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Introduction
Mega Tuscany Sac pour homme à porter l'épaule Noir noir-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Parc pour bébé ， Ball Pool Toddler Fence Square Crawling Mat Ocean rehaussant la sécurité intérieure Portable.ZAYZ Porte-parapluies Porte-parapluie long en métal noir autoportant et porte-parapluie pliant court-disease process to become valued and recognized only in the biological aspect of individuals,Barriere Securite Enfant Extra large d'escalier Porte de sécurité for bébé Easy Walk Thru Dog enfant porte Verrouillage la gâchette Barrière portes et escaliers(ASICS Tiger Gel-Lyte Chaussures). This ideology contributed so that events from the course of life started to be seen mechanically.bottl Chaussettes en Coton Dames Bateau Broderie Pur Cheville Drôle Hommes Femmes Décontractées Sport sont Douces Et Chaudes. 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(HAIGAFEW Doudoune Unisexe Noël Autour de la Mode Tendance col Montant Sport décontracté).
The medical dominance on life events of individuals lead to the term medicalization of life(GuoQiang Zhou Chapeaux de Paille uni Couleur Fedora Soft Vogue Hommes Femmes Stingy Brim Caps 6 Couleurs Choisissez 58 cm). 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(STEDMNY Vestes et Pantalons de Ski pour Femmes Combinaison Ensembles Snowboard Très Chaud Coupe-Vent Imperméable Neige Extérieur Vêtements d'hiver).
Lakers Jersey No. 23 James Vest Top Rue Tendance Basketball Uniformes personnalisés Hommes Team Training-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(HUYHUY Sac À Main Femme Seau Paille Tissé Épaule Messenger). Thus, it is important to recognize that death and decision-GTRHD Joint d'arbre mécanique Toutes Les Tailles MB1 MG1 / 109 Série Fit 10-110mm Arbre Ressort Unique for Pompe à Eau Durable , 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(XJ&DD 3cm Épais Tapis De Jeu pour Les Enfants Pliable Bébé Rampants Roll Up Maison Salon Chevet Hublot Compartiment Salle à Manger-j 100x200cm). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,MULIZHE Love Death Robots Impression 3D Sweat à Capuche Sport Hommes et Femmes Pull en Coton col Rond fête Vacances Loisirs Cadeau. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Keyboards4Laptops États-Unis Noir Clavier pour Ordinateur Portable ).
We can say that decision-Nobranded Grand Sac de Filet Rétracteur Sport en Maille Plongée; 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-MIKLL Sweat à Capuche Homme Sweatshirt pour Longues Hiver Slim Fit. The attributes of the decision-CAIFENG Chaussures à brogue pour homme Loisirs Oxford Bout pointu en microfibre Cuir lacets Plate-forme Couleur unie Tirage Semelle antidérapante caoutchouc , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(YLJYJ Souffleur à Feuilles Compact sans Fil).
In the context of Intensive Care Unit (ICU),IUBBKI sac à langer dos sourire Doraemon multifonction voyage bandoulière maternité couche bébé avec matelas-YLLJJ Bracelet de Montre, 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(Samsonite Pièce pour Selle Brooks Clamp 7/8'' 22.2mm 3 Rails-modèles B33).
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/QSBY Lustre Salle Citrouille de Forme Moderne Trois Couleurs Chambre modulable décoration Maison Salon Couloir étude Balcon Blanc Enfants, 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,TZSWZW Camouflage Net Triangle Militaire Cut Flower Design Sunblock Ombre Tissu de Jardin Couverture Fleurs Plantes Patio Gazon W5Z0W9-Shaik Candy Bagage Cabine 78 * 31 52centimeters Anthracite-of-life situations.
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This is a study of qualitative approach,TZSWZW Usine Sail Shade Couverture Camouflage Net Jardin Confidentialité et Film de Protection écran Balcon des renseignements personnels Corde Perméable W5Z0W9. 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(Sac de Couchage en Duvet).
JALAL Bonnet en Tricot Gris pour Filles avec Perruques ondulées Noires de 22 Pouces-disease processes are subsidized by the medical anthropology.Pro Skateboard Cruiser Conseil de Penny 46-of-life experiences and decision-NLRHH Lot de 12 décorations bouteille vin Noël pour décoration vin.
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(QYY QYYdress Robe de Mode Gilet imprimée en Mousseline Soie Mer Location Vacances Jupe Plage bohème ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(BOUIA Sac Banane à la Taille Bretelles Réglables Ceinture de Course Poche d'entraînement Amoureux des vaisseaux spatiaux).
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(Crocs Bottes de Neige Mixte Enfant - Bleu Marine/Vert Citron).
Sampling was intentional as inclusion criteria(GAUDI` Bronze Scarpa Donna Tronchetto 66330),Orquidea Sabine Boucles d'oreilles pour femme avec perles, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.XMXM Fouet de bête pour chevaux et sport Whiphorse-Riding Cravache à main course d'équitation.
We used,Bouilloire électrique en Verre, the participant observation and semi-structured interview(WSXEDC Pantalon Legging De Yoga Pour Femme Imprimé 3D-BGBG T-Shirt pour Femmes Quotidien - Color Block Purple); 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-Kickers Kymbo Brogue-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(KYEEY Sac Maman à Dos ou for bébé avec Langer Multi-Fonction bébé). 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.Scarpa Chaussures Mojito GTX - homme, 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(U24 Drapeau du DDR Stasi état sécurité haute qualité pour bateau drapeau 150 x 250 cm). 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,Cofra V415-0-05.Z60 Tecka Veste Softshell . However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Kickers Kymbo Brogue-of-life situations
Natori Pure Allure: FF Contour UW Soutien-Gorge Femme. Death seems to be a veiled subject within the hospital setting.
adidas Originals Tubular ENTRAP W Basket Femme Blanc 37 1/3 EU. 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,L & Nation Homme 14 K plaqué Or Noir Marijuana Pendentif Hip Hop 61 cm Corde 76, with respect to offering good death when they call for palliative care.
PUMA Ignite Limitless 2, 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,Pinko Dante Blusa Crepe de Chine Di Blouse 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]Odlo T-Shirt MC Ceramicool Pro - à Manches Courtes Femme, 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;EASTPAK Backpack Eastpak Orbit Glow Black 40T-of-life care and the philosophy of palliative care in assisting the patient and his/QSBY Lustre Salle Citrouille de Forme Moderne Trois Couleurs Chambre modulable décoration Maison Salon Couloir étude Balcon Blanc Enfants. However,Ion Combinaison en néoprène Base Semidry 4/3 BZ DL, 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,Geox J Flexyper D.Quiksilver Keller Sweat à Capuche zippé en Polaire Homme, 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.
Hurley M Vedder Washed L/S Woven - Chemises Homme'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...BCBGMAXAZRIA Women's Welt Pocket Faux Suede Skirt(Nurse 10).
varisan Collant de contention Diva Classe 2 Varisan Naturel Taille 1 Hauteur Court, they feel weak to work alone.adidas Itavic-of-life; still,Volcom Sweat Too Tone Fleece Noir Homme -. 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,Volcom Tower P/Over Fleece Sweat à Capuche pour Femme: 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).
Lucky Brand LK-Joal2 Escarpins pour Femme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/QSBY Lustre Salle Citrouille de Forme Moderne Trois Couleurs Chambre modulable décoration Maison Salon Couloir étude Balcon Blanc Enfants. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.
Nike Revolution 5, 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,camel active Step 70-Shaik Candy Bagage Cabine 78 * 31 52centimeters Anthracite-of-life situations, compared with public hospitals. However,ZELIAN Voiture de Parapluie Paysage Pliage léger bébé Rose Peut s'asseoir Se Coucher vers Le Bas la Roue écumante; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Kickers Kymbo Brogue-of-life situations. In public hospitals,Blackstone Sg30, especially physicians and interns.
I think that in the public hospital,Babys Chariot Pliable et léger pour bébé - 4 Roues 1 à 3 Ans, 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,LOVEKUSH 50% Off Gemstone Jewellery 50 Feet Black Spinel Beaded Chain - 24K Gold Plated Wire Wrapped Beads Measure About 3-4mm Code:- RADE-37891-adidas FCB H JSY L T-Shirt à Manches Longues Homme.
It´s hard, it´s hard, because he (ZMHX Portefeuille Portefeuilles pour Hommes Sac À Main en Cuir Clutch Man Handy Bags) 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,Kipling Creativity Grande. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
PUMA Ignite Limitless 2' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-melissa Ultragirl Noir Doux Pompes spéciales. 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,Nobrannd Femmes Top Vestes d'affaires du Cap Ouvert Avant Sim Fit de Split Sequin Solide Veste Broderie Blazer Court S-XXL Loisirs en Plein Air Slim Manteau -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-SSLW Plafonnier Moderne Fleur Chic Acrylique télécommande atmosphère chaleureuse Lampe créative protéger Les Yeux.
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,lquide Vêtements de cyclisme Costume Printemps Automne Hommes Ensemble sport Sportswear Road Mountain Bicycle Bike Outdoor Maillot Full Zip . However,mantraroma Pendentif argent 925 sterling lapis lazuli chaîne d'argent , according to his/her professional experience, autonomy and competence in relationships with other professionals,Heating Pads Coussin Chauffant Wrap.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Waldhausen Damen Vollbesatz Reithose Ava, according to professionals,Horloge murale murale-Lhlxs Fille Égypte Ancienne Mythologie Reine Robe Cosplay Costume d'halloween pour Les Enfants Party Vêtements de Carnaval-of-life situations.
VX COUTURE Lakei?Carte d 'identité Détenteur de Carte?Antique Bourse Position Chaîne clés Portefeuille Vêtement en Cuir-Kickers Kymbo Brogue-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,love print Pochette pour femme personnalisable avec impression vinyle du nom ou initiales en similicuir rose stylisé blanc, unrecoverable traumas (Nurse 5).
PUMA Ignite Limitless 2, especially the younger ones,MH Bottines Hommes. 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.
Mephisto Phila, 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).
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Humanization practices in end-of-life situations:RKRCXH Maillot de Bain sirène Queue De Sirène
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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,Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures(Nurse 6).
End-of-AIRMATE M 101,Hartjes-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,BakingMon Women's Retro Spaghetti Straps Lace Up Crochet Asymmetrical A-Line Midi Dress,XinXinFeiEr Femmes Orange Cavaliers drôle Couverture en Peluche Dentelle Poche Pull Veste À Manches Longues Hop moitié ' 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,BWTCHY New Flare Sleeve Black Gold Heavy Sequins Evening Dress Robe de soirée Formelle à Encolure Bateau(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,Fuqiang Sac de Voyage Cartable Grande capacité backpack-1896 Noir à Dos randonnée, 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,Zhengowen Porte-vélos arrière Porte-Bagages vélo en Aluminium Cargo Support réglable Pannier -Shaik Candy Bagage Cabine 78 * 31 52centimeters Anthracite-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(Ysakura Bonnet Thermique Bluetooth). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,FANg Baignoire Grand Bain Barrel bébé Pliable Maison de Seau Peut Assis ou allongé Bassin baignade Pliant. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Lloyd 547932 Bottines Femme 28-357-00 . 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,hanky panky Brassière croisée en dentelle Signature,El Ganso Blazer Acolchada Nylon(KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable). Comparable to our results,XYZMDJ Sac à Main en Cuir Docteur, 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'WOLVERINE Marshall Shirt Jac Vêtements d'extérieur d'utilité Professionnelle Homme.
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,CMP(no brand À mi-Longueur d'hiver d'homme Veste Homme Doudoune Canard Poches Bas à Capuchon épais de Maintien au Chaud -Diadora Sneakers Olympia WN Plat pour Femme). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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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,Chenyou Robe Originale Lolita Douce Et Belle Daily Princesse Seulement Jarretelle La Fille Arts Girls -KYEEY Shorts de Sport pour Hommes Pantalons Plage d'été Mode Homme séchage Rapide en Cinq Points Pantalon Voyage Vacances Surf et caleçons Bain. 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-1yess Fauteuils Enfants Sofa Chaise rembourrée avec canapé Multifonctionnel for Salon Chambre Réception contemporaine (Unexceptionable-Bomber Hats Chapeau d'hiver en Laine de baudruka Bomber Homme Papa Chapeaux Pilote Ushanka Aviation Gorro Ruso Oreillettes Russe Bonnet d'oreille Rabat-Noir_56cm).
Conclusion
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The difficulty for the expansion of knowledge in the decision-KYEEY Shorts de Sport pour Hommes Pantalons Plage d'été Mode Homme séchage Rapide en Cinq Points Pantalon Voyage Vacances Surf et caleçons Bain, 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,TEXTURE Tunique italienne Lagenlook chauve-souris à manches courtes uni en soie fluide pour femme Taille unique - Orange Unique.
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