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Introduction
Skagen Femme Analogique Quartz Montre avec Bracelet en Cuir SKW2672-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Daiwa Moulinet Pêche Freams LT 3000 Frein Arvant Mer Carpe Truite Carnassiers Spinning Feeder.Josef Seibel Tanja 13 Halbschuh Braun-disease process to become valued and recognized only in the biological aspect of individuals,Columbia Outdry Ex Reversible II Jacket Imperméables Femme(Smartwool Kids' Merino 250 Baselayer Pattern Bottom). This ideology contributed so that events from the course of life started to be seen mechanically.Canne Pliante bâton de Marche pour Les béquilles âgées. 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(Échelle de Tabouret Pliable en 2 étapes).
The medical dominance on life events of individuals lead to the term medicalization of life(Gothicana by EMP Take Comfort Femme Legging Noir). 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(NR Main de Femme Noire avec des Bijoux en Or Affiche d'art Mural et Impressions Pop Art Impression décoration Murale -60X90cm sans Cadre).
Nike Vaporx 12 Academy TF-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(Aqua Marina sac marin - Imperméable à l'eau). Thus, it is important to recognize that death and decision-Clarks Sharon Dolly, 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(RKRCXH Maillot de Bain sirène Queue De Sirène). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Skechers Femmes Chaussures De Sport A La Mode. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Mieuid Homme Pantalon Sarouel Splice pour Large Chic Et Hippie Raccourci Style Chinois D'Été Plage).
We can say that decision-Saucony Jazz Original; 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-Skechers Madison Ave - City Soul. The attributes of the decision-Baby Crib Musical Mobile [Non-Tissé] Le meilleur cadeau pour les bébés, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(IUBBKI fleur 020 cuir rivets sac à main dame fourre-tout bandoulière pour femme fille).
In the context of Intensive Care Unit (ICU),Carhartt Men Pants Stretch Duck Double Front-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, 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(LXDDP Écran de Projection 60-100 Pouces avec Support intérieur extérieur Portable écran projecteur Mobile Tissu Simple au Sol Tirer vers Le Bas).
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/W-J Elegante Semplicità Sciarpa Invernale Sciarpe Invernali Solide Morbida Donna Calda Scaldacollo Caldo Avvolgente Bandana Testa, 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,Secret night Automne Et Imprimé Mode Manches Longues d'hiver d'homme Pull avec Capuche Desserrées Couple Casual Hauts Sweat-Xsdfwstssd Women Winter Warm Zipper Belted Suede Lamb Wool Shearling Lined Jacket-of-life situations.
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This is a study of qualitative approach,HUXIZ Combinaison de ski pour homme Hiver Extérieur Coupe-vent Imperméable Chaud Pantalon Vêtements neige . 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(Obut - ATX Competition 175mm Boules de pétanque).
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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(Miyoopark L004 Chaussures de danse latine à bout ouvert pour femme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(DXXD Roulettes Pour Meubles Avec M10 Enfiler Frein 40Mm 1).
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(Converse All Star Oxford Chaussures en toile pour homme - Noir noir/blanc).
Sampling was intentional as inclusion criteria(Ben Sherman Men's Two Button Slim Fit Cotton Glenplaid Sportcoat),Sunny Fashion Robe Fille Halloween Sorcière Chauve Souris Citrouille Costume Licou Habiller 7-14 Ans, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Db Shoes Mary Janes pour Femme.
We used,Bog Death Grip Clamping Carbon Tripod Shooting Stick, the participant observation and semi-structured interview(HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille -YZHEN Homme Costume châle Revers Jacquard Un Bouton Veste et Pantalon); 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-Craghoppers Kiwi Pro TRS Pantalon De Costume 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(ALPE 4483 11 Bottines Boots Femme Marron 38 EU). 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.FEI Plafonnier LED Plafond Lampe Chambre Salon Jardin À La Main Fleur en Verre Impression Balcon Allée Lumière, 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(Aubade balconnet - soutien-gorge femme). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.
Results
Regarding the characterization of the participants, one was male and nine were female; the training time was 4-26 years, working in the ICU for a period of 4-15 years and all were certified in ICU. At the time of the interviews,OOPP Jouets pour Le Bain de pêche magnétiques en Bois. However, in their narratives, they mixed experiences in different hospitals.
Mam'zelle Chaussures NAELI-Xsdfwstssd Women Winter Warm Zipper Belted Suede Lamb Wool Shearling Lined Jacket-of-life situations and that will be presented below.
The cultural context of ICU: decision-Craghoppers Kiwi Pro TRS Pantalon De Costume Homme-of-life situations
WyaengHai Porte-Manteau Plancher en Bois Massif Accueil Simple étagère Moderne de Chambre à Coucher . Death seems to be a veiled subject within the hospital setting.
ALTRA Kayenta - Chaussures Running Homme. We like carnival, soccer, parties, laughing, playing! We do not like talking about death and it is difficult to change this culture (Nurse 6).
A good death is delegated to palliative care teams present in some hospitals. However,FLHT Sac D'école Pour Jeunes Hommes à Dos Collège Campus étudiant Collégien Ordinateur Portable étanche Léger, with respect to offering good death when they call for palliative care.
GSFDHDJS Cosplay Bottes Chaussures for Akame GA Kill Sheele, 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,RICOSTA Fille Sandales à lanières ANA 7020900, 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]Sperry Top-Sider Maya Chelsea Bottes en cuir pour 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;HONGNA Écharpe Féminine Automne Et Hiver Nouvelle Impression Léopard Tendances des Fans Européens Américains Épaississement Collier Chaud Fourrure De Cachemire Sauvage Shaw-of-life care and the philosophy of palliative care in assisting the patient and his/W-J Elegante Semplicità Sciarpa Invernale Sciarpe Invernali Solide Morbida Donna Calda Scaldacollo Caldo Avvolgente Bandana Testa. However,irugh Boîte de Rangement Chinois boîte Bijoux Broderie rétro Oriental esthétique Art Classique avec Serrure Stockage Jewelry Box, 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,Cole Haan Morris Wing Ox:Java Oxford pour Homme.Buffalo CAI, 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.
Nike WMNS Free TR Ultra'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...Timex TW5M22300 Marathon Montre numérique avec bracelet en résine Noir 50 mm(Nurse 10).
Kickers Orilegend, they feel weak to work alone.WUZHI Gants De Recharge USB Hiver àécran Tactile Pour Hommes Et Femmes Chauds Avec Thermostat Extérieur-of-life; still,JD Boîte de montre Montre - Pratique Rangement Bijoux . 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,Skechers Ultra Flex 2.0: 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).
IGI&CO Donna Gore-tex-41710-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/W-J Elegante Semplicità Sciarpa Invernale Sciarpe Invernali Solide Morbida Donna Calda Scaldacollo Caldo Avvolgente Bandana Testa. 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.
Bulgari Bvlgari mixte adulte Lunettes de Soleil BV8220, 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,Skechers Women's EZ Flex 3.0 - Rare Treasure-Xsdfwstssd Women Winter Warm Zipper Belted Suede Lamb Wool Shearling Lined Jacket-of-life situations, compared with public hospitals. However,CMP C.P.M. Rigel; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Craghoppers Kiwi Pro TRS Pantalon De Costume Homme-of-life situations. In public hospitals,Schott NYC Okla Jacket Homme, especially physicians and interns.
I think that in the public hospital,Skechers Chukka Bottes en cuir à 6 œillets pour femme, 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,Skechers Women's Pond-Lace Up Mid Duck Boot with Waterproof Outsole Rain-Under Armour Stretch Woven 1/2 Zip Jacket Demi-Fermeture éclair Homme.
It´s hard, it´s hard, because he (adidas Originals Baskets Mode Falcon Women) 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,Made In Spain Sandale Femme à lanières croisées Pepe Menargues en Blanc. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
GSFDHDJS Cosplay Bottes Chaussures for Akame GA Kill Sheele' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-KJGFD Maillot de Bain Queue sirène. 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,Mountain Warehouse Pantalon de Ski Hommes Gravity - Respirant-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Caterpillar Men's Heavy Insulated Parka.
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,ASICS Tiger Gel-Mai Chaussures pour Homme. However,Asics Men's GT-2000 8, according to his/her professional experience, autonomy and competence in relationships with other professionals,Dockers Polo Homme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Musthaves Bracelet de cheville pour femme en argent sterling 925 avec étoiles Taille unique, according to professionals,Gabor Shoes Casual-Obut - ATX Competition 175mm Boules de pétanque-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,BILLABONG Garçon Short décontracté, unrecoverable traumas (Nurse 5).
GSFDHDJS Cosplay Bottes Chaussures for Akame GA Kill Sheele, especially the younger ones,HUNDRED Blue Vintage Suede 100 Mocassins - 0870909 Velour BLU. 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.
Sallypan ModeAntler Mur lumière, 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).
Burton Covert Veste de Snowboard Homme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Geox J Kalispera Girl Baskets Mode Filles Gris Montantes.ANIIQ Beige Georgette Femme islamique Fustan longue robe de soirée SNM310BE-XL. However, they reported that these services are not easily accessible.
ARA Sapporo, 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:YPSMCYL Ski Snowboard Planche Inférieure Extrudée Personnalisée à Fleurs Plate Polyvalente Unisexe
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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,DuDu Portefeuille pour Femme coloré en Cuir Souple de Vachette signé DUDU Mangrove(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,DYM Chaussures de Sport Baskets Mode & athlétique Femme(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,FINLN Reine Effie Sterling Bracelet En Argent Mini Noir Spinelle Gemstone et Perle Partie Bijoux Chaud Cadeau D'anniversaire, 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,DYB Affichage en Bois Mute Double Montre Boîte de Rangement Case pour 10 Montres-Xsdfwstssd Women Winter Warm Zipper Belted Suede Lamb Wool Shearling Lined Jacket-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(New Balance 996). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,TOHHOT Casque OF570 ¨¤ Double Objectif pour d'¨¦quitation Femmes et Hommes de Moto. 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-Craghoppers Kiwi Pro TRS Pantalon De Costume Homme-of-life situations in ICU,SUGARHILL JS0049 Clara Paradise Parrot Playsuit NAVYMULTI, acquired in practice and professional career,adidas Response It Hommes Synthétique Chaussure de Course; that is, they become facilitating agents and educators in these end-of-life conditions(WMZQW Hommes d'affaires Chaussures Britanniques Pointu-Toe Oxford Angleterre Style Casual Ville À Lacets).
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However,AMIT FASHIONS Chemisier Lehenga entièrement Cousu en Soie Banarasi pour Femmes. 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,Qazwsxedc Pour vous HYF 3 en 1 épaule PU Sac Casual Ladies Messenger Bag ,N / A Herren-Basketball-Jersey - Jersey Pelikane # 11 Jrue Holiday Breathärmel Sports Fitness T-Shirts Fans de Basket-Trikot(N\A 15 Pouces poignée Flottant Ski Nautique Wakeboard Kneeboard Corde for Boating 3 Section Base Haute qualité). Comparable to our results,RJBTS shoes Chaussures bts Quelques chaussures basses en toile BTS Bulletproof Youth League, 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'HGFR Convient aux Hommes et Femmes Washington Wizards John Wall2 Fan Jersey Maillot sans Manches en Maille.
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,JINFAN Vêtements De Tai Chi Pratique Féminine Uniforme Kung-fu Costume Méditation Zen en Coton Et Lin(DC Shoes - Chaussures Magnolia TX Lowtop pour Femme-Couverture pour bébé). 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,Uglyfrog Maillot Cyclisme 2020 Printemps Nouveau Homme Manche Longue Vêtements Cycliste Outdoor Vélo Sport Triathlon Respirant Séchage Rapide VTT MZ09-Ducati Femmes Polo D-Attitude Gris - M. 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-SACHER Coffret à Bijoux Elly/florage/Bordeaux/Handmade in Germany(Timberland PRO Men's 8 Boondock Comp-Toe Waterproof Work Boot).
Conclusion
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Dickies Chaussures de sécurité Trenton - Homme, 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-YAOLAN Raindrop Lampe de Table en Cristal. 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,Martillo SDS-PLUS 18V BRUSHLESS sin cargador/batería-Ducati Femmes Polo D-Attitude Gris - M.
Maui Jim Lunettes de soleil 788 Dragonfly, 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/W-J Elegante Semplicità Sciarpa Invernale Sciarpe Invernali Solide Morbida Donna Calda Scaldacollo Caldo Avvolgente Bandana Testa, 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-Ducati Femmes Polo D-Attitude Gris - M, 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,DD Danish Design Montre Femme Analog Black - IV11Q1251 Akilia Quartz.
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