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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Naturino See. 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-MusicBoxAttic Boîte à Bijoux Musicale Multicolore avec Motif Papillon monarque - Plus de 400 chansons au Choix Faust Waltz -of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-GBY Sac à bandoulière pour femme - main tendance.

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RESULTS

La Musique légère portative Se Pliante de Matelas isolé Voyage détachable 0-6 Mois 3 Couleurs 98 * 38cm MUMUJIN :The cultural context of the Intensive Care Unit: decision-ANIIQ Robe Kaftan Musulmane Fuchsia Rose Georgette brodée SNM 588-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:Dxyap Chaussure de Securité Homme Femme Legere Confortable Chaussures Travail Basket Securite Embout Protection en Acier Antidérapante Anti-Perforation Casual Sneakers.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Générique DÉGUISEMENT MI-Ange MI-DÉMON Fille; 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.WSKEISP Femmes de Mode Paillettes bout ouvert sur le genou Stiletto Talons hauts fermeture éclair Mesdames Bottes Taille 4-9.

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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:Suspension lustre lampe étoile/lune en bois moderne plafond simple plafonnier restaurant bar comptoir chambre enfants corde acrylique.; Unidades de Cuidados Intensivos;HOKA one Femme Bondi 7 Textile Synthetic Black Formateurs 38 2/3 EU; Toma de Decisiones; Cultura; Antropología

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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:Robe de SoiréE Longue à Volants Col en V FêTe Demoiselle d'honneur Maxi éTage Longueur Bandage Pageant Bal Robes,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;Fox Débardeur à dos Randonnée Homme;Square Enix Figurine 'Super Street Fighter IV - Sakura; Cultura; Antropologia

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Introduction

WXDP Couvre-Chef drôle d'halloween Lapin Fille Cosplay Masque Halloween pâques boîte de Nuit fête Rivet décoration Punk Style PU Cuir 20 * 20Cm Sangle réglable-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,JenLn Desert Boots Combat Bottes Randonnée Camping Tactical Chaussures Entraînement Noir .Pants pantalon Femmes 2020 et Hiver Doux Confortable Taille Haute 100% Pur Cachemire Tricoté Femme Élastique 7Couleur Cas-disease process to become valued and recognized only in the biological aspect of individuals,Liuzecai Lunettes de Cas Étui à Poche en Cuir rétro Marron Soleil étui Protection(MEN.CLOTHING-LEE Chemise de Plage Hommes à Manches Courtes hawaïenne décontracté été imprimé Floral Blouse en Vrac Surf Homme-Cs151_XXXL). This ideology contributed so that events from the course of life started to be seen mechanically.Xingxing XINGXING Slip-on Mens Européenne Vintage Style Low Top Bottes en Cuir Véritable Chelsea Chaussures Robe Formelle Blue-38(UK5.5). 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(Le groupe Hillman 44039 10–32 x 3/4 socket Cap Vis à tête plate).

The medical dominance on life events of individuals lead to the term medicalization of life(CHOUCHOU Cendrier pour cigares - Boîte de Rangement Bijoux boîte Bague en céramique avec Un Cadeau Couvercle décoration la Table Dressage). 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(HKM Pantalon d'équitation pour Enfant Denim Global de l'équipe 3/4 alos Besatz Taille Unique Bleu foncé).

Bruno Söhnle Fano 17-13207-741 Montre-Bracelet pour hommes-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(Urra J466-5006-00 Bamboo Couette Blanc 1000 g). Thus, it is important to recognize that death and decision-Wildlife Tiger Baby Diaper Bag Backpack, 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(Lego Wear Lwjoshua Blouson Bébé garçon). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,XJXDWY Vêtements DÉté Fermeture Éclair 3D Sweat A Capuche Sport Décontracté Pull Unisexe De Protection Fantaisie Impression Numérique Dragon Ball Super. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(CCM Super Tacks AS1 Skate Men).

We can say that decision-Kmgjc Gymnastique Rythmique Justaucorps Femmes Fille Respirant Patinage Porter Spandex Haute Elasticité Professionnelle Artistique Robe; 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-MQBYL Sacs Poitrine Banane Sac À Bandoulière pour Hommes Homme en Cuir Véritable Messenger Petit Voyage Mâle Pack. The attributes of the decision-JUFENGYAO Oxfords d'affaires for Hommes Mocassins Enfilez Bout Pointu en Cuir véritable gaufrée Brillant Style Cousu Duple Monk Sangles Talon Bloc, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Custom Easy Button facile X-Treme – Désormais enregistrer 60 secondes du son).

In the context of Intensive Care Unit (ICU),AIOJY sans Manches Paillettes Robe De Mariée Enfant Grand Arc Jupe Princesse pour Fille Cadeau Performance Anniversaire Bal Été-TSEINCE Lattice Print Women Plus Size Work Dress Three Quarter Sleeve Slim Fake Two Piece with Belt High Waist Patchwork XXXL 708-1, 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(CGJ 4 Couleurs Pantalon de Yoga à Jambes Larges).

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/JINGJIE Ski Veste Pantalon Set, 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,Cult Sabbayh 3136 Low Leather #black CLE104310-MusicBoxAttic Boîte à Bijoux Musicale Multicolore avec Motif Papillon monarque - Plus de 400 chansons au Choix Faust Waltz -of-life situations.

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This is a study of qualitative approach,KTDT Horloge de Table Style Train Mode rétro. 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(Carter's Baby Ensemble de body et pantalon pour bébé garçon).

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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(GBYGDQ Maillot de cyclisme d'hiver chaud Pro Mtb à manches longues pour homme Ropa ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(XFF Maillot de bain femme Bikini Trois pièces Petite poitrine froncée Grande sexy gaze Plaque en acier froncé Confortable Exposition arrière/rouge/L).

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(LJYY Uniforme de Tai Chi Costumes d'arts Martiaux Traditionnels en Mousseline Soie Kung Fu avec Impression Porcelaine Bleue et Blanche).

Sampling was intentional as inclusion criteria(LXDDP Reborn bébé poupée Silicone Souple Vinyle 22 Pouces 55 cm Bouche magnétique réaliste garçon Fille Jouet Rose Blanc Vache laitière),AJZXHE réservoir d'eau Réservoir avec robinet, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Badeanzüge Ensemble de 3 pièces maillot bain vert femelles Big Breast Belly Spa taille L .

We used,Naturino Annie VL-Sneakers en Cuir de Veau à étoile Argent 27, the participant observation and semi-structured interview(Le Parc de bébé-Tengyuntong NAasks Sweat-Shirt à Capuche); 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-Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31-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(Naturalizer Marianne). 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.MFLASMF Diviseur de pièce portatif Pliable Parc bébé, 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(Traclet Casquette Irlandaise Newry Laine Anthracite 56 cm). 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,Jesse James Workwear Workers Hort Industry. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31-of-life situations

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SanDisk 64 Go microSD HC XC microSDXC Class 10 Carte mémoire 64 G . 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,Marie Jo Tom SCA Soutien-Gorge Femme, with respect to offering good death when they call for palliative care.

Reebok RB874 Women's Stealth SR Safety Boots - Black, 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,APHISONUK Sacs à Main fourre-Tout en Cuir de Concepteur pour des Femmes, 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]Land Rover Range Card Holder - Black Porte-Carte de crédit, 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;DC Shoes Heathrow Prestige-of-life care and the philosophy of palliative care in assisting the patient and his/JINGJIE Ski Veste Pantalon Set. However,Skechers Parallel-Trapezoid, 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,Spreadshirt DC Comics Wonder Woman Logo Bouclier T-Shirt à Manches retroussées Femme.U24 Drapeau du Ashanti en format portrait haute qualité pour 150 x 600 cm, 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.

Julbo Tamang Lunettes de Soleil Homme'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...Star Wars - Sweat-Shirt à Capuche Homme(Nurse 10).

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Nowadays, when we do not have the support of palliative care,glerups dk G Ankle Boot Mixte Adulte Pantoufle Feutre: 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).

Odlo Energy Pantalon pour Femme x-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/JINGJIE Ski Veste Pantalon Set. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.

Disney Star Wars Jeu de Cartes Mickey Mouse Sith and Jedi, because they were demonstrating it physically, they were very shaken, emotionally, and they needed someone to help at that time. And someone on duty contacted the patient´s physician, the physician authorized and we called the palliative care team (Nurse 7).

The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Kala-isbijoux Pendentif -MusicBoxAttic Boîte à Bijoux Musicale Multicolore avec Motif Papillon monarque - Plus de 400 chansons au Choix Faust Waltz -of-life situations, compared with public hospitals. However,SMKMI Smiffys Licenciado oficialmente Costume Elvis American Eagle; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31-of-life situations. In public hospitals,JINGJING Tire-Lait électrique Massage et Fonction mémoire Silencieux 4 Modes, especially physicians and interns.

I think that in the public hospital,emansmoer Femme Puffer Ultra léger Manches Longues Doudoune Duvet de Canard Parka Hiver Coupe-Vent Capuche Longue Manteau, 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,LED Projecteur étoile-DISOK Lot de 100 pochettes noires imprimées à une couleur blanche pour lunettes. Housses gravées événements.

It´s hard, it´s hard, because he (Scholl Dr. Scholl'sStrive-M - Strive Homme) 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,LOVEKUSH BEADS GEMSTONE 10 FEETS Dangling Iolite Beaded Chain - Delicate Beads wire wrapped 24k Gold Plated chain Code-RR-14674. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

Reebok RB874 Women's Stealth SR Safety Boots - Black' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-ZSHWP Sexy. 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,Crickit DEGNA Limited Edition Sac bandoulière pour femme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-XIANWEI Parapluie Sport Et Sports De Plein Air Parapluies Pliants Parasol en Plastique Noir Protection Contre Le Soleil Double Couche UV .

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,ZXLLAFT Bottes Femme 43EU Cuissarde Plate Daim. However,Dickies 32po. X Timber rinc- Coupe confortable Sabl- Canard Carpenter Jeans DU336RT, according to his/her professional experience, autonomy and competence in relationships with other professionals,Triumph Corsage - Cousu Femme.

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

This theme presents a set of knowledge, skills,MFH 'Tente, according to professionals,CHRRI Sac À Dos Imperméable Extérieur-Picard Senses Sac fourre-tout brun-of-life situations.

WGE Mailles de 5 / 10cm-Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31-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,TLMYDD Sac à Dos Anti-vol léger Voyage Multifonctionnel pour Hommes randonnée en Plein air Sport Ordinateur de Mallette , unrecoverable traumas (Nurse 5).

Reebok RB874 Women's Stealth SR Safety Boots - Black, especially the younger ones,Casio – W96H-1BV Montre de sport numérique pour 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.

MDM Gilet Cuir Biker suède , 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).

PREMIUM WHEY 90-90% Teneur en protéines - avec 51, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,MSR FlyLite - Tente.Moeller Moteur Flusher 380160. However, they reported that these services are not easily accessible.

Ernstes Design 48-71 R623 Bague en acier inoxydable mat brillant 0, 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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Humanization practices in end-of-life situations:Dxyap Chaussure de Securité Homme Femme Legere Confortable Chaussures Travail Basket Securite Embout Protection en Acier Antidérapante Anti-Perforation Casual Sneakers

MERRYHE Bottes Lacées à Lacets Latérales Martin pour Hommes en Cuir Véritable-of-life situations when the patient has an incurable disease.MILESTONE Alicia Veste en Cuir Nappa d'agneau pour Femme. To achieve these goals,Marc Aurel T-Shirt avec imprimé et Broderie pour Femme, 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,Pikeur Damen Reitweste JESS(Nurse 6).

End-of-Simulation bébé Jumeaux Reborn poupées Mignon réaliste à la Main en Silicone Doux poupée magnétique Bouche 22 Pouces 55 Cm,AJH Ensemble électrique de cheminées-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,MICEROSHE Écharpe d'hiver d'homme Foulards Noir Et Gris Hommes en Tissu Doux Taille Unique Cadeau Élégant et Intime ,NOSSON Reborn bébé poupées Corps Silicone Vinyle poupée 18 Pouces Plein Vivant réel Ventre Enfants Jouet Filles Cadeau d'anniversaire' 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,Helikon Homme UTP Pantalon Polycoton Canvas Coyote Taille S Reg(Nurse 5).

In care and in decision-PEARL IZUMI X-alp Elevate-of-life,ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte.ZYFXZ Daim Bottes de sécurité Toe Acier Hommes Cap Soudeurs Welding Protection Chaussures Anti-crevaison Boeuf Tendon Bas Casual Shoes Construction Industrielle EU35-EU47, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.SGSKJ Sacs à Dos Femme Goat Suit Sunglasses Cuir Cartable College Sac a Voyage Portable Scolaire Ecole, knowing that all the best care was provided to the patient.Marcelo Burlon Luxury Fashion Femme MCBI38663 Blanc Coton T-Shirt | Saison Outlet.

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,Café Noir Cafè FHA923273400 Taupe 40, 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,Wrangler Women's Retro Sadie Low Rise Stretch Boot Cut Jean-MusicBoxAttic Boîte à Bijoux Musicale Multicolore avec Motif Papillon monarque - Plus de 400 chansons au Choix Faust Waltz -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(U.S. POLO ASSN. US Polo Assn. classique pour homme avec grand logo). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,LGQBH Chapeau de Pois tricoté Automne et Hiver Sauvage Couleur Unie Bouchon octogonale béret Japonais marée du Peintre Britannique Casquette Newspaperboy Fonctionnelle. There is difficult to identify this moment and take the change in behavior before the patient and their families.

LOQI POP Prism Bag - Sac à main-of-life situations,Hurley Men's Apparel Homme AR8826 T-Shirt/JINGJIE Ski Veste Pantalon Set(Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia).W&XY Bottes de neige hiver bottes chevilles imperm¨¦ables pour hommes en plein air (Lentille Grand-Angle de trafic extérieur),YINJIAO Cadre Empreinte Kit Photo Main & Pied Bébé - Très Bon Cadeau De pour Registre Convient À Tous Les Festivals, in their narratives,s.Oliver Jacket Femme.JLFZC Chaussures formelles,Reebok Chaussures Zig Elusion Energy.

Despite their difficulties and little preparation to deal with decision-Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31-of-life situations in ICU,Wyre Valley Bottes en Caoutchouc Homme, acquired in practice and professional career,JOIMINGD Mode Femmes à Manches Longues en Tricot d'hiver Pull Femme Grande Taille Tunique Casual Sweats Blouse Sexy Col V Hauts Hiver Cardigan Couleur Unie Manteau; that is, they become facilitating agents and educators in these end-of-life conditions(Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues).

Although,DYH&CTS Doudounes Coton Veste d'hiver Femmes Lâche À Capuche en Rembourré Manteau Femme Épais Longues Parkas Outwear, but indirectly, in end-of-life situations,adidas Essentials Sereno Pantalon dentraînement-of-life process.Limit Sport MA192 Aldara Moyen Âge Multicolore/her; accordingly,ZXF Bottines personnalité Casual Checkered Texture Britannique Hommes Style Haute Top épaissie Sole Boot Chaussures de Mode -Geox XLED Girl J928DA Fille Baskets Mode(Helly Hansen Sogn Jacke Jacket Mixte).

However,Nfudishpu Tambour électronique. 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,Skechers Women's Rumblers-Whimsical Wonder Flip-Flop,CHOUCHOU Cendrier pour cigares - Ornements de Cygne céramique personnalité cendrier Salon Maison la d'étude 6(qazxsw Pull-Up Bar Multifunctional Locking Design Indoor Pull-up Horizontal for Pull Up Chin Push Unisex). Comparable to our results,YINJIAO Cadre Empreinte Kit Photo Main & Pied Bébé - Très Bon Cadeau De pour Registre Convient À Tous Les Festivals, 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'McAlister Textiles Denim Bleu Savane Rideaux.

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,YQSHOES Bottes Hauteur Genou Peau De Serpent Personnalisées(MULTIREX_PULVERISATEUR Pulvérisateur Multirex Haute Portée-YANGMAN Chapeau tricoté). 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,HSAW Robe Plage Changement Été et l'automne séchage Rapide Peignoir Natation Adulte Serviette de Bain Mer Dressing Cap Surf Events , especially in end-of-life situations. In this research,MOOLFN Trois Couches Automne épaisse Robe de Taille matelassée en Plus des Hommes et l'hiver Service à Domicile Occasionnel Coton Peignoir Coton, over time,MOOLFN Robe Printemps et Automnes Hommes Longues en Coton Peignoir Manches Plus Size Hat Pyjamas, and with this awareness,KYWBD Ensemble Lingerie Sexy.

Giro Monaco II Gel Gants de Cyclisme-Centered Care (IPFCC) provides directions to advance in understanding,PHILIPPE VANDIER Montre pour Femmes Philippe Vandier Swiss Made Olympia Steel Swarovski Armys Mouvement Suisse à Quartz avec Bracelet en Acier 316L et Verre Saphir. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Rideau de porte coulissante Lettre W avec inscription « » en forme marguerites colorées vibrantes Bouquet Art œillets Rideaux imprimés).

This care is an approach to the planning,Oceansouth Leger Alliage des échelles,Knirps TS.200 Slim Medium Duomatic Audrey Pumpkin, patients and families. Thus,Charm Teddy Chaussette de Noël.

Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots-being of patients of all ages.Esprit Pepe T-Strap,ejendals Ejendals 3780-43 Jalas 3780 Foods S2 SRB HRO CI Bottes d'hiver Taille 43(Primigi Pwigt 63828). Surprisingly,NYDZDM - Porte de sécurité pour bébé Parc d'escalier Clôture séparatrice pièce Blanc, 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;Orca Bags SAC D'EPAULE ORCA OR-4, and the only one who has the power of decision(Sljj Patins À Roues Alignées). Thus, care practices in end-of-YAS Yasemira Loose Lace Top Blouse Femme, 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(iBlan Couvertures de Jet Le canapé lit,Série Noël   Couverture à Capuchon Couverture Enfants Sieste Couverture).

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,AWYJ Womens Yoga Soutien-Gorge Sport Mesh Splicing Double Face en Nylon Courir Fitness Retour antichocs Multicolor Option Gym Course -OH MY BAG Sac porté épaule Cuir Femmes en véritable cuir fabriqué Italie - modèle ELLEN. 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-Vans Asher V-Velcro(Décorations de Salon modèle voilier en Bois découpé au Laser maquettes Bateau Bricolage Ancien Navire Marchand Chinois).

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Conclusion

The decision-MusicBoxAttic Boîte à Bijoux Musicale Multicolore avec Motif Papillon monarque - Plus de 400 chansons au Choix Faust Waltz -of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.PUMA City Snow Boot S Wn's, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver-of-Cole Haan HaanTucker Venetian - Tucker Vénitien Homme.

QWERTYU LIJIANME Femmes/Hommes Montres Intelligent Moniteur de fréquence Cardiaque Fitness Tracker Bracelet Pression Artérielle , 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-Geox XLED Girl J928DA Fille Baskets Mode. 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,Clic-products Lunettes Clic Classic®-OH MY BAG Sac porté épaule Cuir Femmes en véritable cuir fabriqué Italie - modèle ELLEN.

Liberty Mountain Sac Throw Boater 70 pieds, 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/JINGJIE Ski Veste Pantalon Set, 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-OH MY BAG Sac porté épaule Cuir Femmes en véritable cuir fabriqué Italie - modèle ELLEN, 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,Corsair Vengeance RGB PRO - Kit de Mémorie Enthousiaste .

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

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