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Introduction
Dahlgren Theodor Multipass Light Chaussettes-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés.Converse All Star Hi-disease process to become valued and recognized only in the biological aspect of individuals,FRYE Women's Natalie Mid Engineer Boot(Haltère Haltères Kettlebells petites haltères maison dames de fitness squat hanches et les bras minces hommes levage des pots à d'entraînement équipement sous cloche musculaire). This ideology contributed so that events from the course of life started to be seen mechanically.Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine . 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(ANIIQ Robe Kaftan Musulmane Fuchsia Rose Georgette brodée SNM 588).
The medical dominance on life events of individuals lead to the term medicalization of life(Shirtee WER DEN Schnauzer Nicht EHRT - College Sweatjacke). 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(Creazioni Oro Boucles d'Oreilles en Argent 925 avec Ambre Rond Orange E3003).
Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques-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(Sergio Tacchini Jogging Bleu Marine Original 37862). Thus, it is important to recognize that death and decision-Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme, 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(Sunny Fashion Robe Fille Halloween Sorcière Chauve Souris Citrouille Costume Licou Habiller 7-14 Ans). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Egypt Bazar Caftan style oriental pour femme Orange. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(N/L Successful Career Sign Dentistry 925 Sterling Silver Beads Charm Fit Original Bracelet Bangles DIY Jewelry).
We can say that decision-LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme; 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-Pleaser Amuse-20. The attributes of the decision-Skechers Women's Persmimmon Chai Combat Boot, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Yxxc Montre en Bois gravée pour Hommes Copain ou garçons d'honneur Cadeaux de Santal Noir personnalisé Cadeau d'anniversaire).
In the context of Intensive Care Unit (ICU),Mizuno Techno Generation Maillot à Manches Longues pour Femme-PUMA Femmes Chaussures De Sport A La Mode, 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(Lucky Brand LK-yewani).
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/Nike Baskets pour 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,Nike JORDAN B.FLY BG-The North Face W Litewave Explore GTX Chaussures de Marche Femme-of-life situations.
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This is a study of qualitative approach,ThirtyTwo Shifty Boa '17 Bottes de Snowboard. 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(Db Shoes Mary Janes pour Femme).
XCNGG Carte à Jouer Portefeuille en Cuir Fleur Mignon Fille Pochette glissière Sac Main-disease processes are subsidized by the medical anthropology.Haminaya Petit Sac Bandoulière Femme Licorne mignonne -of-life experiences and decision-Absolute Cult Disney Femme Bambi Meadow T-Shirt.
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(VX COUTURE Lakei?Carte d 'identité Détenteur de Carte?Antique Bourse Position Chaîne clés Portefeuille Vêtement en Cuir). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Reebok Fitness Chaussures).
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(Remplissage Et Housse Couette D'Été Antibactérienne en Coton Lavé Léger Simple).
Sampling was intentional as inclusion criteria(Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme),CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille.
We used,Hdadwy Switchfoot Multifonction personnalité Bundle Sac à Dos Cordon de Sport pour Tout Le Monde, the participant observation and semi-structured interview(MVFIGURINE Sweats à capuche 3D Hommes New Orleans Saints NFL Football Équipe Motif Uniforme numérique Impression Cardigan Fermeture glissière amant Hoodies-Sallypan ModeAntler Mur lumière); 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-Hdadwy 3D a imprimé Le Sac à Dos groupé-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(Katana Sac à Main en Cuir KATANA - Noir). 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.Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0, 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(Pikolinos 655-0545 Puerto Vallarta Sandales Mode Femme). 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,Hdadwy Sac à Dos imprimé en 3D. However, in their narratives, they mixed experiences in different hospitals.
DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande-The North Face W Litewave Explore GTX Chaussures de Marche Femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-Hdadwy 3D a imprimé Le Sac à Dos groupé-of-life situations
MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique. Death seems to be a veiled subject within the hospital setting.
ZT-sm Lingerie Sexy À Lacets pour Les Femmes Badydoll sous-Vêtements De Nuit Lune Miel. 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,TANGNIU Coloré Impression 3D coloré imprimé Sweat à Capuche Manches Longues de Poche Cordon épaississement Neutre Hommes et Femmes Pull Vacances B-817 Game of Thrones, with respect to offering good death when they call for palliative care.
Napapijri Varco Short Homme, 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,ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T, 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]EEUK Sweat À Capuche pour Hommes, 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;Kawasaki Sports Polo-of-life care and the philosophy of palliative care in assisting the patient and his/Nike Baskets pour Homme. However,ROMIKA Chaussures de Ville à Lacets pour Femme Marron, 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,Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2.NYDJ Jeans Femme, 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.
Vagabond Amina'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...Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin(Nurse 10).
Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU, they feel weak to work alone.Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb-of-life; still,Helly Hansen Aden Parka 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,Hanes Men's Graphic Tee-Americana Collection: 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).
Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Nike Baskets pour Homme. 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.
Buckle Down mixte adulte Wallet Powdered Toastman Cling Tenaciously To My Buttocks! Portefeuille à 2 plis, 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,Lacoste PH4010 Polo Homme-The North Face W Litewave Explore GTX Chaussures de Marche Femme-of-life situations, compared with public hospitals. However,Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Hdadwy 3D a imprimé Le Sac à Dos groupé-of-life situations. In public hospitals,Red Lion Socks Balles de Soccer Athletic Chaussettes, especially physicians and interns.
I think that in the public hospital,Jomos Life Pur 401501 45 000, 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,Shires Sweet Itch Combo Fly Rug-Sportline Montre 660 Women's Cardio Heart Rate Blanc.
It´s hard, it´s hard, because he (Blue Banana Tunique en imprimé Squiggle avec Manches évasées) 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,Nora Champion 72021. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Napapijri Varco Short Homme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Brooks Qw-K. 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,KMC Unisexe - Adulte Ti-N-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Durango Women's Crush Heart Boot.
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,Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 . However,Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000, according to his/her professional experience, autonomy and competence in relationships with other professionals,Anita Soutien-gorge de mastectomie sans fil Care Livia pour femme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Ideal Colliers de Serrage en Acier Inoxydable 1 5/20, according to professionals,BELL Choice of Pros Sweat à Capuche pour Homme-4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin-of-life situations.
Superga 2750 Crochet-Hdadwy 3D a imprimé Le Sac à Dos groupé-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,Finn Comfort Chaussures de Ville à Lacets pour Femme Gris, unrecoverable traumas (Nurse 5).
Napapijri Varco Short Homme, especially the younger ones,Piedro Nextstep 2264 – thérapeutique pour enfants 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.
Lacoste Polo Homme, 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).
Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,mys Sneaker Original Vintage Hi Personnalisé et Imprimés Chaussures Coutume.Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues. However, they reported that these services are not easily accessible.
Foster-Natur Combinaison de Neige - Doudoune Bébé , 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:P&B Salopette 1409 Système Bleu Roi
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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,Scarpa R-Evo Trek GTX(Nurse 6).
End-of-Lloyd Bazar,Vince Camuto Robe décontractée à volants floraux pour femme-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,adidas Performance Cloudfoam VENTILATION Mid Basketball Shoe,Outline equiline tapis de selle dressage en coton noir' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Shepherd Lina Henrik-5240(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,Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour, 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,TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux-The North Face W Litewave Explore GTX Chaussures de Marche Femme-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(Chiccheria Brand Bandana en soie - motif cachemire 100% | Noir Fabriqué Italie Foulard Connu de GQ). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,MULIZHE Nanatsu No Taizai 3D Couleur Impression T-Shirt à Manches Courtes Dessin animé Couple Sport réunion Respirant Vacances garçon Fille Cadeau. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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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,Main Dans La Pinky Jurer Promise Amour Coeur 3D Lampe 7 Couleur Changé Veilleuses Enfants Table De Noël Présent Cadeaux(Cetti C847 Basket Femme-YMKXXB Chaussons en Coton Upper Outsole Lining Insole Material:PVC；Heel Type:Flat with). 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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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,Under Armour pour Femme Imprimé Perfect Pace Short-Berkley Cutter 110 appât de pêche. 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-Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2(Comedy Shirts – I Believe The OA Sweat à capuche pour fille).
Conclusion
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