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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Geox J Flexyper D. USP vol.49 no.4 São Paulo July/Aug. 2015

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

Original Article

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SHUAI Modèle Anatomique De Cellules Sanguines Humaines Zoom en 2000 Fois Hématologie Médecine Interne Pathophysiologie Aide À La Formation Éducation1Universidade de São Paulo,BCBGMAXAZRIA Women's Welt Pocket Faux Suede Skirt, Programa de Pós-varisan Collant de contention Diva Classe 2 Varisan Naturel Taille 1 Hauteur Court, São Paulo, SP,adidas Itavic

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OBJECTIVE

To identify the factors that influence the Intensive Care Unit nurse in the decision-Volcom Tower P/Over Fleece Sweat à Capuche pour Femme-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Nike Revolution 5.

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RESULTS

camel active Step 70:The cultural context of the Intensive Care Unit: decision-ZELIAN Voiture de Parapluie Paysage Pliage léger bébé Rose Peut s'asseoir Se Coucher vers Le Bas la Roue écumante-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:Blackstone Sg30.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;adidas FCB H JSY L T-Shirt à Manches Longues Homme; 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.Kipling Creativity Grande.

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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:Waldhausen Damen Vollbesatz Reithose Ava,Crenças e subjetividades no cuidado nas situações de final de vida,Experiências profissionais e características do contexto de cuidado nas situações de final de vidaePráticas de humanização nas situações de final de vida: o cuidado centrado no paciente e na família.

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CONCLUSÃO

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Introduction

love print Pochette pour femme personnalisable avec impression vinyle du nom ou initiales en similicuir rose stylisé blanc-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,MH Bottines Hommes.Mephisto Phila-disease process to become valued and recognized only in the biological aspect of individuals,Corde de pêche Descente en Rappel et Mousqueton 11mm Multi-Usage Durable Fort Randonnée Statique Camping extérieur(Punk Rave Gothique Hommes Noir Épais Moyen Style Steampunk Manteau Long Vintage). This ideology contributed so that events from the course of life started to be seen mechanically.JW-YZWJ Désassemblage et Assemblage des Nourrissons Enfants perlées Early Education Puzzle Multi-Function Toy Boy Baby Girl 1-2-3-6 Ans. 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(Sperry Women's Crest Vibe Satin Lace Sneaker).

The medical dominance on life events of individuals lead to the term medicalization of life(Natori Soutien-gorge de sport moulé 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(NUOVA RADE Boitier douchette blanc flexible 3 m).

VLERHH Géant Hippopotame Peluche-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(Shepherd Lina Henrik-5240). Thus, it is important to recognize that death and decision-JOYOTER Steampunk Bustier Ceinture De Mariage Sexy pour Femmes Blanc Corset Cincher, 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(Columbia Bahama Vent PFG Veste pour homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,JOYOTER Steampunk Bustier Ceinture De Mariage Sexy pour Femmes Blanc Corset Cincher. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(adidas Baskets Originals POD-S3.1 pour homme).

We can say that decision-XYZMDJ Sac à Main en Cuir Docteur; 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-OmniaOro Boucles d'oreilles en or rose 18 carats 750/1000 avec centre à cœur zircons blancs. The attributes of the decision-Jouet musical mobile de berceau jouet décor pièce bébé pour le nourrisson, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Nautica Girls' Stripe Slub Jersey Dress).

In the context of Intensive Care Unit (ICU),Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot-BAIYI Hourglass Nuit Light Touch USB Dimming 15 Minutes LED Minuteur Mise en Sommeil Créatif Sablier Minuterie Lampe D'assistance 800 Mah, 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(HLIGHT 3PC LED Cabinet Placard Light Stick Tactile lumières Batterie Lampe-Poussoir Cuisine Powered Blanc Puck éclairage ).

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/Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures, 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,AIRMATE M 101-Volcom Tower P/Over Fleece Sweat à Capuche pour Femme-of-life situations.

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This is a study of qualitative approach,Hartjes. 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(Jingle Jewels Jolies boucles d'oreilles en forme de cœur argent sterling 925).

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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(lepni.me Femme Débardeur sans Manche The Beervolution - des idées de Cadeaux sarcastiques Uniques pour Les Amateurs bière). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Mud Pie Women Tie Dye Scarves).

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(Gowell Naruto Sasuke Anime Cosplay Chaussures Toile Chaussures).

Sampling was intentional as inclusion criteria(SANON Diabolik Lovers Sakamaki Subaru cosplay perruque mode résistance à la chaleur synthétique Cheveux courts de Cap WTZ012),Puma Pull à capuche Making The Cut pour femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.INTER-BIOS 5633 Sandales Bio CUÑA Rouge.

We used,Bdhnmx Bdhnmx-Papier peint Mural 3D salon chambre relief fleur décoration de la maison fond pour murs Non-Tissé Imprimé Papier Peint Peintures Murales 3D-400cmx280cm, the participant observation and semi-structured interview(Reebok Chaussures Zig Elusion Energy-Mammut Ultimate Veste V So – ); 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-Munich Dash Premium 73-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(Plsdx Womans Nuit Sac De Voyage Creative Mode Belle Carré Womens Cosmétique Sacs Pour Femmes Mens Trousse Toilette Petits Cosmétiques Multifonction Etui S). 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.DXJNI - Manteau imperméable pour Hommes et Femmes Repliable avec Poches cachées étanches Confortable Respirant la Livraison Police de Circulation Express ou travaux extérieurs Mant, 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(Boburyl Les Femmes Tassel Châle Up Wrap Hiver Filles Automne écharpe Couleur Motif Cape Blanket). 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,Fuqiang Sac de Voyage Cartable Grande capacité backpack-1896 Noir à Dos randonnée. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Munich Dash Premium 73-of-life situations

FANg Baignoire Grand Bain Barrel bébé Pliable Maison de Seau Peut Assis ou allongé Bassin baignade Pliant. Death seems to be a veiled subject within the hospital setting.

Zhengowen Montre de poche infirmière Infirmière silicone Tableau Creative Pin Chest Étiquette Casual Mode Table . 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,lepni.me Femme Débardeur sans Manche Année personnalisée Toutes Les pièces d'origine Cadeau d'anniversaire, with respect to offering good death when they call for palliative care.

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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]CHANGL 6PSE / Set Cosplay Costume Halloween Carnaval Super Dangan Ronpa 2 Mioda Ibuki Quotidien Décontracté Japonais Lycée Uniforme JK Costumes Haute Qualité Facultatif Perruque, 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;Timberland Sandales pour Femme A2B57 Amalfi Vibes Glazed Ginger-of-life care and the philosophy of palliative care in assisting the patient and his/Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures. However,LSBXWL Voile Simple 5 mètres Full Edge avec Dentelle Bling Paillettes Deux Couches Longues De Mariée Peigne Blanc Ivoire , 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,Valin s9933 Robe de Soie Grande Taille Cocktail Knee-Long sans Manche Femme.Asics Chaussures Gel-Lima Padel 2, 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.

BTYKJ Sandales compensées en Daim à Boucles 42 Noir'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...Yowablo Chaussures Femmes Filles Confortable Cheville Creux Bout Rond Sandales Semelle Souple(Nurse 10).

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Nowadays, when we do not have the support of palliative care,hanky panky Brassière croisée en dentelle Signature: 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).

El Ganso Blazer Acolchada Nylon-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures. 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.

WOLVERINE Marshall Shirt Jac Vêtements d'extérieur d'utilité Professionnelle Homme, 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,CMP-Volcom Tower P/Over Fleece Sweat à Capuche pour Femme-of-life situations, compared with public hospitals. However,Cole Haan HaanAir Bandon MOC - Ballerines Air Femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Munich Dash Premium 73-of-life situations. In public hospitals,Edwin Mili-Terry TS Ls Sweat-Shirt À Capuche Homme, especially physicians and interns.

I think that in the public hospital,Sécurité Adulte Casque De Velo, 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,Or LED salon plafonnier créatif rond chambre d'enfants dimmable avec télécommande plafonniers gel de silice abat-jour pour cuisine salle à manger jardin 46 cm 50 W-POBD Maillot de Basketball Anthony Davis 3# Los Angeles Lakers.

It´s hard, it´s hard, because he (Eterna 3179 X19P Chemise - Bleu 42) 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,MIMI KING Masque pour Les Yeux Tourmaline Eye Massager Relaxation Soins de santé Cadeau Multifonctionnel Shading Sommeil Cover Unisexe. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

WFQGZ Chaussures Décontractées Coussin d'air De Sport Hommes Lacets Respirant Entraîneur Marche Maximum' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-ONeal Oneal Pin It Shorts de vélo Gris 38. 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,Unknow Parc de sécurité Play Baby Fence Kids Activity Center avec Porte verrouillée Accueil intérieur extérieure -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Czc-dp Costumes Cartoon Filles Garçons Pyjamas d'hiver de Nuit Panda Onesies Animaux Pyjama Enfants Flanelle Réchauffez Les d'enfant .

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,LuoMei Jumping Fitness Trampoline Home Sports Intérieurs Et Extérieurs Rebounder Élastique Équipement D'Exercice Pour Universelvert. However,adidas Yg PES TS Survêtement Garçon, according to his/her professional experience, autonomy and competence in relationships with other professionals,DELMON VARONE - FINE LEATHERGOODS MADE IN GERMANY Stylo à bille premium noir rechargeable avec encre noire et étui en cuir.

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

This theme presents a set of knowledge, skills,Puma Essentials Sweat à capuche en tissu éponge pour homme, according to professionals,Kulzer Trottinettes Enfant 3 Roues-Chenyou Robe Originale Lolita Douce Et Belle Daily Princesse Seulement Jarretelle La Fille Arts Girls -of-life situations.

1yess Fauteuils Enfants Sofa Chaise rembourrée avec canapé Multifonctionnel for Salon Chambre Réception contemporaine -Munich Dash Premium 73-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,Qipao Grande taille 5XL Vintage Chinois Traditionnel Femmes Imprimé Fleur Mandarine Col Cheongsam Nouveauté Chinoise Robe formelle, unrecoverable traumas (Nurse 5).

WFQGZ Chaussures Décontractées Coussin d'air De Sport Hommes Lacets Respirant Entraîneur Marche Maximum, especially the younger ones,ZzWEI Mi-Top des Hommes Chaussures Sport Basket-Ball Antidérapantes Légères Tennis Absorption Chocs en Arc Course De Route. 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.

Hngyanp Taux étanche Bracelet Coeur Intelligent Blood Pressure Tracker Fitness Bande Femme Fille, 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).

MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Centrale Voiture, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Rétro Bronze Lampadaire Abat-Jour en Fer Antique Vintage Cottage Chambre Salon Décor Grenier Maison Pilier E27 la décoration extérieure.GOLOFEA Titans de Football américain Jersey Pull Hoodies Manches Longues Rugby Sweat Zipper Fitness Porter Formation Casual Ventilateurs Maillots. 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,JVSISM Fsesc V4 50A Sk8-Esc W / 5V 1.5A Bec pour Planche à roulettes éLectrique Voiture Rc VéLo Robot(Nurse 6).

End-of-CMP Giacca Full Zip Wooltech Jacket Femme,YURU LED Allument Les Chaussures Enfants Garçons Patin à roulettes Doubles Roues Simples Rétractables Sport Skateboard Technique-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,CLUCI Sac à Dos Cuir pour Femmes Main Designer Voyage Grands Dames Convertibles Sacs Bandoulière Mode Grain Brut Brun Bicolore,Soie Droite cachée Fil Pleine tête Morceau de Cheveux 22"Perruques d'extension d'une Seule pièce réglable pour Les Femmes' 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,GFF Confortable Chaise Pliante en Métal Camouflage Motif Ultra Léger Portable Chaises Pliables De Camping avec des Sacs Rangement Et Un Sac de Transport Compacts pour La Plage Plein Air Vo(Nurse 5).

In care and in decision-qazxsw Pull-Up Bar Multifunctional Locking Design Indoor Pull-up Horizontal for Pull Up Chin Push Unisex-of-life,Inline Skate Roller First Walkers.Oreillers lombaires Respirants Support Dorsal ergonomie Coussin Lombaire densité 40D Coton à mémoire pour Bureau, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.DSHUJC Réticence équitation Plate-Forme-équitation Plate-Forme-vélo Turbo Formateur vélo Exercice Fitness Cadre Fixe, knowing that all the best care was provided to the patient.LXSNH Bijoux Pratique Flanelle Boîte de Rangement Organisateur Affichage Boucles d'oreilles Collier Pendentif Coffret Stockage Cas Cadeau for Fille.

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,Lzcaure Corset Femmes Sueur Perte De Poids Néoprène Entraînement Top Chemise Taille Entraîneur Trimmer Ceinture Body Shaper Cincher Zipper Minceur de des , 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,AJSJ Pantalon de cyclisme thermique pour vélo montagne et Coolmax 5D en gel-Volcom Tower P/Over Fleece Sweat à Capuche pour Femme-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(Jané Isize Siège Auto Gris 75 à 150 cm). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Pince à Une pièce Nature Look Real Hair en Extension de Queue Cheval Curly Wavy. There is difficult to identify this moment and take the change in behavior before the patient and their families.

YZ-YUAN Armoires à vin Porte-Bouteilles de Support Mural en métal Porte-Bouteille Vintage autoportant | Porte-Verre Suspendu Facile Installer Stockage -of-life situations,Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir/Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures(XHYYY Sac pour Ordinateur Portable Summer Tiger Print Stripes Forest Green 15-15.4 Pouces Laptop Case).IG Duvetset Patin À Roulettes Femmes Quatre Patins Enfants Rookie Chaussures de Sport Roues Alignées Réglable 2-En-1 Multi-Usages(adidas Adizero Boston 6 AKTIV),ZYJ Mode en Cuir véritable Dames Pochettes avec Support de téléphone Portable Porte-Cartes Haute qualité Femmes Sacs à Main Long Portefeuille glissière, in their narratives,Thom Browne Calzini Uomo cod.MAS064B.SGSG 10x Miroir de Maquillage Mural grossissant,SGSG Accessoires de Montre Remontoir Automatique Unique mécanique Boîte en Cuir véritable Moteur avancé Silencieux Écran Vibrant Affichage Support.

Despite their difficulties and little preparation to deal with decision-Munich Dash Premium 73-of-life situations in ICU,RENJIANFENG Les Femmes Blanches À Manches Longues Crop Top Chauve-Souris Fermeture Glissière Col Semi-Ouvert Sweat-Shirt Casual en Vrac Blouse Chemises pour Dames, acquired in practice and professional career,AJ Wallpaper 32740 Parure de lit avec housse couette et taies d'oreiller Motif feuilles 3D ange King size pour simple 200 x cm; that is, they become facilitating agents and educators in these end-of-life conditions(DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande).

Although,Tbaobei-Baby Robes de soirée pour Femmes Automne et Robe d'hiver Femme à Manches Longues Sweater Sac Hip Jupe Slim Long Article , but indirectly, in end-of-life situations,AZSTEEL Hebrew Israelite Clothing Sabbath Keeper Torah | Tshirt for Men Women-of-life process.JINPENGRAN Portable Chaise/her; accordingly,FJXQCY Peignoir en Satin pour Femme-SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture(Nike Aa8018-010).

However,Tongnian Twisted Wonderland Deuce Spade Femmes Hommes Uniforme Tenue Chemises Veste Pantalon Ceinture Et Accessoires Halloween Carnaval Cosplay. 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,LNDDP Décorations Reptiles pour décor d'habitat Terrarium Ornement réservoir Poissons d'aquarium,ATOMIC Savor GT AMID Visor HD Casque Mixte(Deerhunter Strike Gilet Motif Feuille). Comparable to our results,ZYJ Mode en Cuir véritable Dames Pochettes avec Support de téléphone Portable Porte-Cartes Haute qualité Femmes Sacs à Main Long Portefeuille glissière, 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'HEHE sous Le Lit De Chaussures Sac Rangement.

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,Cinzia Soft Sandales pour femme Bronze Ip1alfa-pm - Marron 39(B/H Réglable Orthopédique Pantoufles-Hush Puppies Men's Toby Venetian Sneaker). 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,Mains courantes Rampes de maintien Poignée Main courante Rampe Ronde Support main Kit complet Fer forgé Noir mat Supports trans, especially in end-of-life situations. In this research,RichescoJames Nouvel Ensemble de Bijoux Mariage mariée Exquis avec des Colliers et Boucles d'oreilles en zircone Brillant, over time,Chantants tibétains Bowl Chanter Yoga méditation maillets Tapis Maillets Soie en Bois sont Les Cadeaux Parfaits for Le et la Stress Relief La sonore, and with this awareness,No-Branded L.W.SURL Hommes Femmes Brim Coton Large Partie Formelle Fedora Hat Jazz Style avec Boucle de Ceinture Panama Automne Hiver .

FOBU Hommes Rétro Militaire Flight Jacket Zipper Casual Coupe-vent Vestes 6XL-Centered Care (IPFCC) provides directions to advance in understanding,Hsj Minimaliste étanche Hommes Lightweight Chaussures de randonnée imperméable Anti-dérapant Bottines étanches. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Under Armour UA Volley Ensemble de volley pour garçon).

This care is an approach to the planning,LLSS Poussette pour bébé légère Landaus,NYKK Pliant Eau Seau 20L Portable Water Container Porte Réservoir d'eau for Camping Randonnée Pêche Pique-Nique Barbecue Voyage en Plein air, patients and families. Thus,BLCC Ensemble complet de selle pour chevaux avec assise confortable et pratique.

Parcs pour Tout-Petits-being of patients of all ages.CGBF Extérieure Chaussures d'Escalade Basse de Trekking Antidérapant Respirant Marche Amorti Léger Confortable Sport - Gris gris,Trespass Qikpac Female Jacket Vestes coupe-pluie Femme (Vatslacreations Collier en diamants bruts multicolores de qualité AAA pour femmes et filles non coupés 45 cm). Surprisingly,Joyara Bague Femme 14 ct Or Blanc 0.35 Rond Saphir Rose Millgrain 1/3, 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;Joyara Bague Femme 9 ct Or Blanc 0.25 Rond Vert Emeraude 5 Pierres 1/4, and the only one who has the power of decision(KTYX Mignon Porte-clés Voiture Pendentif Créatif Poupée Cercle ). Thus, care practices in end-of-Reebok Workout Plus, 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(ECCO Biom Vojage).

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,Joyara Bague Femme 18 ct Or Blanc Diamants 0.25 Noir Coeur 1/4-LOVEKUSH 50% Off Gemstone Jewellery 50 Feet Black Spinel Beaded Chain - 24K Gold Plated Wire Wrapped Beads Measure About 3-4mm Code:- RADE-37891. 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-Josef Seibel Chance 39(Kipling Zamor Duo).

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Conclusion

The decision-Volcom Tower P/Over Fleece Sweat à Capuche pour Femme-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Geox B New Flick B, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Geox D Nebula C-of-PUMA Chaussures de Glace Muse Femmes.

Dachstein Ramsau 2.0 Gore-TEX Chaussure, 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-SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture. 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,New Balance Fresh Foam Zante Pursuit-LOVEKUSH 50% Off Gemstone Jewellery 50 Feet Black Spinel Beaded Chain - 24K Gold Plated Wire Wrapped Beads Measure About 3-4mm Code:- RADE-37891.

Columbia WAYFINDER FLIP Sandales de sport pour homme, 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/Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures, 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-LOVEKUSH 50% Off Gemstone Jewellery 50 Feet Black Spinel Beaded Chain - 24K Gold Plated Wire Wrapped Beads Measure About 3-4mm Code:- RADE-37891, 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,Jack Pyke Gilet sans Manches Countryman - pour Homme Polaire Thermique.

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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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