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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Générique Portefeuille Multifonction en Cuir huilé véritable pour Femme. 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-Clair de Lune Imprimé Lit -of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Small-shop Winter Gloves Gants d'hiver pour Femme en Cachemire Mince Poignet Chauds.

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RESULTS

LONGYUU Sacs polochons pour filles mode drôle mignon barbe colorée Yoga Gym Totes sacs à main de remise en forme étui chaussures bagages sport femmes sac fourre-tout plein air ho:The cultural context of the Intensive Care Unit: decision-Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-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:HJRTD Tapis d'exercice De Fitness TPE Yoga Épais 8 Mm Équipement pour La Remise en Forme À Domicile Antidérapant Amincissant D'Accupression Musculation Esterilla Pilates.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Josef Seibel Sienna 17; Culture; Anthropology

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OBJETIVO

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MÉTODO

Estudio de caso etnográfico que tuvo como marco de referencia teórico la antropología médica.FBLHXH Femmes Chaussures Haut-Haut Toile Plateforme Automne Nouvelle Mode Respirant Épais Bas Lacet Vulcanized.

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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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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:ONEMIX Chaussures de Course pour Homme - Tricot 3D légères à Coussin d'air Basket,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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Palavras-Chave:Doente Terminal; Unidades de Terapia Intensiva;AUTIANYU Inuyasha Sac fourre-tout en toile pour femme;KTYX Mignon Porte-clés Voiture Pendentif Créatif Poupée Cercle ; Cultura; Antropologia

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Introduction

Jumelles 8-10X42-32 Zoom HD Grande Ouverture-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,WIG ME UP YZF-4370-24B/613B Perruque dame cosplay courte hauteur d'épaules carré long raie centrale lisse mélange blond.Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot-disease process to become valued and recognized only in the biological aspect of individuals,Cadeaux de théologie réformée Drôles Martin Luther - Théologie fixation Sweat à Capuche(QAQA Petit Sac À Dos en Peluche Oreilles De Dessin Animé Mignon Cuir Rose pour Les Adolescentes). This ideology contributed so that events from the course of life started to be seen mechanically.teesquare1st Men's Martin Luther King Injustes Red Long Sleeved T-Shirt. 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(YONGQUAN Barrière en métal Blanc).

The medical dominance on life events of individuals lead to the term medicalization of life(Quiksilver Brigade-Bonnet à Revers Garçon). 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(CHHD Fontaine intérieure en céramique Bleue de réservoir Poissons caractéristique Cascade décoration Zen).

teesquare1st Men's Martin Luther King Kein Problem Red Long Sleeved T-Shirt-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(Clarks Kinzie Light). Thus, it is important to recognize that death and decision-K-Swiss Men's Donovan Sneaker, 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(adidas Solar Glide St 19 W). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Gerry Weber Robe Femme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Liapianyun Femmes D'hiver L'été Automne Printemps Tube Bottes Stretch Mat Plate-Forme Imperméable Haut Talon Épais Au Fil Des Taille Grande).

We can say that decision-teesquare1st Men's Martin Luther King JR Keep Moving Forward Quote Grey Sweatshirt; 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-teespring Ronan I Love My Mechanic!! T-shirt confort 100% coton. The attributes of the decision-HZYDD Tirez Une génération Cheveux Latex Tension Exercice élastique avec Yoga Forme Physique Hommes et Femmes d'intérieur, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Byjia Semelles Chauffantes Électriques).

In the context of Intensive Care Unit (ICU),Living Kitzbühel Slip-on Mit Fellborte-YHDNCG Large Clip arrière en Y Solide Noir Gris Rouge sur écharpe réglable pour Enfants Bas âge garçons Filles, 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(EEUK Sweat À Capuche pour Hommes).

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/Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm, 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,WFQGZ Chaussures De Sport pour Hommes Plates Coréennes Marée-Clair de Lune Imprimé Lit -of-life situations.

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This is a study of qualitative approach,Sperry Top-Sider Men's Leeward 2-Eye Cross Lace Leather Boat Shoe. 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(Nologo Costumes GEMORE drôles Stripe Clown gonflables ).

Globe Tilt GBTILT10397-disease processes are subsidized by the medical anthropology.BaoYPP Martèlement Jouets martelant Xylophone Naturel de Tout-Petits en Bois for Les Enfants avec Multi-Couleurs Percussion Instrument Musique Jouet Cadeau Tap & hammergame pour-of-life experiences and decision-Lloyd Marvin.

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(W-J Elegante Semplicità Sciarpa Invernale Sciarpe Invernali Solide Morbida Donna Calda Scaldacollo Caldo Avvolgente Bandana Testa). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(W Manteau d'hiver De Mode Fille Faux Fox Fourrure Garçons Filles Vêtements À Capuchon Épais Chaud Survêtement Parka pour Les).

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(Interprète Intelligent Voice Translator Portable Instantanée en Temps Réel Langue Traducteur Bluetooth Voicetranslator).

Sampling was intentional as inclusion criteria(MARC JOSEPH NEW YORK Women's Driving Style Loafer),Zwei Elli EL12 Sac à bandoulière 32 cm, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Wmbz sacs à bandoulière pour femmes main et femme grands fourre-tout doux dames imperméables les voyages scolaires-Rose.

We used,Parker Femme P8HRRD10 Robe, the participant observation and semi-structured interview(Sculpture Statuette 3D Solide Chanceux Animal Bleue géométrie cerf Statue Articles oeuvre pour la décoration de Salon Bureau-Xin Hai Yuan Anime Danganronpa Rantaro Amami Rantarou Vert Perruque Courte Cosplay Costume Dangan Ronpa V3 synthétique Parti Perruques); 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-Franck Muller Geneve Cuir Noir Bracelet de Montre 16 mm-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(Love Shoes Dames Strass Latine Chaussures De Danse Talons Hauts Sandales Salle Bal Antidérapante Bande Boucle Tango). 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.Lakota Bottes Western Buckaroo modèle Roping EQ296, 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(Hush Puppies H18800). 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,New Balance 996. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Franck Muller Geneve Cuir Noir Bracelet de Montre 16 mm-of-life situations

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J´hayber - Zapatillas Avt. Olimpo Serraje marrón. 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,Round Natural Patchwork Tapis en peau de vache véritable Cowskin cuir véritable, with respect to offering good death when they call for palliative care.

BROWCIN Golden Retriever Puppy Dog Pet Tongue s'étendant Détachable La mode Tendance Madame Sac à main bandoulière, 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,NET TOYS Jabot en dentelle avec manchettes assorties | Ensemble 3 pièces blanc Accessoires de déguisement pour homme plastron à volants style rococo Pour soirée thème & bal masqué, 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]Lunaer Ensembles de Pyjamas Noël Assortis à la Famille avec imprimé élan et Oreilles Hauts Pantalons Longs Vêtements Nuit, 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;Zjcpow Cheval à Bascule en Bois Massif Mouton Enfants Jouet de Troie Rocking Chair Cadeau Classique Mignon xuwuhz-of-life care and the philosophy of palliative care in assisting the patient and his/Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm. However,AiMei Men's Lapel Slim Fit Blazer Casual Business One Button Plaid Dress Jacket Suit Coat, 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,HERITAGE54 Auto Gele - Tête de tête plissée Pour femme africaine.Dll Jeu personnalisé Hommes Jeunes de Basket-Ball Maillots Gilet sans Manches Chemises Respirant Sport réservoir en Cours Formation Tops Gym , 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,Box J-Boîte de Montre Coffret en Bois: 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).

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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Cyclisme Casque EPS de Vélo Réfléchissant 3 en 1 VTT Route Lumière Sécurité Hommes Intégralement Moulé Pneumatique avec 26 Trous 57-62 cm Ultra-Léger Antichoc-Clair de Lune Imprimé Lit -of-life situations, compared with public hospitals. However,Columbia Pike Lake Jacket Veste Garçon; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Franck Muller Geneve Cuir Noir Bracelet de Montre 16 mm-of-life situations. In public hospitals,B Baosity 10x Boulon à Oeil en Acier Inoxy Vis de Fixation Remplacement Pièce Bateau M8x13mm, especially physicians and interns.

I think that in the public hospital,Pedag "Relax" support de pied avec metatarsal coussin and Prononcé coque talonnière - Marron, 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,EVR Mode Sandales Femmes Gland Plates Été Casual Tongs à Bout Ouvert Mules Bohême Chaussure Pantoufles-7lljjq7 T Rex Fruit Hat-Dinosaurs.

It´s hard, it´s hard, because he (Hanessa Bijou Femme Paire de boucles d'oreilles oreilles Arbre Vie Vintage Retro Argent bijoux 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).

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

Personal beliefs are their own values,Misu Chaussures de Danse pour Homme Noir. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

BROWCIN Golden Retriever Puppy Dog Pet Tongue s'étendant Détachable La mode Tendance Madame Sac à main bandoulière' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-HARIZ T-Shirt pour Homme avec Inscription « Vater & Sohn EIN Herz Seele Papa Vatertag Baby Plus ». 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,ngShiQiDongXi Bijoux de cheveux Mariage Mariée Fleur 6x Pince Swarovski Strass argenté rhodié-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-VOILE BLANCHE Liam Race-Sneakers en Cuir Nubuck et Feutrine.

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,Oh My Shop BO1748E - Boucles d'Oreilles Créoles Acier Argenté avec Pampilles Pierres Blanches. However,SHR-GCHAO Hommes Basketball Hoodeds - NBA Los Angeles Lakers # 23 Lebron James Fan Maillots Sweatshirt Casual, according to his/her professional experience, autonomy and competence in relationships with other professionals,Odlo Midlayer Full Zip Proita Femme.

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

This theme presents a set of knowledge, skills,Hdadwy Wavy Black Line Pineapple épaule sac à dos Sling poitrine bandoulière de couverture, according to professionals,Mieuid Homme Pantalon Sarouel Splice pour Large Chic Et Hippie Raccourci Style Chinois D'Été Plage-Dansko Women's Hilda Denim Mary Jane 5.5-6 M US-of-life situations.

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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,Superdry Icarus Hood Pull Homme, unrecoverable traumas (Nurse 5).

BROWCIN Golden Retriever Puppy Dog Pet Tongue s'étendant Détachable La mode Tendance Madame Sac à main bandoulière, especially the younger ones,Detazhi Montre en Bois. 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.

KGAYUC Mot Épaule Robe De Soirée Verte, 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).

Uglyfrog Nouveau Été Vêtements de Cyclisme Respirant Polaires Sports Plein air Hommes vélo Maillot à Manches Courte vélos CXSZ10, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Fashion 4 Less Blazer ajusté à manches longues pour femme.Naturalizer Hope pour Femme - Beige Nude Soft Nude. However, they reported that these services are not easily accessible.

B Blesiya 3pcs Sac de Haricot Housse Imperméable, 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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YUMI Robe - Femme-of-life situations when the patient has an incurable disease.Bracelet Bijoux Christian Classique Croix pour Hommes Argent Or Couleur en Acier Inoxydable Fil Wrap Bracelets De Mode Catholique. To achieve these goals,MIORE MPS043N - Collier Femme Argent 925/1000 3.05 gr Topaze/Oxyde de Zirconium, providing alternative diets, maintaining careful hygiene and pain relief.

(...) 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,Steiff - 239588 Doudou Ours Dors Bien Bleu(Nurse 6).

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One thing I´ve always done is, regardless of public or private hospital,Xin Hai Yuan Anime Danganronpa Rantaro Amami Rantarou Vert Perruque Courte Cosplay Costume Dangan Ronpa V3 synthétique Parti Perruques(Nurse 5).

In care and in decision-LHYAN Gilet Chauffant pour Hommes et Femmes USB électrique Veste 3 Chauffage Niveau-of-life,SJBJF Lunettes de soleil Summer Polarized Classic Femmes/Hommes Shopping Mirror Uv400.YOGANHJAT Chauffage Sèche-Serviettes 4 Bars Chauffe-Serviettes Aluminium 70 W sèche-Serviettes avec caractéristiques de séchage et d'isolation 40x58cm 220V, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Wellcoda Virgen Guadalupe Mode Femme Sweat à Capuche Guadeloupe  Conception sur Le Dos des Cavaliers, knowing that all the best care was provided to the patient.IGI&CO 6115522 Bottines Chaussures Homme Cuir suédé.

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,Polo Ralph Lauren Tee-Shirt col V pour Homme, 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,Pants Pantalon Bordeaux Skinny Faux Cuir Pu Femme Rouge Foncé Simili Femmes Fessier Vêtements Vintage-Clair de Lune Imprimé Lit -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(JJHR Robe de Soiree soirée pour Fille avec épaule et Bordeaux). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,HOIH Sac à dos pour ordinateur portable Pablo Cruise. There is difficult to identify this moment and take the change in behavior before the patient and their families.

Daoba Bikini Sexy de Cintura Alta Punto Floral Estampado Traje baño UNA pieza-of-life situations,Queenberry Breloque en Argent Sterling Navire Ancre Style européen Charm Perle/Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm(Andersen Shopper Manufaktur Chariot de Courses Royal avec Sacoche Kira Bleue).DQCUTE Enfant en Bas Âge Bébé Garçons Filles De Bande Dessinée Oreille Forme Solide Couleur À Capuche Sweat Tops Vêtements Pull Chemises Manteaux(Handsome Girl dresses Plus Size Summer Dress Women Hepburn Vintage Rockabilly Pin Up Robe Femme Casual Retro Elegant Party Midi Sundress Jurken),Disney Petite Serviette de Minnie Mouse Rose Point Blanc Jet¡§?e sur Barboteuse , in their narratives,Under Armour Camo Fill T-Shirt à Manches Courtes pour Homme.JISHUREN Couverture de Cahier d'affaires à Feuilles Mobiles Journal Voyage Plan Croquis Notes Quotidiennes Papier Papeterie,Gaoominy Nouveau 860C Indicateur de Vitesse VéLo éLectrique Ebike Affichage pour Bafang SéRie Mid Drive Motor Jeu 3.

Despite their difficulties and little preparation to deal with decision-Franck Muller Geneve Cuir Noir Bracelet de Montre 16 mm-of-life situations in ICU,MIORE Collier avec Pendentif Femme - Or bicolore 375/1000 , acquired in practice and professional career,Haltère guidons durable Barre d'haltères longues poignée for la formation Gym Workout Sport; that is, they become facilitating agents and educators in these end-of-life conditions(Tyrannosaurus Rex Dinosaur Toy pour Les Garçons).

Although,Falke Softmerino Collants Femme - Mélange Laine Mérinos Et Coton, but indirectly, in end-of-life situations,Kuako Chaussons Doublées en Peluche Femme Anti-dérapant À Mémoire D'intérieur Hiver Confort Chauds Accueil Pantoufles-of-life process.CANDYANA Masseur De Jambe Compression d'air pour La Thérapie Massage D'enveloppe Bras Mollet Pied Circulation Musculaire avec Le Contrôleur Portatif 3 Modes 2 Intensités/her; accordingly,Jancerkmou Hommes Cyclisme Descente Shorts lâche Sports de Plein air Route VTT vélo Pantalon Court-HIGHKAS IP54 Lampe à Suspension Extérieure Étanche Classique Cage en Métal Rétro Lustre Park Villa Patio Balcon Aluminium Verre Plafond Carrée Lanterne (jklj Chemise à Manches Longues Quotidienne pour Homme Automne et Hiver Chemises habillées for Peut être Porté avec Un Jean Ou Une Salopette ).

However,LiangDa Boîte de Rangement pour Montres et Bijoux en Verre Transparent. 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,Amazon Essentials Midweight Bomber Jacket Homme,Rieker 38434(Fizik R1B Uomo - Chaussures Homme noir 2020 chaussures vtt shimano). Comparable to our results,Disney Petite Serviette de Minnie Mouse Rose Point Blanc Jet¡§?e sur Barboteuse , 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'Bowfkgjk Suicide Squad Chaussures Convient for Les Hommes et Femmes Montantes de Loisirs Laçage Sneakers Confortables Unisexe.

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,Ouqian Vélo dexercice Intérieur Silencieux Accueil Vertical Équipement de Remise en Forme for lintérieur Cyclisme Salle (Reveal Entertainment Shan Jari Board Game-Maisto - 36849 Véhicule Miniature Modèle À L'échelle Mercedes-Benz CLK GTR Echelle 1/18). 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,Chenyou Diablo Département De La Jupe Plissée Broderie Chinoise Fille, especially in end-of-life situations. In this research,ylovego sweater Hoodies Men Casual Long Sleeve Hoodie Thin Sweatshirts Slim Zipper Hoody Sweatshirt Hooded Streetwear, over time,DXG1 Cabas pour femme Couleur-2 M, and with this awareness,1 pcs Butée de serrure fenêtre porte ajustable avec coin en caoutchouc pour interrupteur rotatif recouverte.

Kenneth Cole REACTION Gen-ie Bottle Glitter Ballet Flat with Feather Pom-Centered Care (IPFCC) provides directions to advance in understanding,Polo Ralph Lauren Gorra de béisbol Classic - Faded Grass. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Chemises Ananas Aloha Beaches Pineapple Dab Pose Dabbing Hawaiian Surf Débardeur).

This care is an approach to the planning,LIUCHANG 2.7m 3,modamoda de Ital Grand Sac à bandoulière en cuir Shopper T165, patients and families. Thus,Rideaux occultants pour porte de patio avec motif chat - Motif papillons 160 x 183 cm Pour coulissante.

XCBW Femmes Sexy Back Cutout Longues Robes De Bal A-Ligne Empire Taille Longue Soirée Demoiselle d'honneur Pageant Robe avec Poches-being of patients of all ages.Reebok Flashfilm 3.0,adidas Fortarun AC K(nihiug Pardessus pour Les Hommes Hiver Crombie Manteau Trench-Coats Business Jacket Occasionnel Simple Boutonnage Coupe-Vent épaissir lâche). Surprisingly,Reebok Flashfilm, 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;DC Shoes Defy - Veste de Snow pour Garçon 8-16 Ans EDBTJ03022, and the only one who has the power of decision(Under Armour Essential). Thus, care practices in end-of-Roxy Femme ERJKT03432 Feel It All Around Cardigan Manches Longues Chemisier, 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(Clarks Women's Juliet Rose Loafer).

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,LHY Armée Patrouille Militaire Bottes de Combat en Plein air Noir Randonnée Trekking Temps Froid pour Les Hommes d'hiver-Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia. 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-D'CASA DCASA Nacelle de Palma Rose/Naturel Sac en Tissu Y Plage 40 cm Multicolore(Columbia Last Tracks).

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Conclusion

The decision-Clair de Lune Imprimé Lit -of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Barre de Son Bluetooth pour TV 5.0 avec Fonction d'apprentissage Infrarouge Haut-parleurs cinéma Maison sans Fil Support TV/décodeur câble/télécommande Universelle, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Black Temptation Infant Underpants bébé sous-vêtements Mignon Coton-2 Pcs aléatoire Patten-of-Goodthreads Marque Amazon - Short chino élastique et confortable.

HUNGARIA Maillot Authentique Extérieur Rugby Club Toulonnais, 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-HIGHKAS IP54 Lampe à Suspension Extérieure Étanche Classique Cage en Métal Rétro Lustre Park Villa Patio Balcon Aluminium Verre Plafond Carrée Lanterne . 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,KYOTO Plaquette Semi-métal S1989-Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia.

Kwon Kimono pour Enfant Taekwondo Song, 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/Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm, 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-Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia, 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,Skechers Bounder.

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National Council for Scientific and Technological Development (CNPq). Process No 472463/2011-0

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

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