Introduction
LIUJUN LIUJUN-WEI Chaussures de Football for garçons et Filles Homme Crampons Professionnel Spike Chaussure -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Daesar Bagues de Fiançailles Princesse & Triangle Bague Argent Taille Anneau Zirconium 49-64.Daesar Bague Promesse Argent Femme Personnaliser Anneau de Coeur Rond Blanc Zirconium Taille 49-64-disease process to become valued and recognized only in the biological aspect of individuals,Mizuno Chaussures de baseball à crampons pour homme 9 Dominant IC Low Metal(SDJJ Sac à dos vintage en cuir pour femme Motif floral). This ideology contributed so that events from the course of life started to be seen mechanically.Casque Activ 2 – Casque de vélo. 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(WANGCY Spin Mop Bucket Clean Double Seau Facile à Utiliser).
The medical dominance on life events of individuals lead to the term medicalization of life(AIYL Pantalons de Motocross pour Hommes Shorts Moto Vélo VTT Descente vélo Montagne Courts Tout-Terrain G-L). 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(Mizuno Wave Paradox 5).
Prana Summit Pant - Regular Inseam Pantalon Couture intérieure Standard Femme-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(Saucony Cohesion 12 Men). Thus, it is important to recognize that death and decision-kentucky Bandes de Repos Repellent Bleu, 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(Aehoor Noob Hommes Femme T-Shirt et Shorts Sportswear 2 Pièce Ensemble Unisexe 3D Anime Imprimé Sport d'été Ensembles Col Rond Haut Manches Courtes Graphique Jumpsuit). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,KesVir Kes-Vir Incontinence Wrapshorts Boy. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Flyye épaule Étui System Panel MOLLE Ranger Vert).
We can say that decision-Désigual Shirt Short Sleeve Azhar Woman Brown Chemise Femme; 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-Dilwe Mini Alcool Réchaud en acier inoxydable. The attributes of the decision-New Balance Women's 5K V5 Running Shoe, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(CBLD Rechargeable Torche LED de Poche Lampe Super Bright 300 Lumens 1700 MAH Outdoor Camping étanche pour l'activité Nuit ou Plus).
In the context of Intensive Care Unit (ICU),Tosca Blu Ankle Boot Kiruna-Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte, 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(GYPING Dames rétro Bottes lacées Plates Martin Hautes d'aide Bottillons Anti-Glisse de Loisirs en Plein air Travail à Pied Casual City).
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/Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes, 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,GonFan Veste réfléchissante Casual Hiphop Coupe-Vent Nuit Manteau de Sport à Capuchon Fluorescent Vêtements Allumez Le Costume scène Lumineux Outwear pour -ejendals Ejendals 7138-42 Jalas 7138 Zenit Evo Easy Roll Chaussure basse Taille 42-of-life situations.
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This is a study of qualitative approach,PUS Vêtements d'entraînement de Football Basket-Ball Apparence Costumes Sports Loisirs Fitness Running Training Camp Enfants Ball Noir-L. 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(Lakota Bottes Western Buckaroo modèle Roping EQ296).
Zyuan Couple De Noël Pyjamas d'hiver Vêtements Nuit for Les Femmes Chaud Thicken Unisexe Pyjama Set À Capuchon Cúter Cartoon Femme Accueil ShanDD -disease processes are subsidized by the medical anthropology.Primigi Pwigt 63828-of-life experiences and decision-Clarks Sandales Sillian2.0 Joy pour Femmes.
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(Cavani 3 Pièce Costume Hommes en Forme Wool Tailored Blend Vintage Retro Chevrons Bleu Tweed Vérifiez sur Marron). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Cicongzai Bottines pour homme à lacets en microfibre avec fermeture éclair latérale style bruni antidérapant).
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(Science Tshirts By Big Mouth Quantum T-shirt pour femme - Bleu X-Small).
Sampling was intentional as inclusion criteria(Jamkf Sandales d'été Hommes Tendance Sandalettes Casual Doux Bas antidérapants résistant à l'usure des intérieur et extérieur Double Usage Talon Chaussons avec Coussin d'air),HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Mammut Bota Ducan High GTX.
We used,Clarks Kaylin 60 Sling, the participant observation and semi-structured interview(California Costumes Mens Royal Storybook Prince Fancy Dress Costume X-Large-Kllomm Pyjama Femme Automne Long en Coton de Style Princesse Printemps et à Manches Longues-M); 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-LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine-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(Armani Exchange Logo Draw Strings Sweat-Shirt À Capuche Femme). 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.Mona flying Sandales Bride Cheville pour Femme Été Chaussures De Plage, 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(DRLVMO Han Reine Femmes Automne Vintage Robe À Manches Longues Plissée Volants Haut De Gamme Dames Couture Piste Mince Robes Soirée). 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,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine-of-life situations
Rideaux occultants larges américains sur le thème des États-Unis d'Amérique Fédéral Fête Révolution Design décoratif thermique Dos coulissant Panneau simple 203 x 213. Death seems to be a veiled subject within the hospital setting.
LJMHG Shorts Summer Denim Women High Waist Jean Female Loose Hole Jeans with Pockets Casual Plus Size S-6Xl L Blue. 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,Bewinch Moustiquaire pour lit, with respect to offering good death when they call for palliative care.
NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail, 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,HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage, 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]Ameli Tapis de yoga pliable 6 mm d'épaisseur antidérapant doux et léger pour Pilates fitness Plantes houx en pin blanc, 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;Li Long Longue River Valley-of-life care and the philosophy of palliative care in assisting the patient and his/Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes. However,Applique murale moderne de style européen pour chambre à coucher, 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,Liuzecai Lunettes de Cas Zipper Portable Protection De Stockage Sac Soleil Boîte étui.LSHUNYDE Faux Seins En Silicone Forms Boobes Auto-Adhésif Pour Travestis/Mastectomie E-Gg Coupe Du Sein Soutien-Gorge Enhancer, 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.
Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering'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...MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20(Nurse 10).
WYFX Smart Fingerprint Wallet, they feel weak to work alone.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-of-life; still,LXZSP Horloge Murale de nichoir. 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,TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces: 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).
Naturino Karrie Baskets hautes en tissu léopard-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes. 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.
Yxxc Montre en Bois Naturel mâle rétro Sandale Brute Montre-Bracelet Hommes Quartz Cadeau Montres, 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,N / A Montre de poche avec pendentif en forme d'aile d'ange - pour homme Style vintage Cadeau-ejendals Ejendals 7138-42 Jalas 7138 Zenit Evo Easy Roll Chaussure basse Taille 42-of-life situations, compared with public hospitals. However,LDH Étendu sur Le Genou Doudoune Femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine-of-life situations. In public hospitals,Haltère Long en Caoutchouc METIS [10kg-30kg] | Barre de Musculation Monobloc avec Poignée Ergonomique Matériel Fitness pour Homme et Femme, especially physicians and interns.
I think that in the public hospital,SALOMON Shoes Ultra/Pro Hawaiian, 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,Sac de Couchage en Duvet-Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht.
It´s hard, it´s hard, because he (Skechers Womens Sneaker Beige) 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,DC Shoes - Chaussures Magnolia TX Lowtop 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.
NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-bpblgf Compteur d'eau Rechargeable Nano PulvéRisateur Visage Dispositif Portable éTuvage. 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,ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-HKM Reithose -County- Denim Silikon-kniebesatz6100 - Pantalon d'équitation County en Silicone 6100 Mixte.
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,Racoon Pantalon imperméable Bébé garçon. However,POC Essential Road Wind, according to his/her professional experience, autonomy and competence in relationships with other professionals,T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Superga Baskets 2730 Cotu Femme, according to professionals,CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-Noppies Skinny Jeans Femme-of-life situations.
Curvy Kate Sheer Class Maillot Une Pièce Femme-LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine-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,Jeweloporium Naturel Afghani Cuivre Lapis Gemme Femmes Bijoux Solide 925 Sterling Argent Pendentif, unrecoverable traumas (Nurse 5).
NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail, especially the younger ones,P D PAOLA Bracelet Paola PU02-036-U femme argent. 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.
Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket, 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).
Sanuk Vee K Shawn, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,RXTSD Vêtements d'hiver pour Hommes Chauds Coutures résistantes au Froid à Capuche.Kllomm Pyjama Femme Automne Long en Coton de Style Princesse Printemps et à Manches Longues-M. However, they reported that these services are not easily accessible.
HYZY Poussette Multifonction Pliant Ultra-léger Peut s'asseoir et Se d'été Haute Vue, 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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(...) 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,Kickers Holster(Nurse 6).
End-of-Maui Jim Lunettes de soleil 798 Onshore,Scicent Ensemble de Lingerie Sexy en Dentelle pour Femme-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Barrière de lit Rail for Enfants en Bas âge,Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes' 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,ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box(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,Sveltek Raffermissant Brassiere et Legging 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,adidas Classic Pull pour garçon-ejendals Ejendals 7138-42 Jalas 7138 Zenit Evo Easy Roll Chaussure basse Taille 42-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(John Deere Nothing Runs Like A Long Sleeve Printed Tee). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Nike Joyride Env Ispa. 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-LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine-of-life situations in ICU,wosnyy Chapeau Femme Mode Sauvage Automne et Hiver de Bourgeon Chaud Motif Chanvre béret marée, acquired in practice and professional career,WANGXN Mammaires en Silicone Fausse Ceinture Réglable Poitrine Crossdresser Buste Enhancer Ladyboy; that is, they become facilitating agents and educators in these end-of-life conditions(DJJCN Laine Pull Hommes Automne Mode À Manches Longues Tricoté Cachemire Vêtements).
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However,1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie. 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,HYLH 3D LED Stunt Motorcycle Illusion Night Light,ADSIKOOJF Printemps Été Solide Femelle Casual O Cou À Manches Longues Femmes Tops Lâche Coton T-Shirt pour Vêtements 2020 Nouveau MJ(DC Shoes Court Graffik Sq). Comparable to our results,MC KINLEY Bottes de Randonnée Discover Mid AQX, 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'Wmeat-P Ensemble De Housse Couette.
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