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Introduction
TianMai Nouvelles Maillots de Bain Musulman Femmes Filles Musulmanes Modeste Beachwear Couverture Complète Islamique Burqini Burkini Hijab Muslim Swimwear-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Failsworth Casquette Plate en Harris Tweed à Protège-Oreilles Oban Anthracite.PYF Short en Spandex Coton lâche et Doux Noir Bleu décontracté Cours d'exécution été Dames Shorts vêtements d'entraînement XXL-disease process to become valued and recognized only in the biological aspect of individuals,Maillot Cyclisme Homme Été Respirant Vêtements Ensembles Manche Courte Velo Short de Vélo pour Vetement Route (YZ-YUAN Armoires à vin Porte-Bouteilles de Support Mural en métal Porte-Bouteille Vintage autoportant | Porte-Verre Suspendu Facile Installer Stockage ). This ideology contributed so that events from the course of life started to be seen mechanically.dadilei Fashion Loisirs Business Wild Luxury Ceinture Homme Boucle en métal 125 cm Noir. 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(Roamers Chaussures de Ville en Cuir - Homme ).
The medical dominance on life events of individuals lead to the term medicalization of life(ARA Rom). 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(HZWLF Pond Garden Solar Fountain Pump Power Floating Pet Lamination).
DFDLNL Leggings de Jogging Femmes Taille Large Pantalon Yoga Sport serré Levage des Fesses Respirant Quotidien Fitness Legging-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(KÜBLER Kübler 21245353-9955-46 Pantalon Pulse Taille 46 noir/rouge). Thus, it is important to recognize that death and decision-Chiba pour Homme Lake Tahoe Gants, 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(MSSJ Bénédiction sur ce monde merveilleux! Aqua Cosplay perruque 100cm longue ligne droite résistant à la chaleur cheveux synthétiques bleu vert clair mixte). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,SPORTUBE Series 1 Platinum Deluxe Étui à snowboard. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(WTFYSYN Building Stacking Learning Blocks).
We can say that decision-Falke 14435 Airport Lot de 6 paires chaussettes pour homme - Gris 45; 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-Nike M NKCT Jacket Stadium Veste Homme. The attributes of the decision-Kipling Kassandra S, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Generic Black Titanium Plated !0 Pack 1.6 x 16mm Tongue Bar Barbell Universal Body Piercing Jewelry).
In the context of Intensive Care Unit (ICU),Skechers Bobs from Women's B-Loved-Fame Time Ankle Bootie-Prana Summit Tall Pantalon pour Femme, 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(BTYKJ Sandales compensées en Daim à Boucles 42 Noir).
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/OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants, 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,Piquadro Porte-Cartes de crédit-Nike Court Borough Mid Winter-of-life situations.
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This is a study of qualitative approach,LIZONGFQ Lit De Nid Bébé Amovible Ou La Taille d'un Enfant en Bas Âge. 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(Love Moschino BORSA QUILTED NAPPA PU).
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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(Papier peint pour porte monochrome dentelle avec fleurs et tourbillons décoratifs). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Shinelyf Longue Boots Femme Bottes Chaussures Fond Épais Confortable Bonne Élasticité Semelle en Caoutchouc Durable pour L'automne Et l'hiver).
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(IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe).
Sampling was intentional as inclusion criteria(Mac Douglas - Vesuvio Gondole Tout en un Veau cuir souple Noir),Glqwe Sac à Dos étanche pour Ordinateur Portable, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Punk Rave Gothique Hommes Noir Épais Moyen Style Steampunk Manteau Long Vintage.
We used,H.yina Table à Langer pour Fille Petits espaces, the participant observation and semi-structured interview(Xingxing XINGXING Slip-on Mens Européenne Vintage Style Low Top Bottes en Cuir Véritable Chelsea Chaussures Robe Formelle Blue-38（UK5.5）-Btybess Bébé Bouncer bébé Berceuse Multi-Fonction Musique Vibration Shaker Siège Enfant Chaise berçante inclinable Réconfortant Nouveau Président); 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-Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier-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(WYH Premium Print Yoga Mat Carry très épais Full-Zip Sac Eco Friendly Fitness Tapis dexercice for Les Femmes entraînement Home Pilates). 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.Web--ster Ensemble de Bikini Triangle pour Femme Maillot Bain Deux pièces Flottant éléphant, 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(find. Marque Amazon - Crossover Block Heel Leather). 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 2020 Pwrshape Solid Woven Skirt 18" Jupe-Short Femme. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier-of-life situations
Cheval à bascule Enfants en Plastique Bébé de Troie Year Old Cadeau Jouet Bleu Rocking Chair Xuan - Worth Having. Death seems to be a veiled subject within the hospital setting.
Plush-NH Lit pour Chien 5 Rond Couleur Pet Lounger Coussin Moyennes Grands Chiens Chat d'hiver Niche Chiot Mat Ped lit. 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,Plyisty Carte de Commande servomoteur à Double Canal CC et Triple pour Moteurs Micro: bit, with respect to offering good death when they call for palliative care.
LetsBuyGold Bague Artisanale , 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,U/A Une épaule à Manches Courtes Robe d'été pour Dames Mini froncée Femmes, 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]BTTNW Chausse-Pied Horn Chaussures en métal Extra poignée Longue Main for Helper Hommes Femmes Enfants 15/20 Pouces Long , 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;Haoshangzh55 Pulls d'homme - San Francisco 49Ers Équipe NFL Football Uniforme-of-life care and the philosophy of palliative care in assisting the patient and his/OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants. However,OLYMP Luxor Chemise à col montant Blanc, 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,TSEINCE Haute Split Élégante Robe pour Dames Plus La Taille XS-3XL Été Casual Streetwear Ceinture Tunique s Solide Bureau Femmes Robes L 0432-drak Bleu.TYBXK Pedalier VTT Vélo Chainwheel en Alliage d'aluminium à Vitesse Unique dent avec manivelle vélo Pliable Pièces Accessoires Velo, 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.
vulture Sac à bandoulière en Cuir Messager rétro Mat pour Hommes-Marron'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...HKJZ Maillots de Bain Mesdames Imprimé Skinny Haut Elasticité Siamois Manches Longues for patauger Wetsuit et Vacances Plage Maillot Bikini (Nurse 10).
O'NEILL Femme Blouse, they feel weak to work alone.Asics Women's Low Cut Performance Short - Coupe Basse pour Femme-of-life; still,MYLW Parasol Stand Bag Patio Beach Detachable Square Umbrella Base Weight avec Grande Ouverture pour Extérieur Portable de Support. 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,Byjia Chaussures De Danse Latine Salsa Cross Strap pour Femme Talons Fête Mariage Impression Sandales: 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).
LMWB Moustiquaire de Lit Pliable-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants. 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.
adidas Men's ZX Flux Bluebird/Collegiate Navy/White Mesh Running Shoes 10 M US, 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,TUDUDU Organisation Spatiale Russe Dôme en Verre Porte-Clés Hommes Femmes Bijoux Cadeaux-Nike Court Borough Mid Winter-of-life situations, compared with public hospitals. However,PUMA S XT nuageux Chaussure gris 359 135 02; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier-of-life situations. In public hospitals,I Luv Ltd Gilchrist Day cuir Sporran Crest clan écossais, especially physicians and interns.
I think that in the public hospital,Portable Floor to Enhance YogaCollage of Stylized Retro Vintage Travel Sticker Style Landmark GraphicsFitness Yoga Mat is non-slip24x71inch, 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,The Dogfather Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga-Chandria's Treasures Fleur de Lotus Infinity Lariat Collier plaqué Argent – Vente Firecracker.
It´s hard, it´s hard, because he (Feel Good Art zoomilly1216 – 04it Impression sur toile de mur en style Typographie et notice 91 x 60 4 cm Arancione) 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,Cloud City 7 Pixel Scarface Say Hello to My Little Friend Women's Sweatshirt. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
LetsBuyGold Bague Artisanale ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-MPOQZI Couvre-Volant de Voiture en Cuir Bricolage. 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,fshsh limeiliF Shorts de Yoga et Pilates Femme Signe la Paix Colombes pétales Femmes 'Low-Rice Stretchy Sexy Gym Workout Tight Short Pants-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-LKM Chaussettes désodorisantes épaisses de Base - Ball en Hiver Printemps et Automne.
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,DPASIi Women Mini Purse Crossbody of Cell Phone，Eastern Foliage Pattern with Warm Tones Lotus Leaves Abstract Motifs Japan. However,ECCO Wayfly, according to his/her professional experience, autonomy and competence in relationships with other professionals,Amanda Walter Cape Adulte pour Halloweenn Requins Nautiques garçons Unisexe Longue Robe Halloween Costume Uniforme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Wellcoda Einstein café Homme Sweat à Capuche Marrant décontracté, according to professionals,Berkemann Tec-Pro Toivo-LUPINZ Sac à dos de voyage durable - Motif cible tir l'arc-of-life situations.
Jurassic World T-Shirt à Manches Longues - Dinosaure Garçon-Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier-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,qishi Fashion Veste décontractée pour homme Couleur unie, unrecoverable traumas (Nurse 5).
LetsBuyGold Bague Artisanale , especially the younger ones,Sloggi Slip . 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.
EMANUELA BIFFOLI Ciabatta Infradito Con applicazione, 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).
Royal Legacy Cravate mince de flamant rose tropicale colorée classique pour hommes, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Timberland Killington.EQWR Hot Anime Houseki No Kuni Cosplay perruques Jade vert 100 CM Halloween carnaval fête terre du brillant. However, they reported that these services are not easily accessible.
HZWLF Pond Garden Solar Fountain Pump Power Floating Pet Lamination, 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:Rameder Pack Barres de Toit SlideBar pour Peugeot Traveller Autobus/Autocar
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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,ENDUL Sacs à Main de soirée boîte Forme Pochette Sac mariée Mariage Dames Bal Portefeuille(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,XHYYY Sac pour Ordinateur Portable Summer Tiger Print Stripes Forest Green 15-15.4 Pouces Laptop Case(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,Mares Volo Race, 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,LCFF Patins à roulettes Simple Roue Skate Sneaker Chaussures LED Clignotant Lumineux Rouleau Lames for Enfants Garçons Filles Juniors Femmes-Nike Court Borough Mid Winter-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(HEJX Pantalon d'entraînement de Basket-Ball Raptors Leonard). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Grunland CI1016 Reps Ciabatta Uomo S. Grigio-Antracite 47. 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-Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier-of-life situations in ICU,Carhartt Henley T-Shirt de Poche pour Homme , acquired in practice and professional career,WHATLEES Veston de Costume Marriage Slim Fit Col V à Fermeture Boutonnée Avec Ceinture Tenue Cérémonie - Homme; that is, they become facilitating agents and educators in these end-of-life conditions(AJSJ Hommes Femmes Coupe-Vent Respirant Vélo Pantalon Sport Équitation Course À Pied Randonnée Pêche Fitness Pantalon).
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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,XWLY Tops Femme Chemisiers Élégant Automne Col Rond Motif Chic À Manches Longues Nouveau Mode Décontracté Confortable All-Match Sexy Vacances Shirt Femmes(adidas Essentials Pantalon de Tricot à Ourlet Ouvert pour Homme Motif 3 Bandes-HOAPL Bottes Vintage Cheville De Femmes Tassel Plat À Glissière Latérale Antidérapante Semelle Confortable Retro Cheville). 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,BDHBB Lampe LED Lampes de Bureau Explosion Champignon-Hell Bunny Ella May Denim Dungarees. 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-Giussman Femme Auto charriage Machine for Adulte Femmes Plaisir télécommande Automatique Massage(Kickers Oxfork).
Conclusion
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YXRPK Usage Déformation Chaussures À roulettes Patins Automatiques Double Quatre Roues, 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/OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants, 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-Hell Bunny Ella May Denim Dungarees, 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,Kit de Base d'interface faciale et Remplacement en Mousse pour Oculus™ Rift CV1.
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