Introduction
Adidas Condivo d'entraînement pour homme Pantalon -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Oliver Peoples BERNARDO OV 5189/S.WFQGZ Chaussures De Sport pour Hommes Bas-disease process to become valued and recognized only in the biological aspect of individuals,Aura Cacia Ginger/Mint Mist aromathérapie(LILILICX Noeud Papillon Polyester De Couleur Pure Multi-Hommes Mariage Homme). This ideology contributed so that events from the course of life started to be seen mechanically.Hush Puppies H18800. 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(Ralph Lauren Pull - Homme).
The medical dominance on life events of individuals lead to the term medicalization of life(LUKUCEA EV Adaptateur pour Transforme Votre Chargeur de Type 2 en Prise 16A La Petite Taille est Facile à Utiliser et Transporter). 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(SALOMON Shoes Ultra/Pro Hawaiian).
IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents-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(Urban Backwoods Carpenter I Femme Zip Hoodie Sweat à Capuche). Thus, it is important to recognize that death and decision-Chariot de magasinage Pliant d'épicerie Roues Pliantes poussant Le Sac Condo Appartement Pique-Nique Plage Voyage Portable Pousser Tirer Panier, 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(Pepe Jeans Pantalon Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Speedo - City NY Pbck AF Maillot de Bain pour Adulte. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Jeffery West K106).
We can say that decision-Thrasher Skate And Destroy' Pullover Hood. Black.; 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-Panter 403041700 – Diamant totale O2 Noir 067 Taille : 47. The attributes of the decision-Maier Sports Oberjoch Pantalon Fonctionnel pour Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(COOLMP Lot de 6 - Mules Princesse Sofia Fille Taille Unique Accessoires fête).
In the context of Intensive Care Unit (ICU),QFYD FDEYL Chaussures pour Femmes diabétiques-T-JMGP Maillot De Cyclisme d'hiver pour Hommes, 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(LED night light).
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/Ventro Pro Turbo VT01 Patins à roulettes 4 roues, 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,Sebago Men's Black Winhall Slip on 8 D-Madden Girl Femmes Bottes-of-life situations.
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This is a study of qualitative approach,RYKA Dévotion pour femme. 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(Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures).
YKJ Anime Cosplay Chaussures Femme Masquerade Bottes en Cuir Blanc Version Bas Personnalisée Heeled-disease processes are subsidized by the medical anthropology.Divers NOW chaussures de sécurité eN 20345 s1P hRO-of-life experiences and decision-TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu.
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(Showers Pass Short de ski léger respirant à séchage rapide pour homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Teeburon Keep Calm and Love Brent Capuche).
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(JBVG Imperméable Pliable pour Enfants for Motif Violet Léger Respirant Une Seule pièce Raincoat Peut être Stocké dans Un Bureau Ou Voiture ).
Sampling was intentional as inclusion criteria(CAPRICE Femme Bottines 26365-23),no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Flyye épaule Étui System Panel MOLLE Ranger Vert.
We used,ICE-Watch Montre Mixte - Quartz Analogique Ice-Shadow Imperial purple Unisex Cadran Violet Bracelet Silicone SW.IMP.U.S.12, the participant observation and semi-structured interview(CAOXN Presbytes Lecture Loupes Lumière Ultra Haute Définition sans Cadre Lentilles De Résine Parés Mode Lunettes Optiques-MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20); 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-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-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(Garde-Corps De Lit d'enfant). 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.Hammer Folding Panier, 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(Clarks Bottines pour Femme Noir). 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,SFOXL Homme Chaussures de Sécurité. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life situations
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Supra Breaker. 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,Ali's Fightgear protège-Tibias Arts Martiaux Noir Taille S, with respect to offering good death when they call for palliative care.
LWQ Moulin Portable, 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,Sergio Tacchini Jogging Bleu Marine Original 37862, 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]ANSUINY Montres pour Hommes, 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;YUXB Sac à dos Gush Water Fontaine pour femme Imperméable Casual Sacs jeunes filles-of-life care and the philosophy of palliative care in assisting the patient and his/Ventro Pro Turbo VT01 Patins à roulettes 4 roues. However,Superga 2730-sueu, 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,NINE WEST Nine West60439867 - Neala Bandoulière Femme.LAURA VITA Vicvianeo, 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.
Tory Burch Cabas pour femme rose Dark Sahara '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...Smartwool Kids' Merino 250 Baselayer Pattern Bottom(Nurse 10).
YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme, they feel weak to work alone.Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond-of-life; still,FEZD Jersey Basketball Masculin -NBA Detroit Pistons 11# Rodman Jersey. 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,ACCO 16024 - Pressboard 25-Pt. Classification Folders: 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).
NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Ventro Pro Turbo VT01 Patins à roulettes 4 roues. 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.
Betts Buddy Cast Net, 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,lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit-Madden Girl Femmes Bottes-of-life situations, compared with public hospitals. However,Katana Cartable 2 Soufflets en Cuir; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life situations. In public hospitals,Nike 828407-602, especially physicians and interns.
I think that in the public hospital,HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver , 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,adidas Senseboost Go M-5.11 Packable Jacket Homme.
It´s hard, it´s hard, because he (Festina Horloge F20439/1) 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,Lego Wear Lwjoshua Blouson Bébé garçon. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
LWQ Moulin Portable' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-BOSS Cocola Blouse Femme. 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,Jubilee HP100MS Lot de 100 Colliers Serrage-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Guess Shawna Pebble Petit sacoche Cali.
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,SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc. However,Puma X Hello Kitty T-shirt pour femme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume, according to professionals,DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport-Weems & Plath Marine Navigation à 3 Branches Rapporteur-of-life situations.
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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,Converse Jack Purcell, unrecoverable traumas (Nurse 5).
LWQ Moulin Portable, especially the younger ones,Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6. 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.
Skechers Street Downtown-Fashion Kourts Baskets pour femme, 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).
Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix.Reebok Sofia Freestyle INF Chaussure classique . However, they reported that these services are not easily accessible.
POC Auric Casque de Ski Mixte, 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:Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris
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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,pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Columbia Sandy River II Short imprimé à séchage rapide pour femme(Nurse 5).
In care and in decision-Asics Dynablast-of-life,Under Armour T-Shirt pour Homme Route Voilés.ZAIPP Enfant Tapis Jouer Tapis, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.No Name Arcade Straps Suede Nara Femme, knowing that all the best care was provided to the patient.Geox B New Gulp ABX C.
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,marvel Comics Homme W000532 Spider-Man Vintage Montre, 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,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes-Madden Girl Femmes Bottes-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(HYLH Sacs à Dos pour Ordinateur Portable étudiant Grande capacité Anti-vol Sac de Planche roulettes Adolescents). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes. 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-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life situations in ICU,QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements, acquired in practice and professional career,Nine West Womens Printed Formal Dress Pants Blue 14; that is, they become facilitating agents and educators in these end-of-life conditions(HOSD Survêtement Hommes 2020 Hip Hop À Manches Longues De Couleur Unie Capuche Sweat Mens Coat Casual Sportswear).
Although,Baggallini Sac à main pour femme, but indirectly, in end-of-life situations,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien-of-life process.CMP Manteau Feel Warm Flat/her; accordingly,SaySure Charms Beads fit Original bracelet Silver Plated-DC Shoes Men's E.tribeka Zip Skate Shoe(adidas Ultraboost DNA Chaussure de course pour homme).
However,Chorchester Robe à capuche pour cobra serpent multiangle Polygon. 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,Xhtoe Jupe Femme,Kamik Stark Veste d'hiver Enfant(Emporio Armani Stretch Long Sleeve T-Shirt). Comparable to our results,Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock, 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'Clarks Bottines pour Femme Noir.
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,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.(Larissr T-Shirt Hommes Vêtements D'été Crâne Imprimer À Manches Courtes 3D Casual Respirant Drôle T-Shirts XXL Txu-1075-Rideaux d'ombrage avec fenêtre et fleurs de style méditerranéen - Panneau simple 160 x 183 cm Marron). 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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Gabor Bottes Chelsea pour femme Semelle amovible-Centered Care (IPFCC) provides directions to advance in understanding,Deerhunter Strike Gilet Motif Feuille. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(RZHSS Sweats à Capuche).
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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,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier-Nike Flex Trainer 9. 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-Shirt sidez Elvis Presley Mug Shot Mens Hoodie(Skechers Madison Ave - My Town).
Conclusion
The decision-Madden Girl Femmes Bottes-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.BOSS Hugo Hybrid_Runn_knmx, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-of-SALOMON XA Pro 3D V8 GTX W.
Kyman Sac Cadre vélo, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-DC Shoes Men's E.tribeka Zip Skate Shoe. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Alpine Advance Keela Pantalon Imperméable Homme-Nike Flex Trainer 9.
Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016, 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/Ventro Pro Turbo VT01 Patins à roulettes 4 roues, 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-Nike Flex Trainer 9, 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,yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes .