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Introduction
Skechers Uno-Night Shades-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,CRSM 3 Morceaux De Fléchettes en Fer Plaqué Gravant Barre avec Pointe Acier Et Laser Volant 22 G / 15.A.OAQRFA Sac à main pour femme-disease process to become valued and recognized only in the biological aspect of individuals,Trussardi Jeans(NOADream Femmes Bout Rond Pompes Cheville Boucle Sangle Talons Hauts Plate-Forme Sexy Mode en Cuir Verni Chaussures habillées Talon Mince Aiguilles). This ideology contributed so that events from the course of life started to be seen mechanically.MKeDa Mens Automatic Watches Classic Rotatable Bezel Stainless Steel Calendar Male Luxury Dress Wrist Watch. 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(Under Armour Stretch Woven 1/2 Zip Jacket Demi-Fermeture éclair Homme).
The medical dominance on life events of individuals lead to the term medicalization of life(Superflybags Sac à Dos En Cuir Véritable modèle TRAPANI 30x33x12cm Made In Italy). 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(ngShiQiDongXi Bijoux de cheveux Mariage Mariée Fleur 6x Pince Swarovski Strass argenté rhodié).
Salamander Vasco-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(METZELDER Valise Souple Basic S Gros Volume Garantie 1 an ). Thus, it is important to recognize that death and decision-Party King Adult 80's Pop Diva Fancy Dress Costume X-Small, 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(Misu Chaussures de Danse pour Homme Noir). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Napapijri Serber Ls T-Shirt Homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(OLYMP Luxor Chemise à col montant Blanc).
We can say that decision-BILLABONG Short de Bain All Day Riot Lt pour Homme; 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-adidas Originals KXT21 Pro Modèle Blanc Taille 14. The attributes of the decision-MATEIN Sac à dos roulettes pour ordinateur portable, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(O'NEILL Short de marche hybride extensible résistant à l'eau pour homme).
In the context of Intensive Care Unit (ICU),Highland Tweed Femmes Authentique Écossais Harris Classique Sac à Main Disponible en Deux Couleurs LB1003-Heatile USB Chauffant Gilet Lavable Chauffage Rapide Trois thermostats Apte à Homme et Femmes pour Le Voyage en Plein air, 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(Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm).
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/ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode , 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,Posterlounge Tableau en Verre Acrylique 60 x 90 cm: Work Hard-Etnies Barge XL-of-life situations.
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This is a study of qualitative approach,Belleashy Boîte de Montre Montres en Bois d'affichage verrouillables Rangement avec Couvercle Verre 6 Machines à sous Brown Couleur pour Hommes Femmes Collection Boxes. 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(Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage).
Mustang 2853-520-disease processes are subsidized by the medical anthropology.YMKXXB Chaussons en Coton Upper Material:Faux Suede；Heel Type:Flat with；Outsole Material:Rubber-of-life experiences and decision-gengxinxin Moustiquaire De Lit À Installation Facile Dôme Rond Baldaquin Net Léger Respirant Fin Compact Filet Maille Auvent pour Home-i California King.
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(Tom Ford FT0609 01C 54 Montures de lunettes). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(ARIAT Chaussures de Travail Catalyst Thunder H2O Comp Toe Western Hommes).
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(Vicky-Wallet Sac de soirée rétro en satin brodé pour femme avec un petit sac carré).
Sampling was intentional as inclusion criteria(YURU Chaussures D'équitation Antidérapantes De Vélo Route Bikiying en Plein Air pour Adultes Unisexe),UMOOIN Basketball Team 3D Housse de Couette, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Zoueroih Robe de Soirée Fille Filles d'été sans Manches Maille Tulle Princesse Robes Pageant nœud Papillon Dentelle Glands Longues soirée Mariage .
We used,YBWEN Reel Fishing Pêche Spinning d'eau Douce de mer à Grande Vitesse 4.1: 1 Rapport d'engrenage Reels Gauche Changeable Droite bobines , the participant observation and semi-structured interview(Jiahe Angle Ailes imprimées en 3D Non tissées Blanches Noires de Halloween-Jack Wolfskin Whirlwind Veste Homme); 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-Landaus for Les Enfants Rocking Horse Trikes Tricycle Enfant en Bas âge Vélo Tout-Petit extérieur bébé vélo intérieur et 1 Ans à 5 Convient des Fournitures pour-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(DazzlingRock Collection 0). 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.Gabor Femme Bottines, 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(Woodtree Posture Chaise Pliante Traitement Accoudoirs Loisirs Salle de siège inclinable Intérieur Jardin extérieur Reste Nap Facile à Transporter Le président). 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,ZGQA-GQA ZGQA-AOQ boîte de cendrier en Bois fabriquée à la Main. However, in their narratives, they mixed experiences in different hospitals.
YPDM Pyjamas-Etnies Barge XL-of-life situations and that will be presented below.
The cultural context of ICU: decision-Landaus for Les Enfants Rocking Horse Trikes Tricycle Enfant en Bas âge Vélo Tout-Petit extérieur bébé vélo intérieur et 1 Ans à 5 Convient des Fournitures pour-of-life situations
Naturalizer Kari Mocassins pour femme. Death seems to be a veiled subject within the hospital setting.
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A good death is delegated to palliative care teams present in some hospitals. However,XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons , with respect to offering good death when they call for palliative care.
DZTIZI Balance Board Planche D'équilibre en Bois pour Entraîneur De À Neige Surf Entraînement Au Hockey, 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,Not Applicable Star Magic Unicorn Sac à dos en cuir véritable 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]HXiaDyG Tente De DôMe Camping Canopy Pare-Soleil Abri Anti-UV Bébé Anti-moustiques Voyage Net Bed Portable Pop Up Plage , 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;JX-PEP Été Imprimer col Rond Manches Courtes-of-life care and the philosophy of palliative care in assisting the patient and his/ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode . However,ZLSANVD 22 pouces cruiser Conseil complète Longboard Édition spéciale y compris T-outils avec haute vitesse ABEC Roulements Chute-par les conseils de patinage Cruiser for enfants garçons jeunes , 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,Pleaser Delight 1018.Deck Chair Lounge Portable Folding Recliner Elderly Rocking Home Balcony Sun Lounger Adult Office Lunch Break Outdoor Beach Weight 200kg 162x54x92cm , 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.
Under Armour W HOVR Phantom Nc 3020976-6'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...ARIAT Skyline Mid H2o(Nurse 10).
ARIAT Quickdraw Venttek, they feel weak to work alone.Danielle Nicole Little Mermaid Ursula Crossbody-of-life; still,YzDnF Robe balancez Vêtements Imprimés Bustier en V Col Décolleté Blanc de Soirée Cocktail Femme . 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,Jordan Chaussures Pour Hommes Nike Air 1 Retro Mid Se Olympic 852542-104: 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).
XYSQWZ Filet De Rail Sécurité pour Enfants Corde Blanche Balcon Patios Protection Intérieure Gardes en Maille Animaux Compagnie Clôture-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode . 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.
SYue Oreiller pour Femme Enceinte Support de Taille dormeur latéral en Forme U, 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,Ouzoub 24 Pouces Moniteur for bébé babymonitor-Etnies Barge XL-of-life situations, compared with public hospitals. However,WYZDQ Bottes Homme Hiver Bottines Randonnée Trekking Chaudes Fourrées Chaussures de Travail Décontractées; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Landaus for Les Enfants Rocking Horse Trikes Tricycle Enfant en Bas âge Vélo Tout-Petit extérieur bébé vélo intérieur et 1 Ans à 5 Convient des Fournitures pour-of-life situations. In public hospitals,yunyu Montre de Poche pour Homme, especially physicians and interns.
I think that in the public hospital,Tru-Spec Pantalon pour Homme en Polyester et Coton Rip Stop BDU, 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,Dock Edge Howell Hardware Floating Inside Corner Kit with 4 Corners and Backer Plates-Dare 2b Analyze Veste pour Homme.
It´s hard, it´s hard, because he (Stacy Adams Templin Chaussures à enfiler avec double élastique sur le côté ) 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,hanky panky Original String en dentelle extensible pour tailles 14-26. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
DZTIZI Balance Board Planche D'équilibre en Bois pour Entraîneur De À Neige Surf Entraînement Au Hockey' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Beistle Farfouil en fête CRAVATE BLANCHE ENSANGLANTEE. 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,HESTRA Henrik Gants de ski court en cuir-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Durango Boots ACCESSORIZE DBT0169 Bottes western pour enfant Marron.
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,dart Solo Rp12np-00055 Jazz 12 g Poly papier froid Cup – 100/Lot. However,Asics Gel Solution Speed Clay, according to his/her professional experience, autonomy and competence in relationships with other professionals,Terratrend Job 3239-50-1062 Révolution Short pour Hommes Taille 50 Noir/Gris.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Under Armour ColdGear Legging ajusté pour Homme, according to professionals,Azonic The Rock FAT35 Stem Vorbau 34-HEAIMONLA Assassination Classroom Pullover Mode Capuche Chaud Gardez Wadded Sweat en Coton Pur Automne Hiver Pull for Hommes Unisexe-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,Converse Chuck Taylor All Star Homme Vintage Leather Hi, unrecoverable traumas (Nurse 5).
DZTIZI Balance Board Planche D'équilibre en Bois pour Entraîneur De À Neige Surf Entraînement Au Hockey, especially the younger ones,no!no! Anti-Pluie Surchaussures. 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.
La Modeuse Richelieus Vernis à Bout Rond, 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).
BOSS Hugo Boss Lunettes de soleil BO 6LB/G4, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,New Balance Fresh Foam Hierro V4.ESDY Ensemble de sous-Vêtements Thermiques Homme. However, they reported that these services are not easily accessible.
Sakkas Tête d'aigle et Fleur de Lys en Relief Argent métallique Manches Courtes Col Rond Coton T-Shirt Fashion Homme, 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,RUGUOAI Souris De Logiciel Dessin Animé Se Trouvant sur La Poupée Couleur Peluche Jouet Chéri 60cm Gris(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,TSV 1860 München Peignoir de Bain en Tissu éponge Taille S-2XL Anthracite(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,Nike Court Borough Mid Winter, 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,Columbia Granite Mountain Veste polaire pour homme-Etnies Barge XL-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(Brooks pour Femme Juno Soutien-Gorge de Sport). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Frankv Shorts de Planche pour Hommes. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,DAXIANIU Homme Manches Courtes T-Shirts Mayhem Face Cotton Black. 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,AILIBOTE Squad T-shirt pour homme,Cavi telecomando Sea Star CC330(ZHLZH Balance de précision Laboratoire). Comparable to our results,MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 41 EU, 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'SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage.
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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,LIZONGFQ Lit De Nid Bébé Amovible Ou La Taille d'un Enfant en Bas Âge-GJ Sac à bandoulière - Femme de Plage Portable Fleurs Crossbody Bag Leisure Sacs Voyage Mode Lady . 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-zxcvg Sac À Dos Femmes De Bande Dessinée Joli Chat Imprimé Sacs Fille en Cuir PU Beau D'École La Mode Féminine Petit(TANGNIU One Piece T-Shirt Unisexe Été Impression 3D À Manches Courtes Homme Décontracté Respirant Chemise Haut Cadeau pour Enfants).
Conclusion
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Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier, 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/ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode , 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-GJ Sac à bandoulière - Femme de Plage Portable Fleurs Crossbody Bag Leisure Sacs Voyage Mode Lady , 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,Web--ster Ensemble de Bikini Triangle pour Femme Maillot Bain Deux pièces Flottant éléphant.
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