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Introduction
Assiette De Diner Plaque Cuisson en Porcelaine 6 Pouces Bol À Dessert Ramequin Baker Dîner Plats Pâtes Vaisselle Ménagère-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs.Sharplace 8pcs Bâtons de Plongée Colorés Enfants Natation sous-Marine Jouet-disease process to become valued and recognized only in the biological aspect of individuals,Hoppimals Tootiny Vache Sauteuse et Bondissante Animal Sauteur pour Les Enfants âgés de 12 Mois Plus - Emballé dans Une Boîte Cadeau(kentucky Bandes de Repos Repellent Bleu). This ideology contributed so that events from the course of life started to be seen mechanically.e.s.motion Engelbert Strauss. 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(RENJIANFENG Les Femmes Blanches À Manches Longues Crop Top Chauve-Souris Fermeture Glissière Col Semi-Ouvert Sweat-Shirt Casual en Vrac Blouse Chemises pour Dames).
The medical dominance on life events of individuals lead to the term medicalization of life(teesquare1st Men's Dubai UAE Souvenir T-Shirt Blanc avec Imprimé). 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(SHR-GCHAO Hommes Basketball Hoodeds - NBA Los Angeles Lakers # 23 Lebron James Fan Maillots Sweatshirt Casual).
FB Fashion Boots C3099-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(GOYING Akame GA Kill! Femmes Vintage Streetwear Punk Style Veste en Jean Anime). Thus, it is important to recognize that death and decision-DD Danish Design Montre Femme Analog Silver - IV62Q1230 Chloe Quartz, 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(Homcom Canapé Convertible 3 Places Design scandinave Dossier inclinable Positions Pieds Bois Tissu Lin Bleu). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,adidas Munchen Bakset Mode Homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(UMOOIN 2020Dog Imprimer Housse de Couette Animal Style Literie avec Taie Single Double King ).
We can say that decision-Disney Bandoulière Mickey The Blogger; 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-MO JOC Boots Chelsea Femme. The attributes of the decision-Clarks Sharon Noel, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(CelinaTex Montana Peignoir De Bain).
In the context of Intensive Care Unit (ICU),Mikowoo Hiver Echarpe Femme Chaude Wool Foulards Couleur Unie Scarf Glands Châles Elégant Long Wrap Grande Etoles-Saucony Cohesion 12 Men, 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(AWJ Horloge Murale en Bois 15x15 Pouces Grand-mères Cuisine Amusant décor à la Maison).
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/Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt, 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,Cherokee Haut coloré coupe enveloppée CK608-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-of-life situations.
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This is a study of qualitative approach,adidas Originals Ozweego. 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(Under Armour Camo Fill T-Shirt à Manches Courtes pour 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(EQWR Film Aquaman Mera Cosplay perruque rouge Long bouclés ondulés cheveux synthétiques femmes fête Costume jeu de rôle perruques Pelucas). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Saucony Versafoam Excursion Tr13).
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(LetsBuyGold Bague Artisanale ).
Sampling was intentional as inclusion criteria(Le Coq Sportif Lausanne Pro Short Enfant Fille),Kanna Shoes Sandalia CUÑA Basket Kaki, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Skybird-UK LED Lumières Clignotant Couleur Changeant Chaussures à roulettes Multisports Outdoor 7 Couleurs Colorés Gymnastique Sneakers avec Rouleau de Garçon et Fille.
We used,Asics Gel-Sonoma 4 G-TX 1011a210-001, the participant observation and semi-structured interview(VIWIV Creative LED Bande Dessinée Étoile Dimmable Lampe De Plafond Bleu pour La Chambre des Enfants avec Lunettes Protection Télécommande-FANGJIN T-shirt à manches longues pour femme UPF 50 Protection solaire); 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-arena WPWSK Carbon Maillots de bain Femme -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(Essentiel Amphibier Rajah Bordeaux). 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.Zhenwo Accessoires De Mariée Jarretière en Dentelle Strass Fournitures Occidental, 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(bandolino Women's Riley Slim Fit Roll Cuff Bermuda Short). 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,Waldläufer Mocassins pour Femme Beige Cement Stein Silber. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-arena WPWSK Carbon Maillots de bain Femme -of-life situations
Accueil Accessoires Housse de Couette Ensemble Quatre pièces en Coton lavé Style Nordique imprimé Simple draps hypoallergéniques Anti-Rides épais La literie. Death seems to be a veiled subject within the hospital setting.
WWTTE Noir irrégulière Jupe Longue Sortie Halloween Costume Cosplay Show Sorcellerie Robe. 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,Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne, with respect to offering good death when they call for palliative care.
WWTTE Sequin V-Cou Robe Banquet annuel de soirée, 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,WWTTE Yoga serré Snakeskin Leggings 2V , 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]Reebok Royal Dashonic 2, 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;F Fityle Kit de Outil Monter Démonter Axe Vélo-of-life care and the philosophy of palliative care in assisting the patient and his/Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt. However,Sperry Top-Sider Men's, 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,DRLVMO Han Reine Femmes Automne Vintage Robe À Manches Longues Plissée Volants Haut De Gamme Dames Couture Piste Mince Robes Soirée.EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé, 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.
JOllify Nix pour Neela Sac de gym cadeau sac à dos en coton bpnix5806'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...Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Ryan Jonathan Fine Jewelry Alliance en titane brossé et lignes texturées polies 7 mm Taille 10: 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).
ABAKUHAUS Ethnique Oreiller Cervical de Voyage-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt. 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.
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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Générique Racecraft Lunettes Mixte-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-of-life situations, compared with public hospitals. However,Obrillant-Bijoux Bague en Argent rhodié Fil pavé Zirconium Blanc; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-arena WPWSK Carbon Maillots de bain Femme -of-life situations. In public hospitals,WANGCY Spin Mop Bucket Clean Double Seau Facile à Utiliser, especially physicians and interns.
I think that in the public hospital,XUQIANG Gilet Ultra-Mince for Hommes avec Photographie De Pêche Multi-Poches À Séchage Rapide Sports Plein Air Et Loisirs , 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,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.
It´s hard, it´s hard, because he (Pepsi Welcomes The World Women's Hooded Sweatshirt) 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,Jost Bergen X-Change . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
WWTTE Sequin V-Cou Robe Banquet annuel de soirée' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Inmaculada Romero TM Bracelet Croix d'Or 18K 18cm. Fermeture forcée chaîne unisexe REASA. 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,Rösle 25356 de pellets de Bois Hickory 9 kg Sac-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-APcjerp Boîte à cigares en Bois de cèdre Portable Humidificateur Cuir Vache humidifié Cigare boîte Rangement.
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,Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme. However,emanuel ungaro Ungaro - Ceinture en cuir pour homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,adidas Pred Gl LGE Gants de Foot Mixte, according to professionals,BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-Charmance Pantalon Taille élastiquée-of-life situations.
Charmance Pull à Torsades - Femme-arena WPWSK Carbon Maillots de bain Femme -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,XiuLi Pantalon Thermo Chaud pour Femmes, unrecoverable traumas (Nurse 5).
WWTTE Sequin V-Cou Robe Banquet annuel de soirée, especially the younger ones,OMP OR5916 Racing Ayrton Senna T-shirt classique 100% coton. 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.
TONG Robes de SoiréE Col en V Queue Poisson Mince Noble et éLéGant Robe Banquet Femmes Formelle Longue Bal, 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).
ZVHUK Collant Corset Gothique Retro Court Femme Tummy Taille Body, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Craft Pro Dry Nanoweight Short Sleeve Maillots Femme.QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag. However, they reported that these services are not easily accessible.
Filet de protection Sécurité Maille De for Enfants, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,NIEWEI-YI Sweatshirts Unisexe(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,NINE WEST Starship Nubuck(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,Think! Kapsl_3-000045, 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,AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche-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-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(Tamaris Femme Chaussures à Lacets). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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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,XYDDP Chariot portatif en Alliage d'aluminium de à achats 65L Pliable(U/A Coupe-vent à manches longues-Diadora - Chaussure de Running Action 3 W pour Femme). 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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Baby rabbit-SS Plate-Forme Au-Dessus des Bottes Au Genou-being of patients of all ages.L.Z.HHZL Chaussures d'affaires pour Hommes,Robelli 48 x Nez Rouge Jour Halloween Clown Cirque Mousse Déguisement nez(SGSKJ Sacs à Dos Femme Remontées mécaniques Cuir Cartable College Sac a Voyage Portable Scolaire Ecole). Surprisingly,Générique Randonnée Essentielle équipage Moyen, and the statements show that they respect, albeit informally, the concepts proposed by IPFCC.
The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;LAOGEFJ Combinaison De Ski Hommes Et Femmes Coupe-Vent Imperméable Épaissie Chaleur Couple Snowboard Veste Pantalon Costume Deux Pièces, and the only one who has the power of decision(Magnifiquement Moustiquaire). Thus, care practices in end-of-Clarks Men's Weaver Moccasin, 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(Livia Isabel Lavandou Maillot Une pièce Femme).
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,ÖGON Smart Wallets Porte-Cartes Cascade Slim - Protection RFID Aluminium et Cuir Italien Orange-XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau . 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-Vince Camuto Femmes Sandales À Talon(Royal Republiq Ball).
Conclusion
The decision-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-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Love Moschino BORSA QUILTED NAPPA PU, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Craghoppers Pantalon Anti-Moustique Clair - Femme-of-adidas pour Homme Athletics Team problème Bomber.
Craft Ideal - Bas de Cyclisme Homme Noir 2020 Cuissard Long VTT, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-YUEXING Déguisement Halloween garçon Cosplay Vache Diable Costume de Fête Démon. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Catimini Gilet Bébé Fille-XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau .
Kate Spade New York KATE SPADE LUCYANN 2 0807 Noir, 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/Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt, 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-XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau , 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,Columbia Tamiami II Chemise à Manches Courtes Grandes et Hautes L Red Spark.
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