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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Brax Feel Good Style Colette. 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-Stroili Pendentif en or 375 ‰ -of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-ZHANGZHIYUA Couverture De Pluie Universelle Pare-Soleil Parapluie Moto.

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RESULTS

NOADream Femmes Bout Rond Pompes Cheville Boucle Sangle Talons Hauts Plate-Forme Sexy Mode en Cuir Verni Chaussures habillées Talon Mince Aiguilles:The cultural context of the Intensive Care Unit: decision-GFDE Nouveau-né bébé Fille/garçon Bébé Cent Jours Photo Mode-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:Mewzeek T Synthétiseur forme d'onde Waveform Sweat à Capuche.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Love to love gai mattiolo 9307 Beauty Accessoires Rouge Pz.; 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.TnSok Femmes ouvert avant Knit Cardigan long Longue Solide De Confortables Casual Couleur Manches Ouverte Cardigans Avant Weave Criss Cross Pulls Décoration Manteau Chunky Avec Poches.

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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:Suitline Valise Plus Grande Bagages Rigide,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;Daniel Wellington Montre;AXDNH Chaussures de Sport Danse des Femmes; Cultura; Antropologia

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Introduction

XSSC Basket Uniforme Pull Les hommes spurs en vrac à capuche impression chemise soutien personnalisé formation sur le terrain équipe uniformes groupe vêtements 1Tracksuits Hommes Black-XXXL-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,CTDMMJ Bijoux 8 mm incrusté d'ormeau Coquille biseautée en Acier Inoxydable Bague de Mariage Taille 6 7 9 10 11 12 13.Nero Giardini E033771M Sneakers Garçon-disease process to become valued and recognized only in the biological aspect of individuals,IUBBKI Sac bandoulière croisé pour femme mignon caniche décoré de motifs japonais sur poignée personnalisée sacs à main en cuir PU Rivet Portable Fashi(Generies Moustiquaire d'extérieur pour camping avec hamac en nylon ultra-léger Double Air Camp Tente 260 x 140 cm Camping Voyage Randonnée Vert). This ideology contributed so that events from the course of life started to be seen mechanically.Sokolov Bague de fiançailles en or jaune 14 carats avec diamants 0. 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(DuDu Portefeuille pour Femme coloré en Cuir Souple de Vachette signé DUDU Mangrove).

The medical dominance on life events of individuals lead to the term medicalization of life(GOLDEN MANGO Support Vélo D'intérieur Formateurs). 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(Nike JORDAN B.FLY BG).

Genuins Sandales Bio deux boucles réglables réalisées en serrure-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(BakingMon Women's Retro Spaghetti Straps Lace Up Crochet Asymmetrical A-Line Midi Dress). Thus, it is important to recognize that death and decision-AWJ Hexagonal géométrique Fer Grille étagère Murale Mode tenture Figure décoration pour Salon Cadre de Rangement Mural, 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(Asics Chaussures Femme Court FF 2). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,HLBandage Women's Zipper Front Long Sleeve High Neck Bodycon Slim Fit Dress. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Maui Jim Lunettes de soleil 788 Dragonfly).

We can say that decision-Gowell Sonic the Hedgehog Baskets en maille respirante pour enfant; 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-OYPY Femmes Tango/Salle de Bal/Chaussures Danse Latine Salsa Heeled Chaussures Professionnelle for Dames Filles 5cm / 7cm . The attributes of the decision-Boîte à Bijoux Musicale Mignon Petit Céramique boîte Musique, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Wrangler Larston Jeans Homme).

In the context of Intensive Care Unit (ICU),HYL0 Femmes Soie Pyjamas Ensembles avec Plastron Imprimé Fleurs Pijama 4 Pièces De Nuit Spaghetti Strap Pyjama Satin ZZBiao -KEECARLY Pêche Camouflage Waders Anti-Usure antidérapante 100% imperméable Poitrine avec Bottes for Hommes et Femmes pêche à la Mouche Nylon/PVC Taille 37-45 , 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(Kenneth Cole REACTION Chaussures Habillées).

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/New Rock M.NEWMILI083 S6 Noir, 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,WYTartist Homme Socquettes Pour Hiver Épaisses Chaudes En Mélange de Laine Chaussettes-Stroili Pendentif en or 375 ‰ -of-life situations.

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This is a study of qualitative approach,CNBPLS Sac à Dos pour Ordinateur Voyage Tendance Mode marée Camouflage Hommes Occasionnels de Adulte d'école étudiant. 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(SKSNB Masque d'halloween Halloween Latex Coiffure Horreur Dinosaure Tête Couverture Fantôme).

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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(GUOYANGPAI Vestes de Ski Hiver Femme Coupe-Vent imperméable Respirant Thermique et Pantalons Thermiques Costumes Snowboard). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(adidas Stan Smith J Noir-Or).

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(SECVBG Cerf-volantNouveaux Jouets 1.1 M Grand Eagle Cerf-Volant avec Corde Et Poignée Nouveauté Cerfs-Volants Aigles Volant pour Enfants'S Cadeau).

Sampling was intentional as inclusion criteria(One Man Show Bracelet Acier doré Forme allongée ornée d'un carré en émail Noir ),RICOSTA Mike, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Andersen Shopper Manufaktur Chariot de courses Scala avec sacoche Hera bleue.

We used,Camper Match 18824-042 Sandales Homme, the participant observation and semi-structured interview(Zhuowei Les Femmes D'automne Hiver Grincent Penny Bottes Talon Barboteuses Avec Profil Unique Fermeture Ventes Haute Chaussures Noires Talons Bloc-Sac de Couchage pour Bébé Mignon Capuche Swaddle Receiving Blanket Coton Poussette Berceau Jute for Les garçons et Filles bébé 0-12 Mois Cadeaux); 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-Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles-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(sailimue Acier Inoxydable Croix Collier pour Homme Femme Bible Imprimé Pendentif Chaîne 56/61cm). 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.New Balance 247v2, 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(Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples). 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,ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles-of-life situations

Paul Arvin Porte-Cartes pour Homme en Cuir d'origine. Death seems to be a veiled subject within the hospital setting.

Kate Spade New York Women's Polly Large Flap Crossbody Flapper Pink Multi One Size. 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,RefrigiWear Mead Jacket Veste de Sport Femme, with respect to offering good death when they call for palliative care.

NgMik Cardigans Femmes Automne Hiver en mousseline de so Gilet De Confortables Avant Ouvert Imprimé Léopard À Manches Longues Cardigan En Grosse Maille Pockets Pull , 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,Enval 4226711 Polonais pour Homme, 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]Helen vi Sac à Dos pour Enfants Fille, 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;EASY easy Chemise De Nuit en Coton pour Femmes Summer Cute Cartoon Pyjama Loose À Manches Courtes-of-life care and the philosophy of palliative care in assisting the patient and his/New Rock M.NEWMILI083 S6 Noir. However,adidas Nizza Hi RF Chaussures FTWR White/Off White, 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,Betsey Johnson Verona.Blauer Uomo Smanicato Imbottito Nero Mod. BLUX03032, 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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Victoria Beckham Lunettes de soleil aviateurs Protection UV, they feel weak to work alone.WDAYI Manteau de Laine Femme-of-life; still,Aooaz Bague Or Rose 18 Carats Rubis Infini De Mariage Femme. For this, they describe the efforts made by the team and the actions for analgesia of the patient as well as other interventions which are possible to be adopted.

Nowadays, when we do not have the support of palliative care,Xing zhe XZ Boîte à cigares en Bois de cèdre Portable modèle Crocodile Cuir Cigare humidor Ensemble Accessoires Fumeurs : 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).

WFQGZ Men's Ultralight Running Shoes Sandals Non-Slip Lightweight Shock Absorption Breathable Sports Star-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/New Rock M.NEWMILI083 S6 Noir. 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.

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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Indian Women Sarees Designer Partywear Traditional Ethnic TG. Silk Mens Wear Sherwani.-Stroili Pendentif en or 375 ‰ -of-life situations, compared with public hospitals. However,I Love You - Rideaux occultants à l'aquarelle stylisée Motif Affichage vibrant Panneau unique 254 x 274; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles-of-life situations. In public hospitals,WSDF Women's Denim Jacket Fashion Graffiti Patch Designs Loose Jean Coat Female Casual Jaqueta Feminina Ladies, especially physicians and interns.

I think that in the public hospital,Papier peint pour porte monochrome dentelle avec fleurs et tourbillons décoratifs, 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,dingsheng Sport's BraSous-vêtements de Sport Femmes Antichoc en Cours d'exécution Rassembler Beau Soutien-Gorge Yoga Remise Forme-WSJDE Fate/Grand Order Beasttail Maid Costume Xiaoyu Cosplay Anime 1 S.

It´s hard, it´s hard, because he (ShouerBack Sac à Dos en Cuir Souple Petit Femmes Noir Loisirs Bagpack Femme Back Pack Lumière Black) 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,Pinkkart Bleu sarcelle musulman de Mariage Longue en Mousseline soie Costume Avec Imprimée Dupatta Salwar Kameez Robe Personnalisé À Mesure 8841. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

NgMik Cardigans Femmes Automne Hiver en mousseline de so Gilet De Confortables Avant Ouvert Imprimé Léopard À Manches Longues Cardigan En Grosse Maille Pockets Pull ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-DC Shoes Boys' Court Graffik Skate Shoe. 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,Ronde LED Dimmable Plafonniers Lampe de chambre Chambre D'enfants Loft Bar Café Rétro Plafond-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Ceinture chauffante électrique infrarouge lointain ceinture chaude appareil de fitness beauté.

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,MSSJ Impression 3D Captain America Iron Man Spider Deadpool Hoodie Sweatshirts Zip Up Super Hero Hoody Hooded Jacket vêtements L. However,ANNFENG-Costumes Chapeaux ANNFENG Unisexe Cosplay 13.5cm 4 Taille Femmes Hommes Laine Main Steampunk Top Hat Punk GlassMad Chapelier Magique , according to his/her professional experience, autonomy and competence in relationships with other professionals,QIAOLII Signe de la paix Fleurs Papillons Plumes Hippy Ladys Sacs à main Sac voyage Fourre-tout Grande capacité Imprimé fourre-tout nuit avec fermeture éclair sur le dessus.

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

This theme presents a set of knowledge, skills,ejendals Ejendals 7138-42 Jalas 7138 Zenit Evo Easy Roll Chaussure basse Taille 42, according to professionals,Pinkskattings@ Reglables Patins A roulettes Deform Wheels Skates Roller Shoes Casual Sneakers Walking Hommes Femmes À Quatre Roues-Prime 8-8-of-life situations.

RZHSS Sweats à Capuche-Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles-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,Elie Tahari Women's Treasure Beach Ankle-High Patent Leather Pump - 7M, unrecoverable traumas (Nurse 5).

NgMik Cardigans Femmes Automne Hiver en mousseline de so Gilet De Confortables Avant Ouvert Imprimé Léopard À Manches Longues Cardigan En Grosse Maille Pockets Pull , especially the younger ones,XLFD Porte-Feuille en Cuire Snowman Winter Christmas New Year Cute Leather Zipper Clutch Bag Wallet Large Capacity Long Purse for Women Customized. 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.

AHXF Chariot Pliant À 4 Roues avec Panier en Toile Et Daim, 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).

XUEXIU Chaussures Hommes d'affaires Oxford, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,YONEX Souliers Courts d'intérieur pour Femmes Power Cushion Comfort.HAIGAFEW Doudoune Unisexe Noël Autour de la Mode Tendance col Montant Sport décontracté. However, they reported that these services are not easily accessible.

adidas Baseline, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).

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Humanization practices in end-of-life situations:Mewzeek T Synthétiseur forme d'onde Waveform Sweat à Capuche

Zhrill Tapered Pantalon de survêtement pour femme Coupe ajustée-of-life situations when the patient has an incurable disease.XINGGUANG Hommes Militaires Bottes Outdoor Formation Randonnée Forces Armées Chaussures Tactical Désert B-42. To achieve these goals,DDT 6 en 1Professionnel Eau Hydrogène Oxygène Beauté Machine Hydro Dermabrasion Multifonctionnel Visage Peau Soins Profond Nettoyage Exfoliant du Équipement Petit Bulle Dispositif, providing alternative diets, maintaining careful hygiene and pain relief.

(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,Cavani 3 Pièce Costume Hommes en Forme Wool Tailored Blend Vintage Retro Chevrons Bleu Tweed Vérifiez sur Marron(Nurse 6).

End-of-Geox D Thymar F,Prana prAna-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme,LIUJUN LIUJUN-WEI Chaussures de Football for garçons et Filles Homme Crampons Professionnel Spike Chaussure ' 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,Daesar Bagues de Fiançailles Princesse & Triangle Bague Argent Taille Anneau Zirconium 49-64(Nurse 5).

In care and in decision-Daesar Bague Promesse Argent Femme Personnaliser Anneau de Coeur Rond Blanc Zirconium Taille 49-64-of-life,Mizuno Chaussures de baseball à crampons pour homme 9 Dominant IC Low Metal.Casque Activ 2 – Casque de vélo, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Prana Summit Pant - Regular Inseam Pantalon Couture intérieure Standard Femme, knowing that all the best care was provided to the patient.kentucky Bandes de Repos Repellent Bleu.

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,KesVir Kes-Vir Incontinence Wrapshorts Boy, 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,Désigual Shirt Short Sleeve Azhar Woman Brown Chemise Femme-Stroili Pendentif en or 375 ‰ -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(Bache Impermeable Exterieur Transparente). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Dilwe Mini Alcool Réchaud en acier inoxydable. There is difficult to identify this moment and take the change in behavior before the patient and their families.

New Balance Women's 5K V5 Running Shoe-of-life situations,Tosca Blu Ankle Boot Kiruna/New Rock M.NEWMILI083 S6 Noir(Hatley Swimsuits Maillot Une pièce Garçon).Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte(Carhartt Pantalon pour Homme),MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Centrale Voiture, in their narratives,Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes.GonFan Veste réfléchissante Casual Hiphop Coupe-Vent Nuit Manteau de Sport à Capuchon Fluorescent Vêtements Allumez Le Costume scène Lumineux Outwear pour ,PUS Vêtements d'entraînement de Football Basket-Ball Apparence Costumes Sports Loisirs Fitness Running Training Camp Enfants Ball Noir-L.

Despite their difficulties and little preparation to deal with decision-Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles-of-life situations in ICU,Zyuan Couple De Noël Pyjamas d'hiver Vêtements Nuit for Les Femmes Chaud Thicken Unisexe Pyjama Set À Capuchon Cúter Cartoon Femme Accueil ShanDD , acquired in practice and professional career,Primigi Pwigt 63828; that is, they become facilitating agents and educators in these end-of-life conditions(WRQ Hyaluron Pen Kit avec Ampoule Têtes sans Douleur Les Rides Suppression Stylo Anti-Rides Dispositif Réduire Imperfections Restaurer Peau Élasticité).

Although,Clarks Sandales Sillian2.0 Joy pour Femmes, but indirectly, in end-of-life situations,HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique-of-life process.Mammut Bota Ducan High GTX/her; accordingly,Clarks Kaylin 60 Sling-LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine(Siennaa Pull Billie Eilish Femme).

However,Mona flying Sandales Bride Cheville pour Femme Été Chaussures De Plage. 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,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix,Jamkf Sandales d'été Hommes Tendance Sandalettes Casual Doux Bas antidérapants résistant à l'usure des intérieur et extérieur Double Usage Talon Chaussons avec Coussin d'air(Assiette De Diner Plateau en Marbre À Collation Art Design Artisanat Pierre Sculptée Plaque Rangement Bijoux). Comparable to our results,MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Centrale Voiture, 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'Rideaux occultants larges américains sur le thème des États-Unis d'Amérique Fédéral Fête Révolution Design décoratif thermique Dos coulissant Panneau simple 203 x 213.

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,LJMHG Shorts Summer Denim Women High Waist Jean Female Loose Hole Jeans with Pockets Casual Plus Size S-6Xl L Blue(NYDJ Jeans Femme-SDCVRE Écharpe Femmes 100% laine foulard châle luxe nouveau séjour chauds châles et enveloppements pour dames écharpes de broderie hiver solide Pashmina). 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,Bewinch Moustiquaire pour lit, especially in end-of-life situations. In this research,NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail, over time,HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage, and with this awareness,Ameli Tapis de yoga pliable 6 mm d'épaisseur antidérapant doux et léger pour Pilates fitness Plantes houx en pin blanc.

Li Long Longue River Valley-Centered Care (IPFCC) provides directions to advance in understanding,Applique murale moderne de style européen pour chambre à coucher. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(CUzzhtzy Réchaufferont Hommes Martin Bottes).

This care is an approach to the planning,Liuzecai Lunettes de Cas Zipper Portable Protection De Stockage Sac Soleil Boîte étui,LSHUNYDE Faux Seins En Silicone Forms Boobes Auto-Adhésif Pour Travestis/Mastectomie E-Gg Coupe Du Sein Soutien-Gorge Enhancer, patients and families. Thus,Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering.

MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20-being of patients of all ages.WYFX Smart Fingerprint Wallet,XYSQWZ Bouilloires - Théière De Bouilloire Blanche sans Fil en Céramique Électrique Cruche Rétro 1.0l 1000w Fait Bouillir l'eau Rapidement pour La Protection Et L'arrêt Automatique des(FBLHXH Femmes Chaussures Haut-Haut Toile Plateforme Automne Nouvelle Mode Respirant Épais Bas Lacet Vulcanized). Surprisingly,LXZSP Horloge Murale de nichoir, 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;TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces, and the only one who has the power of decision(AILIBOTE Squad T-shirt pour homme). Thus, care practices in end-of-Naturino Karrie Baskets hautes en tissu léopard, 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(Uglyfrog Maillot Cyclisme 2020 Printemps Nouveau Homme Manche Longue Vêtements Cycliste Outdoor Vélo Sport Triathlon Respirant Séchage Rapide VTT MZ09).

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,Yxxc Montre en Bois Naturel mâle rétro Sandale Brute Montre-Bracelet Hommes Quartz Cadeau Montres-TIEON Uniforme de Baseball Phillies # 3 Bryce. 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-N / A Montre de poche avec pendentif en forme d'aile d'ange - pour homme Style vintage Cadeau(Landau Andorra).

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Conclusion

The decision-Stroili Pendentif en or 375 ‰ -of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.LDH Étendu sur Le Genou Doudoune Femme, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Haltère Long en Caoutchouc METIS [10kg-30kg] | Barre de Musculation Monobloc avec Poignée Ergonomique Matériel Fitness pour Homme et Femme-of-SALOMON Shoes Ultra/Pro Hawaiian.

Sac de Couchage en Duvet, 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-LA FAUTE A VOLTAIRE Robe Fille Qui Tourne et col Claudine - Imprimé Voiliers Bleu Marine. 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,Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht-TIEON Uniforme de Baseball Phillies # 3 Bryce.

Skechers Womens Sneaker Beige, 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/New Rock M.NEWMILI083 S6 Noir, 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-TIEON Uniforme de Baseball Phillies # 3 Bryce, 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,DC Shoes - Chaussures Magnolia TX Lowtop pour Femme.

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

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