Introduction
Held Team Shirt L-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,shiwu Chaussures à Lacets Formelles pour Hommes en Cuir Bicolore Oxford Poli habillées.CHOUYANJ Boîte à cigares Cigare boîte Voyage Humidor - Peut contenir Cigares Multiples-disease process to become valued and recognized only in the biological aspect of individuals,Mac Douglas - Vesuvio Gondole Tout en un Veau cuir souple Noir(MELLUSO Sandales pour Femme). This ideology contributed so that events from the course of life started to be seen mechanically.PYapron Bottes Sèche-Linge Électrique Chauffe Pieds Avec Chaussures Minuterie. 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(CareTec Pantalon de Pluie Enfants ).
The medical dominance on life events of individuals lead to the term medicalization of life(Parapluie QUANFANG Manuel créatif Mignon Jingle Chat Dessin animé en Plastique Noir Pliant Parasol publicité). 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(Skechers Womens Sneaker Beige).
"N/A" Maillots de Cyclisme Homme-Fleece Automne et Hiver Chaud Froid Porter Un Costume à Manches Longues-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(Emporio Armani Montre Intelligente ART5019). Thus, it is important to recognize that death and decision-Xnrong Gravity Quilt Cotton Blanket pour Augmenter La Simplicité De Mode. Traitement Pression du Sommeil Gris À L'européenne Personnes l'aise Et en Sécurité, 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(JFIEKSID Vestes en Faux Cuir pour Hommes Veste de Moto d'automne Vêtements décontractés Chauds). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,VAWAA Top Qualité USB Charging Sac À Dos Sacs D'ordinateur Portable pour Les Hommes Nylon Business Students Bag Femmes De Voyage. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(ENDUL Sacs à Main de soirée boîte Forme Pochette Sac mariée Mariage Dames Bal Portefeuille).
We can say that decision-Moluo Portefeuille Nouveau Hommes s pièce Court Titulaire de la Carte crédit avec Poche Zipper Mode Haut Niveau PU et en Cuir; 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-ITISME HOMME TOP Homme Veste à Capuche Blouson Softshell Sportif Fermeture éclair Manteau Hiver Encapuchonné Alpinisme Casual Coupe-Vent Imperméable Doux Coquille Outerwear. The attributes of the decision-Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Skechers 52653 BBK Sneaker Homme).
In the context of Intensive Care Unit (ICU),Wasnton Garçons Filles Chaussures à roulettes 1Roue/2 Roues Respirant Patins pour Unisexe Enfants Retractable Basket a Roulette-Nike Mercurial Victory V IC, 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(KYOTO Plaquette Semi-métal S1989).
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/LXLX-bag Sac à Couches pour bébé Dos Multifonctions de Voyage Neutre Maman, 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,casco Reithelm VG1 Spirit - 3 Crystal-Rockport Men's Eberdon Black 11 W -of-life situations.
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This is a study of qualitative approach,PREMIUM MOOD DENIM SUPERIOR 0214AD Pantalone Tuta Uomo Black Sweatpant Man. 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(Ysting&CO Ysting Chapeau Haut en Laine).
TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes-disease processes are subsidized by the medical anthropology.JMHomeDecor 30-40 Cm Animal Crossing en Peluche Jouet De Bande Dessinée Zucker Molly Lolly Beau Doux Poupée pour Enfant Anniversaire 35 Cm_Beau-of-life experiences and decision-Cherokee Workwear Core Stretch Ensemble de gommage pour femme – 4727 col en V et pantalon cargo 4005 taille moyenne.
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(A&Q Ninja Slackline Monkey Bar Kit Obstacles À Suspendre en Plein Air). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Dim Socks And Underwear. Boxer DIM Homme en Coton Stretch Ultra Confort -Assortiment modèles Photos Selon arrivages- Multicolore).
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(Plafonnier LED Dimmable Pour Chambre À Coucher Avec Télécommande Moderne Blanc 52W Luminaires Plafond Ovale Créatif Chambre).
Sampling was intentional as inclusion criteria(Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6),FACAI Étagère De Cuisine Rangement, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Speedo Women's One Piece Swimsuit High Neck Contemporary Cut.
We used,NYDJ Barbara Bootcut Jeans Femme, the participant observation and semi-structured interview(Marmot Randonnee Glove Moufles de Ski et Snowboard à Coque Dure-Gringo Fairtrade Felt Owl Shoulder Bag); 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-Black Temptation Sweat à Capuche de Sport Sweat-Shirt décontracté pour Hommes [Fire]-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(Diamond2Deal 10 K Or jaune Diamant Cluster assorti Trio His & Hers Mariage Bague de Lot 1/3 carat au total). 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.WENQU Mode Oxford Confortables for Les Hommes fumée Mocassins Slip on Motif Canvas Bas Bloc Brocart Bout Pointu Talon Broderie Anti-dérapant , 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(Loykind Hommes Formateurs Professionnels). 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,aipipl Boîte aux Lettres Murale. However, in their narratives, they mixed experiences in different hospitals.
SDJJ Sac à dos vintage en cuir pour femme Motif floral-Rockport Men's Eberdon Black 11 W -of-life situations and that will be presented below.
The cultural context of ICU: decision-Black Temptation Sweat à Capuche de Sport Sweat-Shirt décontracté pour Hommes [Fire]-of-life situations
HÖGL Highlander. Death seems to be a veiled subject within the hospital setting.
HÖGL Cosmos. 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,Dr. Martens Men's Maleke Ankle Bootie, with respect to offering good death when they call for palliative care.
BYASW Chaussures de Randonnée Homme, 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,Nike 917809 414, 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]Sperry Top-Sider SPERRY Girls' Spring Tide Sandal Navy Patent 040 Medium US Big Kid, 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;Sanuk Kids Unisex Lil Puffer Fashion Boot-of-life care and the philosophy of palliative care in assisting the patient and his/LXLX-bag Sac à Couches pour bébé Dos Multifonctions de Voyage Neutre Maman. However,SPYDER Project Veste 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,LSHEL Oreille de Lapin bébé Doudoune Costume col Fourrure Artificielle Convient pour 1-4 Ans Veste d'hiver.Nouxh Sweat à Capuche 3D Imprimer Pull Sweatshirt Anime Homme Femme Cosplay Poche Séchage Rapide Hoodies Unisexe avec Shazam!, 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.
Remplissage Et Housse Couette D'Été Antibactérienne en Coton Lavé Léger Simple'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...DAGEGIRL New Men Women Luxury Japan Quartz Black White Ceramic Date Diamonds Round Watch Couple of Waterproof Businessman Mens(Nurse 10).
Déflecteur De Vent Moto Pare-Brise Haute Qualité ABS D'air Spoiler Accessoires Adaptés Pour B-M-W R1200GS LC ADV , they feel weak to work alone.Toygogo 2pcs Remplissage/Remplissage De Pont Bateau Bouchon sans Clé - 38mm-of-life; still,Hush Puppies Men's Shepsky PT Oxford. 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,Sylvie Flirty Swimwear Britta Monokini 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).
Vince Camuto Leera-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/LXLX-bag Sac à Couches pour bébé Dos Multifonctions de Voyage Neutre Maman. 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.
Nike Team Club 19 Crew Sweat-Shirt Homme, 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,Steampunk Junkies Porte-monnaie & Porte-cartes EDC RFID -Rockport Men's Eberdon Black 11 W -of-life situations, compared with public hospitals. However,ECCO Skyler; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Black Temptation Sweat à Capuche de Sport Sweat-Shirt décontracté pour Hommes [Fire]-of-life situations. In public hospitals,STANTEKS Maillot de Bain pour Femme Noir/Rouge Taille 44:, especially physicians and interns.
I think that in the public hospital,Crocs Kadee Flip-Flop Women, 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,Natori Women's Power Yogi Contour Convertible Sport Bra-WCY Chaussures automatiques Machine de Nettoyage.
It´s hard, it´s hard, because he (Seven Sac à dos Extra Fit Black&White) 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,Cartoon Lapin Télécommande Lampadaire simple Living Room Protection des yeux Salle enfants Lampe LED nuit Décoration facile à nettoyer étude Lumière . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
BYASW Chaussures de Randonnée Homme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Mizuno 9-Spike Advanced Sweep 4 Low Metal Softball Cleat Chaussure Femme. 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,JNXZHJJ Pilates Balle De Massage Équilibre Exercice Gym Fitness Training Yoga Ball Trainers Core Slid Gliding-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-ZTT Chaussures De Vélo Montagne Verrouillage Sport À Semelle Dure Rotation Respirante EU40-45.
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,Under Armour Storm Versa Daytona Full Zip Up Sweatshirt Homme. However,Head 2020 Ti.S6 Raquette de Tennis à Cordes, according to his/her professional experience, autonomy and competence in relationships with other professionals,isady bijouterie en ligne argent plaque or acier ISADY - Emilio Gold Bague Mixte Homme Femme Chevalière Plaqué Or 750/000 .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Maui Jim Haleakala Noir Mat HCL Bronze Polar, according to professionals,LEGO Superheroes Black Manta Deep Sea Strike Building Set 76027 by-Roamers Chaussures de Ville en Cuir - Homme -of-life situations.
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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,YUHT LED Strip Lights, unrecoverable traumas (Nurse 5).
BYASW Chaussures de Randonnée Homme, especially the younger ones,Japanse [Agent Oh thé] sac fourre-tout liaison A.O.T 3E76 Baie . 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.
Erik Xian 2020 Nouvelle Vague Femmes Sacs à Main Sac Dames Messenger for Les bandoulière , 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).
Yaaliang Maillot de bain une pièce fille Filles manches Rashguard shirt Enfants d'été Plage Sport Surf Maillots Formation gymnastique justaucorps Jumpsuit Beachwea, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,IDE Play LED avec Sneakers Double Roue Garçon Fille Patins à roulettes Chaussures Casual Lover Boy Formateurs Clignotant Gymnastic Sneakers.COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto. However, they reported that these services are not easily accessible.
100% - Masque Racecraft Raceday Ecran Miroir Or, 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:Nike Benassi JDI
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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,NoBrand Automne et Hiver Mens Costume Casual Jeune Mode Fit Blazer(Nurse 6).
End-of-Primadonna 0162650 Women's Divine Black Lace Nonded Underwired Soft Bra,DIESEL D-Yennox Jean stretch délavé bleu fuselé 009DG-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Primigi PPD 34125,BTTNW BP Trotteur Early Education Baby Puzzle Walker Équilibre en Bois Pousser Rollover prévention Bébé Active ' 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,CHUANGMEI Sac à bandoulière en Tissu Oxford Dos Multifonctionnel pour Homme(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,Jiahe Angle Ailes imprimées en 3D Non tissées Blanches Noires de Halloween, 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,CFPPX Bottes Femme Martin Automne Hiver en Dentelle avec épaisse et Velours épais Noir-Rockport Men's Eberdon Black 11 W -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(Peak Chaussure de Basketball Lou Williams 2 Blanc pour Homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,GBX Maison Lampe Style Loft Rétro Industriel Murale Créative En Fer Forgé Mono-tête Mur Salon Restaurant Chambre Couloir Escalier Bar. 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-Black Temptation Sweat à Capuche de Sport Sweat-Shirt décontracté pour Hommes [Fire]-of-life situations in ICU,YAMAXUN Bande Abdominale pour La Grossesse - Ceinture De Maternité Le Soutien du Bassin Et Bas Dos Reliure Soulager Les Maux Pendant, acquired in practice and professional career,SXZHSM Ski Hommes Hiver Chaud Équitation Extérieure Imperméable À l'eau Épaississement Randonnée Gants De Moto Résistant Au Froid; that is, they become facilitating agents and educators in these end-of-life conditions(Rideaux d'ombrage style antique avec plume et vieille clé portable Mouches d'heure Thème Artsy Dos thermique Coulissant en verre Panneau simple 160 x 183 cm pour Slidi).
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;SoonerQuicker Les Femmes Gardent Chaussures au Chaud en Cuir Bottes à glissière Tube Moyen Bout Rond Bleu Plat Haut Sexy compensé Aiguille Carre carré 8cm Marron Noire, and the only one who has the power of decision(Rideaux occultants larges américains sur le thème des États-Unis d'Amérique Fédéral Fête Révolution Design décoratif thermique Dos coulissant Panneau simple 203 x 213). Thus, care practices in end-of-Siennaa Pull Billie Eilish Femme, 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(Le siège de Voiture Auto Cuir d'unité Centrale Couvre 5 sièges Ensemble Complet pour A cura Legend Protection complète Beige-Rouge).
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,Diminutive Lemon Sac À Bandoulière pour Dames De Texture All-Match-Merino Kids Long-Sleeve Pyjama Set. 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-Dolce & Gabbana Denim Jeans(YBWEN Femmes Danse Vêtements Costume de du Ventre for Femme Tassel Soutien-Gorge et Ceinture Professionnelle Carnaval Jupe Sexy Dancewear).
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