Introduction
LSX - Fauteuil Roulant Cadre en Titane for Pliable Léger et Facile à Transporter Voyage de Personnes âgées la lumière du Livre -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,LSX - Fauteuil Roulant Roulant.Merrell Jungle MOC-disease process to become valued and recognized only in the biological aspect of individuals,PAPI Étanche DSLR Appareil Photo Sacs À Dos Ordinateur Portable Sac avec Couverture Pluie Grand Professionnel Convient 32 * 17 46cm(Bouilloires Pratiques - Théière Blanche sans Fil en céramique électrique Cruche rétro de 1). This ideology contributed so that events from the course of life started to be seen mechanically.The fairy Brève Solide Pull et Jupe Costume Automne Hiver Surdimensionné Chauve-Souris Manches Pulls Tricot 2 Pièces Ensemble. 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(TYOLOMZ 25L Sac à Dos en Plein air de Camping Randonnée Voyage Chasse).
The medical dominance on life events of individuals lead to the term medicalization of life(Odlo Jacket Zeroweight Homme). 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(ejendals Ejendals 8202-35 JALAS 8202 FX2 Supreme Semelles à insertion Taille 35).
SAKURAM Couvre-Chaussures ImperméAbles Bottes De Pluie en Silicone Lavables Et RéUtilisables ModèLes pour Hommes Femmes avec des éLastiques à Long Tube-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(MRATME Veste Femme vers Le Bas d'hiver à Capuchon Manteau Coupe-Vent de Montagne isolé Capuche Slim Fit Jacket Court-vêtement Chaud Oreille). Thus, it is important to recognize that death and decision-Clicked Figure d'action Accessoires Costume De Mariage Fleurs Sexy pour Poupées Figurines Femme 1/6, 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(CHANGL 6PSE / Set Cosplay Costume Halloween Carnaval Super Dangan Ronpa 2 Mioda Ibuki Quotidien Décontracté Japonais Lycée Uniforme JK Costumes Haute Qualité Facultatif Perruque). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,DONDUP Pantalon Jambe Droite Quadro. P586A432-XXX913 TG. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(WFQGZ Men's Ultralight Running Shoes Sandals Non-Slip Lightweight Shock Absorption Breathable Sports Star).
We can say that decision-SPEED Dresden RK-1 Racewear Protection sur Le Haut du Corps; 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-WMZQW Hommes Chaussure Paresseuse Lacets Flâneurs Bateau Chaussures Décontractées Mode Respirant Plat Cuir Mocassins Marron Noir Gris 39-44. The attributes of the decision-SPIRITSHIRTSHOP Berlin Beat Box Bar – Beatbox, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(QLCY-78OI Mode Le mode 14 pouces Brief Hommes Messenger Bag multifonction portable multi-fonctionnelle Casual).
In the context of Intensive Care Unit (ICU),REFRESH Bottine Plate avec Fermeture Éclair pour Femme-HAIGAFEW Manteau d'hiver en Duvet de Canard à Capuche pour Hommes Court Chaud épais qualité Manteaux Homme d', 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(Feidaeu Chaussures habillées pour Hommes de Mariage à Lacets Faites la Main en Cuir et).
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/Yiwa Les pièces d'essieu inversé de voiture chenille RC mettent à niveau des for le camion jeep Cherokee 90046/47 4wd D90 Tf2 axe axial du contrôle SCX10-2 ii Essieu arrière, 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,YZT QUEEN Bottes Cuissardes Femmes-Ancien Notre Dame De Paris Grande Capacité Sacs À Couche Maman Sac Dos Multi Fonctions Nappy Allaitement Fourre Tout Main Pour Enfants Baby Care Voyage Daily Women-of-life situations.
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This is a study of qualitative approach,Andrea Conti Chaussures basses en cuir à lacets 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(Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge).
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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(Infinity Chemise en Cuir Daim Décontractée 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(Desigual Hindi Dancer Stud - Leggings Danseur Hindi. Femme).
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(Hush Puppies Men's Advice Pt Derby Oxford).
Sampling was intentional as inclusion criteria(Filet de protection Sécurité Maille De for Enfants),Toygogo Lanière De Harnais Ceinture Sécurité Taille Simple Protection, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.XYZMDJ Sac à Main épaule Slung Polyvalent bandoulière.
We used,HUYUQU Femmes Fermé Toe Talons Hauts Salsa Latin Tango Chaussures De Danse Salon Escarpins Femme, the participant observation and semi-structured interview(ARA Rom-ZHMIAO Maillot de Football américain pour Homme 4# Carr); 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-Lacoste Veste Homme-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(WEHOLY Sonnette Avant Cloche Style Industriel Européen Rétro Jardin Nostalgique en Fonte Manuelle Fer Forgé Clochettes À Main Maison Suspendue Décoration Murale). 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.HAIGAFEW Impression Simple de Motifs Autour des Manteaux d'hiver pour Hommes et Femmes Doudounes Vestes légères, 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(Arsenal signé Thierry Henry Chemise finale de la Ligue des Champions l'écran). 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,O'NEILL Bar-à-Plage Shorts Hybrides Chino pour Hommes. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Lacoste Veste Homme-of-life situations
La Strada 1902387 – Chaussures de loisirs pour femme 4590 Couleur froissée. Death seems to be a veiled subject within the hospital setting.
LetsBuyGold Bague Artisanale . 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,Tête de coupe pneumatique, with respect to offering good death when they call for palliative care.
Reebok TS Layering Pant - Pantalon Homme, 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,1200Mbps USB WiFi Adapter, 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]DAGEGIRL Top Hommes Femmes Lady Montre en Acier Inoxydable Japonais Quartz Saphir Argent Noir Blanc Diamants Montres AAA, 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;DAGEGIRL De Acier Inoxydable Saphir Montres Étanches Hommes Automatique Mécanique Diamants Argent Or Noir Blanc Datejust-of-life care and the philosophy of palliative care in assisting the patient and his/Yiwa Les pièces d'essieu inversé de voiture chenille RC mettent à niveau des for le camion jeep Cherokee 90046/47 4wd D90 Tf2 axe axial du contrôle SCX10-2 ii Essieu arrière. However,ZHLZH Balance de précision Laboratoire, 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,Saucony Originals Scarpe Femme Jazz Original Vintage Homme Noir 4955 39.SageBrown Small Zip Around Accordion Coin Purse, 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.
4 pièces rétractable Bar Leveling avec 50 mm Castors - Poignée filetée for charnières et Meubles Lourds M12 Poids 750 kg'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...LIEOAGB Sac à dos en cuir PU pour femmes Vintage Shopping Bag Portable Rucksack Casual Travel Satchel For Ladies(Nurse 10).
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Nowadays, when we do not have the support of palliative care,BaoYPP Martèlement Jouets martelant martèlement Xylophone bébé éducation Set Dinosaur Caterpillar Crocodile Shape Sorter Tap & hammergame pour Les Enfants : 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).
Jumelles # 6 x 36 - Jouet pour enfant Mini jumelles portables Télescope HD étanche en plein air-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Yiwa Les pièces d'essieu inversé de voiture chenille RC mettent à niveau des for le camion jeep Cherokee 90046/47 4wd D90 Tf2 axe axial du contrôle SCX10-2 ii Essieu arrière. 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.
DZWYM Chaussure De Securité Homme Légères, 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,adidas JB A AAC Ft Pt Pantalon Fille-Ancien Notre Dame De Paris Grande Capacité Sacs À Couche Maman Sac Dos Multi Fonctions Nappy Allaitement Fourre Tout Main Pour Enfants Baby Care Voyage Daily Women-of-life situations, compared with public hospitals. However,Hoonmis Robe de soirée Enfant; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Lacoste Veste Homme-of-life situations. In public hospitals,Une Paire de Remise en Forme Haltères Main d'exercice Dumb Bells Set Poids Poignet récupération Maternelle Levage Hommes Femmes Enfants Accueil Frosted Dumbell Équipement Sport, especially physicians and interns.
I think that in the public hospital,Crystallly Position Européenne De Plancher D'Acier Inoxydable Cryptage Moustiquaire Simple Style Avec Le Roi C D'Auvent Toit Plat , 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,PUMA Style Rider Ride on-LEOO Sac à Main Femme tissé Femmes de Grande capacité fourre-Tout Bohemian Voyage Bois Bague Sacs bandoulière Idéal for Voyage/Shopping/Pique-Nique/Camping/extérieur.
It´s hard, it´s hard, because he (Find Nice Trouvez Belle Dames Mode Strass Robe de Mariée Confort Soirée OL Slingback Fête Plat Tongs Sandales) 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,Moulinets de pêche. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Reebok TS Layering Pant - Pantalon Homme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Porte-Serviettes Chauffant Intelligent. 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,Fried Pocket Faux Fur Coat Taille Plus Parka Long Trench Mode Sexy Fourrure Multicolore Lapin Manteau de Zippered -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-GRMO Mens Wool Long Jacket Casual Solid Lapel Topcoat.
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,LAA Queues de Sirène Filles Queue De Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles . However,IUBBKI sac à main rouge et blanc vagues en cuir véritable fourre-tout rivets bandoulière poignée supérieure femmes, according to his/her professional experience, autonomy and competence in relationships with other professionals,LGLE Pyjama en satin à manches longues pour homme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Gants de boxe pour Muay Thai De haute qualité MMA Training professionnelle for les hommes femmes sac lourd en cuir infusé Gel Sparring Kickboxing Fighting Mit, according to professionals,LILONGXI Tapis-SYue Miroir de Maquillage Mural-of-life situations.
Pneus De Scooter Électrique-Lacoste Veste Homme-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,Aden Anais Sac de Couchage Mousseline 100% Coton, unrecoverable traumas (Nurse 5).
Reebok TS Layering Pant - Pantalon Homme, especially the younger ones,Mandarina Duck Hera 3.0 Portafoglio. 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.
Vince Camuto Raner, 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).
Demonia GRIP-103 Blk Faux Leather UK 3 , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,W&XY Escarpins d'hiver pour l'alpinisme .Nike Quest 3. However, they reported that these services are not easily accessible.
ZOMAKE Sac à Dos Petit 25L, 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:Urban Classics Camo Sherpa Pull Over Jacket Blouson Homme
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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,adidas Pro Adversary Low 2020(Nurse 6).
End-of-Under Armour Charged Toccoa 2 Chaussure de course pour homme,MONTBLANC MONT BLANC MB656S-52N-48 Montures de Lunettes-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,RYKA Niah,Beginnings Sterling Silver lapis Grand anneau ovale' 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,adidas Ultraboost DNA Chaussure de course pour homme(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,FONXOS Ensembles De Lingerie Vêtements Nuit pour Femme Sexy Ensemble Bretelles Floral Dentelle Voir À Travers Babydoll Chemises Tentation Nuisettes Erotic Nightdress, 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,arena Sarah Sjostrom Édition limitée pour Fille Accelerate Back-Ancien Notre Dame De Paris Grande Capacité Sacs À Couche Maman Sac Dos Multi Fonctions Nappy Allaitement Fourre Tout Main Pour Enfants Baby Care Voyage Daily Women-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(ZYFXZ Noir en Cuir de Vache embossé entraîneurs des Hommes sécurité étanches). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,CAPRICE Femme Bottines 26365-23. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;The North Face Zipline Vestes imperméable Fille, and the only one who has the power of decision(Top Swords Legend of Zelda hylian Hyrule Twilight Master Princesse Lien épée en mousse). Thus, care practices in end-of-IKKS Jupe Nœud Tulle Noir Fille, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(LXZSP Brûleur d'encens de contrôle la température synchronisation).
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,Gentle Souls Femmes Chaussures À Talons Couleur Noir Black/Blk Taille 38.5 EU /-25L Daysack - Sac à dos résistant l'eau. 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-Snickers 62150404256 RuffWork Pantalon de travail Taille 256 Noir(Patrizia Pepe Sac À Main - 2V6581/A2X0-F1AF One Size).
Conclusion
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PUMA Sneaker Smash WNS Perf Métallique pour femme, 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-MZXU Homme Pantalon de Loisir Mens Ethnique Style imprimé Taille élastique avec Cordon Serrage en Vrac Coton Sarouel Casual Doux . 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,Calden T5102-4 Pouces Taller - Chaussures Elevator Hautes Casaul Lacets Gris-25L Daysack - Sac à dos résistant l'eau.
MIORE Boucles d'oreilles - Or jaune 14 cts Perle d'eau douce MA4001E, 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/Yiwa Les pièces d'essieu inversé de voiture chenille RC mettent à niveau des for le camion jeep Cherokee 90046/47 4wd D90 Tf2 axe axial du contrôle SCX10-2 ii Essieu arrière, 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-25L Daysack - Sac à dos résistant l'eau, 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,puseky Barboteuse - 0 à 24 mois Pour bébé .