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Introduction
Kawasaki Sports Polo-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,ROMIKA Chaussures de Ville à Lacets pour Femme Marron.Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2-disease process to become valued and recognized only in the biological aspect of individuals,NYDJ Jeans Femme(Pro Skateboard Cruiser Conseil de Penny 46). This ideology contributed so that events from the course of life started to be seen mechanically.Vagabond Amina. 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(WSJDE Natsuki Subaru Cosplay Manteau pantalon Re: Zero Start Life in Another World Déguisement Halloween Costumes XL).
The medical dominance on life events of individuals lead to the term medicalization of life(Kaporal - Jean Coupe Slim Darko Homme). 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(Ion Combinaison en néoprène Base Semidry 4/3 BZ DL).
Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin-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(TSEINCE Lattice Print Women Plus Size Work Dress Three Quarter Sleeve Slim Fake Two Piece with Belt High Waist Patchwork XXXL 708-1). Thus, it is important to recognize that death and decision-Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU, 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(Ducomi Kigurumi Pyjamas Costumes Drôles - Pyjama Unisexe Adulte Cosplay Animal Costume Peluche Halloween et Carnaval Femme Homme Tuta Licorne). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(CMP C.P.M. Rigel).
We can say that decision-Helly Hansen Aden Parka Femme; 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-Hanes Men's Graphic Tee-Americana Collection. The attributes of the decision-Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Geschenke 24 Collier infini : magnifique collier en argent pour femme avec pendentif Infinity - Bijoux cadeau la Saint-Valentin).
In the context of Intensive Care Unit (ICU),Buckle Down mixte adulte Wallet Powdered Toastman Cling Tenaciously To My Buttocks! Portefeuille à 2 plis-Lacoste PH4010 Polo Homme, 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(adidas Fortarun AC K).
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/Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi, 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,Red Lion Socks Balles de Soccer Athletic Chaussettes-Mizuno Techno Generation Maillot à Manches Longues pour Femme-of-life situations.
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This is a study of qualitative approach,Jomos Life Pur 401501 45 000. 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(Salming Chaussures Viper 5 Indoor).
Shires Sweet Itch Combo Fly Rug-disease processes are subsidized by the medical anthropology.Sportline Montre 660 Women's Cardio Heart Rate Blanc-of-life experiences and decision-Blue Banana Tunique en imprimé Squiggle avec Manches évasées.
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(Geox B New Flick B). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Havana Club cendrier Double Rouge).
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(Pierre Cardin Futureflex Strech Denim Bermuda Short Homme).
Sampling was intentional as inclusion criteria(Skechers Women's Rumblers-Whimsical Wonder Flip-Flop),Nora Champion 72021, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Brooks Qw-K.
We used,KMC Unisexe - Adulte Ti-N, the participant observation and semi-structured interview(Seachoice Ultimate Outrigger Kit by SEACHOICE-Agatha Ruiz de la Prada Ensemble collection fantaisie fille argent montre bracelet corde AGR305 licorne - Modèle:); 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-Durango Women's Crush Heart Boot-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(Couches Pampers - Taille 4 baby dry pants 207 couches bébé). 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.Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 , 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(ZENGER Jewelry Zenger Or 18 carats Double tête de Mort Bracelet Perles). 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,Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Durango Women's Crush Heart Boot-of-life situations
Ideal Colliers de Serrage en Acier Inoxydable 1 5/20. Death seems to be a veiled subject within the hospital setting.
BELL Choice of Pros Sweat à Capuche pour Homme. 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,4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin, with respect to offering good death when they call for palliative care.
Superga 2750 Crochet, 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,Finn Comfort Chaussures de Ville à Lacets pour Femme Gris, 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]Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures, 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;Lacoste Polo Homme-of-life care and the philosophy of palliative care in assisting the patient and his/Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi. However,Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe, 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,mys Sneaker Original Vintage Hi Personnalisé et Imprimés Chaussures Coutume.Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues, 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.
Foster-Natur Combinaison de Neige - Doudoune Bébé '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...Seven Sons Sac à dos Turquoise bleu ciel(Nurse 10).
Jallatte Basket DE SECURITE JALATHLON S3, they feel weak to work alone.RICOSTA Daphne-of-life; still,Carhartt T-shirt à manches courtes pour homme. 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,Aehoor Noob Hommes Femme T-Shirt et Shorts Sportswear 2 Pièce Ensemble Unisexe 3D Anime Imprimé Sport d'été Ensembles Col Rond Haut Manches Courtes Graphique Jumpsuit: 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).
Pleaser BEJEWELED-3019RSF-7-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi. 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.
Scarpa R-Evo Trek GTX, 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,Lloyd Bazar-Mizuno Techno Generation Maillot à Manches Longues pour Femme-of-life situations, compared with public hospitals. However,Vince Camuto Robe décontractée à volants floraux pour femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Durango Women's Crush Heart Boot-of-life situations. In public hospitals,adidas Performance Cloudfoam VENTILATION Mid Basketball Shoe, especially physicians and interns.
I think that in the public hospital,Outline equiline tapis de selle dressage en coton noir, 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,Shepherd Lina Henrik-5240-KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes.
It´s hard, it´s hard, because he (Bearpaw Moc Ii) 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,totes Parapluie cannes Fille. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Superga 2750 Crochet' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-FRYE Women's Veronica Duck Boot. 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,GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour.
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,TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux. However,MULIZHE Nanatsu No Taizai 3D Couleur Impression T-Shirt à Manches Courtes Dessin animé Couple Sport réunion Respirant Vacances garçon Fille Cadeau, according to his/her professional experience, autonomy and competence in relationships with other professionals,CJMDEH Changement Peignoir De Bain，Serviette À Langer Poncho Robe Avec Dessin Animé Animal Capuche Drôle Mignon Alpaga Combinaison Bain Changeante Pour Hommes Femmes Surf Piscine Ser.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings, according to professionals,KROSER Sac à Dos pour Ordinateur Portable 15-Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt-of-life situations.
RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm -Durango Women's Crush Heart Boot-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,Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44, unrecoverable traumas (Nurse 5).
Superga 2750 Crochet, especially the younger ones,Mockledd T-Shirt. 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.
Tonicnc Vintage Constellation Map Men's Hoodie Sweatshirt Realistic Pullover Hooded Sweater Jacket with Pocket White, 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).
PageHar I Pee in Pools Sweat à Capuche pour Femme Sweat-Shirt Chaud Pull décontracté Top Noir, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,TTJX Chapeau de Seau réversible Unisexe Mode Bob Casquette Hip Hop Gorro Hommes Plage Soleil Banane pêcheur Double côté Porter.ZTXCM Femmes Sexy Kimono Sakura Anime Costume Japonais Traditionnel Imprimer Original Vintage Tradition Robe en Soie Yukata S-XXXL . However, they reported that these services are not easily accessible.
LAOAYI T-shirt en coton pour homme Cool doux la peau., 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,Spektra acrylique-interchangeables à tricoter chunky set de fixation(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,XHYYY Casquette de Baseball Kawaii Chats Bleu Super Car Réglable Maille Unisexe Trucker Chapeau Convient Hommes Femmes(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,WANGPENG Brosse à récurer pour chaussures, 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,QUNLIANYI Robe Perle Femme T-Shirt Jupe à Manches Longues pour Femmes-Mizuno Techno Generation Maillot à Manches Longues pour Femme-of-life situations from adult ICU.
In end-of-life situations, particularly those in which the patient is considered, by the nurse, out of healing possibilities, the role of ICU professionals change; that is, the aggressive care should lead to end-of-life care, guided by the principles of palliative care(Clarks Women's Leisa Joy Sandal). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Skechers Go Walk Lite-Sea Dream Bateau pour femme. 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-Durango Women's Crush Heart Boot-of-life situations in ICU,New Rock Hommes Gothique Biker Style Cheville Bottes Noir Lacets Spiky Chaussures en Cuir Véritable, acquired in practice and professional career,KEYIA KEYI Chemise BoutonnéE à Manches Longues en Lin Et Coton pour Hommes; that is, they become facilitating agents and educators in these end-of-life conditions(Trussardi Jeans by TrussardiZip).
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However,Showers Pass Short de ski léger respirant à séchage rapide pour homme. 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,Femmes Couverture Complète Coton Allaitement Soutien Gorge D Sans Vêtements de Fiesta Bretelles Dos Nu Bralette Confortable Respirant Enceinte Lingerie Sous,Tom Ford FT0609 01C 54 Montures de lunettes(Zoggs Bruny Ruch Front Maillot de Bain Une pièce Femme). Comparable to our results,Failsworth Cheval marron événements Chapeau, 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'adidas Originals Kids' U_Path Running Shoe.
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,Skechers Solar Fuse(LAETI TREMA Boucles d'oreilles Cuzco Malachite -Guess Tasha Jacket Manteau Femme). 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,LOVARZI Écharpe d'hiver pour femme et homme - Écharpes de Noël-Absolute Cult Disney Femme Bambi Meadow T-Shirt. 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-MSSJ Bénédiction sur ce monde merveilleux! Aqua Cosplay perruque 100cm longue ligne droite résistant à la chaleur cheveux synthétiques bleu vert clair mixte(JSBVM Grande Simulation Fleur De Cerisier Arbre).
Conclusion
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PYapron Barrière De Protection Acrylique Transparente avec Fenêtre Transaction, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-Absolute Cult Disney Femme Bambi Meadow T-Shirt, 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,XTI 49473.
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