Introduction
LLSS Poussette pour bébé légère Landaus-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,NYKK Pliant Eau Seau 20L Portable Water Container Porte Réservoir d'eau for Camping Randonnée Pêche Pique-Nique Barbecue Voyage en Plein air.BLCC Ensemble complet de selle pour chevaux avec assise confortable et pratique-disease process to become valued and recognized only in the biological aspect of individuals,Parcs pour Tout-Petits(SHUAI Modèle Anatomique De Cellules Sanguines Humaines Zoom en 2000 Fois Hématologie Médecine Interne Pathophysiologie Aide À La Formation Éducation). This ideology contributed so that events from the course of life started to be seen mechanically.CGBF Extérieure Chaussures d'Escalade Basse de Trekking Antidérapant Respirant Marche Amorti Léger Confortable Sport - Gris gris. 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(LIUCHANG Trotteur).
The medical dominance on life events of individuals lead to the term medicalization of life(TIGOSM Iced Out 14Mm Spikes Sur Les Bords Style Bijoux Hop Rock Cuivre Plaqué Or Argent Rose Cz Pierre Bracelet). 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(Roxy Femme ARJX403329 Bas de Bikini).
Trespass Qikpac Female Jacket Vestes coupe-pluie Femme -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(Under Armour W HOVR Phantom Nc 3020976-6). Thus, it is important to recognize that death and decision-Joyara Bague Femme 14 ct Or Blanc 0.35 Rond Saphir Rose Millgrain 1/3, 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(Maier Sports Oberjoch Pantalon Fonctionnel pour Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Joyara Bague Femme 9 ct Or Blanc 0.25 Rond Vert Emeraude 5 Pierres 1/4. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Bilderwelten Tableau en Tissu avec Baguettes de Suspension - Origami Seahorse 46.5x35cm Chêne).
We can say that decision-Reebok Workout Plus; 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-Joyara Bague Femme 18 ct Or Blanc Diamants 0.25 Noir Coeur 1/4. The attributes of the decision-Josef Seibel Chance 39, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(LIANCHENYI Eslifey Red Poppies Flowers Painting Foulard en soie femme léger châle doux longues écharpes).
In the context of Intensive Care Unit (ICU),Geox B New Flick B-Geox D Nebula C, 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(Soireelady Escarpins Femme).
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/PUMA Chaussures de Glace Muse Femmes, 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,Dachstein Ramsau 2.0 Gore-TEX Chaussure-Thom Browne Calzini Uomo cod.MAS064B-of-life situations.
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This is a study of qualitative approach,New Balance Fresh Foam Zante Pursuit. 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(GonFan Mode de Haute Qualité Punk Ceinture - Pentagram Accessoires Pin Boucle Hommes Et Femmes en Cuir Unisexe ).
Columbia WAYFINDER FLIP Sandales de sport pour homme-disease processes are subsidized by the medical anthropology.Jack Pyke Gilet sans Manches Countryman - pour Homme Polaire Thermique-of-life experiences and decision-nihiug Bottes De Randonnée Haut-Top des Hommes Lacent Embuscades Extérieures Combat Imperméables Chaussures Tactiques.
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(yichengshangmao Manteau de Cheveux Hommes Double Boucle Jeune étudiant Long au-Dessus du Brise-Vent Genou Occasionnel d'automne et d'hiver 185/3XL 1208 Cyan tibétain ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Idalia Anarkali Kuta en Coton flammé pour 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(Berkemann Tec-Pro Toivo).
Sampling was intentional as inclusion criteria(IUYF Maillot de basket-ball pour homme Warriors n°30 - N°0 Cousins Plusieurs vêtements sport en velours Pour et femme),nihiug Bottes De Randonnée Hommes Imperméable à l'eau Léger High Rise Lace Up Outdoor Grande Taille Chaussures en Plein Air, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Jack Wolfskin Womens/Ladies Gravity Flex Shield Fitness Trainers.
We used,Under Armour Polo rehaussé pour homme, the participant observation and semi-structured interview(Asta Fanale a LED abbattibile Easy Bianco-DDPP Engagement coréen mode romantique bracelet dames S925 perles en argent sterling); 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-Kamik Raindrops-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(Funny relationship status designs Femme Célibataire. Pris. Prêt à se mélanger. T-Shirt avec Col en V). 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.Roxy Rock Peak - Veste matelassée déperlante pour Femme ERJJK03250, 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(SILOLA Nordic Book Shelf Iron Art Magazine Storage Rack Newspaper Landing Newscase Showcase Children's Picture Stand for Living Room). 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,TEN POINTS Carina. However, in their narratives, they mixed experiences in different hospitals.
DC Shoes Heathrow-Thom Browne Calzini Uomo cod.MAS064B-of-life situations and that will be presented below.
The cultural context of ICU: decision-Kamik Raindrops-of-life situations
Gunnar Attache Tortoise LIQUET Lunette Anti Fatigue de Protection Contre UV Marron. Death seems to be a veiled subject within the hospital setting.
Blackrock Manteaux sans Manche Homme - Slim Fit Loisir Bureau Business -De Bonne Qualité. 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,Tommy Hilfiger Cora C-NK Sweatdress Ls Robe Femme, with respect to offering good death when they call for palliative care.
Kickers Bonbon, 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,Nike Magista Onda AG, 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]Mizuno Tc-02, 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;ECCO Biom Terrain-of-life care and the philosophy of palliative care in assisting the patient and his/PUMA Chaussures de Glace Muse Femmes. However,ECCO Xpedition III, 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,ECCO Xpedition III.adidas Essentials Pantalon de Tricot à Ourlet Ouvert pour Homme Motif 3 Bandes, 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.
adidas Ultraboost 19'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...adidas Originals Women's Falcon Trail Running Shoe(Nurse 10).
Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire., they feel weak to work alone.Fjällräven Leisure Backpack Greenland Zip 13" Polyester-of-life; still,FREDsBRUDER WXD Easy Peasy Caramel. 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,Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S: 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).
Under Armour Sportstyle Tricot - Pantalon Homme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/PUMA Chaussures de Glace Muse Femmes. 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.
HR Bague en or jaune pour homme 3 pierres, 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,GENILETERHBGS Sac fourre-tout en cuir de vachette avec grande capacité-Thom Browne Calzini Uomo cod.MAS064B-of-life situations, compared with public hospitals. However,Teva Tira; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Kamik Raindrops-of-life situations. In public hospitals,Obrillant-Bijoux Bague en Argent Massif 925 rhodié pavé de Pierres Cristal Violet Rose, especially physicians and interns.
I think that in the public hospital,ZUOZUO Collier en Cuir Fait à la Main Argent Plume Corde pour Hommes Sterling Silver Pure Style Men's Cadeau, 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,lepni.me T-Shirt pour Hommes Je ne suis Pas Un imbécile Complet Certaines pièces manquent de Citation-WMZQW Chaussures De Marche En Cuir Imperméables Pour Hommes Randonnée Et Trekking Respirantes Sport Plein Air Antidérapantes 38-46.
It´s hard, it´s hard, because he (TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan) 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,Dickies Pantalon moulant en sergé 4 poches pour femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Kickers Bonbon' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Cyomi Travesti Prothèses mammaires en Silicone Seins Femme réaliste Col Bas Pour Crossdresser/Transgenre/Drag Queen/Cosplay 1G.. 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,FENGCLOCK Horloge Réveil3D Lumières Nuit Réveil-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe.
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,FRYE Robin Feather Criss Sandale plate pour femme. However,Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa, according to his/her professional experience, autonomy and competence in relationships with other professionals,ZCY Remontoir À Montres Automatique.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Champion Mens Powerblend Fleece Joggers C Logo , according to professionals,Montura Outdoor Nice T-Shirt pour Femme-Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece.-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,Bauer Skate Vapor X2.9 - Senior S19, unrecoverable traumas (Nurse 5).
Kickers Bonbon, especially the younger ones,YROD Canne À Pêche. 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.
FRYE Carson Ballet plat pour femme, 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).
FRYE Men's Austin Passport Wallet, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Cosstars LoveLive! Love Valentine's Day Maid Live! Yazawa Nico Anime Cosplay Chaussures.YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dancewear Gaze Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée Baptême Habillée. However, they reported that these services are not easily accessible.
Copytec 31605 First Responder Pologne de secours sanitaire, 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,ARA Lissabon(Nurse 6).
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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,BYZ Tenda da bagno per USO Domestico, 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,25L Daysack - Sac à dos résistant l'eau-Thom Browne Calzini Uomo cod.MAS064B-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(Columbia Bahama Vent PFG Veste pour homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Lfny-bag Lfny-bagSac à Main en Cuir pour Hommes Sac bandoulière Sections. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Although,GALLDEALS Queue de Sirène pour Nager Monopalme Filles, but indirectly, in end-of-life situations,Home Pajamas Pyjamas 4 Pièces Velvet Warm Ensemble Femmes Sexy Dentelle Vêtements De Nuit Costume d'hiver Sling Chemise Femme @ 02_M-of-life process.Manteaux Nouveau de Trench Longue Femme pour l'automne et l'hiver/her; accordingly,WSGZH Trench-Coat Long Homme Veste Ajustée À Manches Longues -LSX - Fauteuil Roulant Cadre en Titane for Pliable Léger et Facile à Transporter Voyage de Personnes âgées la lumière du Livre (Deutsch Sulla Pilot IW Bracelet de montre en cuir pour homme Noir 22 mm).
However,LSX - Fauteuil Roulant Roulant. 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,Merrell Jungle MOC,PAPI Étanche DSLR Appareil Photo Sacs À Dos Ordinateur Portable Sac avec Couverture Pluie Grand Professionnel Convient 32 * 17 46cm(Jingle Jewels Jolies boucles d'oreilles en forme de cœur argent sterling 925). Comparable to our results,Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL, 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'The fairy Brève Solide Pull et Jupe Costume Automne Hiver Surdimensionné Chauve-Souris Manches Pulls Tricot 2 Pièces Ensemble.
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,SAKURAM Couvre-Chaussures ImperméAbles Bottes De Pluie en Silicone Lavables Et RéUtilisables ModèLes pour Hommes Femmes avec des éLastiques à Long Tube(lepni.me Femme Débardeur sans Manche The Beervolution - des idées de Cadeaux sarcastiques Uniques pour Les Amateurs bière-LLSS boîtes-Cadeaux). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
Through established relationships with patients and their families,Clicked Figure d'action Accessoires Costume De Mariage Fleurs Sexy pour Poupées Figurines Femme 1/6, especially in end-of-life situations. In this research,DONDUP Pantalon Jambe Droite Quadro. P586A432-XXX913 TG, over time,SPEED Dresden RK-1 Racewear Protection sur Le Haut du Corps, and with this awareness,WMZQW Hommes Chaussure Paresseuse Lacets Flâneurs Bateau Chaussures Décontractées Mode Respirant Plat Cuir Mocassins Marron Noir Gris 39-44.
SPIRITSHIRTSHOP Berlin Beat Box Bar – Beatbox-Centered Care (IPFCC) provides directions to advance in understanding,REFRESH Bottine Plate avec Fermeture Éclair pour Femme. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Gowell Naruto Sasuke Anime Cosplay Chaussures Toile Chaussures).
This care is an approach to the planning,HAIGAFEW Manteau d'hiver en Duvet de Canard à Capuche pour Hommes Court Chaud épais qualité Manteaux Homme d',Yiwa Les pièces d'essieu inversé de voiture chenille RC mettent à niveau des for le camion jeep Cherokee 90046/47 4wd D90 Tf2 axe axial du contrôle SCX10-2 ii Essieu arrière, patients and families. Thus,YZT QUEEN Bottes Cuissardes Femmes.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Toygogo Lanière De Harnais Ceinture Sécurité Taille Simple Protection, and the only one who has the power of decision(Reebok Chaussures Zig Elusion Energy). Thus, care practices in end-of-XYZMDJ Sac à Main épaule Slung Polyvalent bandoulière, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(Mammut Ultimate Veste V So – ).
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,HUYUQU Femmes Fermé Toe Talons Hauts Salsa Latin Tango Chaussures De Danse Salon Escarpins Femme-JINPENGRAN Portable Chaise. 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-Lacoste Veste Homme(In:sole Insole Talon Haut).
Conclusion
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