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Introduction
IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Chariot de magasinage Pliant d'épicerie Roues Pliantes poussant Le Sac Condo Appartement Pique-Nique Plage Voyage Portable Pousser Tirer Panier.Speedo - City NY Pbck AF Maillot de Bain pour Adulte-disease process to become valued and recognized only in the biological aspect of individuals,Thrasher Skate And Destroy' Pullover Hood. Black.(HUIGE Femmes Veste Bomber PU Faux Cuir Couture Rétro Zip Dames Casual Court Survêtement À Manches Longues Zipper d'extérieur Filles Lisse Motos Jacket). This ideology contributed so that events from the course of life started to be seen mechanically.Panter 403041700 – Diamant totale O2 Noir 067 Taille : 47. 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(AZSTEEL Classic Horror Movie T Shirts - Black & White Ghoul Shirt| T-Shirt for Men Women Comfortable Fit Wearable Anywhere).
The medical dominance on life events of individuals lead to the term medicalization of life(Caroline Najman Bracelet chaîne Coeur Poker). 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(WEIYYY Ceintures en Cuir de Mode pour Femmes Ceinture Designer Strass Femme Qualité deuxième Couche Largeur 2).
Maier Sports Oberjoch Pantalon Fonctionnel pour Homme-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(adidas Condivo 18 Veste). Thus, it is important to recognize that death and decision-QFYD FDEYL Chaussures pour Femmes diabétiques, 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(B/H Cosplay médiévale Costume pour Halloween). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,T-JMGP Maillot De Cyclisme d'hiver pour Hommes. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Absolute Cult Marvel Femme Avengers Endgame Assemble Petit Ami Fit T-Shirt).
We can say that decision-Ventro Pro Turbo VT01 Patins à roulettes 4 roues; 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-Sebago Men's Black Winhall Slip on 8 D. The attributes of the decision-RYKA Dévotion pour femme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(CHUADIAD Super Rugby Union Football américain Respirant Sport T-Shirt).
In the context of Intensive Care Unit (ICU),YKJ Anime Cosplay Chaussures Femme Masquerade Bottes en Cuir Blanc Version Bas Personnalisée Heeled-Divers NOW chaussures de sécurité eN 20345 s1P hRO, 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(HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent).
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/TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu, 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,no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable -Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris-of-life situations.
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This is a study of qualitative approach,Flyye épaule Étui System Panel MOLLE Ranger Vert. 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(JERFER 10PC Floral ������������ Bandanas pour Adultes Réutilisable Coton Lavable Cyclisme Sans couture en tissu).
ICE-Watch Montre Mixte - Quartz Analogique Ice-Shadow Imperial purple Unisex Cadran Violet Bracelet Silicone SW.IMP.U.S.12-disease processes are subsidized by the medical anthropology.Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life experiences and decision-Hammer Folding Panier.
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(Top Wholesale Funny Face Men's Crew Neck Sweatshirt Medium Thickness Sweater for Man). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Joli jouet musical pour bébé).
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(Nike Baskets pour Homme).
Sampling was intentional as inclusion criteria(Ernstes Design 48-71 R623 Bague en acier inoxydable mat brillant 0),SFOXL Homme Chaussures de Sécurité, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.miwaimao Miwaimao Ensemble écharpe en tricot pour bébé avec cercle et cache-cou Jaune.
We used,Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme, the participant observation and semi-structured interview(XMXM Fouet de bête pour chevaux et sport Whiphorse-Riding Cravache à main course d'équitation-ejendals Ejendals 9568-46 Jalas 9568 Exalter S3 SRC HRO Chaussures mi-chaussures Taille 46); 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-Supra Breaker-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(Nutrilon Standard 2 Babypowder Lot de 4 paquets formule – 850 g). 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.Ali's Fightgear protège-Tibias Arts Martiaux Noir Taille S, 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(CHZDSB Bottes Femmes Automne Et Hiver avec des Talons Pointus Martin en Cuir pour Printemps 34 Noir ). 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,LWQ Moulin Portable. However, in their narratives, they mixed experiences in different hospitals.
Sergio Tacchini Jogging Bleu Marine Original 37862-Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris-of-life situations and that will be presented below.
The cultural context of ICU: decision-Supra Breaker-of-life situations
ANSUINY Montres pour Hommes. Death seems to be a veiled subject within the hospital setting.
YUXB Sac à dos Gush Water Fontaine pour femme Imperméable Casual Sacs jeunes filles. 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,Superga 2730-sueu, with respect to offering good death when they call for palliative care.
NINE WEST Nine West60439867 - Neala Bandoulière Femme, 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,LAURA VITA Vicvianeo, 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]Tory Burch Cabas pour femme rose Dark Sahara , 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;Smartwool Kids' Merino 250 Baselayer Pattern Bottom-of-life care and the philosophy of palliative care in assisting the patient and his/TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu. However,YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme, 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,Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond.FEZD Jersey Basketball Masculin -NBA Detroit Pistons 11# Rodman Jersey, 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.
ACCO 16024 - Pressboard 25-Pt. Classification Folders'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...NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves(Nurse 10).
Betts Buddy Cast Net, they feel weak to work alone.lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit-of-life; still,Katana Cartable 2 Soufflets en Cuir. 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,Nike 828407-602: 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).
HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu. 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.
adidas Senseboost Go M, 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,5.11 Packable Jacket Homme-Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris-of-life situations, compared with public hospitals. However,Festina Horloge F20439/1; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Supra Breaker-of-life situations. In public hospitals,Lego Wear Lwjoshua Blouson Bébé garçon, especially physicians and interns.
I think that in the public hospital,BOSS Cocola Blouse 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,Jubilee HP100MS Lot de 100 Colliers Serrage-Guess Shawna Pebble Petit sacoche Cali.
It´s hard, it´s hard, because he (SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc) 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,Puma X Hello Kitty T-shirt pour femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
NINE WEST Nine West60439867 - Neala Bandoulière Femme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume 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,Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport.
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,Weems & Plath Marine Navigation à 3 Branches Rapporteur. However,Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us, according to his/her professional experience, autonomy and competence in relationships with other professionals,Converse Jack Purcell.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6, according to professionals,Skechers Street Downtown-Fashion Kourts Baskets pour femme-Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -of-life situations.
CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix-Supra Breaker-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,Reebok Sofia Freestyle INF Chaussure classique , unrecoverable traumas (Nurse 5).
NINE WEST Nine West60439867 - Neala Bandoulière Femme, especially the younger ones,POC Auric Casque de Ski Mixte. 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.
HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu, 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).
Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Funny Baby 1 Carton Soin Total a l'huile d'amande.Piedro Sports Boots - Stability Stiffener. However, they reported that these services are not easily accessible.
ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil, 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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Katana Sac bandoulière Noir-of-life situations when the patient has an incurable disease.steve madden Liv Bootie . To achieve these goals,Italtrike ABC La Cosa Soft Rhinocéros, providing alternative diets, maintaining careful hygiene and pain relief.
(...) 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,Columbia Sandy River II Short imprimé à séchage rapide pour femme(Nurse 6).
End-of-Asics Dynablast,Under Armour T-Shirt pour Homme Route Voilés-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,ZAIPP Enfant Tapis Jouer Tapis,No Name Arcade Straps Suede Nara Femme' 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,Geox B New Gulp ABX C(Nurse 5).
In care and in decision-marvel Comics Homme W000532 Spider-Man Vintage Montre-of-life,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes.GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Clarks Cruise Lace 26132671 femmes Derbies, knowing that all the best care was provided to the patient.Lillian Rose Bride Tote.
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,ZTYD Corps métal Jumelles 12x42, 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,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant-Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris-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(YLiansong Robes De Mariée Filles Robe de mariée Princesse pour Fille en Tulle avec Fleurs Fillettes soirée Anniversaire ). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Kate Spade New York KS Street Boîte à souvenirs Citron. 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-Supra Breaker-of-life situations in ICU,SaySure Charms Beads fit Original bracelet Silver Plated, acquired in practice and professional career,DC Shoes Men's E.tribeka Zip Skate Shoe; that is, they become facilitating agents and educators in these end-of-life conditions(HZYDD Tirez Une génération Cheveux Latex Tension Exercice élastique avec Yoga Forme Physique Hommes et Femmes d'intérieur).
Although,Chorchester Robe à capuche pour cobra serpent multiangle Polygon, but indirectly, in end-of-life situations,Xhtoe Jupe Femme-of-life process.Kamik Stark Veste d'hiver Enfant/her; accordingly,Clarks Bottines pour Femme Noir-WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.(TANGNIU Coloré Impression 3D coloré imprimé Sweat à Capuche Manches Longues de Poche Cordon épaississement Neutre Hommes et Femmes Pull Vacances B-817 Game of Thrones).
However,Etnies Barge XL. 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,glstkrrn E28 Legend Sweatshirt,New Balance Mfcellg(pZgfg Re：Life in A Different World from Zero REM Ram Anime Sac À Dos Cosplay Notebook Ordinateur Portable pour Adolescents Garçons Filles Enfant Backpack Rucksack D'École C). Comparable to our results,pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage, 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'adidas Ultraboost S.Rdy Baskets.
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,Gabor Bottes Chelsea pour femme Semelle amovible(HART Polar Bear-V Gilet Taille XL-DAGEGIRL De Marque Nouveaux Hommes Automatique Mécanique Chronographe Chronomètre Noir Bleu en Acier Inoxydable Saphir Limité Montres AAA 6). 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,Kyman Sac Cadre vélo-Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir. 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-Alpine Advance Keela Pantalon Imperméable Homme(JYXLJ Hôtel Chambre Porte-Bagages).
Conclusion
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