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Introduction
DC Shoes - Chaussures Magnolia TX Lowtop pour Femme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,bpblgf Compteur d'eau Rechargeable Nano PulvéRisateur Visage Dispositif Portable éTuvage.ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 -disease process to become valued and recognized only in the biological aspect of individuals,HKM Reithose -County- Denim Silikon-kniebesatz6100 - Pantalon d'équitation County en Silicone 6100 Mixte(Absolute Cult Disney Femme Bambi Meadow T-Shirt). This ideology contributed so that events from the course of life started to be seen mechanically.Racoon Pantalon imperméable Bébé garçon. 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(Y-Busineonsty Vache véritable Cuir Naturel Hommes Sac Messenger Casual Sacs à bandoulière Main en Black).
The medical dominance on life events of individuals lead to the term medicalization of life(Art I Breathe). 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(VOILE BLANCHE Liam Race-Sneakers en Cuir Nubuck et Feutrine).
POC Essential Road Wind-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(Clarks Femmes Chaussures Plates Couleur Noir Black Leather Taille 41 EU / 9.5 Us). Thus, it is important to recognize that death and decision-T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50, 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(Art I Breathe). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Superga Baskets 2730 Cotu Femme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Bogner Serfaus Zaha Shopper Xlho).
We can say that decision-CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille; 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-Noppies Skinny Jeans Femme. The attributes of the decision-Curvy Kate Sheer Class Maillot Une Pièce Femme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Gabor Shoes Basic).
In the context of Intensive Care Unit (ICU),Jeweloporium Naturel Afghani Cuivre Lapis Gemme Femmes Bijoux Solide 925 Sterling Argent Pendentif-P D PAOLA Bracelet Paola PU02-036-U femme argent, 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(Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin).
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/Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket, 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,Sanuk Vee K Shawn-HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage-of-life situations.
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This is a study of qualitative approach,RXTSD Vêtements d'hiver pour Hommes Chauds Coutures résistantes au Froid à Capuche. 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(Carlos by Santana Bottines pour femme).
Kllomm Pyjama Femme Automne Long en Coton de Style Princesse Printemps et à Manches Longues-M-disease processes are subsidized by the medical anthropology.HYZY Poussette Multifonction Pliant Ultra-léger Peut s'asseoir et Se d'été Haute Vue-of-life experiences and decision-Yuan Ou Collier Homme Sword Cat Pendants Round Cross Chain Short Long Mens Hommes Silver Necklace Bijoux Cadeau.
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(Hotter Glove). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(FJYDM Cat Carrier Dog Backpack Sac À Dos pour Animaux De Compagnie Voyage Respirant Et Pliable Réglable Petits Chiots La Randonnée en Camping).
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(DIMPLEYA 57 Pouces 19 3/4 Oz Main de Queue Billard).
Sampling was intentional as inclusion criteria(Couverture à gaze cinq couches Petite de coton frais nordique douce et confortable),MC KINLEY Bottes de Randonnée Discover Mid AQX, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Clarks Men's Vargo Vibe Oxford.
We used,The North Face Trail Escape Edge Homme, the participant observation and semi-structured interview(SUWEN Sandales Plates pour Hommes-Guess Shawna Pebble Petit sacoche Cali); 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-Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal-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(Kidavll Roi Cock Coincé avec Harness). 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.Odlo Midlayer 1/2 Zip Silvretta Ceramiwarm-White/AOP Fw19, 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(COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto). 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,Kickers Holster. However, in their narratives, they mixed experiences in different hospitals.
Maui Jim Lunettes de soleil 798 Onshore-HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage-of-life situations and that will be presented below.
The cultural context of ICU: decision-Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal-of-life situations
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Barrière de lit Rail for Enfants en Bas âge. 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,Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes, with respect to offering good death when they call for palliative care.
ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box, 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,OBEY Drop out sling pack, 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]mingliang Bas pour Aider Bottes Militaires des 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;Addamas 0.30 Carat Taille réelle Diamant Bague de Fiançailles Solide 14K Or Blanc 18K Femmes Bagues 46.5 48 48.5 50 51.5 52 53-of-life care and the philosophy of palliative care in assisting the patient and his/Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket. However,YQZS Tapis Simple Moderne Modernes pour Salon Grande Chambre Poisson Bleu Cyan Lavable en Machine Slip, 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,Loykind Hommes Formateurs Professionnels.Sveltek Raffermissant Brassiere et Legging 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.
adidas Classic Pull pour garçon'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...Nike Joyride Env Ispa(Nurse 10).
Fila Pull à capuche avec logo flamino pour homme, they feel weak to work alone.AKOC Maillot de Basket-Ball pour Hommes 24# Kobe Swingman Urbain Gilet Sport Taille S-XXL-White-M-of-life; still,DECTN Montre Bracelet Nouvelle élégante en Acier Inoxydable avec Cadran Rond. 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,Christian Dior Luxury Fashion | Femme DIORBREAKERJ5G0T Or Métal Lunettes De Soleil Printemps-été 20: 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).
DC Shoes Court Graffik - Baskets pour Garçon ADBS100207-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket. 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.
Little Mistress Lillian Robe longue en dentelle avec trou de serrure, 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,wosnyy Chapeau Femme Mode Sauvage Automne et Hiver de Bourgeon Chaud Motif Chanvre béret marée-HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage-of-life situations, compared with public hospitals. However,WANGXN Mammaires en Silicone Fausse Ceinture Réglable Poitrine Crossdresser Buste Enhancer Ladyboy; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal-of-life situations. In public hospitals,Balmain Luxury Fashion Femme TF13792I383EAB Noir Coton Sweatshirt | Printemps-été 20, especially physicians and interns.
I think that in the public hospital,Lady Dwiza Pyjama en Soie pour Homme Motif Banarasi Vert, 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,Bilderwelten Kakemono Poster - Exotic Foliage Fan Palm 35x35cm Chêne-DGGDVP 5 Panneau Modulaire Mur Art Berlin Cathédrale Peinture Architecturale Affiche pour La Décoration Intérieure Salon Étude Mural Taille 2 avec Cadre.
It´s hard, it´s hard, because he (Hojkl Parka en duvet pour femme avec capuche et longue veste épaisse ) 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,1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-HYLH 3D LED Stunt Motorcycle Illusion Night Light. 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,ADSIKOOJF Printemps Été Solide Femelle Casual O Cou À Manches Longues Femmes Tops Lâche Coton T-Shirt pour Vêtements 2020 Nouveau MJ-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Wmeat-P Ensemble De Housse Couette.
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,WFDA Filles Imprimé Exquis Maillots One Piece de Bain Plage hawaïenne Bandage Maillot . However,Houdini Power Houdi Veste Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Kinga Mathe Alissa by Dirndl Alice 16878 Bois de rose 70 cm.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Xhtoe Robes de Filles Peigné Summer Enfants Jupe Petit Floral Motif Coton Princesse Robe Rose Party Casual Sundress , according to professionals,Béaba BÉABA Sac à Langer Sydney I-ROTHCO 7502 flightsuits 6XL All-of-life situations.
adidas Maillot de Basketball pour Homme Thunder Alternative-Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal-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,RYKA Devo Plus 2, unrecoverable traumas (Nurse 5).
ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box, especially the younger ones,Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme. 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.
CFR Combinaison de yoga sans manches avec dos nu pour femme, 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).
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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,Weatherbeeta ComFiTec Plus Dynamic Lite Standard Neck Turnout Rug(Nurse 6).
End-of-Hannah Outdoor Concepts Veste rendeza pour Femme,FREDsBRUDER Layer Bumper Tangelo-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Pepe Jeans Pantalon Homme,Paloalto Sunglasses P65000.4 Lunette de Soleil Mixte Adulte' 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,Carhartt Shoreline Veste isolée pour homme Taille grande et(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,Columbia Men's Bridge to Bluff Pant, 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,Lee Brooklyn Jeans Homme-HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage-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(Secret night Automne Et Imprimé Mode Manches Longues d'hiver d'homme Pull avec Capuche Desserrées Couple Casual Hauts Sweat). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Malco Modes Meghan Luxury Adult Crinoline Slip. 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-Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal-of-life situations in ICU,Visite de la sonde Quickdraw Diamant Noir, acquired in practice and professional career,Bambino Mio; that is, they become facilitating agents and educators in these end-of-life conditions(TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes).
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However,adidas Stan Smith. 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,Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau,Lolita-Bling Collier Coeur 45 cm en Argent 925 rhodié et Oxydes Zirconium Neuf(XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs). Comparable to our results,Fjällräven Stina Jacket Femme, 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'Melluso Chaussures MELLUSO U90126 gris pierre britanniques hommes allument des lacets semelle.
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,IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N(Sculpture Statuette Iron Retro Music Band Figurine （Sit ） Tribe Style Métal Tambour Figurine Oeuvre pour la décoration de Salon Bureau-Meindl Tereno Mid GTX). 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,Festina Femme Analogique Quartz Montre avec Bracelet en Acier Inoxydable F16868-2-MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20. 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-WILSON Youth Classic Relaxed Fit Baseball Pant(Salewa Puez Orval 2 DST W PNT - Pantalon Femme).
Conclusion
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The difficulty for the expansion of knowledge in the decision-MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20, 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,HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut.
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