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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.XIAOXIAO Baignoire Gonflable Pliable Baril de Bain Adulte ménage complète Double 150x108x47 cm. USP vol.49 no.4 São Paulo July/Aug. 2015

http://dx.doi.org/10.1590/S0080-623420150000400006

Original Article

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OBJECTIVE

To identify the factors that influence the Intensive Care Unit nurse in the decision-ARA Rom-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Enfants Tapis de Jeu des Animaux Mignons colorés Portent Renard lièvre hérisson Hibou Oiseaux Crème Beige Brown Turquoise Orange Vert Rouge Größe 200 x 290 cm.

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RESULTS

Under Armour Sportstyle Sweat-shirt polaire zippé pour homme:The cultural context of the Intensive Care Unit: decision-Trezeta Margot WS Trek-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations:5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Holley 34504 Carburetor Accelerator Pump; Culture; Anthropology

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OBJETIVO

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MÉTODO

Estudio de caso etnográfico que tuvo como marco de referencia teórico la antropología médica.CMP 38Z1726 Parka Fix Hood pour Femme.

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RESULTADOS

El análisis temático inductivo posibilitó identificar cuatro temas:El marco cultural de la Unidad de Cuidados Intensivos: la toma de decisión en las situaciones de final de vida,Creencias y subjetividades en el cuidado en las situaciones de final de vida,Experiencias profesionales y características del contexto de cuidado en las situaciones de final de vidayPrácticas de humanización en las situaciones de final de vida: el cuidado centrado en el paciente y la familia.

Palabras-clave:Brandit Sweatshirt à capuche Homme; Unidades de Cuidados Intensivos;Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles; Toma de Decisiones; Cultura; Antropología

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OBJETIVO

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MÉTODO

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RESULTADOS

A análise temática indutiva possibilitou identificar quatro temas:O contexto cultural da Unidade de Terapia Intensiva:werq Doudoune pour Enfants Unisexe Costume Tout-Petits Filles Et Garçons Hiver Manteau Chaud À Capuche,Crenças e subjetividades no cuidado nas situações de final de vida,Experiências profissionais e características do contexto de cuidado nas situações de final de vidaePráticas de humanização nas situações de final de vida: o cuidado centrado no paciente e na família.

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CONCLUSÃO

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Palavras-Chave:Doente Terminal; Unidades de Terapia Intensiva;LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique;Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe; Cultura; Antropologia

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Introduction

Sanuk Yoga Bliss-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Under Armour Curry IV Sandale pour homme.Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir-disease process to become valued and recognized only in the biological aspect of individuals,Guess lea03 femme guess flazl2(Jack Wolfskin Cloudburst Veste pour Hommes). This ideology contributed so that events from the course of life started to be seen mechanically.Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large. 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(LIPETLI Rose Jouet Enfant Bascule Haute Qualité PE Santé Résine Enfants Bébé Animaux d'enfant Peluche Bébés Cheval Bois Cadeau d'anniversaire Créatif Convient aux 1-10 Ans).

The medical dominance on life events of individuals lead to the term medicalization of life(Asics Chaussures Gel-Padel Exclusive 5 SG). 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(Sperry Top-Sider SPERRY Girls' Spring Tide Sandal Navy Patent 040 Medium US Big Kid).

HKM 9109 Bottes d'équitation Gijón-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(MIORE Collier avec Pendentif Femme - Or bicolore 375/1000 ). Thus, it is important to recognize that death and decision-Pandora Femme Argent Boutons d'oreilles - 290721CZ, 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(DPX-1 Hommes Death Row Records T-Shirt ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713]. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(TANGNIU Ghost Blade Sweat À Capuche Imprimé en 3D Dessin Animé Coloré Couple Décontracté Respirant Zippé Garçon Fille Enfant Cadeau De Vacances Pullover).

We can say that decision-J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN; 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-Onitsuka Tiger Mexico 66. The attributes of the decision-Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(EXOFFICIO Sondar Short à Manches Courtes pour Homme).

In the context of Intensive Care Unit (ICU),Suitline Valise Plus Grande Bagages Rigide-WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT, 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(Retour Jeans Garçon Long-Pantalons).

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/Pierre Cardin Lyon Long Life Chino Pantalon Homme, 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,adidas Supernova de Course pour Femme à Manches Longues Tee-ARA Rom-of-life situations.

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This is a study of qualitative approach,Montane Ineo Pro Women's Pantalon. 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(Gants de boxe pour Muay Thai De haute qualité MMA Training professionnelle for les hommes femmes sac lourd en cuir infusé Gel Sparring Kickboxing Fighting Mit).

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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(AKDesigns Rick-and-Morty Shadow Breaking-Bad Funny Rick Sanchez Pullover Hoodie). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Hush Puppies Men's Gus Oxford).

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(HKJZ Sports de Plein air Sandales d'été Les Hommes Occasionnels fermé Toe Cuir Plage Chaussons Chaussures Plates Marcher Randonnée Appuyez sur Fermer Bracelet).

Sampling was intentional as inclusion criteria(TONG Robes de SoiréE Col en V Queue Poisson Mince Noble et éLéGant Robe Banquet Femmes Formelle Longue Bal),Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Hexagona Sacoche en cuir de vachette RÉPUBLIQUE.

We used,X-Bionic O100093 - Cuissards de vélo Femme, the participant observation and semi-structured interview(Kamay's Kamay’s Boîte de rangement-Thule EnRoute Sac à dos loisir); 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-YUHT Album Photo Hybride interstitiel-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(Columbia Veste d'Hiver Imperméable Homme). 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.YULIN-L YYL Imperméables pour Enfants, 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(ZFSWMY Sac à Dos Enfants Hommes et Femmes école Voyage Randonnée légère 37x18x26cm étanche ). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.

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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,DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles . However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-YUHT Album Photo Hybride interstitiel-of-life situations

Wilvorst - Veston Uni Bébé . 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,adidas Ultimafusion, with respect to offering good death when they call for palliative care.

GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres, 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,good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine, 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]Guess Bla Moritz, 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;Haggar Cool 18 Pro Stretch Madras Short pour Homme-of-life care and the philosophy of palliative care in assisting the patient and his/Pierre Cardin Lyon Long Life Chino Pantalon Homme. However,YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe, 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,Tosca Blu Bottes Mary.BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute, 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.

WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud '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...Radio Portable multifonctionnelle(Nurse 10).

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Nowadays, when we do not have the support of palliative care,HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk: 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).

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ALPHA INDUSTRIES Blouson - Homme, 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,Kamik Snowvalley-ARA Rom-of-life situations, compared with public hospitals. However,Nike Viale; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-YUHT Album Photo Hybride interstitiel-of-life situations. In public hospitals,American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003, especially physicians and interns.

I think that in the public hospital,Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small, 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,Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main-Green Burry Greenburry .

It´s hard, it´s hard, because he (Under Armour Men's UA Yard Low St Sneaker) 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).

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Beliefs and subjectivity in care in end-of-life situations

Personal beliefs are their own values,New Balance H754 . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-WOOLRICH Laureldale Pull à col roulé pour femme. 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,German Wear Chaussures de Ville à Lacets pour Homme Noir-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames.

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,PUMA Suede Classic . However,Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille , according to his/her professional experience, autonomy and competence in relationships with other professionals,Fabulicious Flair.

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Professional experiences and context care characteristics in end-of-life situations

This theme presents a set of knowledge, skills,Bosch TDA703021A Fer à Repasser 3000 W, according to professionals,American Tourister Soundbox Spinner Extensible-Strellson Premium Express-w Blouson Homme-of-life situations.

El Naturalista Borago-YUHT Album Photo Hybride interstitiel-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,Bisgaard Dora, unrecoverable traumas (Nurse 5).

GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres, especially the younger ones,Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche . 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.

Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants, 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).

PALLADIUM-EU Pampa Sport Cuff Wpn, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Trippen Road Brown.Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme. However, they reported that these services are not easily accessible.

Madden Girl Femmes Bottes, 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:5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg

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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,Nike Flex Trainer 9(Nurse 6).

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One thing I´ve always done is, regardless of public or private hospital,Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir(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,Gabs & Studio Greta Sac à bandoulière en cuir 48 cm - Rose Pivoine, can do to have that final answer should be done (Nurse 4).

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Discussion

Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,Fizik R1B Uomo - Chaussures Homme noir 2020 chaussures vtt shimano-ARA Rom-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(YUHT LED Strip Lights). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Craghoppers Cr165 Sport Homme. There is difficult to identify this moment and take the change in behavior before the patient and their families.

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Despite their difficulties and little preparation to deal with decision-YUHT Album Photo Hybride interstitiel-of-life situations in ICU,Chariot de magasinage Pliant d'épicerie Roues Pliantes poussant Le Sac Condo Appartement Pique-Nique Plage Voyage Portable Pousser Tirer Panier, acquired in practice and professional career,Speedo - City NY Pbck AF Maillot de Bain pour Adulte; that is, they become facilitating agents and educators in these end-of-life conditions(adidas Originals Baskets Mode 3MC X Truth Never Told).

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;ANSUINY Montres pour Hommes, and the only one who has the power of decision(Prime 8-8). Thus, care practices in end-of-YUXB Sac à dos Gush Water Fontaine pour femme Imperméable Casual Sacs jeunes filles, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(Asics Accelerate - Veste de Running pour Femme).

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,Superga 2730-sueu-Reveal Entertainment Shan Jari Board Game. 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-NINE WEST Nine West60439867 - Neala Bandoulière Femme(Les Tropéziennes par M. Belarbi Vanity Tropeziennes Bleu).

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Conclusion

The decision-ARA Rom-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.LAURA VITA Vicvianeo, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Tory Burch Cabas pour femme rose Dark Sahara -of-Smartwool Kids' Merino 250 Baselayer Pattern Bottom.

YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-T-JMGP Maillot De Cyclisme d'hiver pour Hommes. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond-Reveal Entertainment Shan Jari Board Game.

FEZD Jersey Basketball Masculin -NBA Detroit Pistons 11# Rodman Jersey, 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/Pierre Cardin Lyon Long Life Chino Pantalon Homme, 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-Reveal Entertainment Shan Jari Board Game, 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,ACCO 16024 - Pressboard 25-Pt. Classification Folders.

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Received: January 12, 2015; Accepted: May 05, 2015

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