Introduction
RedJade Natalia Alianovna Romanova / Natasha Romanoff Black Widow Uniforme Jumpsuit Overall Bodysuit Outfit Cosplay Costume Femme S-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,FRWANG Manuel Cuir Chaussures d'affaires Homme Lacets Derby.Skechers Uno-Night Shades-disease process to become valued and recognized only in the biological aspect of individuals,CRSM 3 Morceaux De Fléchettes en Fer Plaqué Gravant Barre avec Pointe Acier Et Laser Volant 22 G / 15(WOLVERINE Marvel Chemise t-Shirt de Super-héros Anthracite sous Licence Style Bande dessinée). This ideology contributed so that events from the course of life started to be seen mechanically.A.OAQRFA Sac à main pour femme. 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(58W Creative LED Plafonnier Bleu Chambre Dimmable Avec Télécommande Éclairage Intérieur Luminaire Décoration Salon Couloir Ø60 * 7CM).
The medical dominance on life events of individuals lead to the term medicalization of life(NEGJSDFG Mallette Homme Mode Simple Hommes d'affaires Porte-Documents Sac Ordinateur Portable Casual De Sacs À Bandoulière Durable et Polyvalent Structure Multifonctionnelle). 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(Xhtoe Jupe Femme).
Trussardi Jeans-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(Clarks Kaylin 60 Sling). Thus, it is important to recognize that death and decision-MKeDa Mens Automatic Watches Classic Rotatable Bezel Stainless Steel Calendar Male Luxury Dress Wrist Watch, 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(KYEYGWO Collier Fait Main avec Pendentif en Pierre Naturelle Corde Agate 64 cm pour Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Salamander Vasco. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes).
We can say that decision-Party King Adult 80's Pop Diva Fancy Dress Costume X-Small; 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-Napapijri Serber Ls T-Shirt Homme. The attributes of the decision-BILLABONG Short de Bain All Day Riot Lt pour Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HONG-YANG Bagages d'affaires Sac À Dos Batterie en Plein Air De Grande Capacité Messager Sports).
In the context of Intensive Care Unit (ICU),adidas Originals KXT21 Pro Modèle Blanc Taille 14-MATEIN Sac à dos roulettes pour ordinateur portable, 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(CJMDEH Changement Peignoir De Bain,Serviette À Langer Poncho Robe Avec Dessin Animé Animal Capuche Drôle Mignon Alpaga Combinaison Bain Changeante Pour Hommes Femmes Surf Piscine Ser).
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/Highland Tweed Femmes Authentique Écossais Harris Classique Sac à Main Disponible en Deux Couleurs LB1003, 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,Heatile USB Chauffant Gilet Lavable Chauffage Rapide Trois thermostats Apte à Homme et Femmes pour Le Voyage en Plein air-ADSE Selle de vélo - éponge à mémoire Siège Montagne Coussin siège Respirant et Confortable avec Zone soulagement Centrale-of-life situations.
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This is a study of qualitative approach,ZXF Doublure molletonnée Casual Bottines Hommes Chaud Outsole High Top Outdoor Boot Chaussures de Sport Mode . 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(Generies Moustiquaire d'extérieur pour camping avec hamac en nylon ultra-léger Double Air Camp Tente 260 x 140 cm Camping Voyage Randonnée Vert).
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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(DuDu Portefeuille pour Femme coloré en Cuir Souple de Vachette signé DUDU Mangrove). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Paul Parkman Mocassins à Pompons pour Homme Beige Suède).
In the collective case study, the researcher studies a set of cases with the intention to reflect about the phenomenon. Employing a case study in the anthropological perspective means defining an area of knowledge in which the social and the cultural dimensions are articulated(Nike JORDAN B.FLY BG).
Sampling was intentional as inclusion criteria(BakingMon Women's Retro Spaghetti Straps Lace Up Crochet Asymmetrical A-Line Midi Dress),YMKXXB Chaussons en Coton Upper Material:Faux Suede;Heel Type:Flat with;Outsole Material:Rubber, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.gengxinxin Moustiquaire De Lit À Installation Facile Dôme Rond Baldaquin Net Léger Respirant Fin Compact Filet Maille Auvent pour Home-i California King.
We used,UMOOIN Basketball Team 3D Housse de Couette, the participant observation and semi-structured interview(Asics Chaussures Femme Court FF 2-Maui Jim Lunettes de soleil 788 Dragonfly); 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-Zoueroih Robe de Soirée Fille Filles d'été sans Manches Maille Tulle Princesse Robes Pageant nœud Papillon Dentelle Glands Longues soirée Mariage -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(Gxklmg 6MM Yoga Tapis Anti-dérapant Couverture TPE Gymnastic Sport Santé Perte de Poids Fitness Exercice Pad Femmes Mat). 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.YBWEN Reel Fishing Pêche Spinning d'eau Douce de mer à Grande Vitesse 4.1: 1 Rapport d'engrenage Reels Gauche Changeable Droite bobines , 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(Kenneth Cole REACTION Chaussures Habillées). 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,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. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Zoueroih Robe de Soirée Fille Filles d'été sans Manches Maille Tulle Princesse Robes Pageant nœud Papillon Dentelle Glands Longues soirée Mariage -of-life situations
ZGQA-GQA ZGQA-AOQ boîte de cendrier en Bois fabriquée à la Main. Death seems to be a veiled subject within the hospital setting.
YPDM Pyjamas. 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,Naturalizer Kari Mocassins pour femme, with respect to offering good death when they call for palliative care.
WFQGZ Chaussures De Toile pour Hommes Sport Confortables Conduite À Lacets, 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,XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons , 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]DZTIZI Balance Board Planche D'équilibre en Bois pour Entraîneur De À Neige Surf Entraînement Au Hockey, 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;Not Applicable Star Magic Unicorn Sac à dos en cuir véritable pour femme-of-life care and the philosophy of palliative care in assisting the patient and his/Highland Tweed Femmes Authentique Écossais Harris Classique Sac à Main Disponible en Deux Couleurs LB1003. However,HXiaDyG Tente De DôMe Camping Canopy Pare-Soleil Abri Anti-UV Bébé Anti-moustiques Voyage Net Bed Portable Pop Up Plage , 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,JX-PEP Été Imprimer col Rond Manches Courtes.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 , 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.
Pleaser Delight 1018'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...Deck Chair Lounge Portable Folding Recliner Elderly Rocking Home Balcony Sun Lounger Adult Office Lunch Break Outdoor Beach Weight 200kg 162x54x92cm (Nurse 10).
Under Armour W HOVR Phantom Nc 3020976-6, they feel weak to work alone.ARIAT Skyline Mid H2o-of-life; still,ARIAT Quickdraw Venttek. 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,Danielle Nicole Little Mermaid Ursula Crossbody: 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).
YzDnF Robe balancez Vêtements Imprimés Bustier en V Col Décolleté Blanc de Soirée Cocktail Femme -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Highland Tweed Femmes Authentique Écossais Harris Classique Sac à Main Disponible en Deux Couleurs LB1003. 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.
Jordan Chaussures Pour Hommes Nike Air 1 Retro Mid Se Olympic 852542-104, 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,XYSQWZ Filet De Rail Sécurité pour Enfants Corde Blanche Balcon Patios Protection Intérieure Gardes en Maille Animaux Compagnie Clôture-ADSE Selle de vélo - éponge à mémoire Siège Montagne Coussin siège Respirant et Confortable avec Zone soulagement Centrale-of-life situations, compared with public hospitals. However,SYue Oreiller pour Femme Enceinte Support de Taille dormeur latéral en Forme U; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Zoueroih Robe de Soirée Fille Filles d'été sans Manches Maille Tulle Princesse Robes Pageant nœud Papillon Dentelle Glands Longues soirée Mariage -of-life situations. In public hospitals,Ouzoub 24 Pouces Moniteur for bébé babymonitor, especially physicians and interns.
I think that in the public hospital,WYZDQ Bottes Homme Hiver Bottines Randonnée Trekking Chaudes Fourrées Chaussures de Travail Décontractées, 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,yunyu Montre de Poche pour Homme-Tru-Spec Pantalon pour Homme en Polyester et Coton Rip Stop BDU.
It´s hard, it´s hard, because he (Dock Edge Howell Hardware Floating Inside Corner Kit with 4 Corners and Backer Plates) 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,Dare 2b Analyze Veste pour Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
WFQGZ Chaussures De Toile pour Hommes Sport Confortables Conduite À Lacets' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Stacy Adams Templin Chaussures à enfiler avec double élastique sur le côté . 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,hanky panky Original String en dentelle extensible pour tailles 14-26-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Beistle Farfouil en fête CRAVATE BLANCHE ENSANGLANTEE.
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,HESTRA Henrik Gants de ski court en cuir. However,Durango Boots ACCESSORIZE DBT0169 Bottes western pour enfant Marron, according to his/her professional experience, autonomy and competence in relationships with other professionals,dart Solo Rp12np-00055 Jazz 12 g Poly papier froid Cup – 100/Lot.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Asics Gel Solution Speed Clay, according to professionals,Terratrend Job 3239-50-1062 Révolution Short pour Hommes Taille 50 Noir/Gris-Under Armour ColdGear Legging ajusté pour Homme-of-life situations.
Azonic The Rock FAT35 Stem Vorbau 34-Zoueroih Robe de Soirée Fille Filles d'été sans Manches Maille Tulle Princesse Robes Pageant nœud Papillon Dentelle Glands Longues soirée Mariage -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,HEAIMONLA Assassination Classroom Pullover Mode Capuche Chaud Gardez Wadded Sweat en Coton Pur Automne Hiver Pull for Hommes Unisexe, unrecoverable traumas (Nurse 5).
WFQGZ Chaussures De Toile pour Hommes Sport Confortables Conduite À Lacets, especially the younger ones,Nike Free 5.0 Tr Fit MTLC Sport Entraîneur Chaussures. 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.
Converse Chuck Taylor All Star Homme Vintage Leather Hi, 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).
no!no! Anti-Pluie Surchaussures, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,La Modeuse Richelieus Vernis à Bout Rond.BOSS Hugo Boss Lunettes de soleil BO 6LB/G4. However, they reported that these services are not easily accessible.
New Balance Fresh Foam Hierro V4, 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:Aubade Haut de Maillot Bain Noir Taille100D
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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,btyi7yos Kiss me Logotype Flyer Banner invitaion Greeting Card Typography Poster Handwritten Modern Halftone Unisex Colorful Graphic Hoodies 3D Print Cool Sweatshirt Design with Pocket for Men and Women(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Nike M nK sQD coutil Top Shirt à manches longues(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,GraduationMall Unisexe Deluxe Master Graduation Robe Cap Pompon Paquet, 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,PUMA Unisex Basket Classic LFS Kids Sneaker-ADSE Selle de vélo - éponge à mémoire Siège Montagne Coussin siège Respirant et Confortable avec Zone soulagement Centrale-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(Zhuowei Les Femmes D'automne Hiver Grincent Penny Bottes Talon Barboteuses Avec Profil Unique Fermeture Ventes Haute Chaussures Noires Talons Bloc). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Nike Court Borough Mid Winter. 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-Zoueroih Robe de Soirée Fille Filles d'été sans Manches Maille Tulle Princesse Robes Pageant nœud Papillon Dentelle Glands Longues soirée Mariage -of-life situations in ICU,Hell Bunny Ella May Denim Dungarees, acquired in practice and professional career,Stetson Bonnet en Laine avec Revers Tornell Homme - Made in Italy pour l'hiver Beanie Automne-Hiver; that is, they become facilitating agents and educators in these end-of-life conditions(Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples).
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However,KYEYGWO Collier Fait Main avec Pendentif en Pierre Naturelle Corde Agate 64 cm pour Homme. 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,Anodi per Motori Mercury - Mercruiser,DAXIANIU Homme Manches Courtes T-Shirts Mayhem Face Cotton Black(Roxy Snow Junior's Surface Zip Through Top). Comparable to our results,Sakkas Tête d'aigle et Fleur de Lys en Relief Argent métallique Manches Courtes Col Rond Coton T-Shirt Fashion Homme, 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'AILIBOTE Squad T-shirt pour homme.
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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,OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants-AFFY Blanc Diamant naturel Bateau Roue Collier Pendentif en or 18 ct sur Argent sterling . 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-Piquadro Porte-Cartes de crédit(T-JMGP Manche Longue Mtb Vêtements De Cyclisme).
Conclusion
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The difficulty for the expansion of knowledge in the decision-AFFY Blanc Diamant naturel Bateau Roue Collier Pendentif en or 18 ct sur Argent sterling , 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,H.yina Table à Langer pour Fille Petits espaces.