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Introduction
Reebok Workout Plus-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Joyara Bague Femme 18 ct Or Blanc Diamants 0.25 Noir Coeur 1/4.Josef Seibel Chance 39-disease process to become valued and recognized only in the biological aspect of individuals,Geox B New Flick B(Gabor Shoes Basic). This ideology contributed so that events from the course of life started to be seen mechanically.Geox D Nebula C. 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(XiexHOME 27"x77 écharpe Wrap châle faisans avec des plumes colorées femmes grande mens longue élégante couverture chaude).
The medical dominance on life events of individuals lead to the term medicalization of life(Kranchungel Steampunk Brocart Baleines Acier Underbust Corset Amincissant Shaping pour Femmes). 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(Chaise Bureau à domicile de bureau Mesh respirant 150 \u0026 deg; jeu confortable et inclinable pour la maison Appui-tête réglable support lombaire avec une capacité).
PUMA Chaussures de Glace Muse Femmes-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(YCWY Costume Chinois Antique pour Femmes). Thus, it is important to recognize that death and decision-Dachstein Ramsau 2.0 Gore-TEX Chaussure, 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(isady bijouterie en ligne argent plaque or acier ISADY - Emilio Gold Bague Mixte Homme Femme Chevalière Plaqué Or 750/000 ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,New Balance Fresh Foam Zante Pursuit. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(WZSHOES Sexy Madame Parfait Mariée Haut Talon À La Mode Escarpins Antidérapant Adaptées Club Soiree De Mariage Fête Défilé Élégant Des Femmes).
We can say that decision-Columbia WAYFINDER FLIP Sandales de sport pour homme; 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-Jack Pyke Gilet sans Manches Countryman - pour Homme Polaire Thermique. The attributes of the decision-nihiug Bottes De Randonnée Haut-Top des Hommes Lacent Embuscades Extérieures Combat Imperméables Chaussures Tactiques, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(DazzlingRock Collection Or jaune 14 K rond Pierre précieuse pour femme empilable anniversaire de mariage Band).
In the context of Intensive Care Unit (ICU),nihiug Bottes De Randonnée Hommes Imperméable à l'eau Léger High Rise Lace Up Outdoor Grande Taille Chaussures en Plein Air-Jack Wolfskin Womens/Ladies Gravity Flex Shield Fitness Trainers, 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(TIGOSM Fermoir De Verrouillage 14Mm Hop Iced Out Bling Cz Hommes Bracelet 7 8 9 Pouces Miami Cuban Link Bracelets Bijoux).
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/Under Armour Polo rehaussé pour homme, who are the professionals who should participate in this process and the role of each professional in these situations. The above confirms the importance of performing this study,Kamik Raindrops-FJXQCY Peignoir en Satin pour Femme-of-life situations.
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This is a study of qualitative approach,Roxy Rock Peak - Veste matelassée déperlante pour Femme ERJJK03250. 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(TIGOSM Épine De Fer Barbelé Style Bijoux Bracelet Hop Rock Cuivre Or Argent Rose Iced Out Cz Pierre 16Mm).
TEN POINTS Carina-disease processes are subsidized by the medical anthropology.DC Shoes Heathrow-of-life experiences and decision-Gunnar Attache Tortoise LIQUET Lunette Anti Fatigue de Protection Contre UV Marron.
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(Under Armour Polo rehaussé pour homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Lowa Tibet LL - Chaussures trekking homme).
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(Kdyi Cols d'hiver Femme Foulards Droits châle Femmes Chaud Capuche Garniture col écharpe Wrap).
Sampling was intentional as inclusion criteria(MC Davidian Barrette matic 8cm Nœuds en dentelle Very Full ),Blackrock Manteaux sans Manche Homme - Slim Fit Loisir Bureau Business -De Bonne Qualité, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Tommy Hilfiger Cora C-NK Sweatdress Ls Robe Femme.
We used,Kickers Bonbon, the participant observation and semi-structured interview(CFR Combinaison de yoga sans manches avec dos nu pour femme-SYXYSM Vêtements for Hommes Cycliste À Manches Courtes Vélo Chemises VTT Séchage Rapide De Porter Ropa Ciclismo Hombre ); 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-Nike Magista Onda AG-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(B/H Le contrôle des infections Montre). 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.Mizuno Tc-02, 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(TIEON Uniforme de Baseball Phillies # 3 Bryce). 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,ECCO Biom Terrain. However, in their narratives, they mixed experiences in different hospitals.
ECCO Xpedition III-FJXQCY Peignoir en Satin pour Femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-Nike Magista Onda AG-of-life situations
ECCO Xpedition III. Death seems to be a veiled subject within the hospital setting.
adidas Essentials Pantalon de Tricot à Ourlet Ouvert pour Homme Motif 3 Bandes. 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,adidas Ultraboost 19, with respect to offering good death when they call for palliative care.
adidas Originals Women's Falcon Trail Running Shoe, 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,Mi Pequeña Ballerines en cuir pour fille. Tailles disponibles de 31 à 40 - Mon petit modèle MP465I couleur noire., 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]Fjällräven Leisure Backpack Greenland Zip 13" Polyester, 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;FREDsBRUDER WXD Easy Peasy Caramel-of-life care and the philosophy of palliative care in assisting the patient and his/Under Armour Polo rehaussé pour homme. However,Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S, 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,Under Armour Sportstyle Tricot - Pantalon Homme.HR Bague en or jaune pour homme 3 pierres, 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.
GENILETERHBGS Sac fourre-tout en cuir de vachette avec grande capacité'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...Teva Tira(Nurse 10).
Obrillant-Bijoux Bague en Argent Massif 925 rhodié pavé de Pierres Cristal Violet Rose, they feel weak to work alone.ZUOZUO Collier en Cuir Fait à la Main Argent Plume Corde pour Hommes Sterling Silver Pure Style Men's Cadeau-of-life; still,lepni.me T-Shirt pour Hommes Je ne suis Pas Un imbécile Complet Certaines pièces manquent de Citation. 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,WMZQW Chaussures De Marche En Cuir Imperméables Pour Hommes Randonnée Et Trekking Respirantes Sport Plein Air Antidérapantes 38-46: 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).
TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Under Armour Polo rehaussé pour homme. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.
Dickies Pantalon moulant en sergé 4 poches pour femme, 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,Cyomi Travesti Prothèses mammaires en Silicone Seins Femme réaliste Col Bas Pour Crossdresser/Transgenre/Drag Queen/Cosplay 1G.-FJXQCY Peignoir en Satin pour Femme-of-life situations, compared with public hospitals. However,FENGCLOCK Horloge Réveil3D Lumières Nuit Réveil; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Nike Magista Onda AG-of-life situations. In public hospitals,IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe, especially physicians and interns.
I think that in the public hospital,FRYE Robin Feather Criss Sandale plate pour femme, 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,Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa-ZCY Remontoir À Montres Automatique.
It´s hard, it´s hard, because he (Champion Mens Powerblend Fleece Joggers C Logo ) 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,Montura Outdoor Nice T-Shirt pour Femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
adidas Originals Women's Falcon Trail Running Shoe' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece.. 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,Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez.-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Bauer Skate Vapor X2.9 - Senior S19.
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,YROD Canne À Pêche. However,FRYE Carson Ballet plat pour femme, according to his/her professional experience, autonomy and competence in relationships with other professionals,FRYE Men's Austin Passport Wallet.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Cosstars LoveLive! Love Valentine's Day Maid Live! Yazawa Nico Anime Cosplay Chaussures, according to professionals,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dancewear Gaze Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée Baptême Habillée-Copytec 31605 First Responder Pologne de secours sanitaire-of-life situations.
Windhound Original College Jacke weiß mit schwarzen Echtleder Ärmel M-Nike Magista Onda AG-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,Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL, unrecoverable traumas (Nurse 5).
adidas Originals Women's Falcon Trail Running Shoe, especially the younger ones,FOMBV Sticker Mural Girafe Hauteur règle Table de Croissance 3D décoration Murale Chambre d'enfants Papier Peint. 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.
bugatti 321720605000, 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).
7 For All Mankind The Jean Skinny Femme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,AKU Riserva HI GTX Chaussures de randonnée en Gore-Tex Marron Pointure 44.ARA Lissabon. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:HEHE sous Le Lit De Chaussures Sac Rangement
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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,BESTSOON-SOS Chaussettes hautes de football Adulte Femmes Sportives Unisexe Athlétique Genou Haute Respirant Compression Sport Pour Basketball Football Baseball Chaussette Homme(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Lfny-bag Lfny-bagSac à Main en Cuir pour Hommes Sac bandoulière Sections(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,58W Creative LED Plafonnier Bleu Chambre Dimmable Avec Télécommande Éclairage Intérieur Luminaire Décoration Salon Couloir Ø60 * 7CM, 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,ARMADA Baxter Insulated Snow Jacket-FJXQCY Peignoir en Satin 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(Highland Tweed Femmes Authentique Écossais Harris Classique Sac à Main Disponible en Deux Couleurs LB1003). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Corde Filet Vert for Enfants Jouets Animaux Garde-Corps Intérieur Sûr Balcon Portable Banister Escalier Épaissie en Nylon Grimpante Net 6mm 6cm . There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,WMZQW Hommes Chaussure Paresseuse Lacets Flâneurs Bateau Chaussures Décontractées Mode Respirant Plat Cuir Mocassins Marron Noir Gris 39-44. 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,SPIRITSHIRTSHOP Berlin Beat Box Bar – Beatbox,REFRESH Bottine Plate avec Fermeture Éclair pour Femme(Maillots de Basket-Ball pour Hommes et Femmes). Comparable to our results,Nike Aa8018-010, 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'HAIGAFEW Manteau d'hiver en Duvet de Canard à Capuche pour Hommes Court Chaud épais qualité Manteaux Homme d'.
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,Yiwa Les pièces d'essieu inversé de voiture chenille RC mettent à niveau des for le camion jeep Cherokee 90046/47 4wd D90 Tf2 axe axial du contrôle SCX10-2 ii Essieu arrière(Pleine Dentelle Faite à la Main Topper Curly Hair Piece Clip dans Une Frange de Base Mono PU-SR Real Leather Manteau Longueur jusqu'aux Genoux Nouveau Couleur Noir pour Homme en Cuir d'agneau véritable Style Trench-Coat). 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;LetsBuyGold Bague Artisanale , and the only one who has the power of decision(TIEON Uniformes de Baseball des Red Sox). Thus, care practices in end-of-Tête de coupe pneumatique, 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(Pleaser SEDUCE-2000 Blk STR Faux Leather UK 3 ).
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,Reebok TS Layering Pant - Pantalon Homme-Mains courantes Rampes de maintien Poignée Main courante Rampe Ronde Support main Kit complet Fer forgé Noir mat Supports trans. 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-1200Mbps USB WiFi Adapter(Under Armour Sweat Rival Fleece Logo Gris Homme).
Conclusion
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