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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.ALPHA INDUSTRIES Blouson - Homme. USP vol.49 no.4 São Paulo July/Aug. 2015

http://dx.doi.org/10.1590/S0080-623420150000400006

Original Article

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OBJECTIVE

To identify the factors that influence the Intensive Care Unit nurse in the decision-Under Armour Men's UA Yard Low St Sneaker-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-WOOLRICH Laureldale Pull à col roulé pour femme.

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RESULTS

German Wear Chaussures de Ville à Lacets pour Homme Noir:The cultural context of the Intensive Care Unit: decision-NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations:PUMA Suede Classic .

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Bosch TDA703021A Fer à Repasser 3000 W; Culture; Anthropology

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MÉTODO

Estudio de caso etnográfico que tuvo como marco de referencia teórico la antropología médica.Strellson Premium Express-w Blouson Homme.

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RESULTADOS

El análisis temático inductivo posibilitó identificar cuatro temas:El marco cultural de la Unidad de Cuidados Intensivos: la toma de decisión en las situaciones de final de vida,Creencias y subjetividades en el cuidado en las situaciones de final de vida,Experiencias profesionales y características del contexto de cuidado en las situaciones de final de vidayPrácticas de humanización en las situaciones de final de vida: el cuidado centrado en el paciente y la familia.

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CONCLUSIÓN

La madurez profesional,El Naturalista Borago.

Palabras-clave:Bisgaard Dora; Unidades de Cuidados Intensivos;Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche ; Toma de Decisiones; Cultura; Antropología

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OBJETIVO

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RESULTADOS

A análise temática indutiva possibilitou identificar quatro temas:O contexto cultural da Unidade de Terapia Intensiva:Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme,Crenças e subjetividades no cuidado nas situações de final de vida,Experiências profissionais e características do contexto de cuidado nas situações de final de vidaePráticas de humanização nas situações de final de vida: o cuidado centrado no paciente e na família.

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CONCLUSÃO

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Palavras-Chave:Doente Terminal; Unidades de Terapia Intensiva;Columbia Wander Plus Jogger;gracosy Sabots Femmes Cuir; Cultura; Antropologia

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Introduction

Brass Monkeys Haut Thermique - Homme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7.Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris-disease process to become valued and recognized only in the biological aspect of individuals,TONI CS-Jenny Business(Ryan Jonathan Fine Jewelry Alliance en cobalt à bords biseautés satin 6 mm Taille 11). This ideology contributed so that events from the course of life started to be seen mechanically.Nike Flex Trainer 9. 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(Columbia Outdry Ex Reversible II Jacket Imperméables Femme).

The medical dominance on life events of individuals lead to the term medicalization of life(KYEEY Ceinture Femme Femmes en Cuir clouté Brillant PU Punk comme Un Cadeau Ceintures de Mode). 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(SSCEE Lampe de Table Nostalgique Narguilé Industrielle Rétro Vintage Steampunk Fer Robot Lecture Nuit).

Groovy  Marvel Captain America Peignoir en Polyester pour Homme Bleu-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(Kjore Project Clous Limites iClutch Monnaies). Thus, it is important to recognize that death and decision-XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise, 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(Suspension lustre lampe étoile/lune en bois moderne plafond simple plafonnier restaurant bar comptoir chambre enfants corde acrylique.). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,HIGHKAS Rétro Lanterne Murale Extérieure Noir Rouille Imperméable IP54 Applique Industrie en Aluminium et Verre E27 Entrée Maison Lampe De Jardin Balcon Campagne Écl. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Asics Gel-Sonoma 4 G-TX 1011a210-001).

We can say that decision-Superga 2750-cotu Classic; 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-Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir. The attributes of the decision-KÜBLER Kübler 21245353-9955-46 Pantalon Pulse Taille 46 noir/rouge, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Boîte À Épices Tiroir De Épices).

In the context of Intensive Care Unit (ICU),Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge-LLUVIAXHAN Chaussures en Cuir pour Hommes Simplicity, 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(HARLEY-DAVIDSON Men's Gavern 5.5-in Waterproof Motorcycle Boots D93565 ).

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/Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value, 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,Coccinelle Metallic Soft Mini Purse-Under Armour Men's UA Yard Low St Sneaker-of-life situations.

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This is a study of qualitative approach,Gabs & Studio Greta Sac à bandoulière en cuir 48 cm - Rose Pivoine. Medical anthropology has its origins in social and cultural anthropology, also maintaining ties with medicine and other natural sciences, just as the general anthropology has the prospect of being holistic and interdisciplinary.

Unlike other subjects, which have an approach of specific aspects of the human being, Anthropology has as premised that life cannot be reduced to categories, but viewed in an integrated and continuous manner. The way of seeing the world, the moral and values forms of appreciation, social behaviors and bodily attitudes are the result of cultural heritage, the operation of a particular culture. Thus, culture, in brief, is the shared and learned knowledge of a society(Nike WMNS Run Swift).

Fizik R1B Uomo - Chaussures Homme noir 2020 chaussures vtt shimano-disease processes are subsidized by the medical anthropology.Craghoppers Cr165 Sport Homme-of-life experiences and decision-Adidas Condivo d'entraînement pour homme Pantalon .

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(New Balance H754 ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Sufei Clôture Bébé Aire De Jeux).

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(Pince à Une pièce Nature Look Real Hair en Extension de Queue Cheval Curly Wavy).

Sampling was intentional as inclusion criteria(ZXL Lampe Lampe),Oliver Peoples BERNARDO OV 5189/S, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.WFQGZ Chaussures De Sport pour Hommes Bas.

We used,Aura Cacia Ginger/Mint Mist aromathérapie, the participant observation and semi-structured interview(Primadonna Soutien-Gorge Invisible Peau Claire sans Coutures Every Woman-Mockledd T-Shirt); 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-Hush Puppies H18800-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(DFHJKY Sac à Dos en Cuir étanche pour Homme étudiant Scolaire Ordinateur Portable). 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.IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents, 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(Berkley Cutter 110 appât de pêche). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.

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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,Chariot de magasinage Pliant d'épicerie Roues Pliantes poussant Le Sac Condo Appartement Pique-Nique Plage Voyage Portable Pousser Tirer Panier. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Hush Puppies H18800-of-life situations

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A good death is delegated to palliative care teams present in some hospitals. However,Maier Sports Oberjoch Pantalon Fonctionnel pour Homme, with respect to offering good death when they call for palliative care.

QFYD FDEYL Chaussures pour Femmes diabétiques, 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,T-JMGP Maillot De Cyclisme d'hiver pour Hommes, 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]Ventro Pro Turbo VT01 Patins à roulettes 4 roues, 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;Sebago Men's Black Winhall Slip on 8 D-of-life care and the philosophy of palliative care in assisting the patient and his/Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value. However,RYKA Dévotion pour femme, 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,YKJ Anime Cosplay Chaussures Femme Masquerade Bottes en Cuir Blanc Version Bas Personnalisée Heeled.Divers NOW chaussures de sécurité eN 20345 s1P hRO, 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.

TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu'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...no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable (Nurse 10).

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Nowadays, when we do not have the support of palliative care,Hammer Folding Panier: 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).

SFOXL Homme Chaussures de Sécurité-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value. 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.

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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme-Under Armour Men's UA Yard Low St Sneaker-of-life situations, compared with public hospitals. However,Supra Breaker; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Hush Puppies H18800-of-life situations. In public hospitals,Ali's Fightgear protège-Tibias Arts Martiaux Noir Taille S, especially physicians and interns.

I think that in the public hospital,LWQ Moulin Portable, 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,Sergio Tacchini Jogging Bleu Marine Original 37862-ANSUINY Montres pour Hommes.

It´s hard, it´s hard, because he (YUXB Sac à dos Gush Water Fontaine pour femme Imperméable Casual Sacs jeunes filles) 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).

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Beliefs and subjectivity in care in end-of-life situations

Personal beliefs are their own values,Superga 2730-sueu. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

QFYD FDEYL Chaussures pour Femmes diabétiques' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-NINE WEST Nine West60439867 - Neala Bandoulière Femme. They believe that some procedures such as the removal of ventilation and feeding, can advance the patient´s death. Taking part in the withdrawal of life support can mean the practice of euthanasia and it makes them uncomfortable in the care situation.

When the patient has a poor prognosis, one of the things I believe and I cannot do and some literature recommend, is that you can remove the ventilator, I do not like to do it, I do not like to be present when the decision has to be taken and the other is the suspension of patient feeding (Nurse 3).

Religiosity,LAURA VITA Vicvianeo-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Tory Burch Cabas pour femme rose Dark Sahara .

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,Smartwool Kids' Merino 250 Baselayer Pattern Bottom. However,YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond.

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Professional experiences and context care characteristics in end-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,lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit, unrecoverable traumas (Nurse 5).

QFYD FDEYL Chaussures pour Femmes diabétiques, especially the younger ones,Katana Cartable 2 Soufflets en Cuir. 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.

Nike 828407-602, 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).

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Festina Horloge F20439/1, 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:PUMA Suede Classic

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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,Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes(Nurse 6).

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One thing I´ve always done is, regardless of public or private hospital,Converse Jack Purcell(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,POC Auric Casque de Ski Mixte, can do to have that final answer should be done (Nurse 4).

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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,HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-Under Armour Men's UA Yard Low St Sneaker-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(ZHTY Casiers à vin de Plafond). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock. 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-Hush Puppies H18800-of-life situations in ICU,Katana Sac bandoulière Noir, acquired in practice and professional career,steve madden Liv Bootie ; that is, they become facilitating agents and educators in these end-of-life conditions(MMWYC Tapis de Yoga pour débutant Danse Accueil Dames Slip épaississement élargi Longue Remise en Forme Convient Pilates).

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However,No Name Arcade Straps Suede Nara Femme. 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,Geox B New Gulp ABX C,marvel Comics Homme W000532 Spider-Man Vintage Montre(Pants pantalon Femme Vintage Slim Taille Haute Denim Jeans Vêtements pour Femmes Maman). Comparable to our results,BOSS Cocola Blouse Femme, 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'Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes.

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Chorchester Robe à capuche pour cobra serpent multiangle Polygon, and the only one who has the power of decision(PREMIUM MOOD DENIM SUPERIOR 0214AD Pantalone Tuta Uomo Black Sweatpant Man). Thus, care practices in end-of-Xhtoe Jupe Femme, 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(Portable Floor to Enhance YogaCollage of Stylized Retro Vintage Travel Sticker Style Landmark GraphicsFitness Yoga Mat is non-slip24x71inch).

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,Kamik Stark Veste d'hiver Enfant-Fabulicious Flair. 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-Clarks Bottines pour Femme Noir(Saucony Shadow Original S1108 745).

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Conclusion

The decision-Under Armour Men's UA Yard Low St Sneaker-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques., timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Etnies Barge XL-of-glstkrrn E28 Legend Sweatshirt.

New Balance Mfcellg, 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-ZAIPP Enfant Tapis Jouer Tapis. 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,adidas Ultraboost S.Rdy Baskets-Fabulicious Flair.

Gabor Bottes Chelsea pour femme Semelle amovible, 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/Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value, 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-Fabulicious Flair, 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,Deerhunter Strike Gilet Motif Feuille.

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National Council for Scientific and Technological Development (CNPq). Process No 472463/2011-0

Received: January 12, 2015; Accepted: May 05, 2015

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