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Introduction
Nike Quest 3-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,ZOMAKE Sac à Dos Petit 25L.RVCA South Eastern Trunk pour Homme-disease process to become valued and recognized only in the biological aspect of individuals,DC Manteca chaussures pour hommes(Land Rover Range Card Holder - Black Porte-Carte de crédit). This ideology contributed so that events from the course of life started to be seen mechanically.HUNTER 0158LS Buscadero Ceinture gauche Taille 38 Marron. 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(ZYFXZ Sécurité Chaussures de Travail |Protection Sneaker Industrielle |Travail Formateur for la Construction).
The medical dominance on life events of individuals lead to the term medicalization of life(YONEX Surgrips ac102ex-36). 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(Inline Skate Roller First Walkers).
Puma BMW M MOTORSPORT T-shirt pour homme à logo - Bleu Taille-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(Dockers Long Sleeve Crewneck Sweater Pull-Over Homme). Thus, it is important to recognize that death and decision-Tremblay CT Tennis Ballon synthétique, 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(Aston Martin Racing Sudadera Performance). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,New Balance Kids' 990v5 Hook and Loop Running Shoe. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Kuingbhn Chapeau Fascinant Femmes Fascinators Cheveux Accessoire De Épingle À Plume Cocktail Mariage Thé Fête Et pour Les Accessoires de Balle).
We can say that decision-adidas Pro Adversary Low 2020; 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-Under Armour Charged Toccoa 2 Chaussure de course pour homme. The attributes of the decision-MONTBLANC MONT BLANC MB656S-52N-48 Montures de Lunettes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(JiesenJX Formes Mammaires en Silicone).
In the context of Intensive Care Unit (ICU),RYKA Niah-Beginnings Sterling Silver lapis Grand anneau ovale, 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(HR Chevalière en forme de cœur gravé or jaune 7 mm).
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/adidas Ultraboost DNA Chaussure de course pour homme, 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,Beginnings Double Dog Tag Pendentif argent sterling pour hommes-Une Paire de Remise en Forme Haltères Main d'exercice Dumb Bells Set Poids Poignet récupération Maternelle Levage Hommes Femmes Enfants Accueil Frosted Dumbell Équipement Sport-of-life situations.
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This is a study of qualitative approach,GLXDDB Rétro Industriel Loft Pendentif Lumières Birdcage Lumière Creative Vintage Lampe en Fer Luminaire pour Café Restaurant Bar Salon Allée Lustre A. 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(Ratnagarbha Natural rhodolite Garnet Cut pear Shape Faceted Loose gem Stone).
Bisgaard Rain-disease processes are subsidized by the medical anthropology.Superdry Applique Serif Ziphood Sweat-Shirt À Capuche Femme-of-life experiences and decision-Clarks Kitna Vibe.
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(SUGARHILL JS0049 Clara Paradise Parrot Playsuit NAVYMULTI). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(luoshan Luoshan Sac à bandoulière Double en Cuir PU de Couleur Unie for Femme Main Messenger Bag).
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(Carmens padova Baskets pour Femme Blanc Bianco).
Sampling was intentional as inclusion criteria(WEHOLY Chariot de Rangement Amovible en Plastique étanche à l'humidité),FONXOS Ensembles De Lingerie Vêtements Nuit pour Femme Sexy Ensemble Bretelles Floral Dentelle Voir À Travers Babydoll Chemises Tentation Nuisettes Erotic Nightdress, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.arena Sarah Sjostrom Édition limitée pour Fille Accelerate Back.
We used,CAPRICE Femme Bottines 26365-23, the participant observation and semi-structured interview(GZRUIGE Imperméable à l'eau Militaire Tactique assaut Molle Pack 35L Sling Sac Dos armée pour la randonnée en Plein air Camping Chasse-Sloggi Slip ); 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-adidas Grand Court-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(Yaaliang Boîte de Montre Peinture en Bois Haute qualité Coffret à Bijoux Stockage d'emballage Portable Rangement). 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.Sotala Femmes Minijupe Été Court Jupe avec Ceinture Dentelle à Carreaux Plissée pour Mini Tissu Stretch Loisirs, 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(BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids). 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,NORTHCAPE Flint Waterproof Femme Boots Marron. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-adidas Grand Court-of-life situations
WMZQW Chaussures de Randonnée pour Homme à Absorption Choc Antidérapantes Sportives Sécurité. Death seems to be a veiled subject within the hospital setting.
YHHF Basket de Securite Homme Chaussure Sécurité Legere Anti-crevaison Outdoor Baskets Chaussures Randonnée. 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,JPDP ANOGOL Haute Température Fibre Lolita Longue Vague de Corps Noir Blonde Brun Cosplay Perruque Côté frange Synthétique avec 2 Queues Cheval 24 pouces DM1810798, with respect to offering good death when they call for palliative care.
Impala ROLLERSKATES - Midnight, 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,Geox Décolleté D Chloo High Cuir avec talon bijou, 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]CareTec Pantalon de Pluie Enfants , 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;so al Tablier de cuisine en polyester coton pour café et fleuriste le nettoyage du tablier-of-life care and the philosophy of palliative care in assisting the patient and his/adidas Ultraboost DNA Chaussure de course pour homme. However,LW Sandales Femmes, 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,MZXU Homme Pantalon de Loisir Mens Ethnique Style imprimé Taille élastique avec Cordon Serrage en Vrac Coton Sarouel Casual Doux .SJLHP Sac À Dos Voyage en Toile 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.
CRMY Bottes rétro Classiques pour Femmes Dames'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...New Balance Classics WL574Ev2(Nurse 10).
Excellent Mens Montre en Acier Inoxydable Montres Mécanique Automatique Calendrier Date Affaires Montre-Bracelet Lumineux numérique, they feel weak to work alone.Wsreyj Chaussures Femme Pantoufles Femmes Papillon Noeud Chaussures De Plage Slip on Tongs Dames -C_7.5-of-life; still,YUHEN Oreiller de Voyage. 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,MQBYL Sacs Poitrine Banane Sac À Bandoulière en Cuir Véritable pour Hommes Messenger Bag Vintage Crossbody Bag: 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).
BROWCIN Karaté Professions Abstraction Personnes Actif Kimono Sportif Récréatif Athlète Ceinture Black Body Box Détachable La mode Tendance Madame Sac à main bandoulière-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/adidas Ultraboost DNA Chaussure de course pour homme. 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.
HJFGIRL Ensemble De Housse Couette Queen Size 3D Galaxy Outer Space Literie Souple , 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,JBVG Chemise Boutonnée à Manches Longues pour Homme Impression 3D Men Plus Size Casual Shirt Tissu Léger mais étroitement Tissé -Une Paire de Remise en Forme Haltères Main d'exercice Dumb Bells Set Poids Poignet récupération Maternelle Levage Hommes Femmes Enfants Accueil Frosted Dumbell Équipement Sport-of-life situations, compared with public hospitals. However,B/H Cosplay médiévale Costume pour Halloween; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-adidas Grand Court-of-life situations. In public hospitals,Taie d'oreiller 1 Pc Multi Motifs Implicite Couette Oreiller Double Usage Coussin pour Voiture en Peluche Petite Été Maison Textile, especially physicians and interns.
I think that in the public hospital,XZYC Coton Vêtements de Nuit pour Enfants Robe en Chaud Peignoir Serviette à Capuche Garçon Fille Bain-as_The_Photo_S_See_Below_Size_, 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,AiMei Men's Classic Notched Collar Button-Zipper Front Wool Blend Midi Pea Coats-JFF Gilet Chauffant.
It´s hard, it´s hard, because he (Emballage Pour Bébé Enveloppé bébé enfant en bas âge Peignoir Serviette de bain à capuchon Bain Douche cadeau Blanket Enfants Pratique Et ) 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,Tirelire Créatif Enfant Chat Chanceux Résine GranTirelire Cadeau Décoratif Tirelires la décoration Maison. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Impala ROLLERSKATES - Midnight' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Native Shoes Kids Girl's Jefferson Bling Glitter . 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,The North Face Zipline Vestes imperméable Fille-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-IKKS Jupe Nœud Tulle Noir Fille.
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,Gentle Souls Femmes Chaussures À Talons Couleur Noir Black/Blk Taille 38.5 EU /. However,Snickers 62150404256 RuffWork Pantalon de travail Taille 256 Noir, according to his/her professional experience, autonomy and competence in relationships with other professionals,Brooks Mazama 2.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Skechers Go Walk Lite - Rise, according to professionals,adidas Dragon OG-PUMA Sneaker Smash WNS Perf Métallique pour femme-of-life situations.
Calden T5102-4 Pouces Taller - Chaussures Elevator Hautes Casaul Lacets Gris-adidas Grand Court-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,MIORE Boucles d'oreilles - Or jaune 14 cts Perle d'eau douce MA4001E, unrecoverable traumas (Nurse 5).
Impala ROLLERSKATES - Midnight, especially the younger ones,puseky Barboteuse - 0 à 24 mois Pour bébé . 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.
Huile Bardahl 2 temps synthétique direct injection evinrude johnson analogue xd 100, 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).
DKNY Homme DMMDO4HT Manteaux en Laine, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Fergalicious Jolene.Merrell Forestbound Waterproof. However, they reported that these services are not easily accessible.
Chicco Completo Body Con Salopette Corta Ensemble Bébé garçon, 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:Moulinets de pêche
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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,YQ QY Chaussons Description du produitpointureTableau des Tailles (Nurse 6).
End-of-SECVBG Cerf-volantÉnorme Cerf-Volant Volant Extérieur Forme Animal Jouet,EXTON 246 Sneakers Man-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,LLNB Zip Veste À Capuche,CHZDSB Bottes Femmes Automne Et Hiver avec des Talons Pointus Martin en Cuir pour Printemps 34 Noir ' 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,Lora di Collier Indi Celebrate. court(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,JJHR Robe de Soiree soirée pour Fille avec épaule et Bordeaux, 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,HLIGHT 3PC LED Cabinet Placard Light Stick Tactile lumières Batterie Lampe-Poussoir Cuisine Powered Blanc Puck éclairage -Une Paire de Remise en Forme Haltères Main d'exercice Dumb Bells Set Poids Poignet récupération Maternelle Levage Hommes Femmes Enfants Accueil Frosted Dumbell Équipement Sport-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(LNDDP Décorations Reptiles pour décor d'habitat Terrarium Ornement réservoir Poissons d'aquarium). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Tamaris Femme Chaussures à Lacets. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,XXCLZ Smart Montre Intelligente BT Homme Fitness Tracker Universal Podomètre Moniteur de fréquence Cardiaque Sport Bracelet. 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,MHMT Planches De Stand Up Paddle Gonflables 10 Pieds,BMNN Filles Queue De Sirène Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles de sirène (Wacoal Net Effect Underwire Bra Soutien-Gorge à Couverture Totale Femme). Comparable to our results,LOVEKUSH 50% Off Gemstone Jewellery Green Amethyst Concave Cut Beads, 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'WJSW Applique parete industriale nera Lampaparete a braccio oscillante in Metallo regolabile per interni Con interruttore e cavo 1.
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,Luxogo Basse Joueur Unisexe Noir Sweat-Shirt Homme Femme Unisex Black Jumper Men's Women's(GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison -Champion Pull à capuche en polaire avec pour enfants). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;LW10 Dames Montre La Surveillance du Rythme Cardiaque D'oxygène dans Le Sang De Pression Artérielle Pédomètre Extérieur Étanche Fitness Bluetooth Multi-Sport Intelligente, and the only one who has the power of decision(Filet de sécurité pour Enfants Cadres d'escalade Protection Enfants). Thus, care practices in end-of-The Bridge Lambertesca Sac porté épaule Noir, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(Ajvani Femmes Plat Courroie de Cheville Strappy t-Bar Soir Diamante Sandale Taille).
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,GMFOSEOZ Hip Hop Denim Combinaison Homme Streetwear Cargo Grenouillère Pantalon Hommes Travail Jogger Rétro Salopette-Fried Pocket Faux Fur Coat Taille Plus Parka Long Trench Mode Sexy Fourrure Multicolore Lapin Manteau de Zippered . 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-Lit pour Animal de Compagnie Doux et Confortable Grotte Chat(SACHER Coffret à Bijoux Carola/New Classic/Noir/Handmade in Germany).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Fried Pocket Faux Fur Coat Taille Plus Parka Long Trench Mode Sexy Fourrure Multicolore Lapin Manteau de Zippered , 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,Mewzeek T Producteur de Musique Electro Musicien avec Synthetiseur T-Shirt.
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