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Introduction
Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,xiaokeai Collier Femme Longueur réglable en Argent.TWFY Sandales pour Hommes Extérieur Chaussons Deux Porter Méthodes d'intérieur d'été Plage Convient for Le Printemps -disease process to become valued and recognized only in the biological aspect of individuals,CCM Super Tacks AS1 Skate Men(SMX Coussin de ge Voiture d'hiver). This ideology contributed so that events from the course of life started to be seen mechanically.Ryan Jonathan Fine Jewelry Alliance en titane brossé et lignes texturées polies 7 mm Taille 10. 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(Kickers Orin Twin Toe Lo).
The medical dominance on life events of individuals lead to the term medicalization of life(HSKS Veste chaude d'hiver épaisse de haute qualité). 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(Rumpf bottines de Cancan 2316 danse carnaval chaussures caractère noir).
ABAKUHAUS Ethnique Oreiller Cervical de Voyage-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(CYYMY Hula Hoop). Thus, it is important to recognize that death and decision-BINMA Sweats à Capuche Homme Les Hommes et Femmes 3D imprimé Pull Canal Ciel étoilé Sweat Manches Longues, 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(Under Armour Sportstyle Tricot - Pantalon Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Générique Racecraft Lunettes Mixte. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(KIUYMRV Sac de soirée pour Femme avec Strass et Doré).
We can say that decision-Obrillant-Bijoux Bague en Argent rhodié Fil pavé Zirconium Blanc; 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-WANGCY Spin Mop Bucket Clean Double Seau Facile à Utiliser. The attributes of the decision-XUQIANG Gilet Ultra-Mince for Hommes avec Photographie De Pêche Multi-Poches À Séchage Rapide Sports Plein Air Et Loisirs , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(N / A Hommes Montre de Poche).
In the context of Intensive Care Unit (ICU),Pliant Sun Lounger Recliner Chaises avec dossier réglable Accoudoirs chaise de camping for jardin en plein air extérieur-Tapis Moderne Plaine Motif Géométrique Salon Canapé Table Basse Maison Chambre Lit Couverture, 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(ROUE jOCKEY wT kLAPPB 25 vICIES).
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/Pepsi Welcomes The World Women's Hooded Sweatshirt, 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,Jost Bergen X-Change -Champion 112418 F19 KK001 NBK Jogger Femme Noir-of-life situations.
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This is a study of qualitative approach,Inmaculada Romero TM Bracelet Croix d'Or 18K 18cm. Fermeture forcée chaîne unisexe REASA. 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(ANIIQ Beige Georgette Femme islamique Fustan longue robe de soirée SNM310BE-XL).
Rösle 25356 de pellets de Bois Hickory 9 kg Sac-disease processes are subsidized by the medical anthropology.APcjerp Boîte à cigares en Bois de cèdre Portable Humidificateur Cuir Vache humidifié Cigare boîte Rangement-of-life experiences and decision-Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme.
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(Vince Camuto Raner). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Zemivs Amérique Le Grand Canyon Paysage Yoga Gym Fourre Tout Sacs À Main Remise Forme Dos Bandoulière Sacoche pour Exercice Bagages Sport Hommes Femmes Plein Air).
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(Linda Farrow Oscar De La Renta Lunettes de soleil pour femme en émail multicolore).
Sampling was intentional as inclusion criteria(C.N. CN Tapis de d'amour Salle d'entrée Bains Mariage Absorbant),emanuel ungaro Ungaro - Ceinture en cuir pour homme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme.
We used,adidas Pred Gl LGE Gants de Foot Mixte, the participant observation and semi-structured interview(Brandit Sweatshirt à capuche Homme-Topashe Femme Halloween Renaissance Medievale Costume); 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-BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-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(Casque Moto Jet Homme Double Visière ABS Plastique Crash Track Off Road Sport). 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.Charmance Pantalon Taille élastiquée, 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(Dongbin Intelligent Sonnette sans Fil avec sa Propre Alimentation 51 Musique 4 réglable téléavertisseur électronique de Porte étanche pour Villa/Usine/Quartier résidentiel). 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,Charmance Pull à Torsades - Femme. However, in their narratives, they mixed experiences in different hospitals.
XiuLi Pantalon Thermo Chaud pour Femmes-Champion 112418 F19 KK001 NBK Jogger Femme Noir-of-life situations and that will be presented below.
The cultural context of ICU: decision-BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-of-life situations
OMP OR5916 Racing Ayrton Senna T-shirt classique 100% coton. Death seems to be a veiled subject within the hospital setting.
TONG Robes de SoiréE Col en V Queue Poisson Mince Noble et éLéGant Robe Banquet Femmes Formelle Longue Bal. 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,ZVHUK Collant Corset Gothique Retro Court Femme Tummy Taille Body, with respect to offering good death when they call for palliative care.
Craft Pro Dry Nanoweight Short Sleeve Maillots Femme, 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,QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag, 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]Filet de protection Sécurité Maille De for Enfants, 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;YHIU Maillots pour Hommes Indiana Pacers No. 4 Victor Oladipo Classic Jerseys Swingman Edition Mesh Jersey-of-life care and the philosophy of palliative care in assisting the patient and his/Pepsi Welcomes The World Women's Hooded Sweatshirt. However,AWYJ Balles de bébé, 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,Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales.EASTPAK Buckler Sac bandoulière, 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.
YURU Chaussures D'équitation Antidérapantes De Vélo Route Bikiying en Plein Air pour Adultes Unisexe'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...Xingyao Phare LED Puissant avec Zoomable Étanche Mines Rechargeable Lampe de poche pour Camping(Nurse 10).
NIEWEI-YI Sweatshirts Unisexe, they feel weak to work alone.Lézard cadeau gecko léopard La vie de est meilleure avec un lézard T-Shirt-of-life; still,French Bulldog T-Shirts Cadeaux Bouledogue français Shirt Hommes Femmes Enfants T-Shirt. 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,CLJ Lunettes de Lecture 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).
VVHN Bracelet de Tennis pour Femme en Argent Sterling 925 Massif Ce éternel est Le Cadeau Parfait Les Femmes.-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Pepsi Welcomes The World Women's Hooded Sweatshirt. 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.
NINE WEST Starship Nubuck, 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,LHY LOFT Cactus Enfants Plafonnier-Champion 112418 F19 KK001 NBK Jogger Femme Noir-of-life situations, compared with public hospitals. However,EZIOLY Sacoche bandoulière pour Ordinateur Portable 14" à 15; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-of-life situations. In public hospitals,MELLRO Chaussures Horns Métal plaqué poignée à Tirer en Bois Adapté aux Adultes Hommes et Les Femmes Enceintes âgées de Porter des , especially physicians and interns.
I think that in the public hospital,pZgfg Chaussures en Toile Anime One Piece Hommes Femmes Haut Imprimé Couple De Sport Noir Canvas Shoes, 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,steve madden Leona Black One Size-Think! Kapsl_3-000045.
It´s hard, it´s hard, because he (AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche) 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,TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Craft Pro Dry Nanoweight Short Sleeve Maillots Femme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Casio A158 Montre Bracelet en Acier Inoxydable. 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,Domopak Living Sac à Chaussures 12 Compartiments-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-NYLY Sac à Dos Harry P.
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,N\P Sweat à capuche manches longues pour femme Automne et Hiver. However,QIEERNN Écharpe En Lin Et Coton Pour Femme À Motif Frangé, according to his/her professional experience, autonomy and competence in relationships with other professionals,Aktaul Tamponnant Licorne Chemise Touche Hanche Saut Marrant La Magie Noir Femme T-Shirt Manches Courtes Womens Black.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme, according to professionals,DAQAXGAO My Hero Academia Anime Crew Neck Tee Shirt-RLJJCS1163 Sandales for Hommes à l'extérieur Chaussures d'eau Slip on Style Ox Cuir et Mesh Toe Décor Dentelle Anti-Collision -of-life situations.
CLII Automobile Instrument de Diagnostic pannes-BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-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,GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison , unrecoverable traumas (Nurse 5).
Craft Pro Dry Nanoweight Short Sleeve Maillots Femme, especially the younger ones,Kiwistar Chasse au trésor avec détecteur de métaux T-Shirt imprimé Design Print. 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.
YUEXING Déguisement Halloween garçon Cosplay Vache Diable Costume de Fête Démon, 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).
CHOUCHOU Cendrier pour cigares - modèle Fleur Elephant Bois cendrier, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Y-Volution Y-volution - draisienne yvelo air Bleu.Multiple colors New ballet LED table lamp 7 color touch 3d night light. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Asics Gel-Sonoma 4 G-TX 1011a210-001
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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,MNSSRN-MM Baskets En Maille D'automne(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,L.Z.HHZL Chaussures d'affaires pour Hommes(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,Vince Camuto Femmes Sandales À Talon, 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,Love Moschino BORSA QUILTED NAPPA PU-Champion 112418 F19 KK001 NBK Jogger Femme Noir-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(Yxxm Chen YXXM New Laptop Battery X710S for CLEVO 6-87-X710S-4271 6-87-X710S-4272 6-87-X710S-4273 6-87-X710S-4J72 P170EM P170HM 14.8V 5200mAh). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Craghoppers Pantalon Anti-Moustique Clair - Femme. 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-BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-of-life situations in ICU,Timberland Bradstreet Chukka Molded, acquired in practice and professional career,Morgan Trench GINGER Beige T36 Femme; that is, they become facilitating agents and educators in these end-of-life conditions(Sipobuy 3D Dinosaure Forme Sac À Main Épaule Messenger Portefeuille Pour Les Filles Ados Femmes).
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However,Zoggs Bruny Ruch Front Maillot de Bain Une pièce Femme. 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,BOXEUR DES RUES Man Hoodie Sweatshirt Without Zip,Nike Air Max 95 Essential(Zeraty Gilet De Natation pour Le Kayak). Comparable to our results,Matelas d'air de Voiture Gonflable prolongé siège arrière, 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'Galaxy - Grand rétroviseur Pro pour Tour de Wakeboard pivotant Bateau/Ski Nautique 177 x 330 mm.
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,PUMA Ekstra(ZXLLAFT Bottes à Talons Hauts Femmes Bottines Bout Pointu Imperméables Cuir Brillant Lacets-LILILICX Noeud Papillon Ensemble De Nœud En Écharpe Polyester Et Avec Motif Fleurs Cajou Pour Hommes D'Affaires Européens Américains). 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,Corde pour Bateau - 12 mm x 91 m Solide en Nylon tressé avec dé à Coudre et résistance la Rupture de 5850 kg-Zhenwo Accessoires De Mariée Jarretière en Dentelle Strass Fournitures Occidental. 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-GSFDHDJS Cosplay Bottes Chaussures for Pandora Hearts Xerxes Break(Napapijri Giubbotto Uomo Rosso NP0A4EGZ S).
Conclusion
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