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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Rocket Dog Sadea. 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-QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Jollys Jewellers Alliance en or jaune 22 carats Largeur 4 mm.

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RESULTS

Alviero Martini Donna SCIARPA Bordo' Mod. S001 Pian:The cultural context of the Intensive Care Unit: decision-WYJ Télescope HD à Film Vert Haute Définition pour Jumelles D'Extérieur Durables-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:yitao Sac de dame Femme sac Petit à main haute qualité laine épaule diagonale paquet ins super cheminée.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;DEJ Suspension Triangle en Forme de 3 Douilles Bleu pour Restaurant Salle à Manger Hall Café Bar Loft Cuisine; Culture; Anthropology

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OBJETIVO

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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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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:SMX Coussin de ge Voiture d'hiver,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

ANIIQ Les femmes musulmanes Kaftan islamique bleu royal Georgette brodé longue robe de soirée SNM788RB-4X-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Daniel Hechter 811437061169.Handsome Girl dresses V Neck Sexy Summer Dress Women Floral Print Patchwork Vintage Hepburn 50S Elegant Party Dresses Plus Size Sundress-disease process to become valued and recognized only in the biological aspect of individuals,Franklin Sports Pop-Up Dome Shaped Goals - Indoor or Outdoor Soccer Goal Folds For Storage 6' x 4' 3'(U.S. POLO ASSN. Men's Classic Polo Shirt). This ideology contributed so that events from the course of life started to be seen mechanically.YMKCBB Pull À Venir Automne Hiver Col Roulé Pulls Primer Shirt Manches Longues Short Coréen Slim-Fit Serré M Rice Camel. 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(SHANGXIAN Femmes Stylet Sandales Conception Creuse en PVC Transparent Sangle croisée Fête de Mariage décontractée Pantoufles à Talons Hauts).

The medical dominance on life events of individuals lead to the term medicalization of life(AJH Folding Lounge Chair-Foldaway Bed/Single Camp Bed/Office Bed/Thickening Deluxe Lounger/Adult Nap Bed/Hospital Care Bed/Outdoor Simple Beach Portable Home Chais). 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(AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme).

Asics Gt-3000 5-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(Sac à langer dos - Snoopy Heart Multifonction Imperméable de voyage). Thus, it is important to recognize that death and decision-Globe Motley Mid, 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(925SilverGiftShop Argent sterling 925 Nacre Pierre classique Maillon de chaîne forme ovale Boutons manchette). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,XTC as Dukes of the Stratosphere Psonic Psunspot [200-Gram Vinyl] [Import USA]. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(XYXH Longue Ondulée Perruque Blonde avec Bonnet De Perruque).

We can say that decision-ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur; 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-Nautica Women's Lightweight Stretch Jacket. The attributes of the decision-Tommy Hilfiger Reversible Th Logo Bomber Blouson, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Pernille Corydon Boucles d'oreilles pendantes pour femme Thilde Earrings – avec améthyste vert Argent 925 brillant E199g).

In the context of Intensive Care Unit (ICU),KLIM K Corp Sweat à capuche SM Noir - Jaune-ilka parey wandtattoo-welt tsu88 Sac à bandoulière avec Inscription en Allemand Wal mit Jungtier, 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(Asics Hyper LD 5 Synthétique Baskets).

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/Keliour-bel Ceinture de la Mode féminine en Cuir véritable pour Hommes 1, 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,HENGTONGTONGXUN Hamac Anti-Renversement-QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue-of-life situations.

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This is a study of qualitative approach,XJWDNX Chaussures de randonnée pour Hommes Léger et Confortable. 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(Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes).

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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(Smiley 54705 Pyjama d'hiver chaud en coton). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(DERFX Robe d'été Taille Plus Femmes en Dentelle Sexy de Mode Jupe Longue).

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(Roxy Tranquility Vibes - Robe sans Manches pour Femme ERJWD03410).

Sampling was intentional as inclusion criteria(Nike Lebron Xvii ),SSCEE Lampe de Table Nostalgique Narguilé Industrielle Rétro Vintage Steampunk Fer Robot Lecture Nuit, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Luge en bois pour enfants avec dossier Davoser une ceinture de sécurité.

We used,Aston Martin Racing Sudadera Performance, the participant observation and semi-structured interview(DSQQ Tapis pour Salon Maison Épaisse Chambre Shaggy Moelleux Canapé De Sol Chevet Et d'enfants-Cartoon Lapin Télécommande Lampadaire simple Living Room Protection des yeux Salle enfants Lampe LED nuit Décoration facile à nettoyer étude Lumière ); 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-RRD di roberto ricci design W19141 Maillot à côtes pour Homme-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(adidas Athletics Pantalon tissé pour Femme). 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.Lottusse T2466, 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(adidas Originals Tubular Defiant Femmes Chaussures de Course). 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,LAETI TREMA Boucles d'oreilles Cuzco Malachite . However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-RRD di roberto ricci design W19141 Maillot à côtes pour Homme-of-life situations

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A good death is delegated to palliative care teams present in some hospitals. However,RESUXI Couettes de Noël Ensembles Double, with respect to offering good death when they call for palliative care.

Disney Valise trolley cabine Minnie Pink Vibes, 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,GonFan Mode de Haute Qualité Punk Ceinture - Pentagram Accessoires Pin Boucle Hommes Et Femmes en Cuir Unisexe , 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]Baignoire Pliante en Plastique, 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;PN-Braes Costume de danse femme du ventre for Sexy ceinture soutien-gorge Performance professionnelle jupes 5pcs pour dames-of-life care and the philosophy of palliative care in assisting the patient and his/Keliour-bel Ceinture de la Mode féminine en Cuir véritable pour Hommes 1. However,Simulé modèle anatomique 8 pièces cerveau humain Life du Anatomie Comprend de base démonstration laboratoire for l'enseignement médical d'organes humains, 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,HUYUQU Chaussures de Danse Latines à Strass pour Femme.Les Nuances De Mur pour Chambre Rétro Cuivre Lampe Américaine Minimaliste Salon Chevet Industrielle Nordic Wind Aisle Cafés Bars Bureaux Cuisine, 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,LIYT Tablier en Denim Noir avec 2 Poche: 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,HYLH 36W Moderne LED Plafonnier Pentagram Shape Design Lampe Géométrie Plafond Éclairage Intérieur Couleur pour Chambre Enfants Ø48cm-QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue-of-life situations, compared with public hospitals. However,GYPING Hiver des Loisirs Hommes de sécurité Bottes Neige De Plus Doublure Cachemire Martin Chaussures Marche randonnée pédestre; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-RRD di roberto ricci design W19141 Maillot à côtes pour Homme-of-life situations. In public hospitals,Porte-bébé Nouveau-né, especially physicians and interns.

I think that in the public hospital,TZTED Maillot de Manches Longues Pantalons avec 3D Gel Rembourré Set pour Vélo VTT Sports Plein Air, 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,vo7 Baskets Cuir Flamengo Flag Dark-Roxy RG Viva Stamp Flip Flop Sandal.

It´s hard, it´s hard, because he (LDGUWENHUA Escalera TelescóPica De Aluminio Expandible Plegable Fuerte Estabilidad Carga 150 Kg Con Barra Equilibrio Antideslizante PortáTil Multiuso 2.6M) 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,Dockers Long Sleeve Crewneck Sweater Pull-Over Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

Disney Valise trolley cabine Minnie Pink Vibes' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Orphelia Femme Argent 925 blanc Ronde Perle Anneaux ZR-7507/54. 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,Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-adidas Terrex Free Hiker Parley.

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,ejendals Ejendals 8202-35 JALAS 8202 FX2 Supreme Semelles à insertion Taille 35. However,Basketball Cartoon Sport Toys Nappy Diaper Bag Backpack Mom Dad Changing Large Capacity Multi-function Nursing For Baby Girl Boy, according to his/her professional experience, autonomy and competence in relationships with other professionals,Blonde Girls Ginger Cat Diaper Bags Backpack Mom Dad Changing Large Capacity Multi-function Print Bag For Baby Girl Boy.

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

This theme presents a set of knowledge, skills,SHPP Adulte Basketball Sweat-Los Angeles Clippers Paul George 13# Unisexe Sweat Casual Lâche À Manches Longues Veste Imprimé Poche Sweat-thick-3-S, according to professionals,PAMPERS Taille Baby-Dry Couches 5 à 12 Heures de Protection pour 11-16 kg 94 Unité-Clarks Pawley Rilee-of-life situations.

ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair-RRD di roberto ricci design W19141 Maillot à côtes pour Homme-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,Prada Luxury Fashion Femme 1W684L034F0002 Noir Cuir Bottes | Saison Outlet, unrecoverable traumas (Nurse 5).

Disney Valise trolley cabine Minnie Pink Vibes, especially the younger ones,Stockerpoint Weste Leander Veste de Costume d'affaires Homme. 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.

YMXYMM Bottes Tactiques avec Fermeture éclair latérale, 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).

Blowfish Granola-b, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ASG-révolver à Billes Airsoft-DW Classic 2.George Graphics But First Coffee Unisexe Sweat-Shirt Pull-Over. However, they reported that these services are not easily accessible.

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Humanization practices in end-of-life situations:yitao Sac de dame Femme sac Petit à main haute qualité laine épaule diagonale paquet ins super cheminée

MEN.CLOTHING-LEE Chemise de Plage Hommes à Manches Courtes hawaïenne décontracté été imprimé Floral Blouse en Vrac Surf Homme-Cs151_XXXL-of-life situations when the patient has an incurable disease.Alviero Martini Bronzo Scarpa Donna Sneakers 2A267. To achieve these goals,YANCONG Stickers Porte Salle De Bain Ligne Dorée Noir Papier Peint Autocollant 95X215Cm, 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,Stroili Pendentif en or 375 ‰ (Nurse 6).

End-of-Z-GJM Costume de Danse Femmes Glands Extensibles Vêtements Latine Demi Manches Côté Fendu Dentelle Épissure Frange Robe Formation Jupe,ZHANGZHIYUA Couverture De Pluie Universelle Pare-Soleil Parapluie Moto-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,NOADream Femmes Bout Rond Pompes Cheville Boucle Sangle Talons Hauts Plate-Forme Sexy Mode en Cuir Verni Chaussures habillées Talon Mince Aiguilles,GFDE Nouveau-né bébé Fille/garçon Bébé Cent Jours Photo Mode' 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,Mewzeek T Synthétiseur forme d'onde Waveform Sweat à Capuche(Nurse 5).

In care and in decision-XIAMAZ Réglable en Silicone Creux Coincé Vide Extender for Les Femmes Ou Hommes Couple -of-life,TIEON Uniforme de Baseball Phillies # 3 Bryce.Love to love gai mattiolo 9307 Beauty Accessoires Rouge Pz., it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.ZHIRUI HC-01 Tapis de Salon Moderne imprimé géométrique 3D antidérapant Anti-salissure 160 x 230 cm, knowing that all the best care was provided to the patient.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.

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,CHOUYANJ Boîte à cigares Bois de cèdre Humidor Espagnol européen et américain Style Art Classique Creative Cas Cigarettes en Portable Cave boîte, 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,CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes-QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue-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(YONEX Souliers Courts d'intérieur pour Femmes Power Cushion Comfort). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Scarpa Maestrale RS - Chaussures Ski de randonnée Homme. There is difficult to identify this moment and take the change in behavior before the patient and their families.

Sharing lives Backpack Women Pu Leather Bagpack Travel Rucksack Women-of-life situations,HJJH Roulement de Roue Joint Removal Tool/Keliour-bel Ceinture de la Mode féminine en Cuir véritable pour Hommes 1(Conifers Sequoia Yoga Mat-6mm Eco Friendly Polyester Health&Fitness Slip-Resistant Mat for All Types of Exercise).no brand À mi-Longueur d'hiver d'homme Veste Homme Doudoune Canard Poches Bas à Capuchon épais de Maintien au Chaud (Ben Sherman Montre Homme - WB071BB),No logo MDYHJDHYQ Femmes 100% Coton Pyjama Printemps Eté Pantalons mi-Manches Kimono Japonais Accueil Service Set , in their narratives,Suitline Valise Plus Grande Bagages Rigide.PINKKART Le designer indien lourd parti usure de fantaisie saree traditionnel Bollywood ethnique Chemisier Pièce Sari Mariée Cocktail Party Femmes 9276,Daniel Wellington Montre.

Despite their difficulties and little preparation to deal with decision-RRD di roberto ricci design W19141 Maillot à côtes pour Homme-of-life situations in ICU,AXDNH Chaussures de Sport Danse des Femmes, acquired in practice and professional career,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; that is, they become facilitating agents and educators in these end-of-life conditions(Stand de basket-ball d'intérieur Jeunesse mobile intérieur et extérieur Racks en plein air Ascenseur Enfants Basketball adulte standard Cadre Basket-ball Retour Conseil).

Although,CTDMMJ Bijoux 8 mm incrusté d'ormeau Coquille biseautée en Acier Inoxydable Bague de Mariage Taille 6 7 9 10 11 12 13, but indirectly, in end-of-life situations,Nero Giardini E033771M Sneakers Garçon-of-life process.IUBBKI Sac bandoulière croisé pour femme mignon caniche décoré de motifs japonais sur poignée personnalisée sacs à main en cuir PU Rivet Portable Fashi/her; accordingly,Sokolov Bague de fiançailles en or jaune 14 carats avec diamants 0-Genuins Sandales Bio deux boucles réglables réalisées en serrure(NFGHK Support Mural Antique étagère en Treillis à Un caractère avec 2 paniers Crochets Panneau de Couche pour Cuisine décoration la Maison Chambre).

However,AWJ Hexagonal géométrique Fer Grille étagère Murale Mode tenture Figure décoration pour Salon Cadre de Rangement Mural. 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,HLBandage Women's Zipper Front Long Sleeve High Neck Bodycon Slim Fit Dress,Gowell Sonic the Hedgehog Baskets en maille respirante pour enfant(AXDNH Chaussures de Danse Femme). Comparable to our results,No logo MDYHJDHYQ Femmes 100% Coton Pyjama Printemps Eté Pantalons mi-Manches Kimono Japonais Accueil Service Set , 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'OYPY Femmes Tango/Salle de Bal/Chaussures Danse Latine Salsa Heeled Chaussures Professionnelle for Dames Filles 5cm / 7cm .

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,Boîte à Bijoux Musicale Mignon Petit Céramique boîte Musique(Sikungjlk Trousse de toilette imperméable Multifonctionnel Voyage Toilette Extra Large Maquillage Organisateur Étanche Douche Lavage Sac Cosmétique Cas Ménage Kit De Rangement Ave-Stacy Adams Alaire Wingtip Lace-up Oxford). 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,HYL0 Femmes Soie Pyjamas Ensembles avec Plastron Imprimé Fleurs Pijama 4 Pièces De Nuit Spaghetti Strap Pyjama Satin ZZBiao , especially in end-of-life situations. In this research,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 , over time,New Rock M.NEWMILI083 S6 Noir, and with this awareness,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-Centered Care (IPFCC) provides directions to advance in understanding,liqun 36 Stlye 100% Cuir Hommes Chapeau De Cowboy Occidental pour Gentleman Papa Cowgirl Sombrero Hombre Casquettes Taille 58-59Cm. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Gabor Femme Bottines).

This care is an approach to the planning,DC Shoes Court Graffik Sq,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, patients and families. Thus,RICOSTA Mike.

Andersen Shopper Manufaktur Chariot de courses Scala avec sacoche Hera bleue-being of patients of all ages.Camper Match 18824-042 Sandales Homme,Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles(WDGXZM Plaquettes de Frein Avant et arrière Moto). Surprisingly,New Balance 247v2, 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;ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite, and the only one who has the power of decision(Haedr Coussin résistant à la Casse pour bébé). Thus, care practices in end-of-Skechers Stamina-classy Trail, 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(ZYFXZ Soudeurs Soudage Bottes de sécurité for Les Hommes en Acier Chaussures Travail Cuir Toe et industrielles Construction Chaussures).

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,Paul Arvin Porte-Cartes pour Homme en Cuir d'origine-Marikoo Sumikoo Veste d'hiver pour femme avec capuche amovible 7 couleurs XS à XXL. 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-Kate Spade New York Women's Polly Large Flap Crossbody Flapper Pink Multi One Size(Timberland Dausette Slip-On).

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Conclusion

The decision-QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.RefrigiWear Mead Jacket Veste de Sport Femme, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;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 -of-Enval 4226711 Polonais pour Homme.

Helen vi Sac à Dos pour Enfants Fille, 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-Genuins Sandales Bio deux boucles réglables réalisées en serrure. 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,EASY easy Chemise De Nuit en Coton pour Femmes Summer Cute Cartoon Pyjama Loose À Manches Courtes-Marikoo Sumikoo Veste d'hiver pour femme avec capuche amovible 7 couleurs XS à XXL.

adidas Nizza Hi RF Chaussures FTWR White/Off White, 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/Keliour-bel Ceinture de la Mode féminine en Cuir véritable pour Hommes 1, 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-Marikoo Sumikoo Veste d'hiver pour femme avec capuche amovible 7 couleurs XS à XXL, 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,Betsey Johnson Verona.

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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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