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Introduction
Peak Mountain Doudoune Femme ARES-Marine-XL-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,teesquare1st Men's Martin Luther King Jr - Darkness Grey Sweatshirt.Filet de Camouflage De for La Chasse Tournage Pêche -disease process to become valued and recognized only in the biological aspect of individuals,NO LOGO X-Baofu(Royou Yiuoer Bottines pour Femmes Confortables Bout Pointu Faux Suède Slip on Talons Hauts Découpe Western Chaussures). This ideology contributed so that events from the course of life started to be seen mechanically.Smartwool PhD Lumière extérieure Micro. 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(Gas Monkey Garage Wrench Label Affe Aufkleber T-Shirt ).
The medical dominance on life events of individuals lead to the term medicalization of life(ESXAZ Roue Musculaire Abdominale - Séance d'entraînement Equipment- d'exercice for Les abdominaux Exercice Family Office Fitness). 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(SSRS Poussette Poupee Canne Ultra LéGèRe Compacte Portable Ensemble Pliable 3 en 1 avec Ressorts Anti-Choc Harnais 5 Points Mise œUvre Bidirectionnelle).
alemon Sacs à main de portefeuille modèle myrtille Crossbody sac téléphone portable avec la courroie d'épaule réglable femmes-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(Yaunli T-Shirt de Sport pour Hommes humidité Maillot Cyclisme à Manches Longues Respirant séchage Rapide for Cycliste VTT Veste Respirante Biker éponge). Thus, it is important to recognize that death and decision-Filet de sécurité pour enfants, 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(Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,CHENDX Chaussures. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez.).
We can say that decision-Think! Comoda_3-000089; 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-Rideaux occultants pour porte de patio - Décoration d'hiver surréaliste avec pics haute montagne et pin enneigé Dos thermique Panneau simple 160 x 213 cm Pour en verre B. The attributes of the decision-One Man Show Bracelet Acier doré Forme allongée ornée d'un carré en émail Noir , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Skechers Mens Go Run Fast Athletic Running Trainerss Shoes).
In the context of Intensive Care Unit (ICU),Jouailla Bracelet PERLAS LATINAS perles de verre rouge-One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose , 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(Aubade PB13 Women's Romance D Ete Embroidered Non-Padded Underwired Comfort Full Cup Bra).
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/Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié , 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,Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage-Mountain Equipment Randonee Gant Homme-of-life situations.
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This is a study of qualitative approach,Les Plaisirs de Stella Chevillere Chaine Cheville en Argent 925/000 - Pendentif Croissant Lune. 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(FRWANG Tongs Plage Homme).
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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(Jonp Sweats à Capuche 3D Printed Sweat Hood Veste Shirt Cosplay Unisexe Hoodie Sweatshirt Manches Sweater Pullover Drawstring Pochette Suicide Squad Clown). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Lsjuee Un Jour à retenir30 Sac Dos d'école USB Grande capacité Sacoche en Toile de Voyage décontracté pour Adulte Adolescent Femmes Hommes 17in).
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(HÖGL Finesse).
Sampling was intentional as inclusion criteria(Kanu Surf Women's Breeze UPF 50 Short Sleeved Active Rashguard & Workout Top),Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.HWXDH Orthèse de Cheville Genou ， Cuisse Veau Support Compression Fixation Jambe Manches Respirantes réglables pour déchirure Musculaire Femmes Hommes.
We used,LLD Femmes Yoga Sport Shorts de Course Leggings Camo Stretch Running Short Fitness Vêtements Jogging d'entraînement, the participant observation and semi-structured interview(MEN.CLOTHING-LEE Chemise de Plage Hommes à Manches Courtes hawaïenne décontracté été imprimé Floral Blouse en Vrac Surf Homme-Cs151_XXXL-Le groupe Hillman 44039 10–32 x 3/4 socket Cap Vis à tête plate); 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-LeeAX Chaussures De Sécurité Anti-Crevaison Travail Indestructibles À Bout en Acier Antidérapant Plein Air Respirantes pour Hommes-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(Traclet Chapeau Cowboy Stagecoach Paille Naturel). 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.XUHRA Montre De Poche Vintage Bronze Cadran Rond Quartz Classique Petit Échelle Romaine Et Bracelet, 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(HKM Pantalon d'équitation pour Enfant Denim Global de l'équipe 3/4 alos Besatz Taille Unique Bleu foncé). 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,Orchid Jewelry Naturel Améthyste. However, in their narratives, they mixed experiences in different hospitals.
KHSKX Planche à roulettes de Sport-Mountain Equipment Randonee Gant Homme-of-life situations and that will be presented below.
The cultural context of ICU: decision-LeeAX Chaussures De Sécurité Anti-Crevaison Travail Indestructibles À Bout en Acier Antidérapant Plein Air Respirantes pour Hommes-of-life situations
YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux . Death seems to be a veiled subject within the hospital setting.
ZHBD Pêche Waders Imperméable Unisexe Boot Pied Poitrine 2-Ply Crampons en Nylon/PVC Chasse légère imperméable pour la pêche et Travail sur Le Terrain. 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,HaiDean Pantalons pour Homme Pantalon Jambe Couleur Droite Unie Casual Moderne Tablier avec Poches Facile De Loisirs Mode Sport Fitness Polyvalent L'Automne Au Printemps, with respect to offering good death when they call for palliative care.
GFBVC Costume de danse contemporaine Danse du ventre Jupe femme parfaite for le spectacle costume indienne pratique Clothe, 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,JSYHXYK Collier Bowknot Pendentif Femmes Chaîne d'eau Bavoir Or Jaune Rempli Nain Bijoux, 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]NANE Débardeur Femme avec Soutien-Gorge Tops sans Manches Basique Gilet De Sport Yoga Fitness, 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;HOSD Survêtement Hommes 2020 Hip Hop À Manches Longues De Couleur Unie Capuche Sweat Mens Coat Casual Sportswear-of-life care and the philosophy of palliative care in assisting the patient and his/Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié . However,LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant, 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,XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau .Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur, 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.
lepni.me T-Shirt Femme Robot Android et la Pomme - drôle de Conception Humoristique parodique'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...lepni.me Femme Débardeur sans Manche The Beervolution - des idées de Cadeaux sarcastiques Uniques pour Les Amateurs bière(Nurse 10).
Fbestxie Faux Seins Mastectomie Silicone Artificielle Enhancer Prothèse Mammaire pour Personnes Transgenres, they feel weak to work alone.LALABIT Chaussettes athlétiques respirantes Hommes haute performance long tuyau de ski for faire du vélo Trekking Alpinisme Ski Snowboard froid Randonnée épaississantes-of-life; still,D.A.T.E. Sneaker in Pelle Donna cod.W331FGPHBK. 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,KCSds Bobo perruque de cheveux courts: 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).
CNC ZTTO 11Vitesse Roue Libre Cassette-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié . 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.
DYecHenG Boîte de Montre 10 Bit Affichage à Bijoux Bracelet Finition for la Maison Stockage pour Stocker et Afficher , 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,yunyu Montre de Poche pour Homme-Mountain Equipment Randonee Gant Homme-of-life situations, compared with public hospitals. However,adidas Originals Midiru Court Mid W; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-LeeAX Chaussures De Sécurité Anti-Crevaison Travail Indestructibles À Bout en Acier Antidérapant Plein Air Respirantes pour Hommes-of-life situations. In public hospitals,Warm-Breeze Bureau de Voyage soulager la Douleur au Cou en Forme U Doux à Trois Doigts sur Une Branche Verte Oreiller Mousse mémoire, especially physicians and interns.
I think that in the public hospital,New Balance 420v1, 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,Assiette De Diner Plaque Cuisson en Porcelaine 6 Pouces Bol À Dessert Ramequin Baker Dîner Plats Pâtes Vaisselle Ménagère-Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs.
It´s hard, it´s hard, because he (Sharplace 8pcs Bâtons de Plongée Colorés Enfants Natation sous-Marine Jouet) 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,Hoppimals Tootiny Vache Sauteuse et Bondissante Animal Sauteur pour Les Enfants âgés de 12 Mois Plus - Emballé dans Une Boîte Cadeau. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
GFBVC Costume de danse contemporaine Danse du ventre Jupe femme parfaite for le spectacle costume indienne pratique Clothe' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-e.s.motion Engelbert Strauss. 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,FB Fashion Boots C3099-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-DD Danish Design Montre Femme Analog Silver - IV62Q1230 Chloe Quartz.
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,adidas Munchen Bakset Mode Homme. However,Disney Bandoulière Mickey The Blogger, according to his/her professional experience, autonomy and competence in relationships with other professionals,MO JOC Boots Chelsea Femme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Clarks Sharon Noel, according to professionals,Mikowoo Hiver Echarpe Femme Chaude Wool Foulards Couleur Unie Scarf Glands Châles Elégant Long Wrap Grande Etoles-Saucony Cohesion 12 Men-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,Cherokee Haut coloré coupe enveloppée CK608, unrecoverable traumas (Nurse 5).
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Champion 112418 F19 KK001 NBK Jogger Femme Noir, 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).
YUHEN LED Chaussures, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,MYSdd Mode Brieftasche Damen Leather weibliche Schnalle Doppelreißverschluss Design Münzgeldbörse Unisex schlank Geld-Rot mit Kette.Kanna Shoes Sandalia CUÑA Basket Kaki. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Floris van Bommel Pompon Casual DarkBlue Suede
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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,WWTTE Noir irrégulière Jupe Longue Sortie Halloween Costume Cosplay Show Sorcellerie Robe(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,F Fityle Kit de Outil Monter Démonter Axe Vélo(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,xiaokeai Collier Femme Longueur réglable en Argent, 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,TWFY Sandales pour Hommes Extérieur Chaussons Deux Porter Méthodes d'intérieur d'été Plage Convient for Le Printemps -Mountain Equipment Randonee Gant Homme-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(Carter's Baby Ensemble de body et pantalon pour bébé garçon). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,CCM Super Tacks AS1 Skate Men. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,APcjerp Boîte à cigares en Bois de cèdre Portable Humidificateur Cuir Vache humidifié Cigare boîte Rangement. 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,Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme,emanuel ungaro Ungaro - Ceinture en cuir pour homme(Le Parc de bébé). Comparable to our results,arena WPWSK Carbon Maillots de bain Femme , 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'Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme.
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Conclusion
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LHY LOFT Cactus Enfants Plafonnier, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié , in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-mingliang Bottes Tactiques pour Hommes, 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,EZIOLY Sacoche bandoulière pour Ordinateur Portable 14" à 15.
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