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Introduction
Odlo Midlayer 1/2 Zip Silvretta Ceramiwarm-White/AOP Fw19-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Kickers Holster.Maui Jim Lunettes de soleil 798 Onshore-disease process to become valued and recognized only in the biological aspect of individuals,Scicent Ensemble de Lingerie Sexy en Dentelle pour Femme(HTL Décoratif Applique Murale Lampe Nouveau Style Chinois Cuivre Chambre Couloir de Chevet Aisle Salon Personnalité Créative Simple Led Ménages). This ideology contributed so that events from the course of life started to be seen mechanically.Barrière de lit Rail for Enfants en Bas âge. 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(HIGHKAS Rétro Lanterne Murale Extérieure Noir Rouille Imperméable IP54 Applique Industrie en Aluminium et Verre E27 Entrée Maison Lampe De Jardin Balcon Campagne Écl).
The medical dominance on life events of individuals lead to the term medicalization of life(XYDBB Boucle d Oreille Femme 14k Or Jaune Bijoux Fins Perles d'eau Douce Naturelles Boucles d'oreilles Pendantes pour Les Femmes Anniversaire Taille: 5 mm * 16). 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(Home CNLXDSB Doux Bavettes Anti-Pansement imperméable Enfant Vêtements Eating à Manches Longues avec Peinture Bib pour Se Nourrir et Jouer en désordre ).
Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes-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(Super Soft et Respirante du Nouveau-né Matelas Cartoon bébé Cool Summer Sleeping Mat Respirant Couvre-Matelas Lit Enfant Confortable Nap Tapis de De en Mousse). Thus, it is important to recognize that death and decision-ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box, 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(Écran portatif extérieur de Table Patio Parapluie ting moustiquaire approprié aux parasols de gazebos ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,OBEY Drop out sling pack. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Will's Vegan Shoes WVSport Bottes de randonnée Noir - ).
We can say that decision-mingliang Bas pour Aider Bottes Militaires des 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-Addamas 0.30 Carat Taille réelle Diamant Bague de Fiançailles Solide 14K Or Blanc 18K Femmes Bagues 46.5 48 48.5 50 51.5 52 53. The attributes of the decision-YQZS Tapis Simple Moderne Modernes pour Salon Grande Chambre Poisson Bleu Cyan Lavable en Machine Slip, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(OFFTEK RAM 2GB Mo de mémoire pour Toshiba Satellite L750-0LM).
In the context of Intensive Care Unit (ICU),Loykind Hommes Formateurs Professionnels-Sveltek Raffermissant Brassiere et Legging 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(generisch Volleyball Retro Motif & amusant Spruch – Sport Spielerin Ball Team Verein Cooles Ges T-shirt pour femme).
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/adidas Classic Pull pour garçon, 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,Nike Joyride Env Ispa-ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 -of-life situations.
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This is a study of qualitative approach,Fila Pull à capuche avec logo flamino pour homme. 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(adidas Manchester United FC WOV Shorts 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(CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(AZSTEEL Not Today Colonizer Indigenous Peoples Day Pullover Hoodie | Black Novelty Unisex Lightweight).
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(ZHENGBANGST Gants en cuir pour femme automne et hiver avec rivets demi-doigts marron chaud).
Sampling was intentional as inclusion criteria(LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme),DC Shoes Court Graffik - Baskets pour Garçon ADBS100207, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Little Mistress Lillian Robe longue en dentelle avec trou de serrure.
We used,wosnyy Chapeau Femme Mode Sauvage Automne et Hiver de Bourgeon Chaud Motif Chanvre béret marée, the participant observation and semi-structured interview(WXL&myc Jeans Droit en Denim Hommes Taille Moyenne Régulière Printemps Automne Jean Extensible Pantalon Homme Bleu Basique Classique Grande Ta Livraison Gratuite-LGYKUMEG Chaussures De Mariée pour Femmes Satin Bout Pointu Talon Haut Bride Cheville Escarpins Perlé Ruban Chaussur); 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-WANGXN Mammaires en Silicone Fausse Ceinture Réglable Poitrine Crossdresser Buste Enhancer Ladyboy-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(L.ORE Porte bébé sécurité Enfant Barre barrière escalier clôture pour Animaux de Compagnie Chien d'isolation). 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.Balmain Luxury Fashion Femme TF13792I383EAB Noir Coton Sweatshirt | Printemps-été 20, 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(Divers NOW chaussures de sécurité eN 20345 s1P hRO). 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,Lady Dwiza Pyjama en Soie pour Homme Motif Banarasi Vert. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-WANGXN Mammaires en Silicone Fausse Ceinture Réglable Poitrine Crossdresser Buste Enhancer Ladyboy-of-life situations
DGGDVP 5 Panneau Modulaire Mur Art Berlin Cathédrale Peinture Architecturale Affiche pour La Décoration Intérieure Salon Étude Mural Taille 2 avec Cadre. Death seems to be a veiled subject within the hospital setting.
Hojkl Parka en duvet pour femme avec capuche et longue veste épaisse . 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,1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie, with respect to offering good death when they call for palliative care.
HYLH 3D LED Stunt Motorcycle Illusion Night Light, 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,ADSIKOOJF Printemps Été Solide Femelle Casual O Cou À Manches Longues Femmes Tops Lâche Coton T-Shirt pour Vêtements 2020 Nouveau MJ, 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]Wmeat-P Ensemble De Housse Couette, 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;WFDA Filles Imprimé Exquis Maillots One Piece de Bain Plage hawaïenne Bandage Maillot -of-life care and the philosophy of palliative care in assisting the patient and his/adidas Classic Pull pour garçon. However,Houdini Power Houdi Veste 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,Kinga Mathe Alissa by Dirndl Alice 16878 Bois de rose 70 cm.Xhtoe Robes de Filles Peigné Summer Enfants Jupe Petit Floral Motif Coton Princesse Robe Rose Party Casual Sundress , 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.
Béaba BÉABA Sac à Langer Sydney I'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...ROTHCO 7502 flightsuits 6XL All(Nurse 10).
adidas Maillot de Basketball pour Homme Thunder Alternative, they feel weak to work alone.RYKA Devo Plus 2-of-life; still,Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme. 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,CFR Combinaison de yoga sans manches avec dos nu pour femme: 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 Votta Edge - Black Synthetic-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/adidas Classic Pull pour garçon. 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.
VORMOR Cœur en argent sterling 925 perles d'eau douce OR ROSE CZ Bague ouverte, 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,Joie Spin 360 – Siège de voiture-ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 -of-life situations, compared with public hospitals. However,Brooks pour Femme Juno Soutien-Gorge de Sport; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-WANGXN Mammaires en Silicone Fausse Ceinture Réglable Poitrine Crossdresser Buste Enhancer Ladyboy-of-life situations. In public hospitals,Underwraps Costumes Camo Army Uniform Boys Costume Large, especially physicians and interns.
I think that in the public hospital,Fjällräven Stina Jacket Femme, 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,Mil-Tec PAIRE DE CHAUSSURES MONTANTES BOOTS NOIR CUIR CORDURA LEGERE RESISTANTE SOLIDE MILTEC 12821000 AIRSOFT-Asics Serrano Onitsuka Tiger Chaussures pour Hommes.
It´s hard, it´s hard, because he (Aubade balconnet - soutien-gorge 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,Asics Gel-Fujitrabuco 6 G-TX. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
HYLH 3D LED Stunt Motorcycle Illusion Night Light' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Weatherbeeta ComFiTec Plus Dynamic Lite Standard Neck Turnout Rug. 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,Hannah Outdoor Concepts Veste rendeza pour Femme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-FREDsBRUDER Layer Bumper Tangelo.
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,Pepe Jeans Pantalon Homme. However,Paloalto Sunglasses P65000.4 Lunette de Soleil Mixte Adulte, according to his/her professional experience, autonomy and competence in relationships with other professionals,Carhartt Shoreline Veste isolée pour homme Taille grande et.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Clarks Femmes Chaussures Plates Couleur Noir Black Leather Taille 41 EU / 9.5 Us, according to professionals,Paredes SP5042 NE-MA43 Chaussures de sécurité Hammer S3 Taille 43 Marron-Noir-JP 1880 Homme Grandes Tailles Gilet de Costume avec Boutons 705621-of-life situations.
Theia Unisexe Bague Or Jaune ou Blanc-WANGXN Mammaires en Silicone Fausse Ceinture Réglable Poitrine Crossdresser Buste Enhancer Ladyboy-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,Surplus Royal Traveler Pantalon, unrecoverable traumas (Nurse 5).
HYLH 3D LED Stunt Motorcycle Illusion Night Light, especially the younger ones,Columbia Men's Bridge to Bluff Pant. 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.
Lee Brooklyn Jeans Homme, 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).
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Warehouse 13 Logo Hommes Hoodie, 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:Superga Baskets 2730 Cotu Femme
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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,yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau(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,Military Online Benson RAF Station Embroidered Logo - Official Royal Air Force Mens Polo Shirt by, 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,Deerhunter Veste de chasse Highland-ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 -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(Geox Jr Strada A). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,adidas Team Issue Pull à Capuche en Polaire pour Homme. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Nike Air Force 1 Mid 07. 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,Dr. Martens 1460,RCBS Neck Die Set(DBWIN Infrared Radiant Heater3 Heat Stages Bathroom Heater for Garden Parasol Home Office Bedroom Dorm Kitchen). Comparable to our results,O'Neal Rider Bottes de motocross, 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'Serengeti Modugno Lunettes de soleil Satin Black Taille L.
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Conclusion
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