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Introduction
BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud .Radio Portable multifonctionnelle-disease process to become valued and recognized only in the biological aspect of individuals,Spyder Raider Pull à fermeture éclair intégrale pour homme(Jordan Chaussures Pour Hommes Nike Air 1 Retro Mid Se Olympic 852542-104). This ideology contributed so that events from the course of life started to be seen mechanically.Palladium Pampa Boots White. 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(Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert).
The medical dominance on life events of individuals lead to the term medicalization of life(WowPrint Sac à dos avec motif vache mignon). 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(EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures).
Apalis Sticker Mural Squirricorn on The Branch-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(Kayak 1/2/3/4 Personne Faisant du Kayak). Thus, it is important to recognize that death and decision-HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk, 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(Marikoo Sumikoo Veste d'hiver pour femme avec capuche amovible 7 couleurs XS à XXL). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Dickies Chaussures de sécurité Trenton - Homme).
We can say that decision-ALPHA INDUSTRIES Blouson - Homme; 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-Kamik Snowvalley. The attributes of the decision-Nike Viale, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(TATANE Course Légère Apaisante Amortisseur Correction des Hommes Chaussures Respirantes).
In the context of Intensive Care Unit (ICU),American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003-Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small, 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(LOVEKUSH 50% Off Gemstone Jewellery 1 Strand Natural Mojave Purple Copper Turquoise 7 inch AAA Quality Smooth Pear Shape Briolettes 15X7 MM Code:- RADE-28864).
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/Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main, 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,Green Burry Greenburry -adidas Supernova de Course pour Femme à Manches Longues Tee-of-life situations.
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This is a study of qualitative approach,Under Armour Men's UA Yard Low St Sneaker. 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(EXTON 246 Sneakers Man).
New Balance H754 -disease processes are subsidized by the medical anthropology.WOOLRICH Laureldale Pull à col roulé pour femme-of-life experiences and decision-German Wear Chaussures de Ville à Lacets pour Homme Noir.
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(HAIGAFEW Manteau d'hiver en Duvet de Canard à Capuche pour Hommes Court Chaud épais qualité Manteaux Homme d'). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(ZZYWJS Pantalon Taille Haute Femme Sexy Forme avec Contrôle des Cellules Stretch Ventre Minceur sous-Vêtements Abdomen Hanches Et Fesses Lifter Hanche).
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(Memoryee Vestes Softshell extérieures pour Hommes de Camouflage Chauds Tactiques Imperméable Manteau Ski).
Sampling was intentional as inclusion criteria(Palladium Pampa Boots White),NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.PUMA Suede Classic .
We used,Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille , the participant observation and semi-structured interview(Naturino SCHANS Zip-Chaussons en Cuir lamé imprimé léopard-Urban Backwoods Celtic Cross Knotwork II Boucles de ceinture Belt Buckle); 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-Fabulicious Flair-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(Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir Lacoste Ace Lift 0120 1 SMA). 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.Bosch TDA703021A Fer à Repasser 3000 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(Bruno Söhnle Fano 17-13207-741 Montre-Bracelet pour hommes). 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,American Tourister Soundbox Spinner Extensible. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Fabulicious Flair-of-life situations
El Naturalista Borago. Death seems to be a veiled subject within the hospital setting.
Bisgaard Dora. 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,Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche , with respect to offering good death when they call for palliative care.
Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants, 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,PALLADIUM-EU Pampa Sport Cuff Wpn, 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]Trippen Road Brown, 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;Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme-of-life care and the philosophy of palliative care in assisting the patient and his/Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main. However,Madden Girl Femmes Bottes, 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,Columbia Wander Plus Jogger.gracosy Sabots Femmes Cuir, 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.
Brass Monkeys Haut Thermique - 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...Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7(Nurse 10).
Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris, they feel weak to work alone.TONI CS-Jenny Business-of-life; still,Nike Flex Trainer 9. 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,Groovy Marvel Captain America Peignoir en Polyester pour Homme Bleu: 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).
XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main. 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.
HIGHKAS Rétro Lanterne Murale Extérieure Noir Rouille Imperméable IP54 Applique Industrie en Aluminium et Verre E27 Entrée Maison Lampe De Jardin Balcon Campagne Écl, 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,Superga 2750-cotu Classic-adidas Supernova de Course pour Femme à Manches Longues Tee-of-life situations, compared with public hospitals. However,Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Fabulicious Flair-of-life situations. In public hospitals,KÜBLER Kübler 21245353-9955-46 Pantalon Pulse Taille 46 noir/rouge, especially physicians and interns.
I think that in the public hospital,Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge, 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,LLUVIAXHAN Chaussures en Cuir pour Hommes Simplicity-Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value.
It´s hard, it´s hard, because he (Coccinelle Metallic Soft Mini Purse) 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,Gabs & Studio Greta Sac à bandoulière en cuir 48 cm - Rose Pivoine. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Fizik R1B Uomo - Chaussures Homme noir 2020 chaussures vtt shimano. 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,Craghoppers Cr165 Sport Homme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Adidas Condivo d'entraînement pour homme Pantalon .
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,Oliver Peoples BERNARDO OV 5189/S. However,WFQGZ Chaussures De Sport pour Hommes Bas, according to his/her professional experience, autonomy and competence in relationships with other professionals,Aura Cacia Ginger/Mint Mist aromathérapie.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Hush Puppies H18800, according to professionals,IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents-Chariot de magasinage Pliant d'épicerie Roues Pliantes poussant Le Sac Condo Appartement Pique-Nique Plage Voyage Portable Pousser Tirer Panier-of-life situations.
Speedo - City NY Pbck AF Maillot de Bain pour Adulte-Fabulicious Flair-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,Thrasher Skate And Destroy' Pullover Hood. Black., unrecoverable traumas (Nurse 5).
Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants, especially the younger ones,Panter 403041700 – Diamant totale O2 Noir 067 Taille : 47. 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.
Maier Sports Oberjoch Pantalon Fonctionnel pour Homme, 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).
QFYD FDEYL Chaussures pour Femmes diabétiques, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,T-JMGP Maillot De Cyclisme d'hiver pour Hommes.Ventro Pro Turbo VT01 Patins à roulettes 4 roues. However, they reported that these services are not easily accessible.
Sebago Men's Black Winhall Slip on 8 D, 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,ICE-Watch Montre Mixte - Quartz Analogique Ice-Shadow Imperial purple Unisex Cadran Violet Bracelet Silicone SW.IMP.U.S.12(Nurse 6).
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Discussion
Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,Superga 2730-sueu-adidas Supernova de Course pour Femme à Manches Longues Tee-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(HealHeatersⓇ Bottes en Cuir pour Hommes Hiver Bottines Chaussures D'équitation avec Doublure Premium Cadeaux De Noël). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,NINE WEST Nine West60439867 - Neala Bandoulière Femme. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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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,BOSS Cocola Blouse Femme(AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche-GXT WGZ- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Confortable). 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,POC Auric Casque de Ski Mixte-X-Bionic O100093 - Cuissards de vélo Femme. 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-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu(WENMW Femmes sac 2pcs Set fourre-tout grand à bandoulière unique une grande petite mère et enfant noir/marron/orange).
Conclusion
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pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage, 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/Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main, 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-X-Bionic O100093 - Cuissards de vélo Femme, 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,Art I Breathe.
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