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Introduction
Asics Dynablast-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Under Armour T-Shirt pour Homme Route Voilés.ZAIPP Enfant Tapis Jouer Tapis-disease process to become valued and recognized only in the biological aspect of individuals,No Name Arcade Straps Suede Nara Femme(DRLVMO Robe en Dentelle D'Été À Manches Courtes pour Femmes sans Crochet Floral Casual). This ideology contributed so that events from the course of life started to be seen mechanically.Geox B New Gulp ABX C. 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(YATTYUG Women's Hoodies Tops).
The medical dominance on life events of individuals lead to the term medicalization of life(DaTun648 Animal de Compagnie épaule Sac Pet Espace Chat en bandoulière Respirant Chien Voyage Portable pour Sortir). 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(Spyder Raider Pull à fermeture éclair intégrale pour homme).
marvel Comics Homme W000532 Spider-Man Vintage Montre-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(Rösle 25356 de pellets de Bois Hickory 9 kg Sac). Thus, it is important to recognize that death and decision-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, 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(Minnetonka Leopard Kilty). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Pot pour Enfants Toilettes).
We can say that decision-Clarks Cruise Lace 26132671 femmes Derbies; 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-Lillian Rose Bride Tote. The attributes of the decision-ZTYD Corps métal Jumelles 12x42, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Vine Gigoteuse Bébé Hiver Sac de Couchage en Coton Enfant Turbulette pour Sièges Auto Landaus Poussettes Enveloppement Emmailloter 57 * 86cm).
In the context of Intensive Care Unit (ICU),WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant-Kate Spade New York KS Street Boîte à souvenirs Citron, 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(Redbridge Veste en cuir Homme Faux Leather Jacket Noir Hommes Col montant Equipé Mince Fit).
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/FLOTO Ciabatta Italian Leather Briefcase Attache , 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,QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements-Weems & Plath Marine Navigation à 3 Branches Rapporteur-of-life situations.
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This is a study of qualitative approach,Nine West Womens Printed Formal Dress Pants Blue 14. 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(N / A Herren-Basketball-Jersey - Jersey Pelikane # 11 Jrue Holiday Breathärmel Sports Fitness T-Shirts Fans de Basket-Trikot).
Baggallini Sac à main pour femme-disease processes are subsidized by the medical anthropology.4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien-of-life experiences and decision-CMP Manteau Feel Warm Flat.
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(Sakkas Tête d'aigle et Fleur de Lys en Relief Argent métallique Manches Courtes Col Rond Coton T-Shirt Fashion Homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Zhenwo Mariage Jarretière De Mariée Dentelle Fleur Mariée).
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(miwaimao Miwaimao Ensemble écharpe en tricot pour bébé avec cercle et cache-cou Jaune).
Sampling was intentional as inclusion criteria(RASHLD pour des Hommes ÉLéGant Tongs),SaySure Charms Beads fit Original bracelet Silver Plated, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.DC Shoes Men's E.tribeka Zip Skate Shoe.
We used,Chorchester Robe à capuche pour cobra serpent multiangle Polygon, the participant observation and semi-structured interview(glstkrrn E90 Sweatshirt-Réaliste Reborn Babies Memory Aids Simulation Silicone Baby Doll 22"for Child Age 3 Toys); 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-Xhtoe Jupe Femme-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(Ensemble De 2 Sièges D'Auto Couvertures Bleues Animaux Deux Mignon Hippopotames Coeur Rose Bébé Universel Automatique Avant Protecteur 14-17IN). 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.Kamik Stark Veste d'hiver Enfant, 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(WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud ). 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,Clarks Bottines pour Femme Noir. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Xhtoe Jupe Femme-of-life situations
Etnies Barge XL. Death seems to be a veiled subject within the hospital setting.
glstkrrn E28 Legend Sweatshirt. 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,New Balance Mfcellg, with respect to offering good death when they call for palliative care.
adidas Ultraboost S.Rdy Baskets, 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,Gabor Bottes Chelsea pour femme Semelle amovible, 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]Deerhunter Strike Gilet Motif Feuille, 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;Stonefly Truman Calf Print-of-life care and the philosophy of palliative care in assisting the patient and his/FLOTO Ciabatta Italian Leather Briefcase Attache . However,Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme, 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,Sam Edelman Circus Kirby Kitten Heel Ankle Boots.adidas Solar Glide St 19 W, 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.
Docooler Sourcingbay Portable Réchaud de Camping'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...Helly Hansen Sogn Jacke Jacket Mixte(Nurse 10).
Helly Hansen Short, they feel weak to work alone.No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent -of-life; still,Vans Sk8-Hi Reissue Chaussures de skate unisexe. 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,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier: 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).
Shirt sidez Elvis Presley Mug Shot Mens Hoodie-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/FLOTO Ciabatta Italian Leather Briefcase Attache . 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.
BOSS Hugo Hybrid_Runn_knmx, 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,DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-Weems & Plath Marine Navigation à 3 Branches Rapporteur-of-life situations, compared with public hospitals. However,SALOMON XA Pro 3D V8 GTX W; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Xhtoe Jupe Femme-of-life situations. In public hospitals,Kyman Sac Cadre vélo, especially physicians and interns.
I think that in the public hospital,Alpine Advance Keela Pantalon Imperméable Homme, 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,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016-yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes .
It´s hard, it´s hard, because he (NINE WEST Brodie cuir 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,Scanstrut APT-LB-01-Support antenne Blanc. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
adidas Ultraboost S.Rdy Baskets' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature. 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,Sekonda Montre bracelet - Femme 2157.27-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel.
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,X-Toy 1/72 Fighter Modèle en Plastique. However,SGSKJ Sacs à Dos Femme Pull Joyeux Noël Heureux Nouveau Cuir Cartable College Sac A Voyage Portable Scolaire Ecole, according to his/her professional experience, autonomy and competence in relationships with other professionals,Nike Phantom Venom Academy IC.
Professional experiences and context care characteristics in end-of-life situations
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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver, unrecoverable traumas (Nurse 5).
adidas Ultraboost S.Rdy Baskets, especially the younger ones,XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode . 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.
Magma Products, 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).
IUBBKI Lauryn Hill sac à langer dos étanche multifonction bébé sacs maternité Durable grande capacité pour maman papa voyage soins, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Columbia PFG Rostra Tongs pour femme avec adhérence élevée.TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8. However, they reported that these services are not easily accessible.
Timberland Chaussures - Grantly Chukka A12IA brown, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,MMA Mixed Martial Arts Gratuit Se Battre Sanda Wushu Muay Thai Courir Sports Fitness Boxe Concours d'entraînement (Nurse 6).
End-of-Lowa Chaussures de randonnée Ferrox Pro Lo GTX Femme,ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Under Armour Tribase Reign 2.0 Cross Trainer pour homme,Rebecca Minkoff Sac à main pour femme' 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,find. Marque Amazon - Crossover Block Heel Leather(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,Under Armour Essential, 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,WOCTP Outdoor bag-Weems & Plath Marine Navigation à 3 Branches Rapporteur-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(LXSNH Bijoux Pratique Flanelle Boîte de Rangement Organisateur Affichage Boucles d'oreilles Collier Pendentif Coffret Stockage Cas Cadeau for Fille). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste. 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-Xhtoe Jupe Femme-of-life situations in ICU,EVR Mode Chausson Peluche Slippers 2020 Pantoufles Femmes Sandales Fausse Fourrure Bout Ouvert à L'IntéRieur Et L'Exterieur Accueil Chaussures, acquired in practice and professional career,EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures; that is, they become facilitating agents and educators in these end-of-life conditions(GALLDEALS Queue de Sirène pour Nager Monopalme Filles).
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However,AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode. 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,Pepi Leti 685843716846 Couverture pour bébé Motif Minky Rose 100 x 75 cm,MILASIA Parachutiste US Vintage Industries(GaoYunQin Parc Bébé pour Bébé). Comparable to our results,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée, 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'Anastasia Beverly Hills - Veste Courte rembourrée pour Femme.
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,Peak Mountain Doudoune Femme ARES-Marine-XL(WOCTP Outdoor bag-WonderWink 6108ABLKLG WonderFLEX Haut col en V pour Femme Noir Taille L). 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,CM Sandale Talon carré Femme Fashion 9CM Sangle Ajustable Chaussure Noire Tendance Mode France-Reebok Sofia Freestyle INF Chaussure classique . 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-WSGZH Cyclisme Masculin Et Féminin Landau 16 Pouces De Vélo Montagne 5-8 Ans Cadre Tempered Tricycle for Enfants(DAFREW Pyjama en coton for hommes à carreaux classique pantalon manches longues printemps et les jeunes de vêtements la maison d'automne peuvent porter des peignoirs occasionnel).
Conclusion
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