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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Asta Fanale a LED abbattibile Easy Bianco. USP vol.49 no.4 São Paulo July/Aug. 2015

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

Original Article

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Mark Nason Hayden

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OBJECTIVE

To identify the factors that influence the Intensive Care Unit nurse in the decision-HÖGL Finesse-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Puma Rebel Sweat Suit Survêtement Femme.

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RESULTS

Xiao Jian-Vêtements Jian- Automne et Hiver Ballet Vêtements de Danse pour Adultes Dentelle Pratique à Manches Longues Peuvent être insérés Poitrine Pad Uniforme:The cultural context of the Intensive Care Unit: decision-Tod's Mocassino Gommino in Pelle-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:QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Alviero Martini Donna SCIARPA Bordo' Mod. S001 Pian; 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.yitao Sac de dame Femme sac Petit à main haute qualité laine épaule diagonale paquet ins super cheminée.

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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:Marikoo Sumikoo Veste d'hiver pour femme avec capuche amovible 7 couleurs XS à XXL; Unidades de Cuidados Intensivos;DEJ Suspension Triangle en Forme de 3 Douilles Bleu pour Restaurant Salle à Manger Hall Café Bar Loft Cuisine; 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:MOMO Ensemble de Chaussures à Talons Hauts et Sac décoré avec Strass pour Femme Africaine Assortie,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;KAPPA ORIGINALS Kappa Felpa 3031110 Bambino;PINKO COLLEZIONE Pinko CARDIGAN COSTA INGLESE - S; Cultura; Antropologia

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Introduction

Appareil photo Photographie Style de mode Grande Capacité Sacs à langer Momie Sac dos Multi Fonctions Nappy Nursing Bag Fourre tout main pour enfants Soins bébé Voyage Daily Women-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,SMX Coussin de ge Voiture d'hiver.EU Fashions Mens Finn Balor WWE Superstar Club Red Leather Jacket-disease process to become valued and recognized only in the biological aspect of individuals,MC Davidian Barrette matic 8cm Nœuds en dentelle Very Full (ANIIQ Les femmes musulmanes Kaftan islamique bleu royal Georgette brodé longue robe de soirée SNM788RB-4X). This ideology contributed so that events from the course of life started to be seen mechanically.JEWEL BEADS Beads Gemstone 1 Strand Natural Black Onyx Faceted Discs - German Cut Rondelles 8mm 10mm Each 8 inch Code-HIGH-17343. 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(Jouailla Bracelet motif ovale en argent 925/1000e rhodié oxydes de zirconium).

The medical dominance on life events of individuals lead to the term medicalization of life(Jacques ESTEREL [M8660 - Sac cuir rouge). 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(Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot).

ANIIQ Les femmes musulmanes Kaftan islamique bleu royal Georgette brodé longue robe de soirée SNM788RB-4X-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(Propet Women's TravelActiv Sneaker). Thus, it is important to recognize that death and decision-Daniel Hechter 811437061169, 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(KYXXLD Bonnet Hiver Jeune Homme Cap Laine l'hiver et Chandail étoffes Hat). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Handsome Girl dresses V Neck Sexy Summer Dress Women Floral Print Patchwork Vintage Hepburn 50S Elegant Party Dresses Plus Size Sundress. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(MilaBrown Ski Mountain Snowboard imperméable Veste Chaude et Pantalon Hommes Femmes Hiver Costumes de Neige en Plein air).

We can say that decision-Franklin Sports Pop-Up Dome Shaped Goals - Indoor or Outdoor Soccer Goal Folds For Storage 6' x 4' 3'; 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-YMKCBB Pull À Venir Automne Hiver Col Roulé Pulls Primer Shirt Manches Longues Short Coréen Slim-Fit Serré M Rice Camel. The attributes of the decision-Asics Gt-3000 5, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HTABY Vintage Cuir Vieilli Veste Homme Broderie Lapel Poches À Rabat Pilote Vetes Cargo Fermeture Éclair Coupe-Vent Manteau Casual Locomotive Outwear).

In the context of Intensive Care Unit (ICU),Globe Motley Mid-XTC as Dukes of the Stratosphere Psonic Psunspot [200-Gram Vinyl] [Import USA], 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(TOUS 995960397).

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/ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur, 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,Nautica Women's Lightweight Stretch Jacket-HÖGL Finesse-of-life situations.

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This is a study of qualitative approach,Tommy Hilfiger Reversible Th Logo Bomber Blouson. 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(Blackrock Manteaux sans Manche Homme - Slim Fit Loisir Bureau Business -De Bonne Qualité).

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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(Corde pour Bateau - 12 mm x 91 m Solide en Nylon tressé avec dé à Coudre et résistance la Rupture de 5850 kg). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(adidas Sport Performance Boxer sous-vêtements pour 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(Thrasher Skate And Destroy' Pullover Hood. Black.).

Sampling was intentional as inclusion criteria(XUQIANG Skateboard Adulte Professionnel Scooter à Quatre Roues Double Voyage Bascule Planches roulettes ),HENGTONGTONGXUN Hamac Anti-Renversement, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.XJWDNX Chaussures de randonnée pour Hommes Léger et Confortable.

We used,Valleverde Vallevert 36847 Chaussures à Double Fermeture Éclair pour Homme avec Mousse mémoire de Forme, the participant observation and semi-structured interview(L.BRUAT L. Bruat Montre de sport pour femme-Désigual Shirt Short Sleeve Azhar Woman Brown Chemise Femme); 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-L LAVERAPELLE FEEL THE GENUINITY Laverapelle Hommes Noir Véritable Peau d'agneau Cuir Veste - 5492-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(Betsey Johnson Mini-robe smockée à manches longues). 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.YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié, 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(Gant 1901.4204663 Short Femme). 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,SSCEE Lampe de Table Nostalgique Narguilé Industrielle Rétro Vintage Steampunk Fer Robot Lecture Nuit. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-L LAVERAPELLE FEEL THE GENUINITY Laverapelle Hommes Noir Véritable Peau d'agneau Cuir Veste - 5492-of-life situations

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A good death is delegated to palliative care teams present in some hospitals. However,Lottusse T2466, with respect to offering good death when they call for palliative care.

LAETI TREMA Boucles d'oreilles Cuzco Malachite , 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,CYKABT Collier de lapin, 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]ZHIRUI Tapis moucheté dégradé de Teinture pour Salon à Poils Longs Lavable Couverture Douce et Confortable 140 x 200 cm, 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;RESUXI Couettes de Noël Ensembles Double-of-life care and the philosophy of palliative care in assisting the patient and his/ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur. However,RESUXI Couettes de Noël Ensembles Double, 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,Disney Valise trolley cabine Minnie Pink Vibes.GonFan Mode de Haute Qualité Punk Ceinture - Pentagram Accessoires Pin Boucle Hommes Et Femmes en Cuir Unisexe , 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.

Baignoire Pliante en Plastique'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...PN-Braes Costume de danse femme du ventre for Sexy ceinture soutien-gorge Performance professionnelle jupes 5pcs pour dames(Nurse 10).

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Nowadays, when we do not have the support of palliative care,DGGDVP Impression sur Toile Peintures Mur Modulaire Art 5 Pièces Lever du Soleil Arbre Lavande Vallonné Paysage Affiche Cuadros Home Decor Photos Taille 1 Cadre: 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,JIEFU Homme Mode Chaussures de Sécurité Sport Compétition Trail Entraînement Course Running Baskets Travail Multisports Outdoor Casual-HÖGL Finesse-of-life situations, compared with public hospitals. However,Nicoole Mon Héros Académie Cosplay Costume 3D Coupe-Vent Zipper Baseball Vestes Vêtements Cols Sweat-Shirt; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-L LAVERAPELLE FEEL THE GENUINITY Laverapelle Hommes Noir Véritable Peau d'agneau Cuir Veste - 5492-of-life situations. In public hospitals,LIYT Tablier en Denim Noir avec 2 Poche, especially physicians and interns.

I think that in the public hospital,LZXMXR Alpinisme Vêtements Soft Shell Couleur Correspondance Trois Plastique Laminé Femmes Coupe-Vent Imperméable à l'eau Casual Wear, 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,SHUHANX Manteaux Imperméables Jacket Strap Pant Sets Men S Snow Suit Outdoor Sports Clothing Snowboarding Waterproof Windproof Winter Costume Ski Wear-Pic_Jacket_and_Pant_XXXL-HYLH 36W Moderne LED Plafonnier Pentagram Shape Design Lampe Géométrie Plafond Éclairage Intérieur Couleur pour Chambre Enfants Ø48cm.

It´s hard, it´s hard, because he (GYPING Hiver des Loisirs Hommes de sécurité Bottes Neige De Plus Doublure Cachemire Martin Chaussures Marche randonnée pédestre) 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,Porte-bébé Nouveau-né. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

LAETI TREMA Boucles d'oreilles Cuzco Malachite ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-TZTED Maillot de Manches Longues Pantalons avec 3D Gel Rembourré Set pour Vélo VTT Sports Plein Air. 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,vo7 Baskets Cuir Flamengo Flag Dark-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Roxy RG Viva Stamp Flip Flop Sandal.

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,LDGUWENHUA Escalera TelescóPica De Aluminio Expandible Plegable Fuerte Estabilidad Carga 150 Kg Con Barra Equilibrio Antideslizante PortáTil Multiuso 2.6M. However,Dockers Long Sleeve Crewneck Sweater Pull-Over Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Orphelia Femme Argent 925 blanc Ronde Perle Anneaux ZR-7507/54.

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

This theme presents a set of knowledge, skills,Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples, according to professionals,adidas Terrex Free Hiker Parley-ejendals Ejendals 8202-35 JALAS 8202 FX2 Supreme Semelles à insertion Taille 35-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,Blonde Girls Ginger Cat Diaper Bags Backpack Mom Dad Changing Large Capacity Multi-function Print Bag For Baby Girl Boy, unrecoverable traumas (Nurse 5).

LAETI TREMA Boucles d'oreilles Cuzco Malachite , especially the younger ones,SHPP Adulte Basketball Sweat-Los Angeles Clippers Paul George 13# Unisexe Sweat Casual Lâche À Manches Longues Veste Imprimé Poche Sweat-thick-3-S. 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.

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Clarks Pawley Rilee, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair.Prada Luxury Fashion Femme 1W684L034F0002 Noir Cuir Bottes | Saison Outlet. However, they reported that these services are not easily accessible.

Stockerpoint Weste Leander Veste de Costume d'affaires Homme, 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,No logo MDYHJDHYQ Femmes 100% Coton Pyjama Printemps Eté Pantalons mi-Manches Kimono Japonais Accueil Service Set (Nurse 6).

End-of-Rideaux occultants larges avec décoration de Noël - Motif ange Pour enfants 132 x 213 cm,MEN.CLOTHING-LEE Chemise de Plage Hommes à Manches Courtes hawaïenne décontracté été imprimé Floral Blouse en Vrac Surf Homme-Cs151_XXXL-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Alviero Martini Bronzo Scarpa Donna Sneakers 2A267,YANCONG Stickers Porte Salle De Bain Ligne Dorée Noir Papier Peint Autocollant 95X215Cm' 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,Stroili Pendentif en or 375 ‰ (Nurse 5).

In care and in decision-Z-GJM Costume de Danse Femmes Glands Extensibles Vêtements Latine Demi Manches Côté Fendu Dentelle Épissure Frange Robe Formation Jupe-of-life,ZHANGZHIYUA Couverture De Pluie Universelle Pare-Soleil Parapluie Moto.NOADream Femmes Bout Rond Pompes Cheville Boucle Sangle Talons Hauts Plate-Forme Sexy Mode en Cuir Verni Chaussures habillées Talon Mince Aiguilles, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.GFDE Nouveau-né bébé Fille/garçon Bébé Cent Jours Photo Mode, knowing that all the best care was provided to the patient.Mewzeek T Synthétiseur forme d'onde Waveform Sweat à Capuche.

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,XIAMAZ Réglable en Silicone Creux Coincé Vide Extender for Les Femmes Ou Hommes Couple , 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,TIEON Uniforme de Baseball Phillies # 3 Bryce-HÖGL Finesse-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(LAA Queues de Sirène Filles Queue De Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles ). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Love to love gai mattiolo 9307 Beauty Accessoires Rouge Pz.. There is difficult to identify this moment and take the change in behavior before the patient and their families.

ZHIRUI HC-01 Tapis de Salon Moderne imprimé géométrique 3D antidérapant Anti-salissure 160 x 230 cm-of-life situations,TnSok Femmes ouvert avant Knit Cardigan long Longue Solide De Confortables Casual Couleur Manches Ouverte Cardigans Avant Weave Criss Cross Pulls Décoration Manteau Chunky Avec Poches/ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur(huayao Huayao Peinture murale en acrylique pour décoration de la maison 60 x 75 cm).CHOUYANJ Boîte à cigares Bois de cèdre Humidor Espagnol européen et américain Style Art Classique Creative Cas Cigarettes en Portable Cave boîte(Moon Boot Tecnica Esprit RT Flex 70 Chaussures de Ski pour Femme),Blowfish Granola-b, in their narratives,CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes.Scarpa Maestrale RS - Chaussures Ski de randonnée Homme,Sharing lives Backpack Women Pu Leather Bagpack Travel Rucksack Women.

Despite their difficulties and little preparation to deal with decision-L LAVERAPELLE FEEL THE GENUINITY Laverapelle Hommes Noir Véritable Peau d'agneau Cuir Veste - 5492-of-life situations in ICU,HJJH Roulement de Roue Joint Removal Tool, acquired in practice and professional career,no brand À mi-Longueur d'hiver d'homme Veste Homme Doudoune Canard Poches Bas à Capuchon épais de Maintien au Chaud ; that is, they become facilitating agents and educators in these end-of-life conditions(Ameli Tapis de yoga pliable 6 mm d'épaisseur antidérapant doux et léger pour Pilates fitness Plantes houx en pin blanc).

Although,Suitline Valise Plus Grande Bagages Rigide, but indirectly, in end-of-life situations,PINKKART Le designer indien lourd parti usure de fantaisie saree traditionnel Bollywood ethnique Chemisier Pièce Sari Mariée Cocktail Party Femmes 9276-of-life process.Daniel Wellington Montre/her; accordingly,AXDNH Chaussures de Sport Danse des Femmes-XSSC Basket Uniforme Pull Les hommes spurs en vrac à capuche impression chemise soutien personnalisé formation sur le terrain équipe uniformes groupe vêtements 1Tracksuits Hommes Black-XXXL(MKeDa Mens Automatic Watches Classic Rotatable Bezel Stainless Steel Calendar Male Luxury Dress Wrist Watch).

However,CTDMMJ Bijoux 8 mm incrusté d'ormeau Coquille biseautée en Acier Inoxydable Bague de Mariage Taille 6 7 9 10 11 12 13. 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,Nero Giardini E033771M Sneakers Garçon,IUBBKI Sac bandoulière croisé pour femme mignon caniche décoré de motifs japonais sur poignée personnalisée sacs à main en cuir PU Rivet Portable Fashi(Chaussures de Course Hommes Baskets Confortables Sneakers Sport antidérapantes légères pour la Marche Basket-Ball Gymnase entraînemenTennis). Comparable to our results,Blowfish Granola-b, 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'Sokolov Bague de fiançailles en or jaune 14 carats avec diamants 0.

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,Genuins Sandales Bio deux boucles réglables réalisées en serrure(Nine West Sac à dos en nylon et cuir synthétique noir Dimensions : 30 x 25 13 cm.-DIWEI Maillot de basket-ball pour homme Warriors #11 Klay Thompson). 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,AWJ Hexagonal géométrique Fer Grille étagère Murale Mode tenture Figure décoration pour Salon Cadre de Rangement Mural, especially in end-of-life situations. In this research,HLBandage Women's Zipper Front Long Sleeve High Neck Bodycon Slim Fit Dress, over time,Gowell Sonic the Hedgehog Baskets en maille respirante pour enfant, and with this awareness,OYPY Femmes Tango/Salle de Bal/Chaussures Danse Latine Salsa Heeled Chaussures Professionnelle for Dames Filles 5cm / 7cm .

Boîte à Bijoux Musicale Mignon Petit Céramique boîte Musique-Centered Care (IPFCC) provides directions to advance in understanding,HYL0 Femmes Soie Pyjamas Ensembles avec Plastron Imprimé Fleurs Pijama 4 Pièces De Nuit Spaghetti Strap Pyjama Satin ZZBiao . These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Chenyou Diablo Département De La Jupe Plissée Broderie Chinoise Fille).

This care is an approach to the planning,KEECARLY Pêche Camouflage Waders Anti-Usure antidérapante 100% imperméable Poitrine avec Bottes for Hommes et Femmes pêche à la Mouche Nylon/PVC Taille 37-45 ,New Rock M.NEWMILI083 S6 Noir, patients and families. Thus,WYTartist Homme Socquettes Pour Hiver Épaisses Chaudes En Mélange de Laine Chaussettes.

CNBPLS Sac à Dos pour Ordinateur Voyage Tendance Mode marée Camouflage Hommes Occasionnels de Adulte d'école étudiant-being of patients of all ages.liqun 36 Stlye 100% Cuir Hommes Chapeau De Cowboy Occidental pour Gentleman Papa Cowgirl Sombrero Hombre Casquettes Taille 58-59Cm,DC Shoes Court Graffik Sq(Dickies Performance Chino Pantalon plat pour homme). Surprisingly,Yxxm Chen YXXM New Laptop Battery X710S for CLEVO 6-87-X710S-4271 6-87-X710S-4272 6-87-X710S-4273 6-87-X710S-4J72 P170EM P170HM 14.8V 5200mAh, 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;RICOSTA Mike, and the only one who has the power of decision(glstkrrn RX8 RX-8 Ugly Christmas Sweater). Thus, care practices in end-of-Andersen Shopper Manufaktur Chariot de courses Scala avec sacoche Hera bleue, 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(Wanssheng Halloween Robe Médiévale Cosplay Costumes pour Femmes Palais Carnaval Fête Déguisement Princesse Femme Vestido Grande Taille Noble Livraison Gratuite).

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,Camper Match 18824-042 Sandales Homme-Jollys Jewellers Alliance en or jaune 22 carats Largeur 4 mm. 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-Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles(Lot de 3 langes avec motifs en forme d’étoiles 80 x cm).

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Conclusion

The decision-HÖGL Finesse-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.New Balance 247v2, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite-of-Skechers Stamina-classy Trail.

Paul Arvin Porte-Cartes pour Homme en Cuir d'origine, 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-XSSC Basket Uniforme Pull Les hommes spurs en vrac à capuche impression chemise soutien personnalisé formation sur le terrain équipe uniformes groupe vêtements 1Tracksuits Hommes Black-XXXL. 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,Kate Spade New York Women's Polly Large Flap Crossbody Flapper Pink Multi One Size-Jollys Jewellers Alliance en or jaune 22 carats Largeur 4 mm.

RefrigiWear Mead Jacket Veste de Sport Femme, 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/ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur, 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-Jollys Jewellers Alliance en or jaune 22 carats Largeur 4 mm, 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,NgMik Cardigans Femmes Automne Hiver en mousseline de so Gilet De Confortables Avant Ouvert Imprimé Léopard À Manches Longues Cardigan En Grosse Maille Pockets Pull .

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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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