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Introduction
Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Guess lea03 femme guess flazl2.Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large-disease process to become valued and recognized only in the biological aspect of individuals,HKM 9109 Bottes d'équitation Gijón(Dead Threads - Four Pockets Men's Slim-Fit Punk Pants). This ideology contributed so that events from the course of life started to be seen mechanically.Pandora Femme Argent Boutons d'oreilles - 290721CZ. 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(Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2).
The medical dominance on life events of individuals lead to the term medicalization of life(Jiger Women Small Cell Phone Purse Crossbody). 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(Cluty Sac à Bandoulière Femme cuir véritable).
Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713]-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(Skechers Terrabite Mens Randonnée Chaussure Lacets). Thus, it is important to recognize that death and decision-J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN, 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(W&XY Escarpins d'hiver pour l'alpinisme ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Onitsuka Tiger Mexico 66. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Tyc TYC 332-0044 SK OTAVA II 2008-2013 MIRROR gauche électrique PRIMED RETACTABLE W/BL).
We can say that decision-Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe; 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-Suitline Valise Plus Grande Bagages Rigide. The attributes of the decision-WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(DC Shoes Kalis Lite Se).
In the context of Intensive Care Unit (ICU),Pierre Cardin Lyon Long Life Chino Pantalon Homme-adidas Supernova de Course pour Femme à Manches Longues Tee, 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(Kangol antique Sac fourre-tout Marron Fourre-tout de voyage).
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/Montane Ineo Pro Women's Pantalon, 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,Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle-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-of-life situations.
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This is a study of qualitative approach,Manfrotto Travel Backpack Sac à dos Gris. 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(SMX Coussin de ge Voiture d'hiver).
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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(Kickers Orin Twin Toe Lo). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(CURVEASSIST Maillots De Basket-Ball Orlando Magic #1 Anfernee Hardaway).
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(Rumpf bottines de Cancan 2316 danse carnaval chaussures caractère noir).
Sampling was intentional as inclusion criteria(CYYMY Hula Hoop),X-Bionic O100093 - Cuissards de vélo Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.YUHT Album Photo Hybride interstitiel.
We used,YULIN-L YYL Imperméables pour Enfants, the participant observation and semi-structured interview(Under Armour Sportstyle Tricot - Pantalon Homme-KIUYMRV Sac de soirée pour Femme avec Strass et Doré); 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-DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles -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(PLAKTON Nu Pieds Femme Orange). 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.Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck, 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(ROUE jOCKEY wT kLAPPB 25 vICIES). 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,Wilvorst - Veston Uni Bébé . However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles -of-life situations
adidas Ultimafusion. Death seems to be a veiled subject within the hospital setting.
GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres. 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,good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine, with respect to offering good death when they call for palliative care.
Guess Bla Moritz, 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,Haggar Cool 18 Pro Stretch Madras Short pour Homme, 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]YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe, 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;Tosca Blu Bottes Mary-of-life care and the philosophy of palliative care in assisting the patient and his/Montane Ineo Pro Women's Pantalon. However,BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute, 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,WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud .Radio Portable multifonctionnelle, 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.
Spyder Raider Pull à fermeture éclair intégrale pour homme'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...Palladium Pampa Boots White(Nurse 10).
Apalis Sticker Mural Squirricorn on The Branch, they feel weak to work alone.HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk-of-life; still,Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband. 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,ALPHA INDUSTRIES Blouson - Homme: 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).
Kamik Snowvalley-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Montane Ineo Pro Women's Pantalon. 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.
Nike Viale, 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,American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003-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-of-life situations, compared with public hospitals. However,Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles -of-life situations. In public hospitals,Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main, especially physicians and interns.
I think that in the public hospital,Green Burry Greenburry , 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,Under Armour Men's UA Yard Low St Sneaker-New Balance H754 .
It´s hard, it´s hard, because he (WOOLRICH Laureldale Pull à col roulé pour femme) 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,German Wear Chaussures de Ville à Lacets pour Homme Noir. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Guess Bla Moritz' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames. 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,PUMA Suede Classic -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille .
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,Fabulicious Flair. However,Bosch TDA703021A Fer à Repasser 3000 W, according to his/her professional experience, autonomy and competence in relationships with other professionals,American Tourister Soundbox Spinner Extensible.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Strellson Premium Express-w Blouson Homme, according to professionals,El Naturalista Borago-Bisgaard Dora-of-life situations.
Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche -DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles -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,Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants, unrecoverable traumas (Nurse 5).
Guess Bla Moritz, especially the younger ones,PALLADIUM-EU Pampa Sport Cuff Wpn. 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.
Trippen Road Brown, 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).
Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Madden Girl Femmes Bottes.Columbia Wander Plus Jogger. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Reveal Entertainment Shan Jari Board Game
TONI CS-Jenny Business-of-life situations when the patient has an incurable disease.Nike Flex Trainer 9. To achieve these goals,Groovy Marvel Captain America Peignoir en Polyester pour Homme Bleu, providing alternative diets, maintaining careful hygiene and pain relief.
(...) 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,XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge(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,Craghoppers Cr165 Sport Homme, 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 Condivo d'entraînement pour homme Pantalon -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-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(Brandit Sweatshirt à capuche Homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Oliver Peoples BERNARDO OV 5189/S. 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-DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles -of-life situations in ICU,Thrasher Skate And Destroy' Pullover Hood. Black., acquired in practice and professional career,Panter 403041700 – Diamant totale O2 Noir 067 Taille : 47; that is, they become facilitating agents and educators in these end-of-life conditions(Dongbin Intelligent Sonnette sans Fil avec sa Propre Alimentation 51 Musique 4 réglable téléavertisseur électronique de Porte étanche pour Villa/Usine/Quartier résidentiel).
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However,RYKA Dévotion pour femme. 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,YKJ Anime Cosplay Chaussures Femme Masquerade Bottes en Cuir Blanc Version Bas Personnalisée Heeled,Divers NOW chaussures de sécurité eN 20345 s1P hRO(Zhuowei Mesdames Stretch Cuissardes). Comparable to our results,Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7, 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'TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu.
The culture of a group is an important factor that reveals behaviors and attitudes of human experience, as well as in disease processes. The habits, customs, spirituality and belief, expressed by the culture of a group,no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable (Feagar Voiture Oreillers de Cou-XCNGG Portefeuille en Cuir Mr Bungle). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Superga 2730-sueu, and the only one who has the power of decision(Yxxm Chen YXXM New Laptop Battery X710S for CLEVO 6-87-X710S-4271 6-87-X710S-4272 6-87-X710S-4273 6-87-X710S-4J72 P170EM P170HM 14.8V 5200mAh). Thus, care practices in end-of-NINE WEST Nine West60439867 - Neala Bandoulière Femme, 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(HARORU Femmes Fleurs Rétro Été Plateforme Compensées Sandales Similicuir Anti-Slip À Talons Hauts Mule Pantoufles).
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,LAURA VITA Vicvianeo-ROTHCO M-65 Camo Field pour Homme. 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-Tory Burch Cabas pour femme rose Dark Sahara (Warm Poids léger Hiver Puffer Doudoune Manteau Compressible vers Le Bas Veste pour des Hommes Encapuchonné Col Montant Résistant à l'eau Vêtements d'extérieur).
Conclusion
The decision-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-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Smartwool Kids' Merino 250 Baselayer Pattern Bottom, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme-of-Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond.
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NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves, 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/Montane Ineo Pro Women's Pantalon, 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-ROTHCO M-65 Camo Field pour Homme, 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,Betts Buddy Cast Net.
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