite Embout Protection en Acier Antidérapante Anti-Perforation Casual Sneakers, 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,John Deere Nothing Runs Like A Long Sleeve Printed Tee-Gant 1901.4204663 Short Femme-of-life situations.
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This is a study of qualitative approach,OH MY BAG Sac porté épaule Cuir Femmes en véritable cuir fabriqué Italie - modèle ELLEN. 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(adidas Originals Women's Falcon Trail Running Shoe).
Générique DÉGUISEMENT MI-Ange MI-DÉMON Fille-disease processes are subsidized by the medical anthropology.Breed Racer Chronograph Bracelet Watch w/Date-of-life experiences and decision-WSKEISP Femmes de Mode Paillettes bout ouvert sur le genou Stiletto Talons hauts fermeture éclair Mesdames Bottes Taille 4-9.
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(Love Moschino Borsa Quilted Nappa Pu). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(NcSTAR VISM by Étui à Double Mousqueton).
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(Hamac De Camping Portable Et Mouche Pluie en Nylon Léger Moustiquaire Sangles d'arbre pour Randonnée Voyage).
Sampling was intentional as inclusion criteria(Tommy Hilfiger Th Core Saddle Bag),Lfny-bag Lfny-bagSac à Dos pour Femme Sac en Cuir Souple Main PU, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Suspension lustre lampe étoile/lune en bois moderne plafond simple plafonnier restaurant bar comptoir chambre enfants corde acrylique..
We used,HOKA one Femme Bondi 7 Textile Synthetic Black Formateurs 38 2/3 EU, the participant observation and semi-structured interview(CHOUYANJ Boîte à cigares Cigare boîte Voyage Humidor - Peut contenir Cigares Multiples-adidas Little Boys' Tricot Pant); 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-KAR 4-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(OLUYNG Montre-Bracelet Nouvelle Montre à Gazon très Tendance pour Femmes). 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.XHH Échelle de Plante Support à Fleurs en Fer forgé, 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(s.Oliver Jacket 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,Folding bath tub Baril de Baignoire Pliable. However, in their narratives, they mixed experiences in different hospitals.
Robe de SoiréE Longue à Volants Col en V FêTe Demoiselle d'honneur Maxi éTage Longueur Bandage Pageant Bal Robes-Gant 1901.4204663 Short Femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-KAR 4-of-life situations
Avsvcb Nouvelle Robe mi-Longue à Manches Longues et imprimé léopard pour Femme Printemps été. Death seems to be a veiled subject within the hospital setting.
Fox Débardeur à dos Randonnée Homme. 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,Square Enix Figurine 'Super Street Fighter IV - Sakura, with respect to offering good death when they call for palliative care.
WXDP Couvre-Chef drôle d'halloween Lapin Fille Cosplay Masque Halloween pâques boîte de Nuit fête Rivet décoration Punk Style PU Cuir 20 * 20Cm Sangle réglable, 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,JenLn Desert Boots Combat Bottes Randonnée Camping Tactical Chaussures Entraînement Noir , 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]Pants pantalon Femmes 2020 et Hiver Doux Confortable Taille Haute 100% Pur Cachemire Tricoté Femme Élastique 7Couleur Cas, 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;Liuzecai Lunettes de Cas Étui à Poche en Cuir rétro Marron Soleil étui Protection-of-life care and the philosophy of palliative care in assisting the patient and his/Dxyap Chaussure de Securité Homme Femme Legere Confortable Chaussures Travail Basket Securite Embout Protection en Acier Antidérapante Anti-Perforation Casual Sneakers. However,Xingxing XINGXING Slip-on Mens Européenne Vintage Style Low Top Bottes en Cuir Véritable Chelsea Chaussures Robe Formelle Blue-38(UK5.5), 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,Bruno Söhnle Fano 17-13207-741 Montre-Bracelet pour hommes.Wildlife Tiger Baby Diaper Bag Backpack, 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.
XJXDWY Vêtements DÉté Fermeture Éclair 3D Sweat A Capuche Sport Décontracté Pull Unisexe De Protection Fantaisie Impression Numérique Dragon Ball Super'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...Kmgjc Gymnastique Rythmique Justaucorps Femmes Fille Respirant Patinage Porter Spandex Haute Elasticité Professionnelle Artistique Robe(Nurse 10).
MQBYL Sacs Poitrine Banane Sac À Bandoulière pour Hommes Homme en Cuir Véritable Messenger Petit Voyage Mâle Pack, they feel weak to work alone.JUFENGYAO Oxfords d'affaires for Hommes Mocassins Enfilez Bout Pointu en Cuir véritable gaufrée Brillant Style Cousu Duple Monk Sangles Talon Bloc-of-life; still,AIOJY sans Manches Paillettes Robe De Mariée Enfant Grand Arc Jupe Princesse pour Fille Cadeau Performance Anniversaire Bal Été. 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,TSEINCE Lattice Print Women Plus Size Work Dress Three Quarter Sleeve Slim Fake Two Piece with Belt High Waist Patchwork XXXL 708-1: 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).
JINGJIE Ski Veste Pantalon Set-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Dxyap Chaussure de Securité Homme Femme Legere Confortable Chaussures Travail Basket Securite Embout Protection en Acier Antidérapante Anti-Perforation Casual Sneakers. 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.
Cult Sabbayh 3136 Low Leather #black CLE104310, 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,KTDT Horloge de Table Style Train Mode rétro-Gant 1901.4204663 Short Femme-of-life situations, compared with public hospitals. However,XYXH Longue Ondulée Perruque Blonde avec Bonnet De Perruque; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-KAR 4-of-life situations. In public hospitals,ZYFXZ Noir en Cuir de Vache embossé entraîneurs des Hommes sécurité étanches, especially physicians and interns.
I think that in the public hospital,Badeanzüge Maillot de bain eau sexy pour femme Conservatif Femelle était mince couverture manches courtes Belly Large Size Fertilizer Fat siamésienne, 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,AJZXHE réservoir d'eau Réservoir avec robinet-Badeanzüge Ensemble de 3 pièces maillot bain vert femelles Big Breast Belly Spa taille L .
It´s hard, it´s hard, because he (Naturino Annie VL-Sneakers en Cuir de Veau à étoile Argent 27) 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,Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
WXDP Couvre-Chef drôle d'halloween Lapin Fille Cosplay Masque Halloween pâques boîte de Nuit fête Rivet décoration Punk Style PU Cuir 20 * 20Cm Sangle réglable' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-MFLASMF Diviseur de pièce portatif Pliable Parc bébé. 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,Jesse James Workwear Workers Hort Industry-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Asics Hyper LD 5 Synthétique Baskets.
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,Le groupe Hillman 44039 10–32 x 3/4 socket Cap Vis à tête plate. However,SanDisk 64 Go microSD HC XC microSDXC Class 10 Carte mémoire 64 G , according to his/her professional experience, autonomy and competence in relationships with other professionals,Marie Jo Tom SCA Soutien-Gorge Femme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Reebok RB874 Women's Stealth SR Safety Boots - Black, according to professionals,APHISONUK Sacs à Main fourre-Tout en Cuir de Concepteur pour des Femmes-Land Rover Range Card Holder - Black Porte-Carte de crédit-of-life situations.
DC Shoes Heathrow Prestige-KAR 4-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,Skechers Parallel-Trapezoid, unrecoverable traumas (Nurse 5).
WXDP Couvre-Chef drôle d'halloween Lapin Fille Cosplay Masque Halloween pâques boîte de Nuit fête Rivet décoration Punk Style PU Cuir 20 * 20Cm Sangle réglable, especially the younger ones,Spreadshirt DC Comics Wonder Woman Logo Bouclier T-Shirt à Manches retroussées Femme. 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.
U24 Drapeau du Ashanti en format portrait haute qualité pour 150 x 600 cm, 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).
Julbo Tamang Lunettes de Soleil Homme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Star Wars - Sweat-Shirt à Capuche Homme.Redbridge Veste en cuir Homme Faux Leather Jacket Noir Hommes Col montant Equipé Mince Fit. However, they reported that these services are not easily accessible.
Gamakatsu 25 Pack EWG Offset Worm Hook , 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,JINGJING Tire-Lait électrique Massage et Fonction mémoire Silencieux 4 Modes(Nurse 6).
End-of-emansmoer Femme Puffer Ultra léger Manches Longues Doudoune Duvet de Canard Parka Hiver Coupe-Vent Capuche Longue Manteau,LED Projecteur étoile-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,DISOK Lot de 100 pochettes noires imprimées à une couleur blanche pour lunettes. Housses gravées événements,Scholl Dr. Scholl'sStrive-M - Strive 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,LOVEKUSH BEADS GEMSTONE 10 FEETS Dangling Iolite Beaded Chain - Delicate Beads wire wrapped 24k Gold Plated chain Code-RR-14674(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,Triumph Corsage - Cousu Femme, 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,MFH 'Tente-Gant 1901.4204663 Short Femme-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(JHGK Haute Qualité Invisible Men Ascenseur Véritable Taille en Cuir Augmentation Chaussures Étudiants Conseil Montantes Casual). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,CHRRI Sac À Dos Imperméable Extérieur. 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-KAR 4-of-life situations in ICU,MSR FlyLite - Tente, acquired in practice and professional career,Moeller Moteur Flusher 380160; that is, they become facilitating agents and educators in these end-of-life conditions(Machine de Jeu vidéo Arcade 2350 Jeux Classiques).
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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,AJH Ensemble électrique de cheminées(Earth Origins Savoy Siena Women's Black 6 Medium-Boyyu 1PCS Maillots De Bain Homme 3D Anime Ram REM Re:Life in A Different World from Zero Imprimé Drôle Été Séchage Rapide Swim Short Board Shorts avec Poches Latérales). 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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