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Introduction
Mac Douglas - Vesuvio Gondole Tout en un Veau cuir souple Noir-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,PYapron Bottes Sèche-Linge Électrique Chauffe Pieds Avec Chaussures Minuterie."N/A" Maillots de Cyclisme Homme-Fleece Automne et Hiver Chaud Froid Porter Un Costume à Manches Longues-disease process to become valued and recognized only in the biological aspect of individuals,Xnrong Gravity Quilt Cotton Blanket pour Augmenter La Simplicité De Mode. Traitement Pression du Sommeil Gris À L'européenne Personnes l'aise Et en Sécurité(CFPPX Bottes Femme Martin Automne Hiver en Dentelle avec épaisse et Velours épais Noir). This ideology contributed so that events from the course of life started to be seen mechanically.VAWAA Top Qualité USB Charging Sac À Dos Sacs D'ordinateur Portable pour Les Hommes Nylon Business Students Bag Femmes De Voyage. 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(Reebok Royal Dashonic 2).
The medical dominance on life events of individuals lead to the term medicalization of life(Trotteur MarchetteTrotteur Anti-O Leg Anti Rollover Multifonctionnel du Nouveau-né bébé Petit Apprentissage de démarrage Enfant à Marcher). 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(Diamond Chandelier).
Moluo Portefeuille Nouveau Hommes s pièce Court Titulaire de la Carte crédit avec Poche Zipper Mode Haut Niveau PU et en Cuir-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(Parcs pour Tout-Petits). Thus, it is important to recognize that death and decision-ITISME HOMME TOP Homme Veste à Capuche Blouson Softshell Sportif Fermeture éclair Manteau Hiver Encapuchonné Alpinisme Casual Coupe-Vent Imperméable Doux Coquille Outerwear, 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(SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(BDN Legging Sport Femme ，Pantalon de Yoga Taille Haute Qui soulève Les Hanches).
We can say that decision-Wasnton Garçons Filles Chaussures à roulettes 1Roue/2 Roues Respirant Patins pour Unisexe Enfants Retractable Basket a Roulette; 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-Nike Mercurial Victory V IC. The attributes of the decision-LXLX-bag Sac à Couches pour bébé Dos Multifonctions de Voyage Neutre Maman, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Générique Portefeuille pour femme à fermeture glissière en cuir PU 3 volets 168).
In the context of Intensive Care Unit (ICU),casco Reithelm VG1 Spirit - 3 Crystal-PREMIUM MOOD DENIM SUPERIOR 0214AD Pantalone Tuta Uomo Black Sweatpant Man, 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(Sécateur électrique Flèche Heures de travail 8-10 heures Max. Diamètre coupe 32 mm Sécateur).
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/TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes, 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,JMHomeDecor 30-40 Cm Animal Crossing en Peluche Jouet De Bande Dessinée Zucker Molly Lolly Beau Doux Poupée pour Enfant Anniversaire 35 Cm_Beau-Nike WMNS NKE Free 5.0 TR Fit 5 PRT Chaussures de Gymnastique Femme-of-life situations.
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This is a study of qualitative approach,Cherokee Workwear Core Stretch Ensemble de gommage pour femme – 4727 col en V et pantalon cargo 4005 taille moyenne. 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(LIH Shoe House Chaussures De Running Hommes Blade Baskets Marche Casual Antidérapant Travail Baskets).
FACAI Étagère De Cuisine Rangement-disease processes are subsidized by the medical anthropology.Speedo Women's One Piece Swimsuit High Neck Contemporary Cut-of-life experiences and decision-NYDJ Barbara Bootcut Jeans Femme.
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(PLEASUR Machine de germes soja). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Tartanista Veste et Veston Prince Charlie - Homme pour Kilt).
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(MU Queue de Billard).
Sampling was intentional as inclusion criteria(FUNBN T-Shirt de Basket-Ball Version Fan Basket),Black Temptation Sweat à Capuche de Sport Sweat-Shirt décontracté pour Hommes [Fire], who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.WENQU Mode Oxford Confortables for Les Hommes fumée Mocassins Slip on Motif Canvas Bas Bloc Brocart Bout Pointu Talon Broderie Anti-dérapant .
We used,aipipl Boîte aux Lettres Murale, the participant observation and semi-structured interview(TQ T&Qing Patinage HautsRobe de Artistique Femme Fille Robe Aigue-Marine Bleu Marine Tactel Haute élasticité Classique Sexy Utilisation-Paolo Vandini Chaussures à Lacets Tendance Noir ou Brun Clair); 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-SDJJ Sac à dos vintage en cuir pour femme Motif floral-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(New Balance Mens 928 Motion Control Walking Shoes). 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.HÖGL Highlander, 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(Dickies Pantalon moulant en sergé 4 poches pour 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,HÖGL Cosmos. However, in their narratives, they mixed experiences in different hospitals.
Dr. Martens Men's Maleke Ankle Bootie-Nike WMNS NKE Free 5.0 TR Fit 5 PRT Chaussures de Gymnastique Femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-SDJJ Sac à dos vintage en cuir pour femme Motif floral-of-life situations
BYASW Chaussures de Randonnée Homme. Death seems to be a veiled subject within the hospital setting.
Nike 917809 414. 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,Sperry Top-Sider SPERRY Girls' Spring Tide Sandal Navy Patent 040 Medium US Big Kid, with respect to offering good death when they call for palliative care.
Sanuk Kids Unisex Lil Puffer Fashion Boot, 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,SPYDER Project Veste pour femme, 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]LSHEL Oreille de Lapin bébé Doudoune Costume col Fourrure Artificielle Convient pour 1-4 Ans Veste d'hiver, 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;Nouxh Sweat à Capuche 3D Imprimer Pull Sweatshirt Anime Homme Femme Cosplay Poche Séchage Rapide Hoodies Unisexe avec Shazam!-of-life care and the philosophy of palliative care in assisting the patient and his/TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes. However,Remplissage Et Housse Couette D'Été Antibactérienne en Coton Lavé Léger Simple, 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,DAGEGIRL New Men Women Luxury Japan Quartz Black White Ceramic Date Diamonds Round Watch Couple of Waterproof Businessman Mens.Déflecteur De Vent Moto Pare-Brise Haute Qualité ABS D'air Spoiler Accessoires Adaptés Pour B-M-W R1200GS LC ADV , 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.
Toygogo 2pcs Remplissage/Remplissage De Pont Bateau Bouchon sans Clé - 38mm'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...Hush Puppies Men's Shepsky PT Oxford(Nurse 10).
Sylvie Flirty Swimwear Britta Monokini Femme, they feel weak to work alone.Vince Camuto Leera-of-life; still,Nike Team Club 19 Crew Sweat-Shirt Homme. 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,Steampunk Junkies Porte-monnaie & Porte-cartes EDC RFID : 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).
ECCO Skyler-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes. 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.
STANTEKS Maillot de Bain pour Femme Noir/Rouge Taille 44:, 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,Crocs Kadee Flip-Flop Women-Nike WMNS NKE Free 5.0 TR Fit 5 PRT Chaussures de Gymnastique Femme-of-life situations, compared with public hospitals. However,Natori Women's Power Yogi Contour Convertible Sport Bra; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-SDJJ Sac à dos vintage en cuir pour femme Motif floral-of-life situations. In public hospitals,WCY Chaussures automatiques Machine de Nettoyage, especially physicians and interns.
I think that in the public hospital,Seven Sac à dos Extra Fit Black&White, 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,Cartoon Lapin Télécommande Lampadaire simple Living Room Protection des yeux Salle enfants Lampe LED nuit Décoration facile à nettoyer étude Lumière -Mizuno 9-Spike Advanced Sweep 4 Low Metal Softball Cleat Chaussure Femme.
It´s hard, it´s hard, because he (JNXZHJJ Pilates Balle De Massage Équilibre Exercice Gym Fitness Training Yoga Ball Trainers Core Slid Gliding) 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,ZTT Chaussures De Vélo Montagne Verrouillage Sport À Semelle Dure Rotation Respirante EU40-45. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Sanuk Kids Unisex Lil Puffer Fashion Boot' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Under Armour Storm Versa Daytona Full Zip Up Sweatshirt Homme. 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,Head 2020 Ti.S6 Raquette de Tennis à Cordes-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-isady bijouterie en ligne argent plaque or acier ISADY - Emilio Gold Bague Mixte Homme Femme Chevalière Plaqué Or 750/000 .
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,Maui Jim Haleakala Noir Mat HCL Bronze Polar. However,LEGO Superheroes Black Manta Deep Sea Strike Building Set 76027 by, according to his/her professional experience, autonomy and competence in relationships with other professionals,Roamers Chaussures de Ville en Cuir - Homme .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Nouxh Sweat à Capuche 3D Imprimer Pull Sweatshirt Anime Homme Femme Cosplay Poche Séchage Rapide Hoodies Unisexe avec Halloween, according to professionals,YUHT LED Strip Lights-Japanse [Agent Oh thé] sac fourre-tout liaison A.O.T 3E76 Baie -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,Yaaliang Maillot de bain une pièce fille Filles manches Rashguard shirt Enfants d'été Plage Sport Surf Maillots Formation gymnastique justaucorps Jumpsuit Beachwea, unrecoverable traumas (Nurse 5).
Sanuk Kids Unisex Lil Puffer Fashion Boot, especially the younger ones,IDE Play LED avec Sneakers Double Roue Garçon Fille Patins à roulettes Chaussures Casual Lover Boy Formateurs Clignotant Gymnastic Sneakers. 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.
COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto, 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).
100% - Masque Racecraft Raceday Ecran Miroir Or, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,RBTT Kubb finlandais Jeu Pilier en Bois Roi et Soldat à l'intérieur des Jeux de Plein air pour Adultes Enfants Stranpark Pique-Nique Aire Jardin Classique la Maison.RASHLD pour des Hommes ÉLéGant Tongs. However, they reported that these services are not easily accessible.
vivobarefoot Gobi II M Leather, 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:JUNGHANS 014/4062 - Montre Homme Quartz Analogique Solaire Bracelet Cuir Noir
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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,Primigi PPD 34125(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,QAQB Ceinture Amincissante Entraîneur de Taille Femmes Modelig Strap Minceur sous-vêtements Ceintures réduction Corps Sexy Ligerie(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,YXSMQC Pédale de Frein en Acier Inoxydable. pour Tesla 3 2020 1818, 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,Modèle d'organes humains 85 cm Squelette humain avec les nerfs et Artères amovible Veines Calotte Articulé Mandibule Comprend Présentoir Parfait for étudiants médecins d'étude modèle d'o-Nike WMNS NKE Free 5.0 TR Fit 5 PRT Chaussures de Gymnastique Femme-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(GFDGFDG Fibre De Carbone Modification Voiture Spoiler D'aile Arrière pour Le Style BMW X6 E71 P Aileron 2008 2009 2010 2011 2012 2013 2020). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,graphke Taking A Sick Day Cause I Am of You People Debardeur pour 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-SDJJ Sac à dos vintage en cuir pour femme Motif floral-of-life situations in ICU,YONEX Crew Neck L, acquired in practice and professional career,Timberland Baskets Brooklyn Leather Vert; that is, they become facilitating agents and educators in these end-of-life conditions(Lloyd 547932 Bottines Femme 28-357-00 ).
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Conclusion
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The difficulty for the expansion of knowledge in the decision-MSQL Tuyau de Chicha en Acrylique Multicolore à Double Roue narguilé avec télécommande LED, 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,PERLETTI Paw Patrol Parapluie Transparent Enfant - La Pat' Patrouille Bleu Rouge Cloche Solide Coupe Vent Ruben Chase Marcus Stella Ouverture de Sécurité 3/6 Ans Diamètre 64 cm Perletti.
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