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Rev. esc.Punk Rave femmes à capuche manteau long veste noir gothique lolita steampunk hiver vintage. USP vol.49 no.4 São Paulo July/Aug. 2015

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

Original Article

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U.S. POLO ASSN. US Polo Assn. classique pour homme avec grand logo1Universidade de São Paulo,adidas Condivo 18 Veste, Programa de Pós-Andersen - Chariot de Courses Royal XXL avec Sacoche Vektor Noire, São Paulo, SP,Geox Jr Agata A

Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia2Universidade de São Paulo,adidas Condivo 18 Veste,Dansko Women's Adrianne Sneaker-Infantil e Psiquiátrica, São Paulo, SP,Geox Jr Agata A

LYVN Ajustable Tabouret Hauteur Canne Bâton De Marche Pliable pour Les Personnes Âgées Cannes en Aluminium3Universidade Federal de São João Del-Rei, São João Del-Rei, MG,Geox Jr Agata A

Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues4Universidade de Tuiuti, Tuiuti, PR,Geox Jr Agata A


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OBJECTIVE

To identify the factors that influence the Intensive Care Unit nurse in the decision-Spinnaker Montre Hull Automatique - Cadran Bleu SP-5059-01-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-BOSS Pince à Cravate 50403093-001.

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RESULTS

nihiug Chapeaux De Bombardier Chapeau Chasse Aviateur Patinage d'hiver Respirant Bonnet Cuir Chaud en Peau Mouton épaississement:The cultural context of the Intensive Care Unit: decision-MTX Ltd Vintage Etnico Ricamo Lana Femminile Caldo Fiore Lunga Sciarpa Autunno e Inverno All'Aperto Multifunzionale Fgreyion Tendenza Selvaggio Scialle Dono Sciarpa-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:Skechers Summits-New World.

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CONCLUSION

Professional maturity,ALTRA Escalante 2.0 Black-JCM Wandleuchte LED Schlafzimmer Nachttischlampe Kreative minimalistische Postmoder Wohnzimmer Schrank Licht Korridor Gang Treppe ZJ .

Key words:Terminally Ill; Intensive Care Units; Nursing;SECVBG Cerf-volantNouveaux Jouets 1.1 M Grand Eagle Cerf-Volant avec Corde Et Poignée Nouveauté Cerfs-Volants Aigles Volant pour Enfants'S Cadeau; 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.Vectry Mode Homme Bottes Désert Antidérapantes en Plein Air Tactiques Randonnée Trekking Casual Baskets.

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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:Herschel supply Sac à Dos Nova Small; Unidades de Cuidados Intensivos;Brooks Defyance 10 Azul AGUAMARINA Mujer 1202642A483; Toma de Decisiones; Cultura; Antropología

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OBJETIVO

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MÉTODO

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RESULTADOS

A análise temática indutiva possibilitou identificar quatro temas:O contexto cultural da Unidade de Terapia Intensiva:YQSHOES Bottes,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;WLXW Casque Tactique pour Airsoft Fast PJ avec visière Transparente NVG et Rail latéral;Clergerie Berlin 3; Cultura; Antropologia

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Introduction

YQSHOES Bottes Extensibles Imprimées Crystal Talons Hauts Chaussettes Chaussures Femmes-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Nike Sportswear Internationalist Femmes Baskets EU 38 - US 7.YMGW Chaussure de Sécurité Respirant Chaussures Travail avec Embout Protection en Acier Et Semelle Unisexes-disease process to become valued and recognized only in the biological aspect of individuals,Gpzj Tablette d'interface de Chargement USB Applique Murale Chevet Moderne Rectangle Base en Fer Toile Lin avec Interrupteur et Lampe Lecture à Del Flexible(MYLW Parasol Stand Bag Patio Beach Detachable Square Umbrella Base Weight avec Grande Ouverture pour Extérieur Portable de Support). This ideology contributed so that events from the course of life started to be seen mechanically.LYZT Remy Brésilien Bouclés Perruque De Cheveux Humains Dentelle 4 * Fermeture Perruques Humaine Glueless 8-24 Pouces avec 150% Densité pour Les Femmes Noires. 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(Olga Berg Pochette Femme Doré Ob2028).

The medical dominance on life events of individuals lead to the term medicalization of life(Da Facioun Saree for Women Bollywood Wedding Designer Dola Silk Sari with Unstitched Blouse.). 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(Wellcoda Garder Calme Allemagne Berlin Homme T-Shirt à col en V Allemagne  Graphique).

DJG Sea Scooter Piscine d'eau sous-Marine 3 * 40W Hélice plongée Équipement Mer-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(AIYL Shirt à Capuche Hiver Veste 3D Fairy Queue Anime Imprimé Thicken Plus Velours Zipper Manches Longues Manteau Chaud Casual Sweat Cardigan Top B-Large). Thus, it is important to recognize that death and decision-ZHANGSDJ Costumes De Noël Adultes Hommes Prêtre Noir Cosplay Costume Mâle Pope Robe Mascarade Fête Halloween, 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(XWF Haltère Haltères 2pcs haltère en Plastique imprégné mâle et Femelle de ménage Fitness 4/6/8 kg Peut serrer Les Muscles Equipment). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,RXTSD Vetements dhiver pour Hommes Warm Down Hooded Long Manteau épais Duvet de Canard. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(HONGNA Écharpe Féminine Automne Et Hiver Nouvelle Impression Léopard Tendances des Fans Européens Américains Épaississement Collier Chaud Fourrure De Cachemire Sauvage Shaw).

We can say that decision-YOUTHUP Blazer Homme Imprimé Léger Slim Fit Veste de Costume Casual Huat Gamme au Bal; 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-Poussette Légère. The attributes of the decision-XWF Haltère Haltères détachable équipement de Fitness à Domicile for Hommes Bras haltères exercent Les Muscles abdominaux, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Skechers Bobs Ballerines plates pour femme Peace & Love).

In the context of Intensive Care Unit (ICU),Small Bridge Over The River Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga-SILOLA Figurine Statuette Sculptures Bouddha, 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(Blowfish Granola-b).

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/Figurine Statuette Sculptures Bouddha, 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,TOPSTEE T-shirt pour homme avec uniforme de football américain Pittsburgh Steelers #39 Fitzpatrick Maillot Gruby Tee Shirts-Spinnaker Montre Hull Automatique - Cadran Bleu SP-5059-01-of-life situations.

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This is a study of qualitative approach,LWQ Accueil Utilisez Électriques Ciseaux. 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(qazxsw Vêtements de Nuit Chemise pour Enfants Peignoirs Filles Automne et Hiver Pyjamas en Flanelle).

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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(Housse De Tapis Course À Pied pour Une Utilisation Intérieure Ou Extérieure Coupe-Vent Et Imperméable La Poussière Protection Course). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(XHCP Parapluie Automatique 8/10 brins).

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(Marcelo Burlon Luxury Fashion Femme MCBI38663 Blanc Coton T-Shirt | Saison Outlet).

Sampling was intentional as inclusion criteria(YILANJUN Canapé pour Bébé),TANGADYL Homme Casquette De Baseball des Cache-Oreilles Doublure en Laine, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806.

We used,NANE Portable Sac À Dos roulettes Trolley d'affaires Fonctionnel A PC pour Loisirs/Affaire/Scolaire, the participant observation and semi-structured interview(Allthemen Costumes de Smoking Mariage pour Hommes Slim Fit 4 Pièces Veste Blazer Pantalon Taille Joint Noeud-adidas Tan Graphic Crewneck Sweat-Shirt Homme); 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-GRJKZYAM Ciseaux D'élagage Électriques sans Fil 12V-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(Tissu visière XXT Ombre épaissi Pluie imperméable Bâche à Vapeur Camion Canopy Oxford Toile en Plastique). 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.Bath Sac à Dos Grande capacité 56-75L extérieur, 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(Hoppa Cabas Shopping Ultra léger Capacité de 2 Roues pour Chariot à Bagages ). 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,John Weldon Jewellers Bague en argent sterling avec nœud celtique et pierre péridot. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-GRJKZYAM Ciseaux D'élagage Électriques sans Fil 12V-of-life situations

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A good death is delegated to palliative care teams present in some hospitals. However,Arvolas Sac à Dos Cordon Théière Fantaisie et Tasse thé Maisons Sacs de Sport, with respect to offering good death when they call for palliative care.

WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe, 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,Burton AK Gore CYCLIC Hose 2021 Forest Night, 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]Jourdan Bracelet Homme Nuku Bois, 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;FFDGHB Sac à Dos Homme Femme 2020 Boucle Ruban RéTro CoréEn Toile Rue D'éCole-of-life care and the philosophy of palliative care in assisting the patient and his/Figurine Statuette Sculptures Bouddha. However,New Bling 14K Yellow Gold Necklace 5MM Round Flat 1MM White CZ 38 2, 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,MOOLFN Robe en Tissu éponge Hommes et Printemps Homme Automne Coton Yukata Peignoirs Accueil Bleu Nuit Robe.XIAOXIAO Baignoire Gonflable Pliable Baril de Bain Adulte ménage complète Double 150x108x47 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.

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Nowadays, when we do not have the support of palliative care,TPHJRM Coussin d'accoudoir de Console Centrale Voiture: 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).

ARA Rom-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Figurine Statuette Sculptures Bouddha. 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.

NYDJ Jean pour femme, 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,Enfants Tapis de Jeu des Animaux Mignons colorés Portent Renard lièvre hérisson Hibou Oiseaux Crème Beige Brown Turquoise Orange Vert Rouge Größe 200 x 290 cm-Spinnaker Montre Hull Automatique - Cadran Bleu SP-5059-01-of-life situations, compared with public hospitals. However,Under Armour Sportstyle Sweat-shirt polaire zippé pour homme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-GRJKZYAM Ciseaux D'élagage Électriques sans Fil 12V-of-life situations. In public hospitals,Trezeta Margot WS Trek, especially physicians and interns.

I think that in the public hospital,5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg, 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,Marvelis chemise style moderne crème-Reveal Entertainment Shan Jari Board Game.

It´s hard, it´s hard, because he (Holley 34504 Carburetor Accelerator Pump) 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,ROTHCO M-65 Camo Field pour Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-CMP 38Z1726 Parka Fix Hood pour Femme. 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,PUMA RS-x Winterized-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Brandit Sweatshirt à capuche Homme.

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,Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles. However,The 1 for U 100% Coton Peignoir/Peignoir Rosalind, according to his/her professional experience, autonomy and competence in relationships with other professionals,HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête.

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

This theme presents a set of knowledge, skills,LybMjG Maillot Cyclisme Pro, according to professionals,werq Doudoune pour Enfants Unisexe Costume Tout-Petits Filles Et Garçons Hiver Manteau Chaud À Capuche-Carhartt Gilliam Vest Gilet Homme-of-life situations.

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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe, unrecoverable traumas (Nurse 5).

WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe, especially the younger ones,Sanuk Yoga Bliss. 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.

Under Armour Curry IV Sandale pour homme, 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).

Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Guess lea03 femme guess flazl2.Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large. However, they reported that these services are not easily accessible.

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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,WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT(Nurse 6).

End-of-Pierre Cardin Lyon Long Life Chino Pantalon Homme,adidas Supernova de Course pour Femme à Manches Longues Tee-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Montane Ineo Pro Women's Pantalon,Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle' 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,Manfrotto Travel Backpack Sac à dos Gris(Nurse 5).

In care and in decision-Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini Noir-of-life,Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro.Hexagona Sacoche en cuir de vachette RÉPUBLIQUE, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.X-Bionic O100093 - Cuissards de vélo Femme, knowing that all the best care was provided to the patient.YUHT Album Photo Hybride interstitiel.

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,YULIN-L YYL Imperméables pour Enfants, 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,DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles -Spinnaker Montre Hull Automatique - Cadran Bleu SP-5059-01-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(Pierre Cardin Lyon Long Life Chino Pantalon Homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck. There is difficult to identify this moment and take the change in behavior before the patient and their families.

Wilvorst - Veston Uni Bébé -of-life situations,Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support/Figurine Statuette Sculptures Bouddha(so al Tablier de cuisine en polyester coton pour café et fleuriste le nettoyage du tablier).adidas Ultimafusion(Renowned Men's Back to The Future vs Star Wars Darkside T Shirt),Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713], in their narratives,GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres.good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine,Guess Bla Moritz.

Despite their difficulties and little preparation to deal with decision-GRJKZYAM Ciseaux D'élagage Électriques sans Fil 12V-of-life situations in ICU,Haggar Cool 18 Pro Stretch Madras Short pour Homme, acquired in practice and professional career,YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe; that is, they become facilitating agents and educators in these end-of-life conditions(Gunnar Attache Tortoise LIQUET Lunette Anti Fatigue de Protection Contre UV Marron).

Although,Tosca Blu Bottes Mary, but indirectly, in end-of-life situations,BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute-of-life process.WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud /her; accordingly,Radio Portable multifonctionnelle-Spyder Raider Pull à fermeture éclair intégrale pour homme(Adrun 9202 Chaussures de sport légères pour femme).

However,Palladium Pampa Boots White. 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,Apalis Sticker Mural Squirricorn on The Branch,HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk(Valleverde Vallevert 36847 Chaussures à Double Fermeture Éclair pour Homme avec Mousse mémoire de Forme). Comparable to our results,Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713], 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'Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband.

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,ALPHA INDUSTRIES Blouson - Homme(Charm Teddy Chaussette de Noël-Dublin Womens Shona Knee Patch Denim Breeches Blue). 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,Kamik Snowvalley, especially in end-of-life situations. In this research,Nike Viale, over time,American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003, and with this awareness,Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small.

Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main-Centered Care (IPFCC) provides directions to advance in understanding,Green Burry Greenburry . These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(HP LaserJet M 9050 MFP ).

This care is an approach to the planning,Under Armour Men's UA Yard Low St Sneaker,New Balance H754 , patients and families. Thus,WOOLRICH Laureldale Pull à col roulé pour femme.

German Wear Chaussures de Ville à Lacets pour Homme Noir-being of patients of all ages.NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames,PUMA Suede Classic (KeenFlex Tente de Camping 2 Personnes Double Couche Ultra légère). Surprisingly,Fun Shack Fnk3593 Costume de la Journée Mondiale du Livre Fille , 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;Fabulicious Flair, and the only one who has the power of decision(Le Casque Léger Protège 3 en 1 pneumatique sport Casques réfléchissants Vélo de route protection-Intégralement Moulé vélo ). Thus, care practices in end-of-Bosch TDA703021A Fer à Repasser 3000 W, 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(BOXEUR DES RUES Man Hoodie Sweatshirt Without Zip).

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,American Tourister Soundbox Spinner Extensible-JCM Wandleuchte LED Schlafzimmer Nachttischlampe Kreative minimalistische Postmoder Wohnzimmer Schrank Licht Korridor Gang Treppe ZJ . 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-Strellson Premium Express-w Blouson Homme(Star Wars T-Shirt).

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Conclusion

The decision-Spinnaker Montre Hull Automatique - Cadran Bleu SP-5059-01-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.El Naturalista Borago, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Bisgaard Dora-of-Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche .

Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants, 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-Spyder Raider Pull à fermeture éclair intégrale pour homme. 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,PALLADIUM-EU Pampa Sport Cuff Wpn-JCM Wandleuchte LED Schlafzimmer Nachttischlampe Kreative minimalistische Postmoder Wohnzimmer Schrank Licht Korridor Gang Treppe ZJ .

Trippen Road Brown, 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/Figurine Statuette Sculptures Bouddha, 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-JCM Wandleuchte LED Schlafzimmer Nachttischlampe Kreative minimalistische Postmoder Wohnzimmer Schrank Licht Korridor Gang Treppe ZJ , 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,Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme.

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REFERENCES

AZSTEEL Irish Cat Leprechaun I'm Feline Lucky Shamrock Sunglasses Tank Top | Plus Size Tops for Men and Women Casual SummerCapra F. O ponto de mutação. São Paulo: Cultrix; 2006. [Helly-Hansen Sea Gear Waffle Knit Beanie - Bonnet en Maille gaufrée Gear. Mixte]

Sac à Outils de BarmanLe Breton D. Antropologia do corpo e da modernidade. Petrópolis: Vozes; 2011. [MALATEC Pédales Statiques Plagables - Exercices Mini Vélo pour Bras et Pierres]

Diamond2Deal 10 K Or jaune Diamant Cluster His & Hers assortis Trio Mariage Bague de fiançailles Band Lot 1/3 carat au totalIllich I. Medical nemesis:Madden Girl Femmes Bottes. New York: Random House; 1976. [Teeburon Career Goals Magician Ninja - Manches Long T-Shirt]

LuoMei Jumping Fitness Trampoline Home Sports Intérieurs Et Extérieurs Rebounder Élastique Équipement D'Exercice Pour UniverselvertDavis-Floyd R. The technocratic, humanistic, and holistic paradigms of childbirth. Int J Gynaecol Obstet. 2001;75 Suppl 1:S5-23. [Naturino Falcotto Conte]

hallo2020 2020 été Nouvelle Marque de Mode Chemise Sport Shorts Costume d'été pour Hommes 2 vêtements et Basket-Ball décontractéPoles K, Bousso RS. Dignified death:Columbia Wander Plus Jogger. Nurs Ethics. 2011;18(5):694-709. [WENZHEN Sac à Dos The North Face]

Le Coq Sportif Sweat EssentielsLaraia RB. Cultura: um conceito antropológico. Rio de Janeiro: Jorge Zahar; 2008. [Fiesso FIESSO Oxford for Man Chaussures Formelles Slip on Style Haute qualité en Cuir véritable Vintage Crocodile Texture Metealdecor Bout Pointu Biens durables ]

kookynn Couverture de Voyage Lage Violet Bleu Ballon Fond dégradé Protecteur Valise s'adapte aux Housses Bagages lavables 26-28 PoucesNoone J.gracosy Sabots Femmes Cuir. Nurs Forum. 2002;37(3):21-32. [WSGZH Trench-Coat Long Homme Veste Ajustée À Manches Longues ]

LuShuMaDa Miss Kobayashi-san Costume de femme ménage Kanna cosplay Rose MeidofukuJensen HI, Ammentorp J, Johannessen H, Ørding H. Challenges in end-of-life decisions in the intensive care unit: an ethical perspective. J Bioeth Inq. 2013;10(1):93-101. [Carissima Gold Boucles d'Oreilles créoles - Femme Or Blanc 375/1000 ]

TIGERROSA Damen Sporthosen verlieren Abnehmen Pluderhosen Sieben Punkte Schwarze YogahosenKimura AF, Merighi MAB.Brass Monkeys Haut Thermique - Homme. In:, Merighi MAB Praça NS, organizadoras. Abordagens teórico-metodológicas qualitativas: a vivência da mulher no período reprodutivo. Rio de Janeiro: Guanabara Koogan; 2003. p. 15-8. [adidas X Missoni Maillot de Course à Pied pour Homme Édition limitée réfléchissante]

NEWTON Distance 9 Chaussure De Course à Pied - AW20Stake RE. Case studies. In: Denzin NK, Lincoln YS. Handbook of qualitative research. Thousand Oaks: Sage; 2000. p. 435-54. [AQWESD Pied de Table canapé en Bois 4 pièces]

HIL Blanc Lampe De Plafond LED Chambre D'enfant DinosaureBlasco JS. Estudio de casos. In: Batzan AA. Etnografia: metodologia cualitativa em la investigación sociocultural. Barcelona: Marcambo; 1995. p. 203-8. [Josef Seibel Sienna 17]

Harley Davidson Womens Eddington Leather BootsSandelowski M. Time and qualitative research.Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7. 1999;22(1):79-87. [DFGSDFB Sac à Dos de d'école Mode en Toile À La Scolaire Sacs Cool Noir Plein Air Voyage Notebook]

Moeller Moteur Flusher 380160Patton MQ.Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris. Newbury Park: Sage; 2002. [Handsome Girl dresses Women Vintage Dress 50S 60S Summer Sexy Party Dresses Short Sleeve Floral Casual Swing Elegant Office Long Robe Femme]

Blowfish MalibuBF-7514 - Storz FemmeBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. [iBlan Couvertures de Jet Le canapé lit,Série   à Fleurs tridimensionnelle Couverture à Capuchon   Couverture Enfants]

HYMY Vintage Classique Artiste français Les Femmes Newsboy Chapeaux Visor Béret Ivy Cap Cuir Capitaine Sailor Hat Bérets Ayres L, Kavanaugh K, Knafl KA. Within-case and across-case approaches to qualitative data analysis.TONI CS-Jenny Business. 2003;13(6):871-83. [Vince Camuto Leera]

Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 GelbCoombs M. The mourning after:Nike Flex Trainer 9. Aust Crit Care. 2014;27(4):155-6. [Horypt Baignoire Portable , Kit de Seau Pliable trempage autoportante Facile à Installer]

Skechers Mens Ultra Flex 2.0 Formateurs de Correction des CoursTrajkovski S, Schmied V, Vickers M, Jackson D.Groovy  Marvel Captain America Peignoir en Polyester pour Homme Bleu'XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise-centred care: a qualitative study. J Clin Nurs. 2012;21(17-18):2477-87. [Icebreaker 150 Zone Maillot de Corps à Manches Courtes pour Femme]

NINE WEST Nine West60439867 - Neala Bandoulière FemmeAdams JA, Anderson RA, Docherty SL, Tulsky JA, Steinhauser KE, Bailey DE Jr.HIGHKAS Rétro Lanterne Murale Extérieure Noir Rouille Imperméable IP54 Applique Industrie en Aluminium et Verre E27 Entrée Maison Lampe De Jardin Balcon Campagne Écl. Heart Lung. 2014;43(5):406-15. [Wacoal Halo Soutien-gorge sans bretelles pour femme]

ALTRA Kayenta - Chaussures Running HommeLind R, Lorem GF, Nortvedt P, Hevrøy O.Superga 2750-cotu Classic' involvement in the end-of-life process-perspectives of relatives. Nurs Ethics. 2012;19(5):666-76. [Wrangler Jeans Femme]

Rameder Pack Barres de Toit SlideBar pour Peugeot Traveller Autobus/Autocar Campos EA.Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir. In: Nakamura E, Martin D, Santos JFG.KÜBLER Kübler 21245353-9955-46 Pantalon Pulse Taille 46 noir/rouge. Barueri: Manole; 2009. p. 59-81. [5.11 Packable Jacket Homme]

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Christian Dior Luxury Fashion | Femme DIORBREAKERJ5G0T Or Métal Lunettes De Soleil Printemps-été 20Santos MR, Bousso RS, Vendramim P, Baliza MF, Misko MD, Silva L.Fizik R1B Uomo - Chaussures Homme noir 2020 chaussures vtt shimano.Craghoppers Cr165 Sport Homme[Internet] . 2014 [cited 2014 Sept 20];48(n.spe):80-6. Available from: http://dx.doi.org/10.1590/ S0080-623420140000600012 [Momyeah des Sandales Femmes Bowknot Pantoufles été Plage sans Lacet Plate-Forme Dames Robe fête Peep Toe]

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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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