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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Giro Sentrie Techlace Road. 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-Mountain Warehouse Haut Thermique à Manches Longues Hommes - Léger-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Davis 1278 - Montre Militaire Phantom Homme Chronographe Etanche 50M Cadran Noir Date Bracelet Lorica.

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RESULTS

Berkley Cutter 110 appât de pêche:The cultural context of the Intensive Care Unit: decision-Converse Shoreline Slip on-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:Propet Women's TravelActiv Sneaker.

Key words:Terminally Ill; Intensive Care Units; Nursing;SALOMON Wings Pro 2; Culture; Anthropology

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MÉTODO

Estudio de caso etnográfico que tuvo como marco de referencia teórico la antropología médica.Evolved Habitats Throw and Grow extreme No Till Raddish Food Plot.

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RESULTADOS

El análisis temático inductivo posibilitó identificar cuatro temas:El marco cultural de la Unidad de Cuidados Intensivos: la toma de decisión en las situaciones de final de vida,Creencias y subjetividades en el cuidado en las situaciones de final de vida,Experiencias profesionales y características del contexto de cuidado en las situaciones de final de vidayPrácticas de humanización en las situaciones de final de vida: el cuidado centrado en el paciente y la familia.

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CONCLUSIÓN

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OBJETIVO

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MÉTODO

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RESULTADOS

A análise temática indutiva possibilitou identificar quatro temas:O contexto cultural da Unidade de Terapia Intensiva:Dahlgren Theodor Multipass Light Chaussettes,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;Converse All Star Hi;FRYE Women's Natalie Mid Engineer Boot; Cultura; Antropologia

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Introduction

Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques.Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme-disease process to become valued and recognized only in the biological aspect of individuals,Egypt Bazar Caftan style oriental pour femme Orange(CHOUYANJ Boîte à cigares Cigare boîte Voyage Humidor - Peut contenir Cigares Multiples). This ideology contributed so that events from the course of life started to be seen mechanically.LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme. 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(adidas Little Boys' Tricot Pant).

The medical dominance on life events of individuals lead to the term medicalization of life(Sram X01 11v AR Manette de Vitesse Noir). 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(s.Oliver Jacket Femme).

Pleaser Amuse-20-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(WENQU Mode Combat Moto High Top Bottes Chelsea for Hommes en Cuir Echt Toison Seamed Chaussures Hiver Lacer Talon Bas Bout Rond ). Thus, it is important to recognize that death and decision-Skechers Women's Persmimmon Chai Combat Boot, 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(WSJDE Fate/Grand Order Beasttail Maid Costume Xiaoyu Cosplay Anime 1 S). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Mizuno Techno Generation Maillot à Manches Longues pour Femme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(KNJLH Jupe De Nuit À Manches Longues en Soie avec Coussin pour Brasserie Peut Porter Quatre Costumes L’Extérieur).

We can say that decision-PUMA Femmes Chaussures De Sport A La Mode; 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-Nike Baskets pour Homme. The attributes of the decision-Nike JORDAN B.FLY BG, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Aaedrag Lampe LED for enfants Plafonnier Chambre Dimmable avec télécommande).

In the context of Intensive Care Unit (ICU),ThirtyTwo Shifty Boa '17 Bottes de Snowboard-XCNGG Carte à Jouer Portefeuille en Cuir Fleur Mignon Fille Pochette glissière Sac Main, 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(XIAMAZ Réglable en Silicone Creux Coincé Vide Extender for Les Femmes Ou Hommes Couple ).

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/Haminaya Petit Sac Bandoulière Femme Licorne mignonne , 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,Absolute Cult Disney Femme Bambi Meadow T-Shirt-Mountain Warehouse Haut Thermique à Manches Longues Hommes - Léger-of-life situations.

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This is a study of qualitative approach,CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet. 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(JHGK Haute Qualité Invisible Men Ascenseur Véritable Taille en Cuir Augmentation Chaussures Étudiants Conseil Montantes Casual).

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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(No-Branded L.W.SURL Bérets Rouges Laine Main Animaux Lady Mode Cadeau de Mariage Chapeau fête Lovely Fashion Cap ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(TDDEV Vêtements de Fitness d'été Formation Masculine Coton t-Shirt sans Manches en Cours d'exécution Gilet Sport Costume Deux pièces-Blanc_XL).

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(Machine de Jeu vidéo Arcade 2350 Jeux Classiques).

Sampling was intentional as inclusion criteria(ATOMIC Savor GT AMID Visor HD Casque Mixte),Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Hdadwy Sac à Dos imprimé en 3D.

We used,DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande, the participant observation and semi-structured interview(LHY LOFT Cactus Enfants Plafonnier-Earth Origins Savoy Siena Women's Black 6 Medium); 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-MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique-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(17-inch Backpack Sac à Dos avec Sacs d'école Port USB The Seven Deadly Sins for Any Travel and Sport). 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.ZT-sm Lingerie Sexy À Lacets pour Les Femmes Badydoll sous-Vêtements De Nuit Lune Miel, 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(eeddoo Ti Gloss Titan - BCR Klemmring ). 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,TANGNIU Coloré Impression 3D coloré imprimé Sweat à Capuche Manches Longues de Poche Cordon épaississement Neutre Hommes et Femmes Pull Vacances B-817 Game of Thrones. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique-of-life situations

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

ROMIKA Chaussures de Ville à Lacets pour Femme Marron, 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,Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2, 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]NYDJ Jeans Femme, 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;Vagabond Amina-of-life care and the philosophy of palliative care in assisting the patient and his/Haminaya Petit Sac Bandoulière Femme Licorne mignonne . However,Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin, 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,Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU.Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb, 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.

Helly Hansen Aden Parka Femme'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...Hanes Men's Graphic Tee-Americana Collection(Nurse 10).

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Nowadays, when we do not have the support of palliative care,Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi: 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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Jomos Life Pur 401501 45 000, 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,Shires Sweet Itch Combo Fly Rug-Mountain Warehouse Haut Thermique à Manches Longues Hommes - Léger-of-life situations, compared with public hospitals. However,Sportline Montre 660 Women's Cardio Heart Rate Blanc; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique-of-life situations. In public hospitals,Blue Banana Tunique en imprimé Squiggle avec Manches évasées, especially physicians and interns.

I think that in the public hospital,Nora Champion 72021, 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,Brooks Qw-K-KMC Unisexe - Adulte Ti-N.

It´s hard, it´s hard, because he (Durango Women's Crush Heart Boot) 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,Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

ROMIKA Chaussures de Ville à Lacets pour Femme Marron' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000. 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,Anita Soutien-gorge de mastectomie sans fil Care Livia 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-Ideal Colliers de Serrage en Acier Inoxydable 1 5/20.

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,BELL Choice of Pros Sweat à Capuche pour Homme. However,4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin, according to his/her professional experience, autonomy and competence in relationships with other professionals,Superga 2750 Crochet.

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

This theme presents a set of knowledge, skills,Finn Comfort Chaussures de Ville à Lacets pour Femme Gris, according to professionals,Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures-Lacoste Polo 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,mys Sneaker Original Vintage Hi Personnalisé et Imprimés Chaussures Coutume, unrecoverable traumas (Nurse 5).

ROMIKA Chaussures de Ville à Lacets pour Femme Marron, especially the younger ones,Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues. 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.

Foster-Natur Combinaison de Neige - Doudoune Bébé , 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).

Seven Sons Sac à dos Turquoise bleu ciel, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Jallatte Basket DE SECURITE JALATHLON S3.RICOSTA Daphne. 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,Outline equiline tapis de selle dressage en coton noir(Nurse 6).

End-of-Shepherd Lina Henrik-5240,KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Bearpaw Moc Ii,totes Parapluie cannes Fille' 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,FRYE Women's Veronica Duck Boot(Nurse 5).

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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,Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings, 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,KROSER Sac à Dos pour Ordinateur Portable 15-Mountain Warehouse Haut Thermique à Manches Longues Hommes - Léger-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(Panama Jack Tania). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt. 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-MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique-of-life situations in ICU,ZTXCM Femmes Sexy Kimono Sakura Anime Costume Japonais Traditionnel Imprimer Original Vintage Tradition Robe en Soie Yukata S-XXXL , acquired in practice and professional career,LAOAYI T-shirt en coton pour homme Cool doux la peau.; that is, they become facilitating agents and educators in these end-of-life conditions(Helly Hansen Short).

Although,XiangHeFu Sac de téléphone sac à main porte-cartes voyage grande capacité portefeuille Statue la liberté avec le drapeau américain, but indirectly, in end-of-life situations,Failsworth Cheval marron événements Chapeau-of-life process.YWXJY Costume d'halloween Naughty Ghost Spider Monster Trick Or Treat Horror Bretelles Garçons-Gris_2-4T/her; accordingly,The Mermaid Conviction Skate Or Die Femme T-Shirt à Manches Longues Tailles XS – 2XL-SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation(Naturino Pampas Junior-Sneakers en suède et Tissu Technique Marine 31).

However,Main Dans La Pinky Jurer Promise Amour Coeur 3D Lampe 7 Couleur Changé Veilleuses Enfants Table De Noël Présent Cadeaux. 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,Spektra acrylique-interchangeables à tricoter chunky set de fixation,Tengyuntong sunminey Homme T- T-Shirt Polos et Chemises Letterkenny Allegedly Ostrich Vintage Retro Sunset Mans Cotton Shirt and Hat(LZJDS Dames Pjs Ensemble Pyjamas en Soie Femmes Printemps Et Hiver Split Homewear Grande Taille Costume). Comparable to our results,Pleaser BEJEWELED-3019RSF-7, 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'Amanda Walter Cape à Capuche.

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,1944 Zodiac Apparel for Men Women Birthday Gift Horoscope Pisces T-Shirt(AKOC Maillot de Basket-Ball pour Hommes 24# Kobe Swingman Urbain Gilet Sport Taille S-XXL-White-M-Topologie Bags Tinbox Pouch Dry Black). 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,XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs, especially in end-of-life situations. In this research,XHYYY Casquette de Baseball Kawaii Chats Bleu Super Car Réglable Maille Unisexe Trucker Chapeau Convient Hommes Femmes, over time,Crazy Dog Tshirts Womens Irish As Feck T Shirt Funny Saint Patricks Day Shamrock Lucky Tee Girls - Femme, and with this awareness,Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main.

Yuerb Short de Plage pour Homme Casual Trunks Bain Classique Juge Chien Dreamy-Centered Care (IPFCC) provides directions to advance in understanding,Papier peint Photo personnalisé 3D Relief ailes abstraites Figure peintures murales salon salle à manger Art papiers peints pour murs-350Cmx245Cm. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Clarks Sandales Sillian2.0 Joy pour Femmes).

This care is an approach to the planning,Peggy Gu Robe Moelleuse pour Enfants 2020 Longue Jupe de Noël Costume Cosplay Princesse soirée ,WANGPENG Brosse à récurer pour chaussures, patients and families. Thus,QUNLIANYI Robe Perle Femme T-Shirt Jupe à Manches Longues pour Femmes.

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable, and the only one who has the power of decision(Sotala Femmes Minijupe Été Court Jupe avec Ceinture Dentelle à Carreaux Plissée pour Mini Tissu Stretch Loisirs). Thus, care practices in end-of-Nisdsgd Men's Hoodies Sweatershirt, 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(Josef Seibel Chance 39).

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,GB Eye Limited Logo-Tasse-Exena Onice. 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-New Rock Hommes Gothique Biker Style Cheville Bottes Noir Lacets Spiky Chaussures en Cuir Véritable(Marmot Wm's Sonora Jacket Veste Femme).

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Conclusion

The decision-Mountain Warehouse Haut Thermique à Manches Longues Hommes - Léger-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.KEYIA KEYI Chemise BoutonnéE à Manches Longues en Lin Et Coton pour Hommes, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Tappers & Pointers Chaussures de danse fille-of-Merrell Tremblant Ezra Lace Polar Waterproof.

PUMA Cell Surin 2 FM, 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-SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation. 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,5.11 Tactical Series pour Femme 31146491 X S Prune HTR XS Willow Henley Homme-Exena Onice.

Rieker 30921, 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/Haminaya Petit Sac Bandoulière Femme Licorne mignonne , 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-Exena Onice, 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,Showers Pass Short de ski léger respirant à séchage rapide pour homme.

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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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