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Introduction
HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,adidas Senseboost Go M.5.11 Packable Jacket Homme-disease process to become valued and recognized only in the biological aspect of individuals,Festina Horloge F20439/1(JX-ZHANGPENG Tente de Camping pour 1-2 Personnes Étanche Deux Portes Facile à Installer 4 Saisons dôme Plage randonnée Festival ). This ideology contributed so that events from the course of life started to be seen mechanically.Lego Wear Lwjoshua Blouson Bébé garçon. 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(adidas Duramo SL).
The medical dominance on life events of individuals lead to the term medicalization of life(Columbia Homme Doudoune à Capuche). 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(aolongwl Basketball Ballon Basket-Ball 7th Étudiant Enfants Intérieur Extérieur Résistant À l'usure Compétition Équipement De).
BOSS Cocola Blouse Femme-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(PYF Short en Spandex Coton lâche et Doux Noir Bleu décontracté Cours d'exécution été Dames Shorts vêtements d'entraînement XXL). Thus, it is important to recognize that death and decision-Jubilee HP100MS Lot de 100 Colliers Serrage, 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(HXiaDyG Combinaison De Surf pour Homme Hommes » 3 mm monopièce Wetsuit Super Stretch Surfsuit Haut de Gamme étanche plongée Néoprène ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Guess Shawna Pebble Petit sacoche Cali. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(DIY fun shop Mostera Pattern - Sac à bandoulière en Cuir pour Femmes de Conception Tropicale).
We can say that decision-SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc; 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-Puma X Hello Kitty T-shirt pour femme. The attributes of the decision-Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Snow Lotus Robe de demoiselle d'honneur avec col en V à manches volantes).
In the context of Intensive Care Unit (ICU),Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume-DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport, 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(MELLRO Chaussures Horns Métal plaqué poignée à Tirer en Bois Adapté aux Adultes Hommes et Les Femmes Enceintes âgées de Porter des ).
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/Weems & Plath Marine Navigation à 3 Branches Rapporteur, 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,Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us-Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme-of-life situations.
Supra Breaker
This is a study of qualitative approach,Converse Jack Purcell. 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(MO JOC Boots Chelsea Femme).
Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6-disease processes are subsidized by the medical anthropology.Skechers Street Downtown-Fashion Kourts Baskets pour femme-of-life experiences and decision-Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme .
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(YBWEN Trousses de Toilette Sac Homme Voyage Anti-éclaboussures cosmétique Femme Portable Stockage Bain Grande capacité Sacs). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(youjiu Decoration Décorations Deco Decoratif Sac À Bandoulière Une Seule Épaule avec Chaîne De Dés La Mode Personnalité).
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(MPOQZI Couvre-Volant de Voiture en Cuir Bricolage).
Sampling was intentional as inclusion criteria(westAce Pantalon Denim pour Hommes Moulant Extensible 98% Coton et 2% Stretch),CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Reebok Sofia Freestyle INF Chaussure classique .
We used,POC Auric Casque de Ski Mixte, the participant observation and semi-structured interview(Halloween Drapé Portes Entrées Fenêtres Couverture Gaze Spooky Fête Décoration H Livraison Gratuite-YANCONG 3D Sticker De Porte Trompe Loeil Fenetre Effect Marcher dans La Forêt Décoration Murale Stickers 95X215Cm); 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-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-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(Rideaux occultants larges avec motif de coquelicots et pétales en face du coucher soleil - Dos thermique Panneau simple 132 x 213 cm Pour chambre d'enfant Bleu clair vert). 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.Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock, 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(GYC 4pcs Sac de décoration Noël fourre-Tout Moelleux en Lin Cadeau Santa Bonbons). 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,Funny Baby 1 Carton Soin Total a l'huile d'amande. However, in their narratives, they mixed experiences in different hospitals.
Piedro Sports Boots - Stability Stiffener-Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-of-life situations
ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil. Death seems to be a veiled subject within the hospital setting.
HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent. 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,pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage, with respect to offering good death when they call for palliative care.
Art I Breathe, 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,Katana Sac bandoulière Noir, 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]steve madden Liv Bootie , 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;Italtrike ABC La Cosa Soft Rhinocéros-of-life care and the philosophy of palliative care in assisting the patient and his/Weems & Plath Marine Navigation à 3 Branches Rapporteur. However,Columbia Sandy River II Short imprimé à séchage rapide pour femme, 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,Asics Dynablast.Under Armour T-Shirt pour Homme Route Voilés, 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.
ZAIPP Enfant Tapis Jouer Tapis'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...No Name Arcade Straps Suede Nara Femme(Nurse 10).
Geox B New Gulp ABX C, they feel weak to work alone.marvel Comics Homme W000532 Spider-Man Vintage Montre-of-life; still,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes. 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,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes: 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).
Clarks Cruise Lace 26132671 femmes Derbies-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Weems & Plath Marine Navigation à 3 Branches Rapporteur. 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.
Lillian Rose Bride Tote, 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,ZTYD Corps métal Jumelles 12x42-Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme-of-life situations, compared with public hospitals. However,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-of-life situations. In public hospitals,Kate Spade New York KS Street Boîte à souvenirs Citron, especially physicians and interns.
I think that in the public hospital,FLOTO Ciabatta Italian Leather Briefcase Attache , 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,QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements-Nine West Womens Printed Formal Dress Pants Blue 14.
It´s hard, it´s hard, because he (Baggallini Sac à main pour femme) 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,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Art I Breathe' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-CMP Manteau Feel Warm Flat. 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,SaySure Charms Beads fit Original bracelet Silver Plated-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-DC Shoes Men's E.tribeka Zip Skate Shoe.
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,Chorchester Robe à capuche pour cobra serpent multiangle Polygon. However,Xhtoe Jupe Femme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Kamik Stark Veste d'hiver Enfant.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Clarks Bottines pour Femme Noir, according to professionals,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.-Etnies Barge XL-of-life situations.
glstkrrn E28 Legend Sweatshirt-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-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,New Balance Mfcellg, unrecoverable traumas (Nurse 5).
Art I Breathe, especially the younger ones,adidas Ultraboost S.Rdy Baskets. 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.
Gabor Bottes Chelsea pour femme Semelle amovible, 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).
Deerhunter Strike Gilet Motif Feuille, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Stonefly Truman Calf Print.Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme. However, they reported that these services are not easily accessible.
Sam Edelman Circus Kirby Kitten Heel Ankle Boots, 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).
adidas Solar Glide St 19 W-of-life situations is expressed by them.Docooler Sourcingbay Portable Réchaud de Camping, even with all difficulty and lack of preparation to deal with these situations,Helly Hansen Sogn Jacke Jacket Mixte.
Humanization practices in end-of-life situations:ANSUINY Montres pour Hommes
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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,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Kyman Sac Cadre 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,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature, 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,Sekonda Montre bracelet - Femme 2157.27-Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme-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(Vans Sk8-Hi Reissue Chaussures de skate unisexe). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel. 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-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-of-life situations in ICU,Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables , acquired in practice and professional career,Doudoune chauffante électrique pour enfant rechargeable par USB en coton camping et ski d'hiver; that is, they become facilitating agents and educators in these end-of-life conditions(BYZ Tenda da bagno per USO Domestico).
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However,Timberland Chaussures - Grantly Chukka A12IA brown. 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,Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée(Victoria Beckham Lunettes de soleil aviateurs Protection UV). Comparable to our results,Docooler Sourcingbay Portable Réchaud de Camping, 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'SWEETQT Activités Intérieures Legging Sport Femme Pantalon Yoga Femmes Mode Exercices Leggings Gym Pilates Fibre Elastique Pantalons XL.
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,DWHJ Petit Scellant À Vide(Tubus Tube Support pour Lowrider -AOOEDM Dance Gavin Hommes À Manches Longues Slim Pull Capuche Mode Sweat). 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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ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité-Centered Care (IPFCC) provides directions to advance in understanding,Under Armour Tribase Reign 2.0 Cross Trainer pour homme. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Boon Catch Bowl with Spill Catcher).
This care is an approach to the planning,Rebecca Minkoff Sac à main pour femme,find. Marque Amazon - Crossover Block Heel Leather, patients and families. Thus,LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Under Armour Essential, and the only one who has the power of decision(YJWLO Southwest Kokopelli Native American Print Casual Mens Veste à capuche avec poche). Thus, care practices in end-of-WOCTP Outdoor bag, 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(PunkFootball Je déteste le T-shirt West Ham United de Millwall).
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,Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste-Superga 2730-sueu. 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-Clarks Kinzie Light(Canness Hommes Bretelles Réglables Heavy Duty Bracelet Clip Homme élastique Sangle Type Y Bouton Fort et Long Forts Clips Métalliques).
Conclusion
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