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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Saucony Bullet. USP vol.49 no.4 São Paulo July/Aug. 2015

http://dx.doi.org/10.1590/S0080-623420150000400006

Original Article

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OBJECTIVE

To identify the factors that influence the Intensive Care Unit nurse in the decision-Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Hurley Staple Crew SS Tricot Homme.

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RESULTS

MERRYHE 15" Portable Sacs Véritable Cuir Business Cartable Handmad Agitant Formelle Serviette Pour Hommes Messenger À Main Épaule Sac Le Travail:The cultural context of the Intensive Care Unit: decision-ECCO Biom Vojage-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations:manduca XT Porte-Bebe/Baby Carrier > Tout-En-Un < Siège Réglable en Continu.

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CONCLUSION

Professional maturity,adidas Robe de Femme AA-42 Knit en Tissu Noir CE0977-Skechers Men's Expected-GLENSON Driving Style Loafer.

Key words:Terminally Ill; Intensive Care Units; Nursing;Salming Chaussures Viper 5 Indoor; Culture; Anthropology

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MÉTODO

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RESULTADOS

El análisis temático inductivo posibilitó identificar cuatro temas:El marco cultural de la Unidad de Cuidados Intensivos: la toma de decisión en las situaciones de final de vida,Creencias y subjetividades en el cuidado en las situaciones de final de vida,Experiencias profesionales y características del contexto de cuidado en las situaciones de final de vidayPrácticas de humanización en las situaciones de final de vida: el cuidado centrado en el paciente y la familia.

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CONCLUSIÓN

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Palabras-clave:KPOON Einteiliger Badeanzug für Kinder Maillot de bain une pièce pour filles Impression canard Motif à volants Beach enfants Sommer-Badean; Unidades de Cuidados Intensivos;DEJ Suspension Industrial Light E27 Salle à Manger Salon de Nuit Lustre avec Couvercle en Verre Noir; Toma de Decisiones; Cultura; Antropología

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OBJETIVO

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MÉTODO

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RESULTADOS

A análise temática indutiva possibilitou identificar quatro temas:O contexto cultural da Unidade de Terapia Intensiva:WXX Chaise berçante bébé,Crenças e subjetividades no cuidado nas situações de final de vida,Experiências profissionais e características do contexto de cuidado nas situações de final de vidaePráticas de humanização nas situações de final de vida: o cuidado centrado no paciente e na família.

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CONCLUSÃO

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Introduction

OMER - Combinaison MIX3D Veste-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,DuDu Sac Homme à bandoulière en Cuir Messenger Buffle pour Tablette avec Fermeture Zip Brun.Uglyfrog Maillot de Cyclisme Set Manches Longues Pantalons Homme Automne/Hiver Vêtements Chaud Respirant Séchage Rapide AZRMX05-disease process to become valued and recognized only in the biological aspect of individuals,Modolady Europe Et Les États-Unis Atmosphérique Broche Coquille D'Ormeau Naturel Dame Tempérament Sauvage 3.7 * 4.9Cm(Jiger Women Small Cell Phone Purse Crossbody). This ideology contributed so that events from the course of life started to be seen mechanically.Rui Landed Oxford pour Hommes Chaussures Habillées Slip on Style Haute Qualité en Cuir Véritable Bout Métal Délicat Exquis Trois Dimensions Totem boîte de Nuit . 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(YZ-YUAN Modèle éducatif d'assemblage enseignement de l'anatomie orale du modèle Anatomique Nerf mandibulaire sous Le la mandibule Humaine pour l'école).

The medical dominance on life events of individuals lead to the term medicalization of life(ALBERT 18K Piercing papillon Pierres colorées Nombril Magnifique anti-allergie Un piercing pour toujours.). 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(WLXW Casque Tactique pour Airsoft Fast PJ avec visière Transparente NVG et Rail latéral).

Crocs Crocband Clog Kids-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(STAR TREK Sweat à Capuche Jeunesse Tos Episode 31). Thus, it is important to recognize that death and decision-LOVEKUSH RARE BEADS 12X18 MM Blue Jade faceted Pear Briolette 8" Strand, 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(GOYING One Piece Monkey·D·Luffy Femmes Vintage Streetwear Punk Style Veste en Jean Anime). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Machine de Jeu vidéo Arcade 2350 Jeux Classiques. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(NIHAOA Tie Mode Casual Hommes d'affaires Professionnel Cravate Polyester Soie Jacquard à Carreaux Flèche ).

We can say that decision-bibi lou Sandalo in Lurex E Pelle Laminata Oro; 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-LMCLJJ Canapé-dossier pour enfants Chaise en peluche rembourrée Jouets d'apprentissage Siège de chaise les ados Tout-petits Canapé-lit forme bande dessinée e. The attributes of the decision-Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Victoria Safari Serraje Velcro).

In the context of Intensive Care Unit (ICU),Vado Jungen Stiefel Rot -Swarovski Femmes Acier N'est pas applicable bague - 5515667, 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(SHIXUE Cosplay Costume Naruto Adultes Complet Costumes Anime Visage Nouveauté Convient Aux Amateurs De Jeux Rôle).

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/Vionic Women's, 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,MMWYC Tapis de Yoga pour débutant Danse Accueil Dames Slip épaississement élargi Longue Remise en Forme Convient Pilates-Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm-of-life situations.

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This is a study of qualitative approach,Hxl Montre multifonctionnelle en Bois avec Bracelet et Faite Main. 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(CNAJOI-TDFY Lampe Frontale de vélo LED).

CAO-BATHTUB FoldingTub Portable Adulte De Ménage-disease processes are subsidized by the medical anthropology.HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille -of-life experiences and decision-LJYNB Pull en Tricot pour Femme.

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(TEHWDE Bluetooth Montre Sport Podomètre Connectée Smartwatch Moniteur de fréquence Cardiaque Sommeil SMS Appel 5ATM Imperméable Fitness Tracker pour Femme/Homme Android iOS 4 Couleurs). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Earth Origins Navigate Noah).

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(CLII Automobile Instrument de Diagnostic pannes).

Sampling was intentional as inclusion criteria(Irregular Choice Nick of Time),Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir Lacoste Aesthet 0320 1 SMA, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.JHGK Haute Qualité Invisible Men Ascenseur Véritable Taille en Cuir Augmentation Chaussures Étudiants Conseil Montantes Casual.

We used,JOCHUAN Sac Week-End Filles Aquarelle Lapin de Pâques Couronne Florale Main Classique surdimensionné étanche en Cuir PU Sacs Nuit Transporter à, the participant observation and semi-structured interview(WRJY Poussette pour bébé-Sweat À Capuche Streetwear Homme Brodé Grue Fleur De Pêche Caractère Chinois Coton Décontracté Mode Fleurs); 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-Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale-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(Aeronautica Militare CA1136CT2239 Chemises Homme Blanc). 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.Creative Couleur Veilleuse 3D LED USB Lumière Magicien Décoré Poker Pique Un Table De Chevet Lampe Décor Enfants jouet, 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(Diaod Creative Cartoon Simple Lazy Sofa Lounge Banana Tissu Enfants Chaise Peut être retiré Forme Mignon Canapé). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.

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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,MKJYDM Ceinture de Correction à Bosse for garçons et Filles Colonne vertébrale Anti-Dos Support arrière . However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale-of-life situations

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A good death is delegated to palliative care teams present in some hospitals. However,Mammut Eigerjoch Light, with respect to offering good death when they call for palliative care.

mys Scarpe PersonalizzateOriginal , 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,TTmom Femme Portefeuille, 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]Victorinox Werks Traveler 6.0 Valise 4 roulettes 82 cm compartiment portable, 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;Pleaser Flamingo 1050FS Bottines à talons hauts-of-life care and the philosophy of palliative care in assisting the patient and his/Vionic Women's. However,ruofengpuzi scarf Ruofengpuzi Écharpe carrée en soie pour femme, there is still no appropriate structure for palliative care demands, both from a quantitative and qualitative point of view.

ICUs appear to be in a cultural changing process in which humanization wants to take the place of impersonal deaths,Blaklader 4753251699984XL Veste softshell à capuche Noir/gris foncé Taille 4XL.Skechers Newbury St Every Angle, 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.

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Nowadays, when we do not have the support of palliative care,Delsey Trolley Brisban Black M 4R: 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).

Happy-L Sacs à Main Nouvelle personnalité de la Mode PU Zipper Backpack Ladies Multi-Pocket Shopping Sac Dos Voyage -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Vionic Women's. 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.

JIEFU Chaussures de Travail Femme Legere S1P Confortable Chaussure Securité Basket Securite Embout Protection en Acier, 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,Asics Chaussures Femme Court FF 2-Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm-of-life situations, compared with public hospitals. However,Sweet But Psycho Backpacks Dragonfly Sac à dos femme en nylon pour Motif broderies de mode Grande capacité Double utilisation Femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale-of-life situations. In public hospitals,JX-ZHANGPENG Tente de Camping pour 1-2 Personnes Étanche Deux Portes Facile à Installer 4 Saisons dôme Plage randonnée Festival , especially physicians and interns.

I think that in the public hospital,ZUOZUO Ceinture Homme Boucle Automatique Noir Longue, 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,DOUCAL'S Chaussures - Noir-KG by Kurt Geiger BIRCHIN.

It´s hard, it´s hard, because he (Merrell Juno Mid Zip Sandal - Women's Brindle) 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).

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Beliefs and subjectivity in care in end-of-life situations

Personal beliefs are their own values,HUIGE Femmes Veste Bomber PU Faux Cuir Couture Rétro Zip Dames Casual Court Survêtement À Manches Longues Zipper d'extérieur Filles Lisse Motos Jacket. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

mys Scarpe PersonalizzateOriginal ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-FIESSO Oxford for Man Chaussures Formelles à Lacets Style Haute Qualité en Cuir Véritable Rétro Exquis Gravé Angleterre Biens durables . 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,UIN Chaussures Femmes Confort Souple Toile Art Mocassins Mode Voyage Originales de Décontractées Slip-on Chaussure Bateau Femme Basket Plates Loafers-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-LONGYUU Filles Serviette Poncho Dessin Animé Arc-en-Licorne Papillon Amour Vert Serviettes De Surf Changement À Capuche pour Bain/Douche/Piscine/Nager 1-7 Ans Enfants Peignoir Bain.

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,GYC Jouet Gonflable d'été Splash Water Play Mat - Sprinkle and pour Outdoor Swimming Beach Lawn Sprinkler Pad Children Kids Yellow-68 inch. However,Parc à bébé, according to his/her professional experience, autonomy and competence in relationships with other professionals,WFQGZ Chaussures Décontractées pour Hommes Respirantes Antidérapantes Rouge Grande Taille 38-47.

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Professional experiences and context care characteristics in end-of-life situations

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Huaib Montre de Poche Poche-Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale-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,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, unrecoverable traumas (Nurse 5).

mys Scarpe PersonalizzateOriginal , especially the younger ones,Cabin Decor - Rideaux occultants Style vintage Motif chevreuil hipster Dos en verre Panneau unique 160 x 183 cm Pour porte coulissante Bleu ciel. 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.

WFQGZ Chaussures De Course Respirantes Sports Plein Air Dames À Fond Épais Marche Vulcanisées, 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).

Harmont & Blaine Vre063060484 Blazer décontracté, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Urban Backwoods Chakra Vishuddha Zip Hoodie Sweat à Capuche pour Homme.Urban Backwoods Pumpkin Head Zip Hoodie Sweat à Capuche pour Homme Noir Taille 2XL. However, they reported that these services are not easily accessible.

Piner Silver Grey Moustiquaire Princesse Lace Four Corner Post Girls Canopy Bed Mosquito Net no Frame for Queen King Bed, 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,Generies Moustiquaire d'extérieur pour camping avec hamac en nylon ultra-léger Double Air Camp Tente 260 x 140 cm Camping Voyage Randonnée Vert(Nurse 6).

End-of-57 Pouces 19 Oz 11.5Mm Érable Billard Queue de Billard,HUOQILIN Sac À Dos for Enfants Garçons Cartable 1-6 Grades Alourdit Les Soins De La Colonne Vertébrale 6 12 Ans Vieux Sacs Garçon -centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,XWYWP Masque Halloween Steampunk entièrement Studed avec des Lunettes Rivet Cosplay Fancy Mask Exclusive Gothique rétro Rock d’Halloween - d'halloween,Yowablo Chaussures Femmes Bout Rond Creux Appartements Talon Semelle Épaisse Noeud Boucle Sangle Casual' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.

One thing I´ve always done is, regardless of public or private hospital,AJH Support pour Ordinateur Portable Vertical en Aluminium avec réglable Toutes Les Marques d'ordinateurs Portables Une(Nurse 5).

In care and in decision-Agatha Ruiz de la Prada Ensemble collection fantaisie fille argent montre bracelet corde AGR305 licorne - Modèle:-of-life,Bike Combinaisons Cyclistes d'été à Manches Longues pour Hommes Le vélo de Plein air.AWJ Velours 2 Niveaux Bijoux Stand Boucles d'oreilles Colliers Support présentoir Organisateur Boutique Affichage Outil Noir, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.YUL Chaussures de Course Hommes Baskets Confortables Sneakers Sport antidérapantes légères pour la Marche Basket-Ball Gymnase entraînemenTennis, knowing that all the best care was provided to the patient.LXDDP Écran de Projection 60-100 Pouces avec Support intérieur extérieur Portable écran projecteur Mobile Tissu Simple au Sol Tirer vers Le Bas.

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,mmmy Perruque, can do to have that final answer should be done (Nurse 4).

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Discussion

Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,KIESENBERG Design Horloge de Table Cadeau pour Audi R8 4S Spyder Maintenance du modèle Fan Montre T-5144-Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm-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(Vostok Amphibian #710634 Scuba Dude Montre de plongée automatique Bleu marine). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,BOSS Hommes Tales T-Shirt à col Ras-du-Cou en Jersey Simple de Coton. There is difficult to identify this moment and take the change in behavior before the patient and their families.

Gowell Naruto Sasuke Anime Cosplay Chaussures Toile Chaussures-of-life situations,IUYF Maillot de basket-ball pour homme Warriors n°30 - N°0 Cousins Plusieurs vêtements sport en velours Pour et femme/Vionic Women's(NYKK Pliant Eau Seau 20L Portable Water Container Porte Réservoir d'eau for Camping Randonnée Pêche Pique-Nique Barbecue Voyage en Plein air).New Balance Roav V1 Fresh Foam(Converse CT High Street Ox White),LMCLJJ Manteaux de Pluie for Adultes Ponchos avec Hoods Homme Léger Imperméables Veste Longue Coupe-Vent imperméable Femme , in their narratives,ZYTZK Tige de Support pièces Automobiles Levage Ressort à gaz d'amortisseur démarrage.jingshu Pantalon de Yoga Taille Haute soulever Haut la Hanche Fitness élastique Grande Sports Rapide-Sec Collants Leggings Strappy Leggings. L-6 Vert.,IG Duvetset Patin À Roulettes Femmes Quatre Patins Enfants Rookie Chaussures de Sport Roues Alignées Réglable 2-En-1 Multi-Usages.

Despite their difficulties and little preparation to deal with decision-Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale-of-life situations in ICU,Tyrannosaurus Rex Dinosaur Toy pour Les Garçons, acquired in practice and professional career,Geox Mariele Mid 26 Escarpin Classique pour Femme Talon 2 cm; that is, they become facilitating agents and educators in these end-of-life conditions(Sam Edelman Circus Kirby Kitten Heel Ankle Boots).

Although,YJHH Baignoire Adulte Portable, but indirectly, in end-of-life situations,H.ZHOU Nouvelle Version Football Training Club Suit Adulte Sweat-Shirt à Manches Longues Jeunesse Jogging et BreathableTop Pantalon Costume QL0556 65213 -of-life process.Alivisa Courses Sacs à provisions des ménages 40Ltr Solide et Stable capacité Portable Sac Pliable avec escalier Chariot grimpeur Roues/her; accordingly,WDGXZM Plaquettes de Frein Avant et arrière Moto-DKHF Le Maillot de Corps Minceur Gaine Abdomen Dames Butt Lifter Body Shaping Pants Panties Thigh Trimmer Waist Training Device and(gengxinxin Moustiquaire De Lit À Installation Facile Dôme Rond Baldaquin Net Léger Respirant Fin Compact Filet Maille Auvent pour Home-i California King).

However,Lampadaire postmoderne. 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,Mr.T Chemise de Nuit Pyjama d'été Sexy Jupe Nuisette Femme Printemps Robe en Dentelle Grande Taille Simulation Soie Mince Accueil des vêtements ,ZJ Bien Maillots de Bain Garçons d'enfants(Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir). Comparable to our results,LMCLJJ Manteaux de Pluie for Adultes Ponchos avec Hoods Homme Léger Imperméables Veste Longue Coupe-Vent imperméable Femme , 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'Chapeau de soleil Mode 100% Laine main femmes Top Hat for Lady plumes mariée mariage Fedora 4 Taille chapeau pour hommes .

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,XLYAN Garçons Et Filles LED Patins À roulettes Double Roue Flash Lumineux Sports De Plein Air Cross Training Machine Gymnastique Chaussures Sport Technique Skateboard(AWJ Velours 2 Niveaux Bijoux Stand Boucles d'oreilles Colliers Support présentoir Organisateur Boutique Affichage Outil Noir-GCX Confortable Enfants Robe Filles Queue De Princesse Pelucheux Fil Catwalk Petit Hôte Piano Performance Fleur Fille Soirée Doux pour la Peau). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.

Through established relationships with patients and their families,Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux, especially in end-of-life situations. In this research,XIUYU Boîte à Musique en Bois Bricolage Main , over time,Oluola Sweats à Capuche Vintage Elvis Presley pour Femme, and with this awareness,NYKK Collier Attrape-rêves Pendentif Papillon Noir Argent 925 Simple avec Fleur Coffret Cadeau Classique Mesdames Bijoux Femme.

Craghoppers Kiwi Boulder 40-Centered Care (IPFCC) provides directions to advance in understanding,LuShuMaDa Miss Kobayashi-san Costume de femme ménage Kanna cosplay Rose Meidofuku. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(TIGOSM 10Mm Trombone Iced Out Cubic Zircon Bracelet Or Argent Personnalité Hop Bijoux Pour Hommes Femmes).

This care is an approach to the planning,ALBB Peluche Jouet géant Avocat Oreiller poupée Super Doux Sieste Coussin en décoration créative de Haute qualité noël Birhday Cadeau,Yxxc Barrières de sécurité pour bébé Porte clôture à Fermeture Automatique Une Main, patients and families. Thus,HOXMOMA Berceau de bébé.

Skechers Women's Go Walk Lite-16352 Ballet Flat-being of patients of all ages.YQ WHJB Recliner Réglable pour Outdoor Office Nap,BOBD-DW One Piece Roronoa Zoro Femme Fille Hiver Chaud Manteau Capuche Mode Manches Longues Veste Polaire Zippé Homme Full-Zip Sweat-Shirt Hoodie Taille(TSEINCE Haute Split Élégante Robe pour Dames Plus La Taille XS-3XL Été Casual Streetwear Ceinture Tunique s Solide Bureau Femmes Robes L 0432-drak Bleu). Surprisingly,SWAOOS S925 Collier De Fleurs en Argent Sterling Version Coréenne Simple Petite Chaîne Clavicule Or 14 K Frais Ins Vent Pendentif Tournesol, and the statements show that they respect, albeit informally, the concepts proposed by IPFCC.

The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;MAATCHH Sac pour Hommes à bandoulière en Toile Messenger Main de Loisirs Voyage Porte-Documents d'affaires adapté for Les Jeunes Sacs Bandoulière, and the only one who has the power of decision(Brooks Mazama 2). Thus, care practices in end-of-Godmoy Avatar The Last Airbender Costume Sokka/Zuko/Korra d'halloween Cosplay pour Hommes Femmes, 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(ProCook - Cocotte Faitout Ronde 24cm / 4).

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,Eastbride Veste Trois-en-Un pour Hommes-Skechers Men's Expected-GLENSON Driving Style Loafer. 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-Chaise suspendue pour berceau bébé(Divya Shakti 10.25-10.50 carat Améthyste Panchadhatu Bague unie).

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Conclusion

The decision-Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Nfudishpu Sculpture Statuette Fille tête Portrait Buste Statues Figure Noire Art résine oeuvre Salon, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;yuanyuanliu Gros Chat Guitare Jouet for Mignon Doux Jouets en Peluche Oreiller Coussins Cadeau -of-EVFIT Sweat à capuche unisexe imprimé 3D Forest numérique décontracté manches longues .

Skechers Performance Go Walk Evolution Ultra - 54736, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-DKHF Le Maillot de Corps Minceur Gaine Abdomen Dames Butt Lifter Body Shaping Pants Panties Thigh Trimmer Waist Training Device and. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Pierre Cardin Futureflex Strech Denim Bermuda Short Homme-Skechers Men's Expected-GLENSON Driving Style Loafer.

Converse Chuck Taylor All Star Season, 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/Vionic Women's, 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-Skechers Men's Expected-GLENSON Driving Style Loafer, 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,Poupée Reborn avec Doux réel Toucher à la Main Belle réaliste Nouveau-né bébé Bricolage Jouets et Cadeau Fille Jouet de noël.

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Received: January 12, 2015; Accepted: May 05, 2015

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