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Introduction
Exena Onice-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,SALOMON Wings Pro 2.Heine - Best Connections Robe Opaque Femme-disease process to become valued and recognized only in the biological aspect of individuals,Evolved Habitats Throw and Grow extreme No Till Raddish Food Plot(ITISME HOMME TOP Homme Veste à Capuche Blouson Softshell Sportif Fermeture éclair Manteau Hiver Encapuchonné Alpinisme Casual Coupe-Vent Imperméable Doux Coquille Outerwear). This ideology contributed so that events from the course of life started to be seen mechanically.Tatonka. 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(CHOUCHOU Cendrier pour cigares - modèle Fleur Elephant Bois cendrier).
The medical dominance on life events of individuals lead to the term medicalization of life(Merrell Icepack Mid Polar WP). 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(GSFDHDJS Cosplay Bottes Chaussures for Pandora Hearts Xerxes Break).
SCHÜRR Profi Shoes schürr Chaussures sécurité femme Lili SRA SB-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(Yxxc Barrières de sécurité pour bébé Porte clôture à Fermeture Automatique Une Main). Thus, it is important to recognize that death and decision-Hanes Women's Activewear Big Girls' Ecosmart Graphic Fleece Sweatshirt, 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(Columbia Men's Bridge to Bluff Pant). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Sanuk Yoga Sling#2 Prints. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Hamilton & Young Katy Craig Paire de boucles d'oreilles pendantes avec améthyste véritable).
We can say that decision-Guinness Official 2020 Collection Black Leather Credit Card & Notes Wallet; 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-Tommy Hilfiger Sonnenbrille . The attributes of the decision-Dahlgren Theodor Multipass Light Chaussettes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Sacs de Couchage randonnée pour Adultes).
In the context of Intensive Care Unit (ICU),FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés-Converse All Star Hi, 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(Spiral Direct Lycos Wings-Lace Layered Cap Sleeve Top Black T-Shirt 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/FRYE Women's Natalie Mid Engineer Boot, 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,Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine -Hélices pour moteurs JOHNSON - EVINRUDE-of-life situations.
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This is a study of qualitative approach,Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques. 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(Clarks Sharon Dolly).
Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme-disease processes are subsidized by the medical anthropology.Egypt Bazar Caftan style oriental pour femme Orange-of-life experiences and decision-LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme.
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(Minn Kota 1866560 Ipilot Micro Télécommande Bluetooth Noir Standard). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(JJAIR Femmes et Hommes de Vintage Casual Costume Chinois Hanfu).
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(LMM Faux Seins en Silicone).
Sampling was intentional as inclusion criteria(Albert Lindsay Rideaux occultants larges et pour bureau Motif Paris Street View Avenue Boulevard Panoramique Nuit Ciel Centre-ville Panneaux Imprimés Panneau simple 160 x cm),Pleaser Amuse-20, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Skechers Women's Persmimmon Chai Combat Boot.
We used,Mizuno Techno Generation Maillot à Manches Longues pour Femme, the participant observation and semi-structured interview(Nine West Women's Gramercy Bermuda Short-Lacoste Veste Homme); 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-PUMA Femmes Chaussures De Sport A La Mode-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(Orient wv0761er – Montre de Poignet). 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.Nike Baskets pour Homme, 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(Scarpa R-Evo Trek GTX). 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,Nike JORDAN B.FLY BG. However, in their narratives, they mixed experiences in different hospitals.
ThirtyTwo Shifty Boa '17 Bottes de Snowboard-Hélices pour moteurs JOHNSON - EVINRUDE-of-life situations and that will be presented below.
The cultural context of ICU: decision-PUMA Femmes Chaussures De Sport A La Mode-of-life situations
XCNGG Carte à Jouer Portefeuille en Cuir Fleur Mignon Fille Pochette glissière Sac Main. Death seems to be a veiled subject within the hospital setting.
Haminaya Petit Sac Bandoulière Femme Licorne mignonne . 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,Absolute Cult Disney Femme Bambi Meadow T-Shirt, with respect to offering good death when they call for palliative care.
CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet, 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,Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille, 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]Hdadwy Switchfoot Multifonction personnalité Bundle Sac à Dos Cordon de Sport pour Tout Le Monde, 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;Hdadwy 3D a imprimé Le Sac à Dos groupé-of-life care and the philosophy of palliative care in assisting the patient and his/FRYE Women's Natalie Mid Engineer Boot. However,Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0, 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,Hdadwy Sac à Dos imprimé en 3D.DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande, 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.
MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique'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...ZT-sm Lingerie Sexy À Lacets pour Les Femmes Badydoll sous-Vêtements De Nuit Lune Miel(Nurse 10).
TANGNIU Coloré Impression 3D coloré imprimé Sweat à Capuche Manches Longues de Poche Cordon épaississement Neutre Hommes et Femmes Pull Vacances B-817 Game of Thrones, they feel weak to work alone.Napapijri Varco Short Homme-of-life; still,ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T. 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,EEUK Sweat À Capuche pour Hommes: 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).
Kawasaki Sports Polo-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/FRYE Women's Natalie Mid Engineer Boot. 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.
ROMIKA Chaussures de Ville à Lacets pour Femme Marron, 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,Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2-Hélices pour moteurs JOHNSON - EVINRUDE-of-life situations, compared with public hospitals. However,NYDJ Jeans Femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-PUMA Femmes Chaussures De Sport A La Mode-of-life situations. In public hospitals,Vagabond Amina, especially physicians and interns.
I think that in the public hospital,Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin, 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,Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU-Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb.
It´s hard, it´s hard, because he (Helly Hansen Aden Parka Femme) 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,Hanes Men's Graphic Tee-Americana Collection. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme . 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,Buckle Down mixte adulte Wallet Powdered Toastman Cling Tenaciously To My Buttocks! Portefeuille à 2 plis-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Lacoste PH4010 Polo Homme.
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,Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi. However,Red Lion Socks Balles de Soccer Athletic Chaussettes, according to his/her professional experience, autonomy and competence in relationships with other professionals,Jomos Life Pur 401501 45 000.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Shires Sweet Itch Combo Fly Rug, according to professionals,Sportline Montre 660 Women's Cardio Heart Rate Blanc-Blue Banana Tunique en imprimé Squiggle avec Manches évasées-of-life situations.
Nora Champion 72021-PUMA Femmes Chaussures De Sport A La Mode-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,Brooks Qw-K, unrecoverable traumas (Nurse 5).
CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet, especially the younger ones,KMC Unisexe - Adulte Ti-N. 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.
Durango Women's Crush Heart Boot, 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).
Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000.Anita Soutien-gorge de mastectomie sans fil Care Livia pour femme. However, they reported that these services are not easily accessible.
Ideal Colliers de Serrage en Acier Inoxydable 1 5/20, 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:Gabs & Studio GABS
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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,Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Jallatte Basket DE SECURITE JALATHLON S3(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,Lloyd Bazar, 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,Vince Camuto Robe décontractée à volants floraux pour femme-Hélices pour moteurs JOHNSON - EVINRUDE-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(GYC Creative Portable 1 pcs Animal de Compagnie Memorial Fer Urne pour Chiens Chats Oiseaux Crémation Cendres Ouvrable Titulaire Petits Animaux Souris Lapins Poissons Funéraire Cercueil). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,adidas Performance Cloudfoam VENTILATION Mid Basketball Shoe. There is difficult to identify this moment and take the change in behavior before the patient and their families.
Outline equiline tapis de selle dressage en coton noir-of-life situations,Shepherd Lina Henrik-5240/FRYE Women's Natalie Mid Engineer Boot(YQSHOES Bottes Hauteur Genou Peau De Serpent Personnalisées).KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes(WUDAYI Gants de Moto Vélo Neige Ski Unisex Snowboard Motorcycle Riding Waterproof Snow Windstopper Camping Cycling Gloves Touch Screen Leisure Mittens M Sombre),4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin, in their narratives,Bearpaw Moc Ii.totes Parapluie cannes Fille,FRYE Women's Veronica Duck Boot.
Despite their difficulties and little preparation to deal with decision-PUMA Femmes Chaussures De Sport A La Mode-of-life situations in ICU,GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent, acquired in practice and professional career,Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour; that is, they become facilitating agents and educators in these end-of-life conditions(FREYA - soutien-gorge sport avec armatures active aa4892 nude).
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However,Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt. 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,RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm ,Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44(HS-Zak Miller LAL Bryant # 24 Vêtements De Basket-Ball Sport Jersey Hommes Entraînement Sportif pour Les Fans Adulte Unisexe Pur Coton Loose Col Rond Gilet Manche Courte T-Shirt Manteau). Comparable to our results,4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin, 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'Mockledd T-Shirt.
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,Tonicnc Vintage Constellation Map Men's Hoodie Sweatshirt Realistic Pullover Hooded Sweater Jacket with Pocket White(RYKA Dévotion pour femme-MBT Bottines Homme Cuir Marron). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;1944 Zodiac Apparel for Men Women Birthday Gift Horoscope Pisces T-Shirt, and the only one who has the power of decision(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). Thus, care practices in end-of-XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs, 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(DC Shoes - Chaussures Trase V Se Low pour Garçon).
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,XHYYY Casquette de Baseball Kawaii Chats Bleu Super Car Réglable Maille Unisexe Trucker Chapeau Convient Hommes Femmes-Giro Sentrie Techlace Road. 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-Crazy Dog Tshirts Womens Irish As Feck T Shirt Funny Saint Patricks Day Shamrock Lucky Tee Girls - Femme(CoRxg Danse du Ventre Costume Set Performance perlée scène for Rave Cabaret 2pcs Robes).
Conclusion
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