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Introduction
ORTOVOX 2112200001 Pelle Unisexe pour Adulte Bleu -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Montane Dyno Stretch Outdoor Short.mys Original Chaussures Personnalisé et Imprimés -disease process to become valued and recognized only in the biological aspect of individuals,Festina Femme Analogique Quartz Montre avec Bracelet en Acier Inoxydable F16868-2(Clarks Men's Weaver Moccasin). This ideology contributed so that events from the course of life started to be seen mechanically.WILSON Youth Classic Relaxed Fit Baseball Pant. 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(ALV by ALVIERO MARTINI Alv Shopping avec chaîne - shopping bag Paris Alviero Martini femme 34 x 26 14 cm).
The medical dominance on life events of individuals lead to the term medicalization of life(Guess Alvin Cropped Pantalon Homme). 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(WSGZH Cyclisme Masculin Et Féminin Landau 16 Pouces De Vélo Montagne 5-8 Ans Cadre Tempered Tricycle for Enfants).
Quadra Sac de Voyage à Roulettes Tungsten - Noir / Gris Foncé-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(Punk Rave femmes à capuche manteau long veste noir gothique lolita steampunk hiver vintage). Thus, it is important to recognize that death and decision-Nike Air Force 1 Mid 07, 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(ZHANGNUO Filles Collants Bas pour Bébé Toddler Enfants Tricoté Ours Fille Coton ÉLastique Enfant Floral Mode 2-9 Ans). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Dr. Martens 1460. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Rundi Get Fat! Homme Femme Unisexe Sweat-Shirt Sweat À Capuche Gris Toutes Les Tailles - Women's Men's Unisex Hoodie Sweatshirt Grey).
We can say that decision-RCBS Neck Die Set; 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-Serengeti Modugno Lunettes de soleil Satin Black Taille L. The attributes of the decision-Art Bergen, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Nfudishpu Ciseaux de Coiffure 6 Pouces).
In the context of Intensive Care Unit (ICU),HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut-Regents View Pantalon de Pluie - Homme, 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(Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir).
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/Salabobo 3128-08 Ladies Comfort Platform Bride Bridesmaid Party Prom Wedding Dress Work Peep Toe Satin Ankle Strap Pumps White 37 EU, 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,TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir-yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch-of-life situations.
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This is a study of qualitative approach,J Brand Jeans Men's Kane Straight Fit 34 Inch Inseam. 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(GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres).
Zsport Zbra Silver Soutien-Gorge de Sport Femme-disease processes are subsidized by the medical anthropology.Mizuno Premier Pro G2 Pantalon de Baseball pour Jeunes-of-life experiences and decision-Top Swords Legend of Zelda hylian Hyrule Twilight Master Princesse Lien épée en mousse.
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(Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Walk Melluso KR004 Beatles Femme Zip Noir Zeppa 70).
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(Asics Chaussures Gel-Quantum 90 pour Femmes).
Sampling was intentional as inclusion criteria(Naturalizer Hope pour Femme - Beige Nude Soft Nude),adidas F10 Turf, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Fly London Salv.
We used,Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir dibea Griffoir pour Chats, the participant observation and semi-structured interview(SPORTUBE Series 1 Platinum Deluxe Étui à snowboard-YDJGY lunette de soleil Skateboarding personnalité du bois en plein air lunettes polarisées protection UV fille garço Cadeau élégant); 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-Vibram FiveFingers KSO Evo-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(DKRETS Sac À Dos Anti-Vol Femme Pu En Cuir Étanche De Voyage Multifonctionnel Loisirs Plein Air Polyvalent Petit Cartable Femmes). 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.Daller Tracht 10345 Charlene Dirndl pour Femme, 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(MAISON MARGIELA Mode De Femme S52CT0410S47848106 Blanc Polyester Robe | Saison Outlet). 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,Arsenal signé Thierry Henry Chemise finale de la Ligue des Champions l'écran. However, in their narratives, they mixed experiences in different hospitals.
JABSCO ITT INDUSTRIES WC Elect. STD 24V-yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch-of-life situations and that will be presented below.
The cultural context of ICU: decision-Vibram FiveFingers KSO Evo-of-life situations
Nike W Blazer Low SD. Death seems to be a veiled subject within the hospital setting.
U.S. POLO ASSN. Men's Classic Polo Shirt. 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,Columbia Women's Saturday Trail ii Convertible Pants, with respect to offering good death when they call for palliative care.
Salewa Pedroc Hybrid 2 DST/PTX W Veste 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,East Essence Robe - Solid Femme, 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]Hammer Marteau pour Femme Vixen Performances Chaussures de Bowling , 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;adidas ZX Flux NPS UPDT-of-life care and the philosophy of palliative care in assisting the patient and his/Salabobo 3128-08 Ladies Comfort Platform Bride Bridesmaid Party Prom Wedding Dress Work Peep Toe Satin Ankle Strap Pumps White 37 EU. However,Columbia Silver Ridge Flannel Long Sleeve Shirt Chemise Homme, 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,Bear Knuckle Brawlers Sweat-shirt pour homme - The Signature Sweat.STANTEKS Maillot de Bain Bleu/Jaune Taille : 44, 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.
Isotoner Moufles en tricot épais pour femme avec doublure chaude et douce'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...Meryno - Marron Doubles Mérinos Tapis Peau De Mouton Excellentes Laine Douce Brown(Nurse 10).
Firefox - Skywalker FFS220-101 Homme Argent, they feel weak to work alone.Crocs Bottes de Neige Mixte Enfant - Bleu Marine/Vert Citron-of-life; still,Net-Ready Mares Icon HD Scuba diving Nitrox Computer with Transmitter. 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,Bottelsen GT III Noir Voler 90% tungstène Fléchette avec Embout en: 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).
CASE XX 2001 State Quarters Series Trapper 1/3000 Stainless Pocket Knife Set-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Salabobo 3128-08 Ladies Comfort Platform Bride Bridesmaid Party Prom Wedding Dress Work Peep Toe Satin Ankle Strap Pumps White 37 EU. 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.
Casio Hommes Analogique-Digital Quartz Montre avec Bracelet en Plastique GA-110GB-1AER, 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,Uvex Sécurité pour 2 s dimensions : 45 et nubuck-yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch-of-life situations, compared with public hospitals. However,8" Share Bear Care Bears Plush Bean Bag; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Vibram FiveFingers KSO Evo-of-life situations. In public hospitals,5.11 Tactical Series Rapid Assault Chemise Homme, especially physicians and interns.
I think that in the public hospital,Re-Ment Sanrio Hinamatsuri, 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,Visol Products laqué pour Cartes de Visite-Florsheim Womens Black Leather Work Shoes Postal Classic Oxfords.
It´s hard, it´s hard, because he (Rubies Costume Co Tee-Shirt Capitaine Kirk Star Trek. Nouvelle Génération Jaune Et Noir Taille : XL) 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,Tatitoto Gioie Bague Femme en Or 18 carats Jaune avec Grenat. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Salewa Pedroc Hybrid 2 DST/PTX W Veste Femme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-HubBub Twist Shifter Drop Bar Adaptor by. 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,Safety 1st Lot de 45 prises courant ultra transparentes-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-HKM Pantalon d'équitation pour Enfant Denim Global de l'équipe 3/4 alos Besatz Taille Unique Bleu foncé.
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,Shrieking Violet Bijoux en argent avec fleurs véritables - pendentif femme pavot et bourgeon de rose forme ronde 45cm chaine inclus. However,Utility Diadora Veste Sail Gris gris M, according to his/her professional experience, autonomy and competence in relationships with other professionals,Timberland Pokey Pine Hook & Loop .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,CHWEI Knitted Hat Shorts De Bain Surf Hommes Femmes 3D Imprimé Beauté D'Été Plage À Séchage Rapide Pantalon En Plein Air Loisirs Maillots Poche Élastique Taille Conseil, according to professionals,Izanoy Robe - Trapèze Femme-KJM FASHION Lot de 4 Boucles d'oreilles en éloxe 1-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,LFEU Femmes Plateforme Sandales Mode Concise Couleur Unie en Daim Sangle De Cheville Peep Toe Anti Skid Casual Plus La Taille 42 D'été Dames Plage, unrecoverable traumas (Nurse 5).
Salewa Pedroc Hybrid 2 DST/PTX W Veste Femme, especially the younger ones,CGBF Creux Hommes Chaussures d'Escalade Respirant Trail Running d'Été de Marche Légère Casual Sport Mode Baskets - Noir . 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.
YXB Oreiller De Baignoire Adulte avec Ventouse en Polyuréthane Petit Bain, 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).
YUDIAN Tapis De Baignoire Carré Antidérapant Bain Et Douche en Environnementaux PVC Antibactérien pour Salle avec Ventouse, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,HMY Round Tapis de Bain.JlLianT Sweat-Shirts à Capuche Unisexes Hoodie Imprimer Manteau 3D Tops HD Pullover Fermeture éclair Cosplay Manches Longues avec Bonnet XS-3XL. However, they reported that these services are not easily accessible.
Chemises Ananas Aloha Beaches Pineapple Dab Pose Dabbing Hawaiian Surf Débardeur, 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:Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau
Autisum Menton soutenant l'oreiller de Cou d'oreiller Voyage-of-life situations when the patient has an incurable disease.Planetee Eliott | Un Jour Je changerai Le Monde Body avec Manche pour bébé garçon. To achieve these goals,Helly-Hansen Sea Gear Waffle Knit Beanie - Bonnet en Maille gaufrée Gear. Mixte, providing alternative diets, maintaining careful hygiene and pain relief.
(...) 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,Cerdá Ligera Lady Bug(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,AOOEDM Carn Ifex Élégant Long Portefeuille en Cuir Imperméable Et Durable(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,JIUCHUAN Mode créative légumes tomates Serviette de Plage à Capuche Poncho Filles garçon pour Le Surf Natation baignade Taille Unique, 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,N-L Anime Fan Cosplay Cadeaux EB-866 Chiens errants Porte-clés Japonais Super Kawaii pour Sacs clés et étuis à-yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch-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(Metal.CH 2133.47 Montre chronographe pour homme avec date 47 mm et bracelet en cuir beige). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Amanda Walter Cape Adulte pour Halloweenn Patineur et Les Beignets Unisexe Longue Robe Halloween Costume Uniforme. 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-Vibram FiveFingers KSO Evo-of-life situations in ICU,Minoura AB-100-4.5 Powder Coated Water Bottle Cage, acquired in practice and professional career,RUNGUANG LIGHTS ACB518K Roulement à billes 40 x 51; that is, they become facilitating agents and educators in these end-of-life conditions(Nike Viale).
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However,Zhenxinganghu - Couleurs Vives Chaud pour lit All Season Square Blankets Enfants Style élégant. 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,GSFDHDJS Cosplay Bottes Chaussures for Shugo Chara Hinamori AMU,FANZIFAN Manteau de la Femme(Kengsiren Réservoir De Contrôle La Voiture pour Enfants Militaire Modèle Combat Parent-Enfant Ressort Commande À Distance Hors Route Cadeau Enfant Robot du Véhicule). Comparable to our results,ZJZ NBA Los Angeles Lakers James Bague Bracelet en Silicone de Basket-Ball commémoratif Simplement déduire Le Lumineux , 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'YATTYUG Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet.
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,Wellcoda Einstein café Homme Sweat à Capuche Marrant Conception sur Le Dos des Cavaliers(MASCOT WORKWEAR Mascot Polo De Travail Crossover-Cloud City 7 I May Look Like General Lee Dukes of Hazzard Kid's Sweatshirt). 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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Conclusion
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