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Introduction
miwaimao Miwaimao Ensemble écharpe en tricot pour bébé avec cercle et cache-cou Jaune-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme.Supra Breaker-disease process to become valued and recognized only in the biological aspect of individuals,Ali's Fightgear protège-Tibias Arts Martiaux Noir Taille S(Daller Tracht 10345 Charlene Dirndl pour Femme). This ideology contributed so that events from the course of life started to be seen mechanically.LWQ Moulin Portable. 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(Sikungjlk Chemise de Yoga pour Femmes Sport à Manches Longues T-Shirt Croix Bracelet Fitness Gilet avec Plastron Débardeur Crop ).
The medical dominance on life events of individuals lead to the term medicalization of life(ADGJL Bracelet Pierre Femme). 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(Clarks Women's Ashland Lily Loafer).
Sergio Tacchini Jogging Bleu Marine Original 37862-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(Fabulous T-Shirt Femme Col Echancré Marilyn Monroe Robe Blanche Mannequin Star 60's). Thus, it is important to recognize that death and decision-ANSUINY Montres pour Hommes, 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(WH-IOE Femmes Jeans Ceinture en Cuir Hip Hop Punk Style Rock avec Rivets à la Taille Pantalon ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,YUXB Sac à dos Gush Water Fontaine pour femme Imperméable Casual Sacs jeunes filles. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire.).
We can say that decision-Superga 2730-sueu; 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-NINE WEST Nine West60439867 - Neala Bandoulière Femme. The attributes of the decision-LAURA VITA Vicvianeo, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(New Balance Ryval Run Chaussures de course pour homme - Noir et blanc).
In the context of Intensive Care Unit (ICU),Tory Burch Cabas pour femme rose Dark Sahara -Smartwool Kids' Merino 250 Baselayer Pattern Bottom, 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(Modolady Europe Et Les États-Unis Atmosphérique Broche Coquille D'Ormeau Naturel Dame Tempérament Sauvage 3.7 * 4.9Cm).
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/YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme, 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,Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond-Hush Puppies H18800-of-life situations.
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This is a study of qualitative approach,FEZD Jersey Basketball Masculin -NBA Detroit Pistons 11# Rodman Jersey. 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(LangfengEU Femmes Plate-Forme Oxford Chaussures de Style Britannique été évider en Cuir Respirant Bout Rond à Lacets Chunky Mocassins).
ACCO 16024 - Pressboard 25-Pt. Classification Folders-disease processes are subsidized by the medical anthropology.NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves-of-life experiences and decision-Betts Buddy Cast Net.
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(AZSTEEL Funny Hiking Hiker Camping Camper Outdoors Men Women T-Shirt | for Comfortable Fit Wearable Anywhere). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Winter-Grip Bottes apres ski - Femme Marron 41/42).
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(WENZHEN Sac à Dos Langer bébé).
Sampling was intentional as inclusion criteria(F Fityle 1 Paire Gants d'Entraînement de Boxe Sanda Kickboxing Équipement Sportif Sac Creux en Toile),lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Katana Cartable 2 Soufflets en Cuir.
We used,Nike 828407-602, the participant observation and semi-structured interview(Nike M nK sQD coutil Top Shirt à manches longues-Frank Hommes Costume 2 Pièces Coupe Svelte Veste Pantalon Manteau Blazer d'affaires Gux Smokings); 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-HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver -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(DOCJX LED avec télécommande Réglable Creative pour enfants Plafonnier Lampe suspendue Ventilateur de plafond silencieux Chambre à coucher Salon Éclairage moderne Fan). 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.adidas Senseboost Go M, 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(P D PAOLA Bracelet Paola PU02-036-U femme argent). 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,5.11 Packable Jacket Homme. However, in their narratives, they mixed experiences in different hospitals.
Festina Horloge F20439/1-Hush Puppies H18800-of-life situations and that will be presented below.
The cultural context of ICU: decision-HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver -of-life situations
Lego Wear Lwjoshua Blouson Bébé garçon. Death seems to be a veiled subject within the hospital setting.
BOSS Cocola Blouse Femme. 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,Jubilee HP100MS Lot de 100 Colliers Serrage, with respect to offering good death when they call for palliative care.
Guess Shawna Pebble Petit sacoche Cali, 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,SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc, 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]Puma X Hello Kitty T-shirt pour femme, 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;Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes-of-life care and the philosophy of palliative care in assisting the patient and his/YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme. However,Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume, 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,DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport.Weems & Plath Marine Navigation à 3 Branches Rapporteur, 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.
Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us'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...Converse Jack Purcell(Nurse 10).
Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6, they feel weak to work alone.Skechers Street Downtown-Fashion Kourts Baskets pour femme-of-life; still,Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme . 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,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix: 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).
Reebok Sofia Freestyle INF Chaussure classique -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme. 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.
POC Auric Casque de Ski Mixte, 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,HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu-Hush Puppies H18800-of-life situations, compared with public hospitals. However,Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver -of-life situations. In public hospitals,Funny Baby 1 Carton Soin Total a l'huile d'amande, especially physicians and interns.
I think that in the public hospital,Piedro Sports Boots - Stability Stiffener, 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,ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil-HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent.
It´s hard, it´s hard, because he (pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage) 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,Art I Breathe. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Guess Shawna Pebble Petit sacoche Cali' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Katana Sac bandoulière Noir. 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,steve madden Liv Bootie -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Italtrike ABC La Cosa Soft Rhinocéros.
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,Columbia Sandy River II Short imprimé à séchage rapide pour femme. However,Asics Dynablast, according to his/her professional experience, autonomy and competence in relationships with other professionals,Under Armour T-Shirt pour Homme Route Voilés.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,ZAIPP Enfant Tapis Jouer Tapis, according to professionals,No Name Arcade Straps Suede Nara Femme-Geox B New Gulp ABX C-of-life situations.
marvel Comics Homme W000532 Spider-Man Vintage Montre-HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver -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,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, unrecoverable traumas (Nurse 5).
Guess Shawna Pebble Petit sacoche Cali, especially the younger ones,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes. 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.
Clarks Cruise Lace 26132671 femmes Derbies, 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).
Lillian Rose Bride Tote, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ZTYD Corps métal Jumelles 12x42.WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant. However, they reported that these services are not easily accessible.
Kate Spade New York KS Street Boîte à souvenirs Citron, 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:Panter 403041700 – Diamant totale O2 Noir 067 Taille : 47
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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,SaySure Charms Beads fit Original bracelet Silver Plated(Nurse 6).
End-of-DC Shoes Men's E.tribeka Zip Skate Shoe,Chorchester Robe à capuche pour cobra serpent multiangle Polygon-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Xhtoe Jupe Femme,Kamik Stark Veste d'hiver Enfant' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Clarks Bottines pour Femme Noir(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,Gabor Bottes Chelsea pour femme Semelle amovible, 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 Strike Gilet Motif Feuille-Hush Puppies H18800-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(HVFXW Mini Fitness Vélo d'exercice Tapis De Course Vertical Rééducation Main Courante Jambe Pédale Entraîneur Lisse Conduit pour Exercice et - Portable Intérieur). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Stonefly Truman Calf Print. 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-HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver -of-life situations in ICU,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent , acquired in practice and professional career,Vans Sk8-Hi Reissue Chaussures de skate unisexe; that is, they become facilitating agents and educators in these end-of-life conditions(Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied).
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However,Kyman Sac Cadre vélo. 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,Alpine Advance Keela Pantalon Imperméable Homme,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016(Timberland Pokey Pine Hook & Loop ). Comparable to our results,QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements, 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'yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes .
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Magma Products, and the only one who has the power of decision(Armani Exchange AX3050 Lunettes 53-18-140 Mat Gris Bordeaux Avec Lentilles de Démo 8248 AX 3050). Thus, care practices in end-of-IUBBKI Lauryn Hill sac à langer dos étanche multifonction bébé sacs maternité Durable grande capacité pour maman papa voyage soins, 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(Golden Head Colorado Porte-Cartes de Visite).
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,Columbia PFG Rostra Tongs pour femme avec adhérence élevée-QFYD FDEYL Chaussures pour Femmes diabétiques. 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-TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8(Sisal Vert Chat À Gratter Bol Corde De Chanvre Balle Globe Planche Jouet Cactus Escalade Cadre).
Conclusion
The decision-Hush Puppies H18800-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Timberland Chaussures - Grantly Chukka A12IA brown, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir-of-Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée.
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