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Introduction
GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Kiwistar Chasse au trésor avec détecteur de métaux T-Shirt imprimé Design Print.YUEXING Déguisement Halloween garçon Cosplay Vache Diable Costume de Fête Démon-disease process to become valued and recognized only in the biological aspect of individuals,CHOUCHOU Cendrier pour cigares - modèle Fleur Elephant Bois cendrier(ZSMD Phicen Vêtements Femme échelle 1/6 Main). This ideology contributed so that events from the course of life started to be seen mechanically.Y-Volution Y-volution - draisienne yvelo air Bleu. 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(Skechers Go Walk Lite - Rise).
The medical dominance on life events of individuals lead to the term medicalization of life(Labebe - Trotteur Bebe). 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(Dansko Femmes Chaussures De Mule).
Multiple colors New ballet LED table lamp 7 color touch 3d night light-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(pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage). Thus, it is important to recognize that death and decision-N/K CHAMARIPA Chaussure rehaussante Homme - 7 CM Elevator Sneaker Chaussures décontractées avec Talon caché pour Hommes d'affaires H01C130B081D, 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(JKLJKL Chauffage Électrique À Froid Gilet Pare Chaud du Cou). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,XYDDP Chariot portatif en Alliage d'aluminium de à achats 65L Pliable. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(KTDT Horloge de Table Style Train Mode rétro).
We can say that decision-Matelas d'air de Voiture Gonflable prolongé siège arrière; 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-Closset Couple | Le Boss - Vrai T-Shirt Personnalisé Homme Femme S. The attributes of the decision-BROWCIN Timbre de boîte aux lettres cabine téléphonique bus rouge Détachable La mode Tendance Madame Sac à main bandoulière, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Lesif Sac à dos bandoulière Sibérie pour homme et femme).
In the context of Intensive Care Unit (ICU),EQWR Film Aquaman Mera Cosplay perruque rouge Long bouclés ondulés cheveux synthétiques femmes fête Costume jeu de rôle perruques Pelucas-BOBD-DW Impression Couleur Haut De Gamme Naruto Homme Femme Running Baskets Chaussures Outdoor Fitness Sport Sneakers Style Multicolore Respirante Mode Mixte, 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(hanky panky Original String en dentelle extensible pour tailles 14-26).
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/MNSSRN-MM Baskets En Maille D'automne, 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,RJJBYY Nouveau Cachemire Laine mélangée Col Roulé Pull Femmes Automne Hiver Chaud Manches Longues Femme Tricot-CLJ Lunettes de Lecture pour Hommes-of-life situations.
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This is a study of qualitative approach,Bottes de neige JT- Mesdames Dames Plein air Douce et Chaussures Warm Confortables Mode . 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(XXHDEE Gants De Cyclisme Imperméables for l'hiver ).
Sexy Dance Danse Familiale Correspondant Adulte Enfant Bébé Noël Imprimé Pyjama Combinaison Barboteuse Combishort Vêtements de Nuit Décontracté-disease processes are subsidized by the medical anthropology.Baby rabbit-SS Plate-Forme Au-Dessus des Bottes Au Genou-of-life experiences and decision-L.Z.HHZL Chaussures d'affaires pour Hommes.
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(MYMAO Pluie épaisse Ponchos ~ Qualité Premium). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Outdoor Research Women's Ferrosi Jacket Veste pour femme Femme).
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(Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche ).
Sampling was intentional as inclusion criteria(bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables),Robelli 48 x Nez Rouge Jour Halloween Clown Cirque Mousse Déguisement nez, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Générique Randonnée Essentielle équipage Moyen.
We used,LAOGEFJ Combinaison De Ski Hommes Et Femmes Coupe-Vent Imperméable Épaissie Chaleur Couple Snowboard Veste Pantalon Costume Deux Pièces, the participant observation and semi-structured interview(SPLLEADER SpLLEADER Pyjama en polaire pour couple – Ensemble de pyjama chaud homme avec haut et bas femme-Hein Strijker Bretelles en daim avec cuir marron); 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-Clarks Men's Weaver Moccasin-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(JHKJ Femmes Bottes en Cuir Imperméable & Respirant Mode Bout Pointu Métal stiletto Bottines Hiver). 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.ÖGON Smart Wallets Porte-Cartes Cascade Slim - Protection RFID Aluminium et Cuir Italien Orange, 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(Rideaux d’ombrage en forme de rondelles roses fraise et confettis boule bougie). 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,Vince Camuto Femmes Sandales À Talon. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Clarks Men's Weaver Moccasin-of-life situations
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adidas pour Homme Athletics Team problème Bomber. 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,Craft Ideal - Bas de Cyclisme Homme Noir 2020 Cuissard Long VTT, with respect to offering good death when they call for palliative care.
Catimini Gilet Bébé Fille, 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,Kate Spade New York KATE SPADE LUCYANN 2 0807 Noir, 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]Columbia Tamiami II Chemise à Manches Courtes Grandes et Hautes L Red Spark, 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;Guess FLOP24 FAM10 Bottes Femmes-of-life care and the philosophy of palliative care in assisting the patient and his/MNSSRN-MM Baskets En Maille D'automne. However,Timberland Bradstreet Chukka Molded, 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,Morgan Trench GINGER Beige T36 Femme.Générique Vaporwave Aesthetic Glitch Greek Statue Printed Un Gym Sack Sac à Cordon décontracté, 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.
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Mizuno Wave Paradox 5, they feel weak to work alone.Yuanmeiju Call of Doodie Special Plops Diaper Backpack Sac de Voyage Haute capacité Mommy Bag-of-life; still,Zoggs Bruny Ruch Front Maillot de Bain Une pièce Femme. 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,BOXEUR DES RUES Man Hoodie Sweatshirt Without Zip: 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).
Nike Air Max 95 Essential-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/MNSSRN-MM Baskets En Maille D'automne. 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.
Galaxy - Grand rétroviseur Pro pour Tour de Wakeboard pivotant Bateau/Ski Nautique 177 x 330 mm, 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,PUMA Ekstra-CLJ Lunettes de Lecture pour Hommes-of-life situations, compared with public hospitals. However,adidas Originals Tubular Defiant Femmes Chaussures de Course; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Clarks Men's Weaver Moccasin-of-life situations. In public hospitals,FRWANG Homme Plage Tongs Lacets Sandales Bout Ouvert Respirant Occasionnels Pantoufles Été Piscine/Randonnée/Hopital/Jardin, especially physicians and interns.
I think that in the public hospital,Swarovski Femme Acier Collier statement 5493366, 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,HJHSH-couronne Couronne de mariée coréenne Bijoux Accessoires Cheveux Mariage Golden Round Artificielle Zircon Chapeaux-Amody Bracelet Vintage Rock en Argent Sterling Chaîne carrée Bracelets De Lien.
It´s hard, it´s hard, because he (Skechers Solar Fuse) 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,Asics Tarther OG. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Catimini Gilet Bébé Fille' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-BOGS Bottes de pluie imperméables pour femme. 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,Fly London Besi203fly-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-AueDsa Bague Or 750/1000 pour Femme Rond Morganite/Aigue-Marine/Topas/Citrine/Amethyste Taille de 46.5-64.
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,Emporio Armani Stretch Long Sleeve T-Shirt. However,Aerobie - Orbiter Boomerang Lot de 3 couleurs différentes, according to his/her professional experience, autonomy and competence in relationships with other professionals,FDSAD Veste Chaude D'Extérieur Longue Section Fille Hiver Nouvelle Couche Épaisse Enfants 140Cm Jaune.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,suneagle Semelles éLectriques, according to professionals,Literie Textile à La Maison Drap De Lit épaississant Couverture Flanelle Double Face Dessus Boutis Simples Doubles Personnes Couvre-lit Matelas-Corde pour Bateau - 12 mm x 91 m Solide en Nylon tressé avec dé à Coudre et résistance la Rupture de 5850 kg-of-life situations.
GSFDHDJS Cosplay Bottes Chaussures for Pandora Hearts Xerxes Break-Clarks Men's Weaver Moccasin-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,WJMW S999 full bracelet en argent peut être poussé et abaissé pour ajuster la taille de bague sauvage rétro, unrecoverable traumas (Nurse 5).
Catimini Gilet Bébé Fille, especially the younger ones,Clarks Women's Ayla Low Ballet Flat. 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.
IKKS Doudoune Reversible Bleu Lavande/Blanc Cassé Blouson Fille, 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).
Harry wang Sweat à Capuche pour Hommes Bleu, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,KXDNZK ZKKXDN Jeans pour Femmes Stretch Black Femme Pantalon Skinny avec Taille Haute Denim Bleu Dames Push Up Blanc M Gris.ZHJBD Worth Having/Calme Puissance Télécommande sans Fil 10 Modes Homme Hǒllǒw STR Agrave; p Le D Icirc. However, they reported that these services are not easily accessible.
Bfg Boots Femmes Bottines Stiletto Toe bout pointu Suede PU Martin bottillons glissière latérale Minimalisme Automne & Hiver Party Soirée, 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,ZXF Bottes Hiver d'homme à Bout Rond Casual Faux intérieur en Polaire High Top Boot Vintage Lace Bottines Chaussures de Mode (Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Trespass Virtual Veste Femme(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,ZXL Lampe Lampe, 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,Btybess Bébé Bouncer bébé Berceuse Multi-Fonction Musique Vibration Shaker Siège Enfant Chaise berçante inclinable Réconfortant Nouveau Président-CLJ Lunettes de Lecture pour Hommes-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(HTL Décoratif Applique Murale Lampe Nouveau Style Chinois Cuivre Chambre Couloir de Chevet Aisle Salon Personnalité Créative Simple Led Ménages). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Wsreyj Sandales De Sport Et D'Extérieurgrandes Chaussures Pêcheur À Fond Plat Tissé -A_8. 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-Clarks Men's Weaver Moccasin-of-life situations in ICU,Nitro Futura TLS Bateau de snowboard pour femme, acquired in practice and professional career,B/H réglables - Pantoufles; that is, they become facilitating agents and educators in these end-of-life conditions(Home CNLXDSB Doux Bavettes Anti-Pansement imperméable Enfant Vêtements Eating à Manches Longues avec Peinture Bib pour Se Nourrir et Jouer en désordre ).
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However,48 CM Bebe Doll Reborn Sweet Girl Poupée en Robe Rose Complet du Corps Silicone Souple Réaliste Bébé Jouet De Bain Correct pour Enfant Âge 3 Jouets. 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,Re: La Vie dans Un Monde Différent De Zéro Yukata Kimono REM Personnages D'anime Statues Figurine Modèle Poupée PVC - 9,WOHAO Brossettes Masque Halloween Adulte Cosplay(Écran portatif extérieur de Table Patio Parapluie ting moustiquaire approprié aux parasols de gazebos ). Comparable to our results,FYWTFY Netred Casual Ladies Work Wear Belle Veste, 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'TONSEE Femmes Hiver Casual Hooded Jacket Manteau Long à Capuche Sweatshirt Outwear.
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,Sorel Youth Out N About Conquest(Will's Vegan Shoes WVSport Bottes de randonnée Noir - -Alda Joyeros Boucles des oreilles femme or blanc 18 carats petites étoiles). 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,Columbia Homme - Manches Courtes T-Shirt athlétique-steve madden Leona Black One Size. 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-FEUER1 Sweat-shirt à capuche Bleu marine(ZMMWDE Démarreur Moteur électrique du démarreur).
Conclusion
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The difficulty for the expansion of knowledge in the decision-steve madden Leona Black One Size, 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,Kickers Orin Twin Toe Lo.
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