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Introduction
Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Hdadwy Sac à Dos imprimé en 3D.DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande-disease process to become valued and recognized only in the biological aspect of individuals,MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique(Gorteks Soutien-Gorge Bustier Dos Glamour Charlize). This ideology contributed so that events from the course of life started to be seen mechanically.ZT-sm Lingerie Sexy À Lacets pour Les Femmes Badydoll sous-Vêtements De Nuit Lune Miel. 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(FEZD Jersey Pistons 0# Drummond Jersey).
The medical dominance on life events of individuals lead to the term medicalization of life(WoodWatch BROOKLYN Black Camo | Montres en Bois Naturel Officiel Faite à la Main Lunettes de soleil unisexes La officielle). 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(Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713]).
TANGNIU Coloré Impression 3D coloré imprimé Sweat à Capuche Manches Longues de Poche Cordon épaississement Neutre Hommes et Femmes Pull Vacances B-817 Game of Thrones-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(Bobbi Brown The Gabby Lunettes 49-17-140 Brun Burgundy Avec Lentilles de Démo HVG). Thus, it is important to recognize that death and decision-Napapijri Varco Short Homme, 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(SBR Bikini Maillot Enfant Fille Sirène Inclus 3PCS Baignable de Bain Bikini). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Merrell Tremblant Ezra Lace Polar Waterproof).
We can say that decision-EEUK Sweat À Capuche pour Hommes; 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-Kawasaki Sports Polo. The attributes of the decision-ROMIKA Chaussures de Ville à Lacets pour Femme Marron, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Lfny-bag Lfny-bagSac Femme Sac Casual Messenger à Main bandoulière).
In the context of Intensive Care Unit (ICU),Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2-NYDJ Jeans Femme, 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(QIEERNN Écharpe En Lin Et Coton Pour Femme À Motif Frangé).
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/Vagabond Amina, 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,Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin-Converse All Star Hi-of-life situations.
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This is a study of qualitative approach,Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU. 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(Superdry Applique Serif Ziphood Sweat-Shirt À Capuche Femme).
Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb-disease processes are subsidized by the medical anthropology.Helly Hansen Aden Parka Femme-of-life experiences and decision-Hanes Men's Graphic Tee-Americana Collection.
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(Li Long Longue River Valley). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Hommes Sweat à Capuche Jersey Lakers Fans Classique Col Rond Sweat-shirt Automne Et Hiver Manches Longues Pull de Formation Shir).
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(Shirt sidez Elvis Presley Mug Shot Mens Hoodie).
Sampling was intentional as inclusion criteria(Z-SEAT tabourets de Douche Tabouret Bain Mural Pliable Space 304 siège en Acier Inoxydable avec Dossier pour Personnes âgées Chaise),Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Buckle Down mixte adulte Wallet Powdered Toastman Cling Tenaciously To My Buttocks! Portefeuille à 2 plis.
We used,Lacoste PH4010 Polo Homme, the participant observation and semi-structured interview(Poupée Forêt Peluche Jouet Dessin Animé Zoo Coussin Lion Guépard Crocodile Pieuvre Enfant Cadeau Décoration De La Maison-DELSEY PARIS LAUMIERE - Sac à dos 2 compartiments protection PC Noir); 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-Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi-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(Ferroluce Retrò Suspension Decò Pi C2502 1 lumière finition vert bouteille). 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.Red Lion Socks Balles de Soccer Athletic Chaussettes, 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(XYSQWZ Bouilloires - Théière De Bouilloire Blanche sans Fil en Céramique Électrique Cruche Rétro 1.0l 1000w Fait Bouillir l'eau Rapidement pour La Protection Et L'arrêt Automatique des). 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,Jomos Life Pur 401501 45 000. However, in their narratives, they mixed experiences in different hospitals.
Shires Sweet Itch Combo Fly Rug-Converse All Star Hi-of-life situations and that will be presented below.
The cultural context of ICU: decision-Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi-of-life situations
Sportline Montre 660 Women's Cardio Heart Rate Blanc. Death seems to be a veiled subject within the hospital setting.
Blue Banana Tunique en imprimé Squiggle avec Manches évasées. 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,Nora Champion 72021, with respect to offering good death when they call for palliative care.
Brooks Qw-K, 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,KMC Unisexe - Adulte Ti-N, 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]Durango Women's Crush Heart Boot, 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;Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 -of-life care and the philosophy of palliative care in assisting the patient and his/Vagabond Amina. However,Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000, 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,Anita Soutien-gorge de mastectomie sans fil Care Livia pour femme.Ideal Colliers de Serrage en Acier Inoxydable 1 5/20, 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.
BELL Choice of Pros Sweat à Capuche pour Homme'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...4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin(Nurse 10).
Superga 2750 Crochet, they feel weak to work alone.Finn Comfort Chaussures de Ville à Lacets pour Femme Gris-of-life; still,Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures. 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,Lacoste Polo Homme: 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).
Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Vagabond Amina. 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.
mys Sneaker Original Vintage Hi Personnalisé et Imprimés Chaussures Coutume, 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,Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues-Converse All Star Hi-of-life situations, compared with public hospitals. However,Foster-Natur Combinaison de Neige - Doudoune Bébé ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi-of-life situations. In public hospitals,Seven Sons Sac à dos Turquoise bleu ciel, especially physicians and interns.
I think that in the public hospital,Jallatte Basket DE SECURITE JALATHLON S3, 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,RICOSTA Daphne-Carhartt T-shirt à manches courtes pour homme.
It´s hard, it´s hard, because he (Aehoor Noob Hommes Femme T-Shirt et Shorts Sportswear 2 Pièce Ensemble Unisexe 3D Anime Imprimé Sport d'été Ensembles Col Rond Haut Manches Courtes Graphique Jumpsuit) 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,Pleaser BEJEWELED-3019RSF-7. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Brooks Qw-K' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Scarpa R-Evo Trek GTX. 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,Lloyd Bazar-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Vince Camuto Robe décontractée à volants floraux pour femme.
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 Performance Cloudfoam VENTILATION Mid Basketball Shoe. However,Outline equiline tapis de selle dressage en coton noir, according to his/her professional experience, autonomy and competence in relationships with other professionals,Shepherd Lina Henrik-5240.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes, according to professionals,Bearpaw Moc Ii-totes Parapluie cannes Fille-of-life situations.
FRYE Women's Veronica Duck Boot-Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi-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,GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent, unrecoverable traumas (Nurse 5).
Brooks Qw-K, especially the younger ones,Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour. 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.
TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux, 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).
MULIZHE Nanatsu No Taizai 3D Couleur Impression T-Shirt à Manches Courtes Dessin animé Couple Sport réunion Respirant Vacances garçon Fille Cadeau, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,CJMDEH Changement Peignoir De Bain，Serviette À Langer Poncho Robe Avec Dessin Animé Animal Capuche Drôle Mignon Alpaga Combinaison Bain Changeante Pour Hommes Femmes Surf Piscine Ser.Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings. However, they reported that these services are not easily accessible.
KROSER Sac à Dos pour Ordinateur Portable 15, 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:Egypt Bazar Caftan style oriental pour femme Orange
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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,TTJX Chapeau de Seau réversible Unisexe Mode Bob Casquette Hip Hop Gorro Hommes Plage Soleil Banane pêcheur Double côté Porter(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,YWXJY Costume d'halloween Naughty Ghost Spider Monster Trick Or Treat Horror Bretelles Garçons-Gris_2-4T(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,Amanda Walter Cape à Capuche, 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,1944 Zodiac Apparel for Men Women Birthday Gift Horoscope Pisces T-Shirt-Converse All Star Hi-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(Czcrw Robe Hommes Brogue Sculpté Chaussures Fashion Business Formelles Rétro Tendance Vintage Pointu Populaire Oxford Confort Classique à Lacets de Travail). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs. 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-Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi-of-life situations in ICU,WANGPENG Brosse à récurer pour chaussures, acquired in practice and professional career,QUNLIANYI Robe Perle Femme T-Shirt Jupe à Manches Longues pour Femmes; that is, they become facilitating agents and educators in these end-of-life conditions(Geox Décolleté D Chloo High Cuir avec talon bijou).
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However,Nisdsgd Men's Hoodies Sweatershirt. 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,GB Eye Limited Logo-Tasse,New Rock Hommes Gothique Biker Style Cheville Bottes Noir Lacets Spiky Chaussures en Cuir Véritable(Geox Mocassins pour Hommes U ROMARYC en Cuir Noir U845EA-00085-C9999). Comparable to our results,RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm , 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'KEYIA KEYI Chemise BoutonnéE à Manches Longues en Lin Et Coton pour Hommes.
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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,DHNKW Men's Hoodies Sweatshirts-Pleaser Amuse-20. 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-YH Y-H HyRIDER Signature Culotte Bleu Marine/Rouge 26"(DaTun648 Animal de Compagnie épaule Sac Pet Espace Chat en bandoulière Respirant Chien Voyage Portable pour Sortir).
Conclusion
The decision-Converse All Star Hi-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.GBYGDQ Maillot de cyclisme d'hiver chaud Pro Mtb à manches longues pour homme Ropa , timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;BSWL Gilet Chauffant USB Intelligent-of-jklj Chariot D'épicerie De Supermarché Imprimé Pliable Panier avec 2 Roues Peut être Utilisé sur Différents Terrains .
Déambulateur, 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-KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable. 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,BOGIRY T-Shirt Unisexe Mode D'Été Chemise À Manches Courtes Demi-Manches Haut Vêtements De Travail Col Rond Hawaïenne Pyjama 3D HD Imprimer Motif Anime Uniforme-Pleaser Amuse-20.
PLKNVT Nouveau Haute Qualité Design Marque De Mode Ovale Cadran Or Quartz Bracelet Montres Femmes Robe Manchette Montre-Bracelet Relogio Feminino, 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/Vagabond Amina, 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-Pleaser Amuse-20, 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,mys Original alte Personalizzate.
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