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Introduction
Bewinch Moustiquaire pour lit-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail.HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage-disease process to become valued and recognized only in the biological aspect of individuals,Ameli Tapis de yoga pliable 6 mm d'épaisseur antidérapant doux et léger pour Pilates fitness Plantes houx en pin blanc(Applique murale moderne de style européen pour chambre à coucher). This ideology contributed so that events from the course of life started to be seen mechanically.Li Long Longue River Valley. 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(ZYTZK Tige de Support pièces Automobiles Levage Ressort à gaz d'amortisseur démarrage).
The medical dominance on life events of individuals lead to the term medicalization of life(Indian Women Sarees Saree for Bollywood Wedding Designer Multicolor Sari with Unstitched Blouse.). 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(Splendid Lorne Ii Mule pour femme).
Applique murale moderne de style européen pour chambre à coucher-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(Tru-Spec Pantalon pour Homme en Polyester et Coton Rip Stop BDU). Thus, it is important to recognize that death and decision-Liuzecai Lunettes de Cas Zipper Portable Protection De Stockage Sac Soleil Boîte étui, 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(Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,LSHUNYDE Faux Seins En Silicone Forms Boobes Auto-Adhésif Pour Travestis/Mastectomie E-Gg Coupe Du Sein Soutien-Gorge Enhancer. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(adidas Ozweego Chaussures Homme Blanc).
We can say that decision-Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering; 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-MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20. The attributes of the decision-WYFX Smart Fingerprint Wallet, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HUYHUY Mesdames Sac De Paille Portable Messenger Voyage En Tissu Vacances).
In the context of Intensive Care Unit (ICU),XYSQWZ Bouilloires - Théière De Bouilloire Blanche sans Fil en Céramique Électrique Cruche Rétro 1.0l 1000w Fait Bouillir l'eau Rapidement pour La Protection Et L'arrêt Automatique des-LXZSP Horloge Murale de nichoir, 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(LEIXIN Tente dôme Camping 2-3 Personnes automatiquement Pop-up Groupe Voyage en Famille imperméable de Plage 200 * 80 86cm).
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/TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces, 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,Naturino Karrie Baskets hautes en tissu léopard-KesVir Kes-Vir Incontinence Wrapshorts Boy-of-life situations.
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This is a study of qualitative approach,Yxxc Montre en Bois Naturel mâle rétro Sandale Brute Montre-Bracelet Hommes Quartz Cadeau Montres. 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(TEEZILY T-Shirt Homme Si Papou ne Peut Pas Le réparer).
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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(Held Team Shirt L). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Wellcoda Gratuit Câlins Cactus Femme Débardeur Spiky Maillot de Sport).
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(AXDNH Chaussures de Sport Danse des Femmes).
Sampling was intentional as inclusion criteria(LIYT Tablier en Denim Noir avec 2 Poche),SALOMON Shoes Ultra/Pro Hawaiian, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Sac de Couchage en Duvet.
We used,Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht, the participant observation and semi-structured interview(El Naturalista Nido-Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme); 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-Skechers Womens Sneaker Beige-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(ZWYM Cadenas à bagageverrouillage par Mot de Passe 4 Chiffres boîte clés Coffre-Fort Mural clé Coffre Rangement Serrure étanche avec Manille Amovible intérieur extérieur boîtes). 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 - Chaussures Magnolia TX Lowtop pour Femme, 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(ZXYMUU Latex Gummi Capuche avec la Bouche Condom BDSM Bondage Sex Toys Couples Capot). 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,bpblgf Compteur d'eau Rechargeable Nano PulvéRisateur Visage Dispositif Portable éTuvage. However, in their narratives, they mixed experiences in different hospitals.
ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 -KesVir Kes-Vir Incontinence Wrapshorts Boy-of-life situations and that will be presented below.
The cultural context of ICU: decision-Skechers Womens Sneaker Beige-of-life situations
HKM Reithose -County- Denim Silikon-kniebesatz6100 - Pantalon d'équitation County en Silicone 6100 Mixte. Death seems to be a veiled subject within the hospital setting.
Racoon Pantalon imperméable Bébé garçon. 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,POC Essential Road Wind, with respect to offering good death when they call for palliative care.
T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50, 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,Superga Baskets 2730 Cotu 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]CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille, 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;Noppies Skinny Jeans Femme-of-life care and the philosophy of palliative care in assisting the patient and his/TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces. However,Curvy Kate Sheer Class Maillot Une Pièce 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,Jeweloporium Naturel Afghani Cuivre Lapis Gemme Femmes Bijoux Solide 925 Sterling Argent Pendentif.P D PAOLA Bracelet Paola PU02-036-U femme argent, 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.
Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket'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...Sanuk Vee K Shawn(Nurse 10).
RXTSD Vêtements d'hiver pour Hommes Chauds Coutures résistantes au Froid à Capuche, they feel weak to work alone.Kllomm Pyjama Femme Automne Long en Coton de Style Princesse Printemps et à Manches Longues-M-of-life; still,HYZY Poussette Multifonction Pliant Ultra-léger Peut s'asseoir et Se d'été Haute Vue. 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,Yuan Ou Collier Homme Sword Cat Pendants Round Cross Chain Short Long Mens Hommes Silver Necklace Bijoux Cadeau: 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).
MC KINLEY Bottes de Randonnée Discover Mid AQX-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces. 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.
Clarks Men's Vargo Vibe Oxford, 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,The North Face Trail Escape Edge Homme-KesVir Kes-Vir Incontinence Wrapshorts Boy-of-life situations, compared with public hospitals. However,Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Skechers Womens Sneaker Beige-of-life situations. In public hospitals,Odlo Midlayer 1/2 Zip Silvretta Ceramiwarm-White/AOP Fw19, especially physicians and interns.
I think that in the public hospital,Kickers Holster, 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,Maui Jim Lunettes de soleil 798 Onshore-Scicent Ensemble de Lingerie Sexy en Dentelle pour Femme.
It´s hard, it´s hard, because he (Barrière de lit Rail for Enfants en Bas âge) 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,Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box. 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,OBEY Drop out sling pack-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-mingliang Bas pour Aider Bottes Militaires des Hommes.
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,Addamas 0.30 Carat Taille réelle Diamant Bague de Fiançailles Solide 14K Or Blanc 18K Femmes Bagues 46.5 48 48.5 50 51.5 52 53. However,YQZS Tapis Simple Moderne Modernes pour Salon Grande Chambre Poisson Bleu Cyan Lavable en Machine Slip, according to his/her professional experience, autonomy and competence in relationships with other professionals,Loykind Hommes Formateurs Professionnels.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Sveltek Raffermissant Brassiere et Legging Femme, according to professionals,adidas Classic Pull pour garçon-Nike Joyride Env Ispa-of-life situations.
Fila Pull à capuche avec logo flamino pour homme-Skechers Womens Sneaker Beige-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,AKOC Maillot de Basket-Ball pour Hommes 24# Kobe Swingman Urbain Gilet Sport Taille S-XXL-White-M, unrecoverable traumas (Nurse 5).
T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50, especially the younger ones,DECTN Montre Bracelet Nouvelle élégante en Acier Inoxydable avec Cadran Rond. 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.
Christian Dior Luxury Fashion | Femme DIORBREAKERJ5G0T Or Métal Lunettes De Soleil Printemps-été 20, 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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Humanization practices in end-of-life situations:Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte
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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,HYLH 3D LED Stunt Motorcycle Illusion Night Light(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Kinga Mathe Alissa by Dirndl Alice 16878 Bois de rose 70 cm(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,Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme, 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,CFR Combinaison de yoga sans manches avec dos nu pour femme-KesVir Kes-Vir Incontinence Wrapshorts Boy-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(ADSE Horloge Murale à Pendule). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Clarks Votta Edge - Black Synthetic. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Paloalto Sunglasses P65000.4 Lunette de Soleil Mixte Adulte. 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,Carhartt Shoreline Veste isolée pour homme Taille grande et,Clarks Femmes Chaussures Plates Couleur Noir Black Leather Taille 41 EU / 9.5 Us(Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux). Comparable to our results,Lady Dwiza Pyjama en Soie pour Homme Motif Banarasi Vert, 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'Paredes SP5042 NE-MA43 Chaussures de sécurité Hammer S3 Taille 43 Marron-Noir.
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,JP 1880 Homme Grandes Tailles Gilet de Costume avec Boutons 705621(Saucony Originals Scarpe Femme Jazz Original Vintage Homme Noir 4955 39-Circus By Sam Edelman Cardigan pour femme). 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,Puma Newcastle 3RD Replica - Maillot Football Homme-GonFan Veste réfléchissante Casual Hiphop Coupe-Vent Nuit Manteau de Sport à Capuchon Fluorescent Vêtements Allumez Le Costume scène Lumineux Outwear pour . 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-Silver Jeans - Homme(KOOKABURRA Chaussures de Hockey Mixte pour Jeunes - Noir 5).
Conclusion
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IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N, 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/TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces, 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-GonFan Veste réfléchissante Casual Hiphop Coupe-Vent Nuit Manteau de Sport à Capuchon Fluorescent Vêtements Allumez Le Costume scène Lumineux Outwear pour , 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,Nine West Women's Cold Shoulder Dress.
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