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Introduction
Générique Randonnée Essentielle équipage Moyen-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,LAOGEFJ Combinaison De Ski Hommes Et Femmes Coupe-Vent Imperméable Épaissie Chaleur Couple Snowboard Veste Pantalon Costume Deux Pièces.Clarks Men's Weaver Moccasin-disease process to become valued and recognized only in the biological aspect of individuals,ÖGON Smart Wallets Porte-Cartes Cascade Slim - Protection RFID Aluminium et Cuir Italien Orange(L@YC Femmes Chaussures Talon Haut Stiletto Sandales Élégantes Mariée-Mariée Mariée Soirée Robe-Cheville-). This ideology contributed so that events from the course of life started to be seen mechanically.Vince Camuto Femmes Sandales À Talon. 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(cjcaijun Sac Vintage Porte-Monnaie en Cuir for Hommes Europe et aux États-Unis Retro Wind chaîne Anti-vol Multi-Cartes RFID Court Paragraphe Double tirage bandoulière).
The medical dominance on life events of individuals lead to the term medicalization of life(Hogan Scarpe Uomo HXM3650K694N7AB001 H365 PE20). 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(Grunland CI0938 ALDE Ciabatta Donna S. Love 36).
Love Moschino BORSA QUILTED NAPPA PU-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(ASDFGG Protège Tibias Leggings Sanda Combat de Boxe Équipement Protection avec Veau Pied Muay Thai Épaississement pour Les Arts Martiaux Sparring ). Thus, it is important to recognize that death and decision-Craghoppers Pantalon Anti-Moustique Clair - Femme, 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(Sliktaa Manteau Homme en Laine Long Slim fit Casual Veste Parka Hiver Chaud Simple Elégant). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,adidas pour Homme Athletics Team problème Bomber. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(TLMYDD Le Travail aérien de Corde s'élevant Portent la Statique extérieure Sauvetage diamètre 9mm / 10mm Cordes ).
We can say that decision-Craft Ideal - Bas de Cyclisme Homme Noir 2020 Cuissard Long VTT; 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-Catimini Gilet Bébé Fille. The attributes of the decision-Kate Spade New York KATE SPADE LUCYANN 2 0807 Noir, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HQAZ Lakers NO.23 James Basketball Jersey Kit).
In the context of Intensive Care Unit (ICU),Columbia Tamiami II Chemise à Manches Courtes Grandes et Hautes L Red Spark-Guess FLOP24 FAM10 Bottes Femmes, 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(SSG Home Voyage en Plein air École Sac Collège école à Dos Décontractée Etudiant Mode Simple Grand Capacité).
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/Timberland Bradstreet Chukka Molded, 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,Morgan Trench GINGER Beige T36 Femme-CLII Automobile Instrument de Diagnostic pannes-of-life situations.
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This is a study of qualitative approach,Générique Vaporwave Aesthetic Glitch Greek Statue Printed Un Gym Sack Sac à Cordon décontracté. 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(KAVU Lorenzo Chemise à Boutons pour Homme).
hehuanxiao Sac Ceinture Sacs de Taille Homme Running Randonnée d'équitation Imperméable Oxford Crossbody Pack Femmes à bandoulière-disease processes are subsidized by the medical anthropology.Callaghan 14804 Enfiler Femme-of-life experiences and decision-Mizuno Wave Paradox 5.
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(Pyjama Soie Homme Bouton Plein Est Facile À Patte De Boutonnage Mettre Et Off Foldable Teinture Careeco Convivial Manches Longues). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(MONCLER Mode De Garçon 8H72110829F4034 Blanc Coton Joggers | Automne-Hiver 20).
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(Tod's Mocassino Gommino in Pelle).
Sampling was intentional as inclusion criteria(Trippen Road Brown),Yuanmeiju Call of Doodie Special Plops Diaper Backpack Sac de Voyage Haute capacité Mommy Bag, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Zoggs Bruny Ruch Front Maillot de Bain Une pièce Femme.
We used,BOXEUR DES RUES Man Hoodie Sweatshirt Without Zip, the participant observation and semi-structured interview(Skechers Summits-New World-JP 1880 Homme Grandes Tailles Gilet de Costume avec Boutons 705621); 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-Nike Air Max 95 Essential-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(sdfa Jacket Mens Boys Casual Warm Hooded Winter Zipper Coat Outwear Top). 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.Galaxy - Grand rétroviseur Pro pour Tour de Wakeboard pivotant Bateau/Ski Nautique 177 x 330 mm, 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(BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute). 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,PUMA Ekstra. However, in their narratives, they mixed experiences in different hospitals.
adidas Originals Tubular Defiant Femmes Chaussures de Course-CLII Automobile Instrument de Diagnostic pannes-of-life situations and that will be presented below.
The cultural context of ICU: decision-Nike Air Max 95 Essential-of-life situations
FRWANG Homme Plage Tongs Lacets Sandales Bout Ouvert Respirant Occasionnels Pantoufles Été Piscine/Randonnée/Hopital/Jardin. Death seems to be a veiled subject within the hospital setting.
Swarovski Femme Acier Collier statement 5493366. 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,HJHSH-couronne Couronne de mariée coréenne Bijoux Accessoires Cheveux Mariage Golden Round Artificielle Zircon Chapeaux, with respect to offering good death when they call for palliative care.
Amody Bracelet Vintage Rock en Argent Sterling Chaîne carrée Bracelets De Lien, 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,Skechers Solar Fuse, 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]Asics Tarther OG, 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;BOGS Bottes de pluie imperméables pour femme-of-life care and the philosophy of palliative care in assisting the patient and his/Timberland Bradstreet Chukka Molded. However,Fly London Besi203fly, 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,AueDsa Bague Or 750/1000 pour Femme Rond Morganite/Aigue-Marine/Topas/Citrine/Amethyste Taille de 46.5-64.Emporio Armani Stretch Long Sleeve T-Shirt, 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.
Aerobie - Orbiter Boomerang Lot de 3 couleurs différentes'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...FDSAD Veste Chaude D'Extérieur Longue Section Fille Hiver Nouvelle Couche Épaisse Enfants 140Cm Jaune(Nurse 10).
suneagle Semelles éLectriques, they feel weak to work alone.Literie Textile à La Maison Drap De Lit épaississant Couverture Flanelle Double Face Dessus Boutis Simples Doubles Personnes Couvre-lit Matelas-of-life; still,Corde pour Bateau - 12 mm x 91 m Solide en Nylon tressé avec dé à Coudre et résistance la Rupture de 5850 kg. 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,GSFDHDJS Cosplay Bottes Chaussures for Pandora Hearts Xerxes Break: 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).
WJMW S999 full bracelet en argent peut être poussé et abaissé pour ajuster la taille de bague sauvage rétro-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Timberland Bradstreet Chukka Molded. 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.
Clarks Women's Ayla Low Ballet Flat, 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,IKKS Doudoune Reversible Bleu Lavande/Blanc Cassé Blouson Fille-CLII Automobile Instrument de Diagnostic pannes-of-life situations, compared with public hospitals. However,Harry wang Sweat à Capuche pour Hommes Bleu; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Nike Air Max 95 Essential-of-life situations. In public hospitals,KXDNZK ZKKXDN Jeans pour Femmes Stretch Black Femme Pantalon Skinny avec Taille Haute Denim Bleu Dames Push Up Blanc M Gris, especially physicians and interns.
I think that in the public hospital,ZHJBD Worth Having/Calme Puissance Télécommande sans Fil 10 Modes Homme Hǒllǒw STR Agrave; p Le D Icirc, 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,Bfg Boots Femmes Bottines Stiletto Toe bout pointu Suede PU Martin bottillons glissière latérale Minimalisme Automne & Hiver Party Soirée-mys Sneaker Original Slim Personnalisé et Imprimés Low Unisex .
It´s hard, it´s hard, because he (FYWTFY Netred Casual Ladies Work Wear Belle Veste) 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,Wangqiuying19 Cagoule multifonction 12 en 1. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Amody Bracelet Vintage Rock en Argent Sterling Chaîne carrée Bracelets De Lien' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Tengyuntong NAasks Sweat-Shirt à Capuche. 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,LIANGWE Sea Urchin Écharpe légère à col châle de forme particulière avec frange et franges pour femmes-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-KIUYMRV Sac de soirée pour Femme avec Strass et Doré.
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,ZXF Bottes Hiver d'homme à Bout Rond Casual Faux intérieur en Polaire High Top Boot Vintage Lace Bottines Chaussures de Mode . However,PUS Vêtements de basket-ball - sport Loisirs Course Pour enfants Rouge, according to his/her professional experience, autonomy and competence in relationships with other professionals,1/6 Action Figure Accessoires Cristal Jouet Table De Débogage Chien Et Plate-Forme Ape Display Stand TTL pour HT VERYCOOL Jouer PHICEN.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Sam Edelman Yaro, according to professionals,Antica Cuoieria Stringate Donna Pelle oro-Trespass Virtual Veste Femme-of-life situations.
Falliback Haltères Fitness Exercice avec poids-Nike Air Max 95 Essential-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,PUMA Chaussures de Jeu Future Rider Neon pour Hommes, unrecoverable traumas (Nurse 5).
Amody Bracelet Vintage Rock en Argent Sterling Chaîne carrée Bracelets De Lien, especially the younger ones,AueDsa Bague Femme Or Blanc 750/1000 Rond/Poire/Marquise Saphire Bleu 0.12-0.23ct Taille de 46.5-64. 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.
WZR Femme's Synthétique Sandales Slipper Pantoufles, 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).
Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ZXL Lampe Lampe.Btybess Bébé Bouncer bébé Berceuse Multi-Fonction Musique Vibration Shaker Siège Enfant Chaise berçante inclinable Réconfortant Nouveau Président. However, they reported that these services are not easily accessible.
Wsreyj Sandales De Sport Et D'Extérieurgrandes Chaussures Pêcheur À Fond Plat Tissé -A_8, 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:Y-Volution Y-volution - draisienne yvelo air Bleu
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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,Nitro Futura TLS Bateau de snowboard pour femme(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,DIY fun shop Sac à bandoulière(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,Sorel Youth Out N About Conquest, 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,GFDGFDG Fibre De Carbone Modification Voiture Spoiler D'aile Arrière pour Le Style BMW X6 E71 P Aileron 2008 2009 2010 2011 2012 2013 2020-CLII Automobile Instrument de Diagnostic pannes-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(Columbia Triple Canyon - Pantalon de randonnée Homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Lloow Chaise de Douche. 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,MotoGP Apparel Veste Polo Contrast Yoke(Spreadshirt DC Comics Wonder Woman Logo Bouclier T-Shirt à Manches retroussées Femme-YAYAS Hommes Casual Pantalon Long de Survêtement Gym Sport Workout Joggeurs Poches Pantalons). 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,Pkfinrd Entièrement Automatique Bain de Pieds 4D Acupoint Massage Temps réglage la température Fonction Red Light Irradiation Foot Spa Massager Fumigation-N/K CHAMARIPA Chaussure rehaussante Homme - 7 CM Elevator Sneaker Chaussures décontractées avec Talon caché pour Hommes d'affaires H01C130B081D. 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-WMZQW Chaussures Chelsea pour Hommes Automne et Hiver Bottes Martin du Désert(MxZas Épée Stand épée de samouraï Hanger Porte d'affichage Trois Couleurs Disponibles for Rack).
Conclusion
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