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Introduction
Lakers Jersey No. 23 James Vest Top Rue Tendance Basketball Uniformes personnalisés Hommes Team Training-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,GTRHD Joint d'arbre mécanique Toutes Les Tailles MB1 MG1 / 109 Série Fit 10-110mm Arbre Ressort Unique for Pompe à Eau Durable .MULIZHE Love Death Robots Impression 3D Sweat à Capuche Sport Hommes et Femmes Pull en Coton col Rond fête Vacances Loisirs Cadeau-disease process to become valued and recognized only in the biological aspect of individuals,Nobranded Grand Sac de Filet Rétracteur Sport en Maille Plongée(Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set). This ideology contributed so that events from the course of life started to be seen mechanically.MIKLL Sweat à Capuche Homme Sweatshirt pour Longues Hiver Slim Fit. 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(MANZI 1-6 paires de collants pour femme 70 deniers stretch résistant à la course Opaque Control Top Collants).
The medical dominance on life events of individuals lead to the term medicalization of life(YATTYUG Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet). 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(ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806).
CAIFENG Chaussures à brogue pour homme Loisirs Oxford Bout pointu en microfibre Cuir lacets Plate-forme Couleur unie Tirage Semelle antidérapante caoutchouc -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(German Wear Chaussures de Ville à Lacets pour Homme Noir). Thus, it is important to recognize that death and decision-IUBBKI sac à langer dos sourire Doraemon multifonction voyage bandoulière maternité couche bébé avec matelas, 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(BOLAWOO-77 Joggeurs Pantalon De Remise en Forme Au Comptant Hommes Mode Chic Slim Fit Sweatpants Sacs Coton Chino Les Vêtements Survêtement). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,YLLJJ Bracelet de Montre. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Powerslide R4 Trinity Rollers).
We can say that decision-QSBY Lustre Salle Citrouille de Forme Moderne Trois Couleurs Chambre modulable décoration Maison Salon Couloir étude Balcon Blanc Enfants; 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-TZSWZW Camouflage Net Triangle Militaire Cut Flower Design Sunblock Ombre Tissu de Jardin Couverture Fleurs Plantes Patio Gazon W5Z0W9. The attributes of the decision-TZSWZW Usine Sail Shade Couverture Camouflage Net Jardin Confidentialité et Film de Protection écran Balcon des renseignements personnels Corde Perméable W5Z0W9, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(VOILE BLANCHE scarpa uomo).
In the context of Intensive Care Unit (ICU),JALAL Bonnet en Tricot Gris pour Filles avec Perruques ondulées Noires de 22 Pouces-Pro Skateboard Cruiser Conseil de Penny 46, 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(EinStein Bague solitaire en diamant 0).
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/NLRHH Lot de 12 décorations bouteille vin Noël pour décoration vin, 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,Orquidea Sabine Boucles d'oreilles pour femme avec perles-RKRCXH Maillot de Bain sirène Queue De Sirène-of-life situations.
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This is a study of qualitative approach,XMXM Fouet de bête pour chevaux et sport Whiphorse-Riding Cravache à main course d'équitation. 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(Nike Team Club 19 Crew Sweat-Shirt Homme).
Bouilloire électrique en Verre-disease processes are subsidized by the medical anthropology.Kickers Kymbo Brogue-of-life experiences and decision-Scarpa Chaussures Mojito GTX - homme.
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(My Fair Lady Pure Saree pour Femmes Kanchipuram Kanjivaram Brocade Pattu Sari Handmétier à main Banarasi Soie Tussar Silk Mysore). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(NINE WEST Femmes Chaussures À Talons).
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(Asics Gt-2000 8).
Sampling was intentional as inclusion criteria(Kiki Haltères Eco-Friendly Fitness et à l'intérieur Exercice Équipement réglable Musculation Body Building Domicile),Cofra V415-0-05.Z60 Tecka Veste Softshell , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Livia Isabel Lavandou Maillot Une pièce Femme.
We used,Natori Pure Allure: FF Contour UW Soutien-Gorge Femme, the participant observation and semi-structured interview(YURU LED Allument Les Chaussures Enfants Garçons Patin à roulettes Doubles Roues Simples Rétractables Sport Skateboard Technique-Vince Camuto Femme Robe); 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 Originals Tubular ENTRAP W Basket Femme Blanc 37 1/3 EU-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(Brütting Himalaya). 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.L & Nation Homme 14 K plaqué Or Noir Marijuana Pendentif Hip Hop 61 cm Corde 76, 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(Kulzer Trottinettes Enfant 3 Roues). 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 Ignite Limitless 2. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-adidas Originals Tubular ENTRAP W Basket Femme Blanc 37 1/3 EU-of-life situations
Odlo T-Shirt MC Ceramicool Pro - à Manches Courtes Femme. Death seems to be a veiled subject within the hospital setting.
EASTPAK Backpack Eastpak Orbit Glow Black 40T. 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,Ion Combinaison en néoprène Base Semidry 4/3 BZ DL, with respect to offering good death when they call for palliative care.
Geox J Flexyper D, 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,Quiksilver Keller Sweat à Capuche zippé en Polaire Homme, 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]Hurley M Vedder Washed L/S Woven - Chemises Homme, 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;BCBGMAXAZRIA Women's Welt Pocket Faux Suede Skirt-of-life care and the philosophy of palliative care in assisting the patient and his/NLRHH Lot de 12 décorations bouteille vin Noël pour décoration vin. However,varisan Collant de contention Diva Classe 2 Varisan Naturel Taille 1 Hauteur Court, 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,adidas Itavic.Volcom Sweat Too Tone Fleece Noir Homme -, 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.
Volcom Tower P/Over Fleece Sweat à Capuche pour Femme'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...Lucky Brand LK-Joal2 Escarpins pour Femme(Nurse 10).
Nike Revolution 5, they feel weak to work alone.camel active Step 70-of-life; still,ZELIAN Voiture de Parapluie Paysage Pliage léger bébé Rose Peut s'asseoir Se Coucher vers Le Bas la Roue écumante. 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,Blackstone Sg30: 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).
Babys Chariot Pliable et léger pour bébé - 4 Roues 1 à 3 Ans-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/NLRHH Lot de 12 décorations bouteille vin Noël pour décoration vin. 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.
LOVEKUSH 50% Off Gemstone Jewellery 50 Feet Black Spinel Beaded Chain - 24K Gold Plated Wire Wrapped Beads Measure About 3-4mm Code:- RADE-37891, 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,adidas FCB H JSY L T-Shirt à Manches Longues Homme-RKRCXH Maillot de Bain sirène Queue De Sirène-of-life situations, compared with public hospitals. However,ZMHX Portefeuille Portefeuilles pour Hommes Sac À Main en Cuir Clutch Man Handy Bags; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-adidas Originals Tubular ENTRAP W Basket Femme Blanc 37 1/3 EU-of-life situations. In public hospitals,Kipling Creativity Grande, especially physicians and interns.
I think that in the public hospital,melissa Ultragirl Noir Doux Pompes spéciales, 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,Nobrannd Femmes Top Vestes d'affaires du Cap Ouvert Avant Sim Fit de Split Sequin Solide Veste Broderie Blazer Court S-XXL Loisirs en Plein Air Slim Manteau -SSLW Plafonnier Moderne Fleur Chic Acrylique télécommande atmosphère chaleureuse Lampe créative protéger Les Yeux.
It´s hard, it´s hard, because he (lquide Vêtements de cyclisme Costume Printemps Automne Hommes Ensemble sport Sportswear Road Mountain Bicycle Bike Outdoor Maillot Full Zip ) 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,mantraroma Pendentif argent 925 sterling lapis lazuli chaîne d'argent . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Geox J Flexyper D' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Heating Pads Coussin Chauffant Wrap. 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,Waldhausen Damen Vollbesatz Reithose Ava-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Horloge murale murale.
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,Lhlxs Fille Égypte Ancienne Mythologie Reine Robe Cosplay Costume d'halloween pour Les Enfants Party Vêtements de Carnaval. However,VX COUTURE Lakei?Carte d 'identité Détenteur de Carte?Antique Bourse Position Chaîne clés Portefeuille Vêtement en Cuir, according to his/her professional experience, autonomy and competence in relationships with other professionals,love print Pochette pour femme personnalisable avec impression vinyle du nom ou initiales en similicuir rose stylisé blanc.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,MH Bottines Hommes, according to professionals,Mephisto Phila-Corde de pêche Descente en Rappel et Mousqueton 11mm Multi-Usage Durable Fort Randonnée Statique Camping extérieur-of-life situations.
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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,VLERHH Géant Hippopotame Peluche, unrecoverable traumas (Nurse 5).
Geox J Flexyper D, especially the younger ones,JOYOTER Steampunk Bustier Ceinture De Mariage Sexy pour Femmes Blanc Corset Cincher. 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.
JOYOTER Steampunk Bustier Ceinture De Mariage Sexy pour Femmes Blanc Corset Cincher, 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).
XYZMDJ Sac à Main en Cuir Docteur, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,OmniaOro Boucles d'oreilles en or rose 18 carats 750/1000 avec centre à cœur zircons blancs.Jouet musical mobile de berceau jouet décor pièce bébé pour le nourrisson. However, they reported that these services are not easily accessible.
Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot, 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:Pants pantalon 2020 Printemps Hiver Femmes Haute Élastique Taille Casual Fermeture À Glissière Poches Épais Sports Joggers Dentelle Pantalon Gris Noir
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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,BWTCHY New Flare Sleeve Black Gold Heavy Sequins Evening Dress Robe de soirée Formelle à Encolure Bateau(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,DXJNI - Manteau imperméable pour Hommes et Femmes Repliable avec Poches cachées étanches Confortable Respirant la Livraison Police de Circulation Express ou travaux extérieurs Mant(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,WFQGZ Chaussures Décontractées Coussin d'air De Sport Hommes Lacets Respirant Entraîneur Marche Maximum, 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,Rideau de fenêtre hawaïen avec des arbres montagne-RKRCXH Maillot de Bain sirène Queue De Sirène-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(Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,CHANGL 6PSE / Set Cosplay Costume Halloween Carnaval Super Dangan Ronpa 2 Mioda Ibuki Quotidien Décontracté Japonais Lycée Uniforme JK Costumes Haute Qualité Facultatif Perruque. 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-adidas Originals Tubular ENTRAP W Basket Femme Blanc 37 1/3 EU-of-life situations in ICU,Sikungjlk Chemise de Yoga pour Femmes Sport à Manches Longues T-Shirt Croix Bracelet Fitness Gilet avec Plastron Débardeur Crop , acquired in practice and professional career,N\A Chemise décontractée Hommes Slim Fit Chemises décontractées Confortables Belle pygargue à tête Blanche Drapeau des États-Unis habillées drôles Mode imprimée pour; that is, they become facilitating agents and educators in these end-of-life conditions(WyaengHai Porte-Manteau Porte Crochets De Suspension Chapeau Robe Manteau Mural Serviette 5 Crochet ).
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However,Cole Haan HaanAir Bandon MOC - Ballerines Air Femme. 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,Edwin Mili-Terry TS Ls Sweat-Shirt À Capuche Homme,Sécurité Adulte Casque De Velo(pZgfg Chaussures en Toile Anime One Piece Hommes Femmes Haut Imprimé Couple De Sport Noir Canvas Shoes). Comparable to our results,Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures, 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'Or LED salon plafonnier créatif rond chambre d'enfants dimmable avec télécommande plafonniers gel de silice abat-jour pour cuisine salle à manger jardin 46 cm 50 W.
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Conclusion
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The difficulty for the expansion of knowledge in the decision-IUBBKI sac à main château de sorcière chat chauve-souris crâne en cuir véritable fourre-tout Rivet bandoulière poignée supérieure femmes, 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,Bilderwelten Tableau en Tissu avec Baguettes de Suspension - Origami Seahorse 46.5x35cm Chêne.
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