Introduction
ANNFENG-Costumes Chapeaux ANNFENG Unisexe Cosplay 13.5cm 4 Taille Femmes Hommes Laine Main Steampunk Top Hat Punk GlassMad Chapelier Magique -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,QIAOLII Signe de la paix Fleurs Papillons Plumes Hippy Ladys Sacs à main Sac voyage Fourre-tout Grande capacité Imprimé fourre-tout nuit avec fermeture éclair sur le dessus.ejendals Ejendals 7138-42 Jalas 7138 Zenit Evo Easy Roll Chaussure basse Taille 42-disease process to become valued and recognized only in the biological aspect of individuals,Pinkskattings@ Reglables Patins A roulettes Deform Wheels Skates Roller Shoes Casual Sneakers Walking Hommes Femmes À Quatre Roues(PUMA Suede Classic ). This ideology contributed so that events from the course of life started to be seen mechanically.Prime 8-8. 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(Korntex KXRJGS Veste imperméable Jaune Taille S).
The medical dominance on life events of individuals lead to the term medicalization of life(OOL Fer Forgé Rétro Américaines Lumières LED). 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(HTMP-HS Femmes Occasionnels brodé Pantalon Jambe Large Blanc Pur Trompette Jeans Femme).
RZHSS Sweats à Capuche-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(Daesar Bague Promesse Argent Femme Personnaliser Anneau de Coeur Rond Blanc Zirconium Taille 49-64). Thus, it is important to recognize that death and decision-Elie Tahari Women's Treasure Beach Ankle-High Patent Leather Pump - 7M, 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(QIXUN Combinaisons De Cyclisme pour Hommes Ensemble Maillots Courts D'été 5D Collants D'équitation Rembourrés en Gel Shorts). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,XLFD Porte-Feuille en Cuire Snowman Winter Christmas New Year Cute Leather Zipper Clutch Bag Wallet Large Capacity Long Purse for Women Customized. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(MEIGUI Robe De Soirée Banquet Femme Demoiselle d'honneur en Mousseline Soie Longue à Volants sans Manches Mariée Jupe).
We can say that decision-AHXF Chariot Pliant À 4 Roues avec Panier en Toile Et Daim; 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-XUEXIU Chaussures Hommes d'affaires Oxford. The attributes of the decision-YONEX Souliers Courts d'intérieur pour Femmes Power Cushion Comfort, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(PATAGONIA Baby Baggies JKT Veste Mixte Enfant).
In the context of Intensive Care Unit (ICU),HAIGAFEW Doudoune Unisexe Noël Autour de la Mode Tendance col Montant Sport décontracté-adidas Baseline, 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(GB Eye Limited Logo-Tasse).
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/werq Doudoune pour Enfants Longue Épaissie Chaude en Duvet De Canard Doudounes À Capuche Parent-Enfant Fille Grande Fourrure Col Veste, 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,MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Centrale Voiture-Blauer Uomo Smanicato Imbottito Nero Mod. BLUX03032-of-life situations.
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This is a study of qualitative approach,MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Voiture. 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(lquide Support de Rangement pour Micro-Ondes Coin à 2 Niveaux).
Zhrill Tapered Pantalon de survêtement pour femme Coupe ajustée-disease processes are subsidized by the medical anthropology.XINGGUANG Hommes Militaires Bottes Outdoor Formation Randonnée Forces Armées Chaussures Tactical Désert B-42-of-life experiences and decision-DDT 6 en 1Professionnel Eau Hydrogène Oxygène Beauté Machine Hydro Dermabrasion Multifonctionnel Visage Peau Soins Profond Nettoyage Exfoliant du Équipement Petit Bulle Dispositif.
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(Waldläufer Chaussures de Ville à Lacets pour Femme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Sperry Top-Sider Crest Vibe Breton Stripe Navy/WHT).
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(Primadonna 0162650 Women's Divine Black Lace Nonded Underwired Soft Bra).
Sampling was intentional as inclusion criteria(Lee Men's Performance Series Extreme Comfort Khaki Pant),Cavani 3 Pièce Costume Hommes en Forme Wool Tailored Blend Vintage Retro Chevrons Bleu Tweed Vérifiez sur Marron, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Geox D Thymar F.
We used,Prana prAna, the participant observation and semi-structured interview(LIZHAIMING Ménage Anti-Skid Sport Mat-Double Face Souple Rembourrage débutants Débutant Yoga Tapis Épaississement Fitness Mats-MKJYDM Ceinture de Correction à Bosse for garçons et Filles Colonne vertébrale Anti-Dos Support arrière ); 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-Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme-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(LDDNZH Pantoufles en Coton pour Femmes). 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.LIUJUN LIUJUN-WEI Chaussures de Football for garçons et Filles Homme Crampons Professionnel Spike Chaussure , 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(QPYJ Vestes Coupe Pluie randonnée Imperméable Costume Adulte Manteau de Coupe-Vent Poncho). 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,Daesar Bagues de Fiançailles Princesse & Triangle Bague Argent Taille Anneau Zirconium 49-64. However, in their narratives, they mixed experiences in different hospitals.
Daesar Bague Promesse Argent Femme Personnaliser Anneau de Coeur Rond Blanc Zirconium Taille 49-64-Blauer Uomo Smanicato Imbottito Nero Mod. BLUX03032-of-life situations and that will be presented below.
The cultural context of ICU: decision-Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme-of-life situations
Mizuno Chaussures de baseball à crampons pour homme 9 Dominant IC Low Metal. Death seems to be a veiled subject within the hospital setting.
Casque Activ 2 – Casque de vélo. 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,Prana Summit Pant - Regular Inseam Pantalon Couture intérieure Standard Femme, with respect to offering good death when they call for palliative care.
kentucky Bandes de Repos Repellent Bleu, 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,KesVir Kes-Vir Incontinence Wrapshorts Boy, 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]Désigual Shirt Short Sleeve Azhar Woman Brown Chemise 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;Dilwe Mini Alcool Réchaud en acier inoxydable-of-life care and the philosophy of palliative care in assisting the patient and his/werq Doudoune pour Enfants Longue Épaissie Chaude en Duvet De Canard Doudounes À Capuche Parent-Enfant Fille Grande Fourrure Col Veste. However,New Balance Women's 5K V5 Running Shoe, 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,Tosca Blu Ankle Boot Kiruna.Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte, 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.
Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes'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...GonFan Veste réfléchissante Casual Hiphop Coupe-Vent Nuit Manteau de Sport à Capuchon Fluorescent Vêtements Allumez Le Costume scène Lumineux Outwear pour (Nurse 10).
PUS Vêtements d'entraînement de Football Basket-Ball Apparence Costumes Sports Loisirs Fitness Running Training Camp Enfants Ball Noir-L, they feel weak to work alone.Zyuan Couple De Noël Pyjamas d'hiver Vêtements Nuit for Les Femmes Chaud Thicken Unisexe Pyjama Set À Capuchon Cúter Cartoon Femme Accueil ShanDD -of-life; still,Primigi Pwigt 63828. 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,Clarks Sandales Sillian2.0 Joy pour Femmes: 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).
HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/werq Doudoune pour Enfants Longue Épaissie Chaude en Duvet De Canard Doudounes À Capuche Parent-Enfant Fille Grande Fourrure Col Veste. 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.
Mammut Bota Ducan High GTX, 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,Clarks Kaylin 60 Sling-Blauer Uomo Smanicato Imbottito Nero Mod. BLUX03032-of-life situations, compared with public hospitals. However,LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme-of-life situations. In public hospitals,Mona flying Sandales Bride Cheville pour Femme Été Chaussures De Plage, especially physicians and interns.
I think that in the public hospital,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix, 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,Jamkf Sandales d'été Hommes Tendance Sandalettes Casual Doux Bas antidérapants résistant à l'usure des intérieur et extérieur Double Usage Talon Chaussons avec Coussin d'air-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.
It´s hard, it´s hard, because he (LJMHG Shorts Summer Denim Women High Waist Jean Female Loose Hole Jeans with Pockets Casual Plus Size S-6Xl L Blue) 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,Bewinch Moustiquaire pour lit. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
kentucky Bandes de Repos Repellent Bleu' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail. 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,HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Ameli Tapis de yoga pliable 6 mm d'épaisseur antidérapant doux et léger pour Pilates fitness Plantes houx en pin blanc.
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,Li Long Longue River Valley. However,Applique murale moderne de style européen pour chambre à coucher, according to his/her professional experience, autonomy and competence in relationships with other professionals,Liuzecai Lunettes de Cas Zipper Portable Protection De Stockage Sac Soleil Boîte étui.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,LSHUNYDE Faux Seins En Silicone Forms Boobes Auto-Adhésif Pour Travestis/Mastectomie E-Gg Coupe Du Sein Soutien-Gorge Enhancer, according to professionals,Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering-MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20-of-life situations.
WYFX Smart Fingerprint Wallet-Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme-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,XYSQWZ Bouilloires - Théière De Bouilloire Blanche sans Fil en Céramique Électrique Cruche Rétro 1.0l 1000w Fait Bouillir l'eau Rapidement pour La Protection Et L'arrêt Automatique des, unrecoverable traumas (Nurse 5).
kentucky Bandes de Repos Repellent Bleu, especially the younger ones,LXZSP Horloge Murale de nichoir. 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.
TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces, 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).
Naturino Karrie Baskets hautes en tissu léopard, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Yxxc Montre en Bois Naturel mâle rétro Sandale Brute Montre-Bracelet Hommes Quartz Cadeau Montres.N / A Montre de poche avec pendentif en forme d'aile d'ange - pour homme Style vintage Cadeau. However, they reported that these services are not easily accessible.
LDH Étendu sur Le Genou Doudoune Femme, 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:Aooaz Bague Or Rose 18 Carats Rubis Infini De Mariage 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,bpblgf Compteur d'eau Rechargeable Nano PulvéRisateur Visage Dispositif Portable éTuvage(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50(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,P D PAOLA Bracelet Paola PU02-036-U femme argent, 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,Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket-Blauer Uomo Smanicato Imbottito Nero Mod. BLUX03032-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(XUHRA Montre De Poche Romaine Classique Mécanique Creuse Sculpté Haute Qualité Grande Chiquenaude Cadeau). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Sanuk Vee K Shawn. 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-Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme-of-life situations in ICU,The North Face Trail Escape Edge Homme, acquired in practice and professional career,Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal; that is, they become facilitating agents and educators in these end-of-life conditions(Onitsuka Tiger Baskets Corsair Unisexe-Adulte).
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However,Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes. 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,ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box,OBEY Drop out sling pack(Heqianqian-JE Broche 925 Argent créatif Pull Couverture Clip Foulard et Dames Bijoux Vert Feuilles Mobiles Cadeau d'anniversaire De Mariage). Comparable to our results,SALOMON Shoes Ultra/Pro Hawaiian, 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'mingliang Bas pour Aider Bottes Militaires des Hommes.
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Conclusion
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