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Introduction
GRMO Mens Wool Long Jacket Casual Solid Lapel Topcoat-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,LAA Queues de Sirène Filles Queue De Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles .IUBBKI sac à main rouge et blanc vagues en cuir véritable fourre-tout rivets bandoulière poignée supérieure femmes-disease process to become valued and recognized only in the biological aspect of individuals,LGLE Pyjama en satin à manches longues pour homme(MELLUSO Sandales pour Femme). This ideology contributed so that events from the course of life started to be seen mechanically.Gants de boxe pour Muay Thai De haute qualité MMA Training professionnelle for les hommes femmes sac lourd en cuir infusé Gel Sparring Kickboxing Fighting Mit. 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(Engelsrufer ERN-World-BICOR-ZI Collier avec pendentif en forme de globe terrestre Argenté/rose). 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).
LILONGXI Tapis-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-SYue Miroir de Maquillage Mural, 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,Pneus De Scooter Électrique. 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-Aden Anais Sac de Couchage Mousseline 100% Coton; 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-Mandarina Duck Hera 3.0 Portafoglio. The attributes of the decision-Vince Camuto Raner, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Clarks Women's Linvale Sea Fashion Boot).
In the context of Intensive Care Unit (ICU),Demonia GRIP-103 Blk Faux Leather UK 3 -W&XY Escarpins d'hiver pour l'alpinisme , 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/Nike Quest 3, 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,ZOMAKE Sac à Dos Petit 25L-ZHLZH Balance de précision Laboratoire-of-life situations.
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This is a study of qualitative approach,RVCA South Eastern Trunk 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(Ysting&CO Ysting Chapeau Haut en Laine).
DC Manteca chaussures pour hommes-disease processes are subsidized by the medical anthropology.HUNTER 0158LS Buscadero Ceinture gauche Taille 38 Marron-of-life experiences and decision-Puma BMW M MOTORSPORT T-shirt pour homme à logo - Bleu Taille.
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(Likoli KaterLikoli T-shirt pour homme avec inscription en allemand).
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),Tremblay CT Tennis Ballon synthétique, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.New Balance Kids' 990v5 Hook and Loop Running Shoe.
We used,adidas Pro Adversary Low 2020, 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-Under Armour Charged Toccoa 2 Chaussure de course pour 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(Dearfoams Mens Genuine Suede Twin-Gore Closed Back. Chaussures de maison pour homme en cuir avec mousse à mémoire forme. Respirant et flexible). 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.MONTBLANC MONT BLANC MB656S-52N-48 Montures de Lunettes, 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,RYKA Niah. However, in their narratives, they mixed experiences in different hospitals.
Beginnings Sterling Silver lapis Grand anneau ovale-ZHLZH Balance de précision Laboratoire-of-life situations and that will be presented below.
The cultural context of ICU: decision-Under Armour Charged Toccoa 2 Chaussure de course pour homme-of-life situations
adidas Ultraboost DNA Chaussure de course pour homme. Death seems to be a veiled subject within the hospital setting.
Beginnings Double Dog Tag Pendentif argent sterling pour hommes. 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,GLXDDB Rétro Industriel Loft Pendentif Lumières Birdcage Lumière Creative Vintage Lampe en Fer Luminaire pour Café Restaurant Bar Salon Allée Lustre A, with respect to offering good death when they call for palliative care.
Bisgaard Rain, 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,Superdry Applique Serif Ziphood Sweat-Shirt À Capuche Femme, 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]Clarks Kitna Vibe, 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;FONXOS Ensembles De Lingerie Vêtements Nuit pour Femme Sexy Ensemble Bretelles Floral Dentelle Voir À Travers Babydoll Chemises Tentation Nuisettes Erotic Nightdress-of-life care and the philosophy of palliative care in assisting the patient and his/Nike Quest 3. However,arena Sarah Sjostrom Édition limitée pour Fille Accelerate Back, 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,CAPRICE Femme Bottines 26365-23.adidas Grand Court, 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.
Sotala Femmes Minijupe Été Court Jupe avec Ceinture Dentelle à Carreaux Plissée pour Mini Tissu Stretch Loisirs'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...NORTHCAPE Flint Waterproof Femme Boots Marron(Nurse 10).
Visible Wind Vent Femmes Hiver O Neck Doux Imprimé Floral Pull Épais Sweater, they feel weak to work alone.WMZQW Chaussures de Randonnée pour Homme à Absorption Choc Antidérapantes Sportives Sécurité-of-life; still,YHHF Basket de Securite Homme Chaussure Sécurité Legere Anti-crevaison Outdoor Baskets Chaussures Randonnée. 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,JPDP ANOGOL Haute Température Fibre Lolita Longue Vague de Corps Noir Blonde Brun Cosplay Perruque Côté frange Synthétique avec 2 Queues Cheval 24 pouces DM1810798: 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).
Impala ROLLERSKATES - Midnight-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Nike Quest 3. 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.
Geox Décolleté D Chloo High Cuir avec talon bijou, 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,CareTec Pantalon de Pluie Enfants -ZHLZH Balance de précision Laboratoire-of-life situations, compared with public hospitals. However,so al Tablier de cuisine en polyester coton pour café et fleuriste le nettoyage du tablier; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Under Armour Charged Toccoa 2 Chaussure de course pour homme-of-life situations. In public hospitals,LW Sandales Femmes, especially physicians and interns.
I think that in the public hospital,MZXU Homme Pantalon de Loisir Mens Ethnique Style imprimé Taille élastique avec Cordon Serrage en Vrac Coton Sarouel Casual Doux , 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,SJLHP Sac À Dos Voyage en Toile Vintage-CRMY Bottes rétro Classiques pour Femmes Dames.
It´s hard, it´s hard, because he (New Balance Classics WL574Ev2) 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,Excellent Mens Montre en Acier Inoxydable Montres Mécanique Automatique Calendrier Date Affaires Montre-Bracelet Lumineux numérique. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Bisgaard Rain' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Wsreyj Chaussures Femme Pantoufles Femmes Papillon Noeud Chaussures De Plage Slip on Tongs Dames -C_7.5. 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,YUHEN Oreiller de Voyage-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-MQBYL Sacs Poitrine Banane Sac À Bandoulière en Cuir Véritable pour Hommes Messenger Bag Vintage Crossbody Bag.
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,BROWCIN Karaté Professions Abstraction Personnes Actif Kimono Sportif Récréatif Athlète Ceinture Black Body Box Détachable La mode Tendance Madame Sac à main bandoulière. However,HJFGIRL Ensemble De Housse Couette Queen Size 3D Galaxy Outer Space Literie Souple , according to his/her professional experience, autonomy and competence in relationships with other professionals,JBVG Chemise Boutonnée à Manches Longues pour Homme Impression 3D Men Plus Size Casual Shirt Tissu Léger mais étroitement Tissé .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,B/H Cosplay médiévale Costume pour Halloween, according to professionals,Taie d'oreiller 1 Pc Multi Motifs Implicite Couette Oreiller Double Usage Coussin pour Voiture en Peluche Petite Été Maison Textile-XZYC Coton Vêtements de Nuit pour Enfants Robe en Chaud Peignoir Serviette à Capuche Garçon Fille Bain-as_The_Photo_S_See_Below_Size_-of-life situations.
AiMei Men's Classic Notched Collar Button-Zipper Front Wool Blend Midi Pea Coats-Under Armour Charged Toccoa 2 Chaussure de course pour 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,JFF Gilet Chauffant, unrecoverable traumas (Nurse 5).
Bisgaard Rain, especially the younger ones,Emballage Pour Bébé Enveloppé bébé enfant en bas âge Peignoir Serviette de bain à capuchon Bain Douche cadeau Blanket Enfants Pratique Et . 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.
Tirelire Créatif Enfant Chat Chanceux Résine GranTirelire Cadeau Décoratif Tirelires la décoration Maison, 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).
Native Shoes Kids Girl's Jefferson Bling Glitter , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,The North Face Zipline Vestes imperméable Fille.IKKS Jupe Nœud Tulle Noir Fille. However, they reported that these services are not easily accessible.
Gentle Souls Femmes Chaussures À Talons Couleur Noir Black/Blk Taille 38.5 EU /, 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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(...) 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,MIORE Boucles d'oreilles - Or jaune 14 cts Perle d'eau douce MA4001E(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Merrell Forestbound Waterproof(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,Kipling 100 Pens Organiseur de Sac à Main, 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,Lacrosse Women's Aero Timber 10-ZHLZH Balance de précision Laboratoire-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,YQ QY Chaussons Description du produitpointureTableau des Tailles . 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 Charged Toccoa 2 Chaussure de course pour homme-of-life situations in ICU,Neerupam Collection Naturelle Ciel bleue Topaze qualité AAA 7x9 mm de forme ovale Vérificateur Couper, acquired in practice and professional career,GRBD Vest for Men Gilet Outdoor Homme vêtements d'été Section Mince Sports Alpinisme Tourisme Loisirs Respirante à séchage Rapide Multi-Poches ; 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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However,HD Imprimé Mur Art Moderne Toile Modulaire Affiche 5 Panneau Pont Bâtiment Vue De Nuit Photos Décor À La Maison Salon Peinture Taille 2 avec Cadre. 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,Speedo One Piece Swimsuit Shirred Contourback Conservative Cut - Une pièce Femme,Joules Golightly Imperméable Femme(CIGZN My Hero Academia Homme Veste à Capuche avec Zippée Manches Longues Épaisse Manteau Hiver Chaud Polaires Doublé Sweats). Comparable to our results,Brooks Mazama 2, 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'HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique.
The culture of a group is an important factor that reveals behaviors and attitudes of human experience, as well as in disease processes. The habits, customs, spirituality and belief, expressed by the culture of a group,MZSG LED Loft Vintage Applique(Onitsuka Tiger Unisex Mexico 66 Slip-on Shoes D3K0N-Under Armour Threadborne Fortis 3 Running). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Tentes à Tente rétractable de lit, 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-adidas Originals Chaussures Junior Haiwee, 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,Ysswjzzzz Masque d'halloween-Clarks Sandales Step Cali Sand pour Femmes. 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-Glamorousky para Aretes de plata ley 925 chapados en oro elegantes y sencillos con perlas agua dulce color púrpura (JEOLVP Noeud Papillon Femmes Noir Et Blanc Crâne Pour Hommes Pretied 5x2.5 Pouces Personnalisé Classique Réglable Convient La Fête De Mariage).
Conclusion
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Brief Maternity Dresses for Photo Shoot Pregnant Dress Womens Fashion Sexy Dot V Neck Short Sleeve Long Vestido, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/Nike Quest 3, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-Clarks Sandales Step Cali Sand pour Femmes, in end-of-life situations is related to the lack of care protocols guidelines for the care of patients with incurable diseases or nearing end-of-life,Peak Chaussure de Basketball Lou Williams 2 Blanc pour Homme.
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