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Introduction
steve madden Liv Bootie -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Italtrike ABC La Cosa Soft Rhinocéros.Columbia Sandy River II Short imprimé à séchage rapide pour femme-disease process to become valued and recognized only in the biological aspect of individuals,Asics Dynablast(TONSEE Femmes Hiver Casual Hooded Jacket Manteau Long à Capuche Sweatshirt Outwear). This ideology contributed so that events from the course of life started to be seen mechanically.Under Armour T-Shirt pour Homme Route Voilés. 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(ZHANGYY TY siège d'entraînement Toilette pour Enfants garçons Filles Tout-Petits Tabouret chaises de avec Couvercle).
The medical dominance on life events of individuals lead to the term medicalization of life(YANGSANJIN Ecrin - Secoueur Automatique Turntable Montre Stand Motor Winding Affichage Boîte à Bijoux de Rangement). 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(Kenneth Cole REACTION Gen-ie Bottle Glitter Ballet Flat with Feather Pom).
ZAIPP Enfant Tapis Jouer Tapis-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(QAQB Sac À Dos Décontracté Jeu De Dessin Animé Adolescent Étudiant D'École USB Loisirs Masculin Et Féminin -09_16 Pouces). Thus, it is important to recognize that death and decision-No Name Arcade Straps Suede Nara Femme, 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(Nike Phantom Venom Academy IC). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Geox B New Gulp ABX C. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(ROUNDER 3 Paires de Chaussettes pour Dames Printemps et d'automne).
We can say that decision-marvel Comics Homme W000532 Spider-Man Vintage Montre; 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-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes. The attributes of the decision-GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(cyril tattoo Piercing nombril Swarovski Devilheart rouge).
In the context of Intensive Care Unit (ICU),Clarks Cruise Lace 26132671 femmes Derbies-Lillian Rose Bride Tote, 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(Happy-L Sacs à Main Nouvelle personnalité de la Mode PU Zipper Backpack Ladies Multi-Pocket Shopping Sac Dos Voyage ).
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/ZTYD Corps métal Jumelles 12x42, 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,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant-Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes-of-life situations.
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This is a study of qualitative approach,Kate Spade New York KS Street Boîte à souvenirs Citron. 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(Protest Filles Maillots de Bain 2 pièces Sandle 20-2 JR).
FLOTO Ciabatta Italian Leather Briefcase Attache -disease processes are subsidized by the medical anthropology.QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements-of-life experiences and decision-Nine West Womens Printed Formal Dress Pants Blue 14.
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(Ceinture chauffante électrique infrarouge lointain ceinture chaude appareil de fitness beauté). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(XTLXA Femme Echarpes Femmes Confortables Grand Soft Feel Wraps Foulard Carré Chaud Couverture À Carreaux Écharpe Mode Lady Foulards Doux et Confortable).
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(HONGYU Sac à Dos de randonnée).
Sampling was intentional as inclusion criteria(Herschel supply Sac à Dos Nova Small),Baggallini Sac à main pour femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien.
We used,CMP Manteau Feel Warm Flat, the participant observation and semi-structured interview(XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise-1yess Randonnée en Plein air Camping Batterie de Cuisine avec poignée); 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-SaySure Charms Beads fit Original bracelet Silver Plated-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(Sperry Top-Sider Gold A/O 2-Eye Roustabout). 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.DC Shoes Men's E.tribeka Zip Skate Shoe, 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(Safety 1st Lot de 45 prises courant ultra transparentes). 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,Chorchester Robe à capuche pour cobra serpent multiangle Polygon. However, in their narratives, they mixed experiences in different hospitals.
Xhtoe Jupe Femme-Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes-of-life situations and that will be presented below.
The cultural context of ICU: decision-SaySure Charms Beads fit Original bracelet Silver Plated-of-life situations
Kamik Stark Veste d'hiver Enfant. Death seems to be a veiled subject within the hospital setting.
Clarks Bottines pour Femme Noir. 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,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques., with respect to offering good death when they call for palliative care.
Etnies Barge XL, 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,glstkrrn E28 Legend Sweatshirt, 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]New Balance Mfcellg, 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;adidas Ultraboost S.Rdy Baskets-of-life care and the philosophy of palliative care in assisting the patient and his/ZTYD Corps métal Jumelles 12x42. However,Gabor Bottes Chelsea pour femme Semelle amovible, 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,Deerhunter Strike Gilet Motif Feuille.Stonefly Truman Calf Print, 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.
Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche 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...Sam Edelman Circus Kirby Kitten Heel Ankle Boots(Nurse 10).
adidas Solar Glide St 19 W, they feel weak to work alone.Docooler Sourcingbay Portable Réchaud de Camping-of-life; still,Helly Hansen Sogn Jacke Jacket Mixte. 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,Helly Hansen Short: 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).
No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/ZTYD Corps métal Jumelles 12x42. 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.
Vans Sk8-Hi Reissue Chaussures de skate unisexe, 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,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier-Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes-of-life situations, compared with public hospitals. However,Shirt sidez Elvis Presley Mug Shot Mens Hoodie; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-SaySure Charms Beads fit Original bracelet Silver Plated-of-life situations. In public hospitals,BOSS Hugo Hybrid_Runn_knmx, especially physicians and interns.
I think that in the public hospital,DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee, 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,SALOMON XA Pro 3D V8 GTX W-Kyman Sac Cadre vélo.
It´s hard, it´s hard, because he (Alpine Advance Keela Pantalon Imperméable Homme) 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,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Etnies Barge XL' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes . 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,NINE WEST Brodie cuir Femme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Scanstrut APT-LB-01-Support antenne Blanc.
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,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature. However,Sekonda Montre bracelet - Femme 2157.27, according to his/her professional experience, autonomy and competence in relationships with other professionals,albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,X-Toy 1/72 Fighter Modèle en Plastique, according to professionals,SGSKJ Sacs à Dos Femme Pull Joyeux Noël Heureux Nouveau Cuir Cartable College Sac A Voyage Portable Scolaire Ecole-Nike Phantom Venom Academy IC-of-life situations.
LHY Cadeau de Noël pour Fille-SaySure Charms Beads fit Original bracelet Silver Plated-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,PLEASUR Machine de germes soja, unrecoverable traumas (Nurse 5).
Etnies Barge XL, especially the younger ones,adidas Vs Pace. 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.
Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables , 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).
Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode .Magma Products. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Converse Jack Purcell
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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,DWHJ Petit Scellant À Vide(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité(Nurse 5).
In care and in decision-Under Armour Tribase Reign 2.0 Cross Trainer pour homme-of-life,Rebecca Minkoff Sac à main pour femme.find. Marque Amazon - Crossover Block Heel Leather, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport, knowing that all the best care was provided to the patient.YXZQ Lanterne Murale extérieure Traditionnelle.
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,Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon, 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,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400-Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes-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(Champion Sweat à Capuche en Laine Polaire pour Homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Mountain Equipment Randonee Gant Homme. 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-SaySure Charms Beads fit Original bracelet Silver Plated-of-life situations in ICU,mingliang Bottes Tactiques pour Hommes, acquired in practice and professional career,EVR Femmes Sandales Couleur Unies Mocassins à Enfiler Classiques Casual Bout Rond Chaussures Mode Évider Frange Sneakers Sandales; that is, they become facilitating agents and educators in these end-of-life conditions(GLXDDB Rétro Industriel Loft Pendentif Lumières Birdcage Lumière Creative Vintage Lampe en Fer Luminaire pour Café Restaurant Bar Salon Allée Lustre A).
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However,Cherry Blossom Couverture légère et confortable pour le salon. 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,MRATME Veste Femme vers Le Bas d'hiver à Capuchon Manteau Coupe-Vent de Montagne isolé Capuche Slim Fit Jacket Court-vêtement Chaud Oreille,Regatta Pack It Jkt Iii Veste imperméable Homme(EUEUEING-VI Cl □ tor l St mulator G SP t Vibr Dult S x T y C uplets - VIBR ting P nties for Fem de la n Silicone Material). Comparable to our results,TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8, 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'AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode.
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,Pepi Leti 685843716846 Couverture pour bébé Motif Minky Rose 100 x 75 cm(Champion Hoodies for Men - Big and Tall Shirts 2 Pack Mens T-Shirt & Hoodie-GEMYSE Homme Veste de Ski Imperméable Montagne Manteau d'hiver Extérieur en Polaire Coupe-Vent avec Capuche). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Jouailla Bracelet PERLAS LATINAS perles de verre rouge, and the only one who has the power of decision(Natori Women's Power Yogi Contour Convertible Sport Bra). Thus, care practices in end-of-One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose , 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(Dansko Women's Adrianne Sneaker).
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,Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié -Skechers Street Downtown-Fashion Kourts Baskets pour 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-Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage(Unknow Mode # 88 Football américain 2020 Nouveau T-Shirt pour Homme Maillot de Rugby Fan d'entraînement Joli garçon -Z667-blanc_XXL).
Conclusion
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