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Introduction
HWXDH Orthèse de Cheville Genou ， Cuisse Veau Support Compression Fixation Jambe Manches Respirantes réglables pour déchirure Musculaire Femmes Hommes-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,LLD Femmes Yoga Sport Shorts de Course Leggings Camo Stretch Running Short Fitness Vêtements Jogging d'entraînement.LeeAX Chaussures De Sécurité Anti-Crevaison Travail Indestructibles À Bout en Acier Antidérapant Plein Air Respirantes pour Hommes-disease process to become valued and recognized only in the biological aspect of individuals,XUHRA Montre De Poche Vintage Bronze Cadran Rond Quartz Classique Petit Échelle Romaine Et Bracelet(TEEZILY T-Shirt Homme Si Papou ne Peut Pas Le réparer). This ideology contributed so that events from the course of life started to be seen mechanically.Orchid Jewelry Naturel Améthyste. 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(Held Team Shirt L).
The medical dominance on life events of individuals lead to the term medicalization of life(Alma en Pena V19996 - Sandales Arena 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(AXDNH Chaussures de Sport Danse des Femmes).
KHSKX Planche à roulettes de Sport-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(LIYT Tablier en Denim Noir avec 2 Poche). Thus, it is important to recognize that death and decision-YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux , 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(El Naturalista Nido). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,ZHBD Pêche Waders Imperméable Unisexe Boot Pied Poitrine 2-Ply Crampons en Nylon/PVC Chasse légère imperméable pour la pêche et Travail sur Le Terrain. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme).
We can say that decision-HaiDean Pantalons pour Homme Pantalon Jambe Couleur Droite Unie Casual Moderne Tablier avec Poches Facile De Loisirs Mode Sport Fitness Polyvalent L'Automne Au Printemps; 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-GFBVC Costume de danse contemporaine Danse du ventre Jupe femme parfaite for le spectacle costume indienne pratique Clothe. The attributes of the decision-JSYHXYK Collier Bowknot Pendentif Femmes Chaîne d'eau Bavoir Or Jaune Rempli Nain Bijoux, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Frau 42C2 Sable Bottes Chaussures Amalfi Femme mi Daim de randonnée).
In the context of Intensive Care Unit (ICU),NANE Débardeur Femme avec Soutien-Gorge Tops sans Manches Basique Gilet De Sport Yoga Fitness-HOSD Survêtement Hommes 2020 Hip Hop À Manches Longues De Couleur Unie Capuche Sweat Mens Coat Casual Sportswear, 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(ZXYMUU Latex Gummi Capuche avec la Bouche Condom BDSM Bondage Sex Toys Couples Capot).
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/LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant, 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,XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau -Anastasia Beverly Hills - Veste Courte rembourrée pour Femme-of-life situations.
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This is a study of qualitative approach,Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur. 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(Tatitoto Gioie Bague Femme en Or 18 carats Jaune avec Grenat).
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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(Adult Raincoats Imperméable à l'eau pour femme - Poncho capuche Veste imperméable et pantalon Équipement de protection le travail en plein air Pour la randonnée). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Tommy Hilfiger Honey Flap Satchel).
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(WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude).
Sampling was intentional as inclusion criteria(New Balance Fresh Foam Zante Pursuit),LALABIT Chaussettes athlétiques respirantes Hommes haute performance long tuyau de ski for faire du vélo Trekking Alpinisme Ski Snowboard froid Randonnée épaississantes, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.D.A.T.E. Sneaker in Pelle Donna cod.W331FGPHBK.
We used,KCSds Bobo perruque de cheveux courts, the participant observation and semi-structured interview(ADSE Horloge Murale à Pendule-Jackson 34 # Las Vegas Raiders Maillot de rugby pour homme d'entraînement à manches courtes Top Homme Casual Sport T-shirt Rugby ); 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-CNC ZTTO 11Vitesse Roue Libre Cassette-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(Airsoft Parts APS 3-Gun Competition Receiver Receveur de compétition for CAM870 Shotgun Fusil à Pompe). 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.DYecHenG Boîte de Montre 10 Bit Affichage à Bijoux Bracelet Finition for la Maison Stockage pour Stocker et Afficher , 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(Pleaser BEJEWELED-3019RSF-7). 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,yunyu Montre de Poche pour Homme. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-CNC ZTTO 11Vitesse Roue Libre Cassette-of-life situations
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New Balance 420v1. 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,Assiette De Diner Plaque Cuisson en Porcelaine 6 Pouces Bol À Dessert Ramequin Baker Dîner Plats Pâtes Vaisselle Ménagère, with respect to offering good death when they call for palliative care.
Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs, 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,Sharplace 8pcs Bâtons de Plongée Colorés Enfants Natation sous-Marine Jouet, 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]Hoppimals Tootiny Vache Sauteuse et Bondissante Animal Sauteur pour Les Enfants âgés de 12 Mois Plus - Emballé dans Une Boîte Cadeau, 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;e.s.motion Engelbert Strauss-of-life care and the philosophy of palliative care in assisting the patient and his/LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant. However,FB Fashion Boots C3099, 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,DD Danish Design Montre Femme Analog Silver - IV62Q1230 Chloe Quartz.adidas Munchen Bakset Mode Homme, 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.
Disney Bandoulière Mickey The Blogger'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...MO JOC Boots Chelsea Femme(Nurse 10).
Clarks Sharon Noel, they feel weak to work alone.Mikowoo Hiver Echarpe Femme Chaude Wool Foulards Couleur Unie Scarf Glands Châles Elégant Long Wrap Grande Etoles-of-life; still,Saucony Cohesion 12 Men. 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,Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt: 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).
Cherokee Haut coloré coupe enveloppée CK608-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant. 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.
adidas Originals Ozweego, 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,Champion 112418 F19 KK001 NBK Jogger Femme Noir-Anastasia Beverly Hills - Veste Courte rembourrée pour Femme-of-life situations, compared with public hospitals. However,YUHEN LED Chaussures; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-CNC ZTTO 11Vitesse Roue Libre Cassette-of-life situations. In public hospitals,MYSdd Mode Brieftasche Damen Leather weibliche Schnalle Doppelreißverschluss Design Münzgeldbörse Unisex schlank Geld-Rot mit Kette, especially physicians and interns.
I think that in the public hospital,Kanna Shoes Sandalia CUÑA Basket Kaki, 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,Skybird-UK LED Lumières Clignotant Couleur Changeant Chaussures à roulettes Multisports Outdoor 7 Couleurs Colorés Gymnastique Sneakers avec Rouleau de Garçon et Fille-Asics Gel-Sonoma 4 G-TX 1011a210-001.
It´s hard, it´s hard, because he (arena WPWSK Carbon Maillots de bain Femme ) is absolutely sure that the patient will be discharged, that the patient will go home and we are absolutely sure that he will not. It is a great responsibility... Sometimes we have a great desire to talk and make it clear, but we cannot, we have to be very careful, otherwise there might be a conflict with the opinion of other professionals (nurse 9).
Beliefs and subjectivity in care in end-of-life situations
Personal beliefs are their own values,Zhenwo Accessoires De Mariée Jarretière en Dentelle Strass Fournitures Occidental. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Waldläufer Mocassins pour Femme Beige Cement Stein Silber. 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,Générique Homme Bottes de sécurité Bout en Acier Anti-crevaison Travail Baskets Respirant Cuir Oxford Casual Chaussures Conduite Outillage Affaires Ville Plate Grande Taille-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Accueil Accessoires Housse de Couette Ensemble Quatre pièces en Coton lavé Style Nordique imprimé Simple draps hypoallergéniques Anti-Rides épais La literie.
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,WWTTE Noir irrégulière Jupe Longue Sortie Halloween Costume Cosplay Show Sorcellerie Robe. However,Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne, according to his/her professional experience, autonomy and competence in relationships with other professionals,WWTTE Sequin V-Cou Robe Banquet annuel de soirée.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,WWTTE Yoga serré Snakeskin Leggings 2V , according to professionals,Reebok Royal Dashonic 2-F Fityle Kit de Outil Monter Démonter Axe Vélo-of-life situations.
Sperry Top-Sider Men's-CNC ZTTO 11Vitesse Roue Libre Cassette-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,DRLVMO Han Reine Femmes Automne Vintage Robe À Manches Longues Plissée Volants Haut De Gamme Dames Couture Piste Mince Robes Soirée, unrecoverable traumas (Nurse 5).
Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs, especially the younger ones,EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé. 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.
JOllify Nix pour Neela Sac de gym cadeau sac à dos en coton bpnix5806, 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).
Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,xiaokeai Collier Femme Longueur réglable en Argent.TWFY Sandales pour Hommes Extérieur Chaussons Deux Porter Méthodes d'intérieur d'été Plage Convient for Le Printemps . However, they reported that these services are not easily accessible.
CCM Super Tacks AS1 Skate Men, 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:Smartwool PhD Lumière extérieure Micro
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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,XUQIANG Gilet Ultra-Mince for Hommes avec Photographie De Pêche Multi-Poches À Séchage Rapide Sports Plein Air Et Loisirs (Nurse 6).
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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,adidas Pred Gl LGE Gants de Foot Mixte, 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,BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids-Anastasia Beverly Hills - Veste Courte rembourrée pour Femme-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(Pedag "Relax" support de pied avec metatarsal coussin and Prononcé coque talonnière - Marron). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Charmance Pantalon Taille élastiquée. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Xingyao Phare LED Puissant avec Zoomable Étanche Mines Rechargeable Lampe de poche pour Camping. 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,NIEWEI-YI Sweatshirts Unisexe,Lézard cadeau gecko léopard La vie de est meilleure avec un lézard T-Shirt(Theia Unisexe Bague Or Jaune ou Blanc). Comparable to our results,ABAKUHAUS Ethnique Oreiller Cervical de Voyage, 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'French Bulldog T-Shirts Cadeaux Bouledogue français Shirt Hommes Femmes Enfants T-Shirt.
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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,Aktaul Tamponnant Licorne Chemise Touche Hanche Saut Marrant La Magie Noir Femme T-Shirt Manches Courtes Womens Black-Filet de sécurité pour enfants. 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-AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme(Traclet Chapeau Cowboy Stagecoach Paille Naturel).
Conclusion
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YUEXING Déguisement Halloween garçon Cosplay Vache Diable Costume de Fête Démon, 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/LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant, 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-Filet de sécurité pour enfants, 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,CHOUCHOU Cendrier pour cigares - modèle Fleur Elephant Bois cendrier.
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