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Introduction
axley Proud Peacock Basic T-shirt à manches courtes pour femme Noir-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Hell Bunny Ella May Denim Dungarees.Stetson Bonnet en Laine avec Revers Tornell Homme - Made in Italy pour l'hiver Beanie Automne-Hiver-disease process to become valued and recognized only in the biological aspect of individuals,Gas Monkey Garage Wrench Label Affe Aufkleber T-Shirt (Wuqiang 18cm tapota 3D Imprimer Jupiter Lampe). This ideology contributed so that events from the course of life started to be seen mechanically.Columbia Fall Pine Washed Crew Chemise Femme. This culminated in the establishment of the biomedical model; thus, medicine has become indifferent to the trajectories of individuals, to their will, and to their anguish and death(Sekonda Montre bracelet - Femme 2157.27).
The medical dominance on life events of individuals lead to the term medicalization of life(Esprit Manteau Femme). 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(Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet).
Feagar Voiture Oreillers de Cou-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(ZUOZUO Ceinture Homme Boucle Automatique Noir Longue). Thus, it is important to recognize that death and decision-TropicalLife iRoad Mini sac à main New York Statue de la Liberté Sac avec bandoulière pour femme et fille, 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(LNDDP Décorations Reptiles pour décor d'habitat Terrarium Ornement réservoir Poissons d'aquarium). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Ericos Montre Bracelet Liberty Statue Personnalisée Design Quartz Analogique Cadran Or Classique Cuir Femme Homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(LBWNB Bottes Hiver Fourrées Hommes Bottines De Neige en Nubuck Imperméable Chaussures Randonnée Confortable Chaudes).
We can say that decision-KYEYGWO Collier Fait Main avec Pendentif en Pierre Naturelle Corde Agate 64 cm pour Homme; 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-Anodi per Motori Mercury - Mercruiser. The attributes of the decision-DAXIANIU Homme Manches Courtes T-Shirts Mayhem Face Cotton Black, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Miwaimao Lot de 2 chaises pêche).
In the context of Intensive Care Unit (ICU),AILIBOTE Squad T-shirt pour homme-Cavi telecomando Sea Star CC330, 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(Skechers Femmes Chaussures De Sport A La Mode).
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/SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage, 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,Timberland Jayne Bottes de confort pour femme 15 cm-WPQBS Porte-clés-of-life situations.
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This is a study of qualitative approach,TianMai Nouvelles Maillots de Bain Musulman Femmes Filles Musulmanes Modeste Beachwear Couverture Complète Islamique Burqini Burkini Hijab Muslim Swimwear. 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(Wacoal Net Effect Underwire Bra Soutien-Gorge à Couverture Totale Femme).
Failsworth Casquette Plate en Harris Tweed à Protège-Oreilles Oban Anthracite-disease processes are subsidized by the medical anthropology.PYF Short en Spandex Coton lâche et Doux Noir Bleu décontracté Cours d'exécution été Dames Shorts vêtements d'entraînement XXL-of-life experiences and decision-Maillot Cyclisme Homme Été Respirant Vêtements Ensembles Manche Courte Velo Short de Vélo pour Vetement Route .
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(GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(MHZ Ecrin boîtier de Montre avec Amovible Oreiller Support Couvercle en Verre).
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(Adidas Condivo d'entraînement pour homme Pantalon ).
Sampling was intentional as inclusion criteria(HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu),dadilei Fashion Loisirs Business Wild Luxury Ceinture Homme Boucle en métal 125 cm Noir, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.DFDLNL Leggings de Jogging Femmes Taille Large Pantalon Yoga Sport serré Levage des Fesses Respirant Quotidien Fitness Legging.
We used,Chiba pour Homme Lake Tahoe Gants, the participant observation and semi-structured interview(Filet de sécurité pour Enfants Cadres d'escalade Protection Enfants-Ajvani Femmes Plat Courroie de Cheville Strappy t-Bar Soir Diamante Sandale Taille); 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-SPORTUBE Series 1 Platinum Deluxe Étui à snowboard-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(Jockey Leggings Femme). 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.Falke 14435 Airport Lot de 6 paires chaussettes pour homme - Gris 45, 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(ACCEY 3D stéréo haut de gamme européen bleu chambre papier peint américain rétro luxe salon TV fond ménage A1917). 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,Nike M NKCT Jacket Stadium Veste Homme. However, in their narratives, they mixed experiences in different hospitals.
Kipling Kassandra S-WPQBS Porte-clés-of-life situations and that will be presented below.
The cultural context of ICU: decision-SPORTUBE Series 1 Platinum Deluxe Étui à snowboard-of-life situations
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Prana Summit Tall Pantalon pour Femme. 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,OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants, with respect to offering good death when they call for palliative care.
Piquadro Porte-Cartes de crédit, 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,LIZONGFQ Lit De Nid Bébé Amovible Ou La Taille d'un Enfant en Bas Âge, 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]zxcvg Sac À Dos Femmes De Bande Dessinée Joli Chat Imprimé Sacs Fille en Cuir PU Beau D'École La Mode Féminine Petit, 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;FRWANG Hommes Chaussures Cuir Brogue Lacets-of-life care and the philosophy of palliative care in assisting the patient and his/SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage. However,CryGtal&lxwK des Lunettes de Soleil Sunglasses Vintage Carrées Surdimensionnées Cadre Femmes Mode Grandes Transparentes Femme Lentille Livraison Gratuite, 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,Glqwe Sac à Dos étanche pour Ordinateur Portable.Punk Rave Gothique Hommes Noir Épais Moyen Style Steampunk Manteau Long Vintage, 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.
H.yina Table à Langer pour Fille Petits espaces'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...Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier(Nurse 10).
Web--ster Ensemble de Bikini Triangle pour Femme Maillot Bain Deux pièces Flottant éléphant, they feel weak to work alone.Puma 2020 Pwrshape Solid Woven Skirt 18" Jupe-Short Femme-of-life; still,huatongxin The Original Founding Fathers Men's Hoodie Sweatshirt. 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,Cheval à bascule Enfants en Plastique Bébé de Troie Year Old Cadeau Jouet Bleu Rocking Chair Xuan - Worth Having: 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).
Plush-NH Lit pour Chien 5 Rond Couleur Pet Lounger Coussin Moyennes Grands Chiens Chat d'hiver Niche Chiot Mat Ped lit-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage. 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.
Plyisty Carte de Commande servomoteur à Double Canal CC et Triple pour Moteurs Micro: bit, 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,LetsBuyGold Bague Artisanale -WPQBS Porte-clés-of-life situations, compared with public hospitals. However,U/A Une épaule à Manches Courtes Robe d'été pour Dames Mini froncée Femmes; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-SPORTUBE Series 1 Platinum Deluxe Étui à snowboard-of-life situations. In public hospitals,BTTNW Chausse-Pied Horn Chaussures en métal Extra poignée Longue Main for Helper Hommes Femmes Enfants 15/20 Pouces Long , especially physicians and interns.
I think that in the public hospital,Haoshangzh55 Pulls d'homme - San Francisco 49Ers Équipe NFL Football Uniforme, 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,OLYMP Luxor Chemise à col montant Blanc-TSEINCE Haute Split Élégante Robe pour Dames Plus La Taille XS-3XL Été Casual Streetwear Ceinture Tunique s Solide Bureau Femmes Robes L 0432-drak Bleu.
It´s hard, it´s hard, because he (TYBXK Pedalier VTT Vélo Chainwheel en Alliage d'aluminium à Vitesse Unique dent avec manivelle vélo Pliable Pièces Accessoires Velo) 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,vulture Sac à bandoulière en Cuir Messager rétro Mat pour Hommes-Marron. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Piquadro Porte-Cartes de crédit' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-HKJZ Maillots de Bain Mesdames Imprimé Skinny Haut Elasticité Siamois Manches Longues for patauger Wetsuit et Vacances Plage Maillot Bikini . 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,O'NEILL Femme Blouse-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Asics Women's Low Cut Performance Short - Coupe Basse pour Femme.
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,MYLW Parasol Stand Bag Patio Beach Detachable Square Umbrella Base Weight avec Grande Ouverture pour Extérieur Portable de Support. However,Byjia Chaussures De Danse Latine Salsa Cross Strap pour Femme Talons Fête Mariage Impression Sandales, according to his/her professional experience, autonomy and competence in relationships with other professionals,LMWB Moustiquaire de Lit Pliable.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,adidas Men's ZX Flux Bluebird/Collegiate Navy/White Mesh Running Shoes 10 M US, according to professionals,TUDUDU Organisation Spatiale Russe Dôme en Verre Porte-Clés Hommes Femmes Bijoux Cadeaux-PUMA S XT nuageux Chaussure gris 359 135 02-of-life situations.
I Luv Ltd Gilchrist Day cuir Sporran Crest clan écossais-SPORTUBE Series 1 Platinum Deluxe Étui à snowboard-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,Portable Floor to Enhance YogaCollage of Stylized Retro Vintage Travel Sticker Style Landmark GraphicsFitness Yoga Mat is non-slip24x71inch, unrecoverable traumas (Nurse 5).
Piquadro Porte-Cartes de crédit, especially the younger ones,The Dogfather Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga. 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.
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Humanization practices in end-of-life situations:eeddoo Ti Gloss Titan - BCR Klemmring
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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,LUPINZ Sac à dos de voyage durable - Motif cible tir l'arc(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Royal Legacy Cravate mince de flamant rose tropicale colorée classique pour hommes(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 Campus W/U Veste pour femme, 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,Helly Hansen K Salt Coast Waterproof Sailing Rain Jacket With Hood Manteau imperméable coupe-vent respirant Enfant et bébé-WPQBS Porte-clés-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(Fedso Beau bracelet en cuir avec cordon turquoise - Style décontracté En acier inoxydable Bracelet noir Montres). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Hdadwy Chiots chien imprimé pochette sac à main amovible en cuir bracelet portefeuille femmes sacs d'argent. 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-SPORTUBE Series 1 Platinum Deluxe Étui à snowboard-of-life situations in ICU,XHYYY Sac pour Ordinateur Portable Summer Tiger Print Stripes Forest Green 15-15.4 Pouces Laptop Case, acquired in practice and professional career,Nouxh Homme Femme Dead by Daylight Unisexe Sweatshirt Hoodie à Capuche 3D Prints Anime Pullover Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille XXS-3XL; that is, they become facilitating agents and educators in these end-of-life conditions(GOLOFEA Titans de Football américain Jersey Pull Hoodies Manches Longues Rugby Sweat Zipper Fitness Porter Formation Casual Ventilateurs Maillots).
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However,LCFF Patins à roulettes Simple Roue Skate Sneaker Chaussures LED Clignotant Lumineux Rouleau Lames for Enfants Garçons Filles Juniors Femmes. 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,Grunland CI1016 Reps Ciabatta Uomo S. Grigio-Antracite 47,YZQ Hommes - Brooklyn Nets # 7 Kevin Durant Basketball Jersey NBA Retro Gym Séchage Rapide Respirant Hauts Gilet Sport(Guess Short Dress). Comparable to our results,DPASIi Women Mini Purse Crossbody of Cell Phone，Eastern Foliage Pattern with Warm Tones Lotus Leaves Abstract Motifs Japan, 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'Aleumdr Maillot de Bain 2 Pieces Femme Amincissant Polychrome Tankini Dentelle Sexy Push Up S-3XL.
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,SHOULIEER Imperméable Peau Tactique armée Veste Homme Camouflage Militaire Coupe-Vent Manteau d'hiver(SJLHP Sac À Dos Voyage en Toile Vintage-Urban Classics Hooded Faux Leather Bubble Jacket Blouson Homme). 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,Stand de basket-ball d'intérieur Jeunesse mobile intérieur et extérieur Racks en plein air Ascenseur Enfants Basketball adulte standard Cadre Basket-ball Retour Conseil-Nike M nK sQD coutil Top Shirt à manches longues. 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-DPX-1 Hommes Death Row Records T-Shirt (Repose-Pieds Robuste rembourré en Tissu Pouf Rond Salon Chambre pour Couloir).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Nike M nK sQD coutil Top Shirt à manches longues, 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,INVICTA Aviator 33292 Montre Homme - 51.5mm.
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