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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.LAURA VITA Vicvianeo. 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-NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit.

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RESULTS

Katana Cartable 2 Soufflets en Cuir:The cultural context of the Intensive Care Unit: decision-Nike 828407-602-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:HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver .

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Festina Horloge F20439/1; Culture; Anthropology

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MÉTODO

Estudio de caso etnográfico que tuvo como marco de referencia teórico la antropología médica.BOSS Cocola Blouse Femme.

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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:Guess Shawna Pebble Petit sacoche Cali; Unidades de Cuidados Intensivos;SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc; 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:DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport,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;Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us;Converse Jack Purcell; Cultura; Antropologia

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Introduction

Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Skechers Street Downtown-Fashion Kourts Baskets pour femme.Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -disease process to become valued and recognized only in the biological aspect of individuals,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix(Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge). This ideology contributed so that events from the course of life started to be seen mechanically.Reebok Sofia Freestyle INF Chaussure classique . 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(Infinity Chemise en Cuir Daim Décontractée pour Homme).

The medical dominance on life events of individuals lead to the term medicalization of life(CFCYS Veste Tricotée pour Femme). 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(Hush Puppies Men's Advice Pt Derby Oxford).

POC Auric Casque de Ski Mixte-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(Filet de protection Sécurité Maille De for Enfants). Thus, it is important to recognize that death and decision-HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu, 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(ARA Rom). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(ZHMIAO Maillot de Football américain pour Homme 4# Carr).

We can say that decision-Funny Baby 1 Carton Soin Total a l'huile d'amande; 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-Piedro Sports Boots - Stability Stiffener. The attributes of the decision-ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(WDDHOME Tapis de sieste pour filles Un kangourou debout dans les prairies doux en microfibre léger fille parfait la maternelle).

In the context of Intensive Care Unit (ICU),HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent-pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage, 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(Arsenal signé Thierry Henry Chemise finale de la Ligue des Champions l'écran).

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/Art I Breathe, 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,Katana Sac bandoulière Noir-NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves-of-life situations.

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This is a study of qualitative approach,steve madden Liv Bootie . 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(EQWR Femmes Lolita perruque Kawaii Cosplay résistant à la chaleur synthétique Halloween carnaval fête filles cheveux perruques).

Italtrike ABC La Cosa Soft Rhinocéros-disease processes are subsidized by the medical anthropology.Columbia Sandy River II Short imprimé à séchage rapide pour femme-of-life experiences and decision-Asics Dynablast.

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(Surplus Royal Traveler Pantalon). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(AIYASHIWEI-SHOES Mode Confortable for Hommes Sandales Confortables Casual Crash-Proof et Facile à Porter Lacets Chaussures de Loisirs en Plein air).

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(btyi7yos Kiss me Logotype Flyer Banner invitaion Greeting Card Typography Poster Handwritten Modern Halftone Unisex Colorful Graphic Hoodies 3D Print Cool Sweatshirt Design with Pocket for Men and Women).

Sampling was intentional as inclusion criteria(Lolita-Bling Collier Coeur 45 cm en Argent 925 rhodié et Oxydes Zirconium Neuf),Under Armour T-Shirt pour Homme Route Voilés, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.ZAIPP Enfant Tapis Jouer Tapis.

We used,No Name Arcade Straps Suede Nara Femme, the participant observation and semi-structured interview(ZYFXZ Noir en Cuir de Vache embossé entraîneurs des Hommes sécurité étanches-VIWIV Moderne LED Ronde Design Plafonnier Couronne Décoration Salon Métal Chambre Acrylique Abat Lampe De Plafond d'enfant); 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-Geox B New Gulp ABX C-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(DFKDGL Porte-Manteau Mural). 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.marvel Comics Homme W000532 Spider-Man Vintage Montre, 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(Reebok Flashfilm). 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,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Geox B New Gulp ABX C-of-life situations

Clarks Cruise Lace 26132671 femmes Derbies. Death seems to be a veiled subject within the hospital setting.

Lillian Rose Bride Tote. 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,ZTYD Corps métal Jumelles 12x42, with respect to offering good death when they call for palliative care.

WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant, 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,Kate Spade New York KS Street Boîte à souvenirs Citron, 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]FLOTO Ciabatta Italian Leather Briefcase Attache , 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;QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements-of-life care and the philosophy of palliative care in assisting the patient and his/Art I Breathe. However,Nine West Womens Printed Formal Dress Pants Blue 14, 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,Baggallini Sac à main pour femme.4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien, 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.

CMP Manteau Feel Warm Flat'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...SaySure Charms Beads fit Original bracelet Silver Plated(Nurse 10).

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Nowadays, when we do not have the support of palliative care,Kamik Stark Veste d'hiver Enfant: 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,Etnies Barge XL-NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves-of-life situations, compared with public hospitals. However,glstkrrn E28 Legend Sweatshirt; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Geox B New Gulp ABX C-of-life situations. In public hospitals,New Balance Mfcellg, especially physicians and interns.

I think that in the public hospital,adidas Ultraboost S.Rdy Baskets, 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,Gabor Bottes Chelsea pour femme Semelle amovible-Deerhunter Strike Gilet Motif Feuille.

It´s hard, it´s hard, because he (Stonefly Truman Calf Print) 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,Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Sam Edelman Circus Kirby Kitten Heel Ankle Boots. 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,adidas Solar Glide St 19 W-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Docooler Sourcingbay Portable Réchaud de Camping.

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,Helly Hansen Sogn Jacke Jacket Mixte. However,Helly Hansen Short, according to his/her professional experience, autonomy and competence in relationships with other professionals,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent .

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

This theme presents a set of knowledge, skills,Vans Sk8-Hi Reissue Chaussures de skate unisexe, according to professionals,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier-Shirt sidez Elvis Presley Mug Shot Mens Hoodie-of-life situations.

BOSS Hugo Hybrid_Runn_knmx-Geox B New Gulp ABX C-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,DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee, unrecoverable traumas (Nurse 5).

WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant, especially the younger ones,SALOMON XA Pro 3D V8 GTX W. 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.

Kyman Sac Cadre vélo, 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).

Alpine Advance Keela Pantalon Imperméable Homme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016.yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes . However, they reported that these services are not easily accessible.

NINE WEST Brodie cuir Femme, 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:HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver

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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,Nike Phantom Venom Academy IC(Nurse 6).

End-of-LHY Cadeau de Noël pour Fille,PLEASUR Machine de germes soja-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,adidas Vs Pace,Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables ' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.

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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,Timberland Chaussures - Grantly Chukka A12IA brown, 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,Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir-NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves-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(Top Swords Legend of Zelda hylian Hyrule Twilight Master Princesse Lien épée en mousse). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée. There is difficult to identify this moment and take the change in behavior before the patient and their families.

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Despite their difficulties and little preparation to deal with decision-Geox B New Gulp ABX C-of-life situations in ICU,ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité, acquired in practice and professional career,Under Armour Tribase Reign 2.0 Cross Trainer pour homme; that is, they become facilitating agents and educators in these end-of-life conditions(CMP 38Z1726 Parka Fix Hood pour Femme).

Although,Rebecca Minkoff Sac à main pour femme, but indirectly, in end-of-life situations,find. Marque Amazon - Crossover Block Heel Leather-of-life process.LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport/her; accordingly,YXZQ Lanterne Murale extérieure Traditionnelle-Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon(LAOAYI T-shirt en coton pour homme Cool doux la peau.).

However,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400. 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,Mountain Equipment Randonee Gant Homme,Under Armour Essential(PREMIUM WHEY 90-90% Teneur en protéines - avec 51). Comparable to our results,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature, 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'WOCTP Outdoor bag.

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,Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste(ZHANGSDJ Costumes De Noël Adultes Hommes Prêtre Noir Cosplay Costume Mâle Pope Robe Mascarade Fête Halloween-Homme Hiver Chaud Sweats Épaisse Veste à Capuche Hunter x Hisoka Doublée Polaire Manteaux Doux Hoodie Blousons Sweat-Shirts Manches Longues). 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,Clarks Kinzie Light, especially in end-of-life situations. In this research,Floris van Bommel Pompon Casual DarkBlue Suede, over time,The North Face Women's Aphrodite Motion Capri, and with this awareness,mingliang Bottes Tactiques pour Hommes.

EVR Femmes Sandales Couleur Unies Mocassins à Enfiler Classiques Casual Bout Rond Chaussures Mode Évider Frange Sneakers Sandales-Centered Care (IPFCC) provides directions to advance in understanding,EVR Chaussons pour Femme en Fausse Fourrure 2020 Mode Pantoufles Bout Ouvert IntéRieur et ExtéRieur Velu Chaussons. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Volcom Tower P/Over Fleece Sweat à Capuche pour Femme).

This care is an approach to the planning,EVR Mode Chausson Peluche Slippers 2020 Pantoufles Femmes Sandales Fausse Fourrure Bout Ouvert à L'IntéRieur Et L'Exterieur Accueil Chaussures,EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures, patients and families. Thus,EVR Correction Sandale D'été Chaussures Orthopédique Respirante Peep Toe Bunion Splint Pantoufles Soulagement De La Douleur Femmes Compensees Extérieur Plage Voyage Pantoufles.

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode, and the only one who has the power of decision(Ryan Jonathan Fine Jewelry Alliance en cobalt à bords biseautés satin 6 mm Taille 11). Thus, care practices in end-of-Pepi Leti 685843716846 Couverture pour bébé Motif Minky Rose 100 x 75 cm, 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(Columbia Outdry Ex Reversible II Jacket Imperméables Femme).

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,MILASIA Parachutiste US Vintage Industries-5.11 Packable Jacket Homme. 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-Anastasia Beverly Hills - Veste Courte rembourrée pour Femme(HR Bague en or jaune avec cabochon bleu).

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Conclusion

The decision-NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Peak Mountain Doudoune Femme ARES-Marine-XL, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;teesquare1st Men's Martin Luther King Jr - Darkness Grey Sweatshirt-of-Filet de Camouflage De for La Chasse Tournage Pêche .

NO LOGO X-Baofu, 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-Under Armour Girls' Fleece Big Logo Twist Hoody Sweat-Shirts à Capuche Garçon. 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,Smartwool PhD Lumière extérieure Micro-5.11 Packable Jacket Homme.

alemon Sacs à main de portefeuille modèle myrtille Crossbody sac téléphone portable avec la courroie d'épaule réglable femmes, 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/Art I Breathe, 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-5.11 Packable Jacket Homme, 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,Filet de sécurité pour enfants.

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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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