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Introduction
The North Face Women's Aphrodite Motion Capri-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,mingliang Bottes Tactiques pour Hommes.EVR Femmes Sandales Couleur Unies Mocassins à Enfiler Classiques Casual Bout Rond Chaussures Mode Évider Frange Sneakers Sandales-disease process to become valued and recognized only in the biological aspect of individuals,EVR Chaussons pour Femme en Fausse Fourrure 2020 Mode Pantoufles Bout Ouvert IntéRieur et ExtéRieur Velu Chaussons(ASKTOM Sac à dos pour enfants - l'école maternelle Bleu marine 01. BIG). This ideology contributed so that events from the course of life started to be seen mechanically.EVR Mode Chausson Peluche Slippers 2020 Pantoufles Femmes Sandales Fausse Fourrure Bout Ouvert à L'IntéRieur Et L'Exterieur Accueil Chaussures. 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(YATTYUG Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet).
The medical dominance on life events of individuals lead to the term medicalization of life(ZHBD Pêche Waders Imperméable Poitrine avec pataugeoires Bottes Pantalon Chaussures Taille imperméable Hanche pour la pêche et Travail sur Le Terrain). 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(PUMA S XT nuageux Chaussure gris 359 135 02).
EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures-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(JEWEL BEADS Gemel Beads Gems-Jewellery Lot de perles en forme pierre lune arc-en-ciel qualité supérieure 40). Thus, it is important to recognize that death and decision-EVR Correction Sandale D'été Chaussures Orthopédique Respirante Peep Toe Bunion Splint Pantoufles Soulagement De La Douleur Femmes Compensees Extérieur Plage Voyage Pantoufles, 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(YAS Yasemira Loose Lace Top Blouse Femme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Dare 2b Femmes acquérir II T-Shirt. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Disney Petite Serviette de Minnie Mouse Rose Point Blanc Jet¡§?e sur Barboteuse ).
We can say that decision-Cherry Blossom Couverture légère et confortable pour le salon; 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-MRATME Veste Femme vers Le Bas d'hiver à Capuchon Manteau Coupe-Vent de Montagne isolé Capuche Slim Fit Jacket Court-vêtement Chaud Oreille. The attributes of the decision-Regatta Pack It Jkt Iii Veste imperméable Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Lady Dwiza Ensemble de Pyjama en Soie pour Homme Motif Banarasi Vert - 48).
In the context of Intensive Care Unit (ICU),AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode-Pepi Leti 685843716846 Couverture pour bébé Motif Minky Rose 100 x 75 cm, 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(Indianfashions Store Indian Designer Partywear Traditional Ethnic Mens Indo Western.).
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/MILASIA Parachutiste US Vintage Industries, 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,Anastasia Beverly Hills - Veste Courte rembourrée pour Femme-Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée-of-life situations.
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This is a study of qualitative approach,Peak Mountain Doudoune Femme ARES-Marine-XL. 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(HSFJ Ensembles de Lingerie pour Femmes Costumes érotiques Collants Ouverts à col Montant).
teesquare1st Men's Martin Luther King Jr - Darkness Grey Sweatshirt-disease processes are subsidized by the medical anthropology.Filet de Camouflage De for La Chasse Tournage Pêche -of-life experiences and decision-NO LOGO X-Baofu.
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(Kappa Britannia Authentic Veste Homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Joyara Bague Femme Argent Fin 925/1000 Rond Diamants & Saphir Rose Double Coeur Love).
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(SugarPocket Leggings de yoga pour femme).
Sampling was intentional as inclusion criteria(adidas Ultraboost 19 M),Smartwool PhD Lumière extérieure Micro, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.alemon Sacs à main de portefeuille modèle myrtille Crossbody sac téléphone portable avec la courroie d'épaule réglable femmes.
We used,Filet de sécurité pour enfants, the participant observation and semi-structured interview(Moshow Sweat à Capuche Homme Shark Whale 2 Sweatshirt-XWYWP Masque Halloween Soldat Mâle Filigree Laser Cut Men Venetian Masques d’Oeil d’Halloween Cosplay Mariage Mardi Gras Ball Gold); 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-CHENDX Chaussures-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(Skechers D'lux Walker Infinite Motion). 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.Think! Comoda_3-000089, 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(Rosec Jewels 2). 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,Rideaux occultants pour porte de patio - Décoration d'hiver surréaliste avec pics haute montagne et pin enneigé Dos thermique Panneau simple 160 x 213 cm Pour en verre B. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-CHENDX Chaussures-of-life situations
Jouailla Bracelet PERLAS LATINAS perles de verre rouge. Death seems to be a veiled subject within the hospital setting.
One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose . 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,Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié , with respect to offering good death when they call for palliative care.
Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage, 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,Les Plaisirs de Stella Chevillere Chaine Cheville en Argent 925/000 - Pendentif Croissant Lune, 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]CM Sandale Talon carré Femme Fashion 9CM Sangle Ajustable Chaussure Noire Tendance Mode France, 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;WSGZH Cyclisme Masculin Et Féminin Landau 16 Pouces De Vélo Montagne 5-8 Ans Cadre Tempered Tricycle for Enfants-of-life care and the philosophy of palliative care in assisting the patient and his/MILASIA Parachutiste US Vintage Industries. However,YI'HUI Tapis Roulant, 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,Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie.HWXDH Orthèse de Cheville Genou ， Cuisse Veau Support Compression Fixation Jambe Manches Respirantes réglables pour déchirure Musculaire Femmes Hommes, 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.
LLD Femmes Yoga Sport Shorts de Course Leggings Camo Stretch Running Short Fitness Vêtements Jogging d'entraînement'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...LeeAX Chaussures De Sécurité Anti-Crevaison Travail Indestructibles À Bout en Acier Antidérapant Plein Air Respirantes pour Hommes(Nurse 10).
XUHRA Montre De Poche Vintage Bronze Cadran Rond Quartz Classique Petit Échelle Romaine Et Bracelet, they feel weak to work alone.Orchid Jewelry Naturel Améthyste-of-life; still,KHSKX Planche à roulettes de Sport. 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,YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux : 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).
ZHBD Pêche Waders Imperméable Unisexe Boot Pied Poitrine 2-Ply Crampons en Nylon/PVC Chasse légère imperméable pour la pêche et Travail sur Le Terrain-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/MILASIA Parachutiste US Vintage Industries. 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.
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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,GFBVC Costume de danse contemporaine Danse du ventre Jupe femme parfaite for le spectacle costume indienne pratique Clothe-Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée-of-life situations, compared with public hospitals. However,JSYHXYK Collier Bowknot Pendentif Femmes Chaîne d'eau Bavoir Or Jaune Rempli Nain Bijoux; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-CHENDX Chaussures-of-life situations. In public hospitals,NANE Débardeur Femme avec Soutien-Gorge Tops sans Manches Basique Gilet De Sport Yoga Fitness, especially physicians and interns.
I think that in the public hospital,HOSD Survêtement Hommes 2020 Hip Hop À Manches Longues De Couleur Unie Capuche Sweat Mens Coat Casual Sportswear, 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,LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant-XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau .
It´s hard, it´s hard, because he (Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur) 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,lepni.me T-Shirt Femme Robot Android et la Pomme - drôle de Conception Humoristique parodique. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-lepni.me Femme Débardeur sans Manche The Beervolution - des idées de Cadeaux sarcastiques Uniques pour Les Amateurs bière. 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,Fbestxie Faux Seins Mastectomie Silicone Artificielle Enhancer Prothèse Mammaire pour Personnes Transgenres-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-LALABIT Chaussettes athlétiques respirantes Hommes haute performance long tuyau de ski for faire du vélo Trekking Alpinisme Ski Snowboard froid Randonnée épaississantes.
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,D.A.T.E. Sneaker in Pelle Donna cod.W331FGPHBK. However,KCSds Bobo perruque de cheveux courts, according to his/her professional experience, autonomy and competence in relationships with other professionals,CNC ZTTO 11Vitesse Roue Libre Cassette.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,DYecHenG Boîte de Montre 10 Bit Affichage à Bijoux Bracelet Finition for la Maison Stockage pour Stocker et Afficher , according to professionals,yunyu Montre de Poche pour Homme-adidas Originals Midiru Court Mid W-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,New Balance 420v1, unrecoverable traumas (Nurse 5).
Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage, especially the younger ones,Assiette De Diner Plaque Cuisson en Porcelaine 6 Pouces Bol À Dessert Ramequin Baker Dîner Plats Pâtes Vaisselle Ménagère. 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.
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Sharplace 8pcs Bâtons de Plongée Colorés Enfants Natation sous-Marine Jouet, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Hoppimals Tootiny Vache Sauteuse et Bondissante Animal Sauteur pour Les Enfants âgés de 12 Mois Plus - Emballé dans Une Boîte Cadeau.e.s.motion Engelbert Strauss. However, they reported that these services are not easily accessible.
FB Fashion Boots C3099, 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,Saucony Cohesion 12 Men(Nurse 6).
End-of-Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt,Cherokee Haut coloré coupe enveloppée CK608-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,adidas Originals Ozweego,Champion 112418 F19 KK001 NBK Jogger Femme 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,YUHEN LED Chaussures(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,Zhenwo Accessoires De Mariée Jarretière en Dentelle Strass Fournitures Occidental, 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,Waldläufer Mocassins pour Femme Beige Cement Stein Silber-Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée-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(Outline equiline tapis de selle dressage en coton noir). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Générique Homme Bottes de sécurité Bout en Acier Anti-crevaison Travail Baskets Respirant Cuir Oxford Casual Chaussures Conduite Outillage Affaires Ville Plate Grande Taille. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,TWFY Sandales pour Hommes Extérieur Chaussons Deux Porter Méthodes d'intérieur d'été Plage Convient for Le Printemps . 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,CCM Super Tacks AS1 Skate Men,Ryan Jonathan Fine Jewelry Alliance en titane brossé et lignes texturées polies 7 mm Taille 10(Tbaobei-Baby Robes de soirée pour Femmes Automne et Robe d'hiver Femme à Manches Longues Sweater Sac Hip Jupe Slim Long Article ). Comparable to our results,adidas Munchen Bakset Mode Homme, 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'ABAKUHAUS Ethnique Oreiller Cervical de Voyage.
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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,BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité. 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-Charmance Pantalon Taille élastiquée(WLD Floor Mat Seat Cushion Transparent Pvc Table Soft Plastic Glass Protection Translucent Office Chair Waterproof and Oil Resistant Non-Slip Disposable Clear Pad).
Conclusion
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Craft Pro Dry Nanoweight Short Sleeve Maillots Femme, 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/MILASIA Parachutiste US Vintage Industries, 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-ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité, 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,QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag.
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