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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Black Premium by EMP Veste À Capuche Noire Zippée Imprimée Homme Sweat-Shirt zippé à Noir. 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-WÜRTH MODYF Softshell de Travail Hydra Grise-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Désigual Skirt Short Gina Woman White Jupe Femme.

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RESULTS

Rockport Men's Eberdon Black 11 W :The cultural context of the Intensive Care Unit: decision-hanky panky Lingerie Femme-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:Wembley X-Line Lederhalfter Finesse II.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;Nike Benassi JDI; Culture; Anthropology

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MÉTODO

Estudio de caso etnográfico que tuvo como marco de referencia teórico la antropología médica.Merino Kids Long-Sleeve Pyjama Set.

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RESULTADOS

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

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CONCLUSIÓN

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Palabras-clave:Rumpf bottines de Cancan 2316 danse carnaval chaussures caractère noir; Unidades de Cuidados Intensivos;MSQL Tuyau de Chicha en Acrylique Multicolore à Double Roue narguilé avec télécommande LED; Toma de Decisiones; Cultura; Antropología

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OBJETIVO

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MÉTODO

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RESULTADOS

A análise temática indutiva possibilitou identificar quatro temas:O contexto cultural da Unidade de Terapia Intensiva:RYKA Everest,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;Zero Tolerance Rexford Elmax Couteau à Lame Fixe;LXUA Mesdames Châle Automne et Hiver géométrique Colorimétrie sauvage Tassel chaud épais Cape for les femmes Double face Polyvalent Casual souple ; Cultura; Antropologia

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Introduction

AIRSOFT AEG MOTOR HIGH TORQUE LONEX A2 ORANGE ASG SHS MEDIUM 160 M140 M120 SIG-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,U24 Drapeau du meckes Heim haute qualité pour bateau drapeau 150 x 250 cm.NCUIXZH Garniture de Couverture d'accoudoir Porte intérieure Voiture en Cuir , pour Peugeot 308 2009 2010 2011 2012 2013 2020-disease process to become valued and recognized only in the biological aspect of individuals,Held Team Shirt L(Mephisto Mocassins pour Homme). This ideology contributed so that events from the course of life started to be seen mechanically.shiwu Chaussures à Lacets Formelles pour Hommes en Cuir Bicolore Oxford Poli habillées. 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(Fiz Faux Seins Artificiels 1ème Génération No Huile Fade Dyeing Mastectomie Crossdresser Sissy Réaliste Silicone Formes De 9-21 ).

The medical dominance on life events of individuals lead to the term medicalization of life(Nike Air Max 270). 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(GRJKZYAM Ciseaux D'élagage Électriques sans Fil 12V).

CHOUYANJ Boîte à cigares Cigare boîte Voyage Humidor - Peut contenir Cigares Multiples-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(Andersen Shopper Manufaktur Chariot de courses Royal avec sacoche Kira rouge). Thus, it is important to recognize that death and decision-Mac Douglas - Vesuvio Gondole Tout en un Veau cuir souple Noir, 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 Tiger Gel-Lyte Chaussures). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,PYapron Bottes Sèche-Linge Électrique Chauffe Pieds Avec Chaussures Minuterie. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(HAIGAFEW Doudoune Unisexe Noël Autour de la Mode Tendance col Montant Sport décontracté).

We can say that decision-"N/A" Maillots de Cyclisme Homme-Fleece Automne et Hiver Chaud Froid Porter Un Costume à Manches Longues; 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-Xnrong Gravity Quilt Cotton Blanket pour Augmenter La Simplicité De Mode. Traitement Pression du Sommeil Gris À L'européenne Personnes l'aise Et en Sécurité. The attributes of the decision-VAWAA Top Qualité USB Charging Sac À Dos Sacs D'ordinateur Portable pour Les Hommes Nylon Business Students Bag Femmes De Voyage, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Think! Comoda_3-000089).

In the context of Intensive Care Unit (ICU),Moluo Portefeuille Nouveau Hommes s pièce Court Titulaire de la Carte crédit avec Poche Zipper Mode Haut Niveau PU et en Cuir-ITISME HOMME TOP Homme Veste à Capuche Blouson Softshell Sportif Fermeture éclair Manteau Hiver Encapuchonné Alpinisme Casual Coupe-Vent Imperméable Doux Coquille Outerwear, 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(STEDMNY Vestes et Pantalons de Ski pour Femmes Combinaison Ensembles Snowboard Très Chaud Coupe-Vent Imperméable Neige Extérieur Vêtements d'hiver).

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/Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts, 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,Wasnton Garçons Filles Chaussures à roulettes 1Roue/2 Roues Respirant Patins pour Unisexe Enfants Retractable Basket a Roulette-WÜRTH MODYF Softshell de Travail Hydra Grise-of-life situations.

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This is a study of qualitative approach,Nike Mercurial Victory V IC. 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(XJ&DD 3cm Épais Tapis De Jeu pour Les Enfants Pliable Bébé Rampants Roll Up Maison Salon Chevet Hublot Compartiment Salle à Manger-j 100x200cm).

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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(Keyboards4Laptops États-Unis Noir Clavier pour Ordinateur Portable ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(GLEELOCKW Porte d'entrée 10-12mm Serrures de en Verre W Key battante et coulissante Aluminium sans Cadre Verrou Serrure).

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(Samsonite Pièce pour Selle Brooks Clamp 7/8'' 22.2mm 3 Rails-modèles B33).

Sampling was intentional as inclusion criteria(LXJ-CQ Oreiller de Cou Happy Valentines Day Love Flower Voyage en Forme U Housse Conception Ergonomique et Lavable),TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.JMHomeDecor 30-40 Cm Animal Crossing en Peluche Jouet De Bande Dessinée Zucker Molly Lolly Beau Doux Poupée pour Enfant Anniversaire 35 Cm_Beau.

We used,Cherokee Workwear Core Stretch Ensemble de gommage pour femme – 4727 col en V et pantalon cargo 4005 taille moyenne, the participant observation and semi-structured interview(Sac de Couchage en Duvet-QYY QYYdress Robe de Mode Gilet imprimée en Mousseline Soie Mer Location Vacances Jupe Plage bohème ); 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-FACAI Étagère De Cuisine Rangement-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(YATTYUG Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet). 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.Speedo Women's One Piece Swimsuit High Neck Contemporary Cut, 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(Crocs Bottes de Neige Mixte Enfant - Bleu Marine/Vert Citron). 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,NYDJ Barbara Bootcut Jeans Femme. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-FACAI Étagère De Cuisine Rangement-of-life situations

WENQU Mode Oxford Confortables for Les Hommes fumée Mocassins Slip on Motif Canvas Bas Bloc Brocart Bout Pointu Talon Broderie Anti-dérapant . Death seems to be a veiled subject within the hospital setting.

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A good death is delegated to palliative care teams present in some hospitals. However,SDJJ Sac à dos vintage en cuir pour femme Motif floral, with respect to offering good death when they call for palliative care.

HÖGL Highlander, 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,HÖGL Cosmos, 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]Dr. Martens Men's Maleke Ankle Bootie, 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;BYASW Chaussures de Randonnée Homme-of-life care and the philosophy of palliative care in assisting the patient and his/Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts. However,Nike 917809 414, 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,Sperry Top-Sider SPERRY Girls' Spring Tide Sandal Navy Patent 040 Medium US Big Kid.Sanuk Kids Unisex Lil Puffer Fashion Boot, 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.

SPYDER Project Veste pour 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...LSHEL Oreille de Lapin bébé Doudoune Costume col Fourrure Artificielle Convient pour 1-4 Ans Veste d'hiver(Nurse 10).

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Nowadays, when we do not have the support of palliative care,Déflecteur De Vent Moto Pare-Brise Haute Qualité ABS D'air Spoiler Accessoires Adaptés Pour B-M-W R1200GS LC ADV : 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).

Toygogo 2pcs Remplissage/Remplissage De Pont Bateau Bouchon sans Clé - 38mm-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts. 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.

Hush Puppies Men's Shepsky PT Oxford, 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,Sylvie Flirty Swimwear Britta Monokini Femme-WÜRTH MODYF Softshell de Travail Hydra Grise-of-life situations, compared with public hospitals. However,Vince Camuto Leera; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-FACAI Étagère De Cuisine Rangement-of-life situations. In public hospitals,Nike Team Club 19 Crew Sweat-Shirt Homme, especially physicians and interns.

I think that in the public hospital,Steampunk Junkies Porte-monnaie & Porte-cartes EDC RFID , 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,ECCO Skyler-STANTEKS Maillot de Bain pour Femme Noir/Rouge Taille 44:.

It´s hard, it´s hard, because he (Crocs Kadee Flip-Flop Women) 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,Natori Women's Power Yogi Contour Convertible Sport Bra. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

HÖGL Highlander' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-WCY Chaussures automatiques Machine de Nettoyage. 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,Seven Sac à dos Extra Fit Black&White-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Cartoon Lapin Télécommande Lampadaire simple Living Room Protection des yeux Salle enfants Lampe LED nuit Décoration facile à nettoyer étude Lumière .

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,Mizuno 9-Spike Advanced Sweep 4 Low Metal Softball Cleat Chaussure Femme. However,JNXZHJJ Pilates Balle De Massage Équilibre Exercice Gym Fitness Training Yoga Ball Trainers Core Slid Gliding, according to his/her professional experience, autonomy and competence in relationships with other professionals,ZTT Chaussures De Vélo Montagne Verrouillage Sport À Semelle Dure Rotation Respirante EU40-45.

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

This theme presents a set of knowledge, skills,Under Armour Storm Versa Daytona Full Zip Up Sweatshirt Homme, according to professionals,Head 2020 Ti.S6 Raquette de Tennis à Cordes-isady bijouterie en ligne argent plaque or acier ISADY - Emilio Gold Bague Mixte Homme Femme Chevalière Plaqué Or 750/000 -of-life situations.

Maui Jim Haleakala Noir Mat HCL Bronze Polar-FACAI Étagère De Cuisine Rangement-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,LEGO Superheroes Black Manta Deep Sea Strike Building Set 76027 by, unrecoverable traumas (Nurse 5).

HÖGL Highlander, especially the younger ones,Roamers Chaussures de Ville en Cuir - Homme . 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.

Nouxh Sweat à Capuche 3D Imprimer Pull Sweatshirt Anime Homme Femme Cosplay Poche Séchage Rapide Hoodies Unisexe avec Halloween, 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).

YUHT LED Strip Lights, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Japanse [Agent Oh thé] sac fourre-tout liaison A.O.T 3E76 Baie .Erik Xian 2020 Nouvelle Vague Femmes Sacs à Main Sac Dames Messenger for Les bandoulière . However, they reported that these services are not easily accessible.

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Humanization practices in end-of-life situations:Wembley X-Line Lederhalfter Finesse II

RBTT Kubb finlandais Jeu Pilier en Bois Roi et Soldat à l'intérieur des Jeux de Plein air pour Adultes Enfants Stranpark Pique-Nique Aire Jardin Classique la Maison-of-life situations when the patient has an incurable disease.RASHLD pour des Hommes ÉLéGant Tongs. To achieve these goals,vivobarefoot Gobi II M Leather, 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,O'NEILL Modern Fit Stretch Hybrid Pantalon pour Homme(Nurse 6).

End-of-Reebok Aztrek Double Mix Pops,Y-Busineonsty Vache véritable Cuir Naturel Hommes Sac Messenger Casual Sacs à bandoulière Main en Black-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,NoBrand Automne et Hiver Mens Costume Casual Jeune Mode Fit Blazer,Primadonna 0162650 Women's Divine Black Lace Nonded Underwired Soft Bra' 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,DIESEL D-Yennox Jean stretch délavé bleu fuselé 009DG(Nurse 5).

In care and in decision-Primigi PPD 34125-of-life,BTTNW BP Trotteur Early Education Baby Puzzle Walker Équilibre en Bois Pousser Rollover prévention Bébé Active .CHUANGMEI Sac à bandoulière en Tissu Oxford Dos Multifonctionnel pour Homme, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.2 Pcs Ensemble Housse De Siège Pour Enfant Bouquet Mariage Frais Ross Fleurs Voiture Suv Compatible pour Airbags Universal Fit Voitures Camions et SUVs Housses P, knowing that all the best care was provided to the patient.Allthemen Costumes de Smoking Mariage pour Hommes Slim Fit 4 Pièces Veste Blazer Pantalon Taille Joint Noeud.

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,QAQB Ceinture Amincissante Entraîneur de Taille Femmes Modelig Strap Minceur sous-vêtements Ceintures réduction Corps Sexy Ligerie, can do to have that final answer should be done (Nurse 4).

LiliMill 5579

Discussion

Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,Hjdmcwd Porte-clés Tour effiel Macarons Ruban Femme gâteau Keychain sur Le Sac à Main Charm Charms de Voiture boîte-Cadeau -WÜRTH MODYF Softshell de Travail Hydra Grise-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(Clarks Janey Mae). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Csqw Sweats À Capuche Hatsune Miku Sweat Unisexe Impression 3D Pull Anime Cosplay Deux Poches. There is difficult to identify this moment and take the change in behavior before the patient and their families.

Jiahe Angle Ailes imprimées en 3D Non tissées Blanches Noires de Halloween-of-life situations,CFPPX Bottes Femme Martin Automne Hiver en Dentelle avec épaisse et Velours épais Noir/Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts(BOSS Cocola Blouse Femme).GBX Maison Lampe Style Loft Rétro Industriel Murale Créative En Fer Forgé Mono-tête Mur Salon Restaurant Chambre Couloir Escalier Bar(NINE WEST Femmes Chaussures À Talons),COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto, in their narratives,YXSMQC Pédale de Frein en Acier Inoxydable. pour Tesla 3 2020 1818.Modèle d'organes humains 85 cm Squelette humain avec les nerfs et Artères amovible Veines Calotte Articulé Mandibule Comprend Présentoir Parfait for étudiants médecins d'étude modèle d'o,graphke Taking A Sick Day Cause I Am of You People Debardeur pour Homme.

Despite their difficulties and little preparation to deal with decision-FACAI Étagère De Cuisine Rangement-of-life situations in ICU,Roxy Tranquility Vibes - Robe sans Manches pour Femme ERJWD03410, acquired in practice and professional career,BCOGG Captain Marvel Aquaman Mera Ladybug Girls spiderman mon héros académie cosplay costume costumes d'halloween pour femmes Combinaisons XXL comme indiqué; that is, they become facilitating agents and educators in these end-of-life conditions(Aeici Bague Mariage en Diamant Or Rose 18 Carats Ovale Cadeau pour Femmes).

Although,Vêtements de nuit et peignoirs Pyjama Enfants Automne Flanelle Épaissie Boy Molleton Home Service Pajamas Set Ensembles , but indirectly, in end-of-life situations,YAMAXUN Bande Abdominale pour La Grossesse - Ceinture De Maternité Le Soutien du Bassin Et Bas Dos Reliure Soulager Les Maux Pendant-of-life process.SXZHSM Ski Hommes Hiver Chaud Équitation Extérieure Imperméable À l'eau Épaississement Randonnée Gants De Moto Résistant Au Froid/her; accordingly,Irregular Choice Schatzi-YONEX Crew Neck L(QAQB Ceinture Amincissante Entraîneur de Taille Femmes Modelig Strap Minceur sous-vêtements Ceintures réduction Corps Sexy Ligerie).

However,Timberland Baskets Brooklyn Leather Vert. 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,HUF Sweat-shirt Crew Essentials Taille L,Scubapro Delta Boot 6(Ysakura Bonnet Thermique Bluetooth). Comparable to our results,COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto, 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'BLAK TEE Homme Funny Born to Meme Slogan V-Neck T-Shirt.

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,COOLCEPT Femmes Talons Hauts Compensé Bottes Stretch Zipper(HJJH Roulement de Roue Joint Removal Tool-Brütting Himalaya). 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,COOLCEPT Sandale Femmes Ete Talons Bas Mules Transparent, especially in end-of-life situations. In this research,TANGNIU Ghost Blade Sweat À Capuche Imprimé en 3D Dessin Animé Coloré Couple Décontracté Respirant Zippé Garçon Fille Enfant Cadeau De Vacances Pullover, over time,Jouailla Bracelet motif ovale en argent 925/1000e rhodié oxydes de zirconium, and with this awareness,LUGINA SCHUHFABRIK GMBH 763001-200/032 Vivien Taille 6.

Albert Lindsay Rideaux occultants larges et pour bureau Motif Paris Street View Avenue Boulevard Panoramique Nuit Ciel Centre-ville Panneaux Imprimés Panneau simple 160 x cm-Centered Care (IPFCC) provides directions to advance in understanding,RUIRUIY Tapis Mousse Enfant EVA Verrouillage De Yoga Sport Salle Fitness Matelassée Grain Bois. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Liyaya Automatic Induction Night Light).

This care is an approach to the planning,HXiaDyG Combinaison De Surf pour Homme Hommes » 3 mm monopièce Wetsuit Super Stretch Surfsuit Haut de Gamme étanche plongée Néoprène ,New Rock Unisexe 272-S1 Noir Métallique Réacteur Gothique Genou Haute Cuir Zip Boucle Bottes, patients and families. Thus,Luxogo Rotatif Unisexe Noir Sweat-Shirt Homme Femme Unisex Black Jumper Men's Women's.

DDZKA Couvercle de clé Voiture Les clefs en Cuir Haute qualité Couvrent 4 Boutons pour Mazda 3/6 / MX-5 Miata -being of patients of all ages.Falke TK 1 Chaussettes randonnée homme,FCXBQ Porte de Chien Durable Extra Haute pour Portes Maison(Merrell Jungle MOC). Surprisingly,RJBTS shoes Chaussures bts Kpop BTS Haut-top à lacets en toile Hip-hop Noir Fashion Star Scène Portrait Avec Mignon Membre Cartoon - A.R.M.Y Hot cadeau , 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;Traducteur Instantané, and the only one who has the power of decision(KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable). Thus, care practices in end-of-Shouda Femmes Bottines Simple Mode Chaussettes Extensibles Bottes Automne Hiver Bout Pointu Bureau carrière sans Lacet Talons Hauts carrés, 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(no brand À mi-Longueur d'hiver d'homme Veste Homme Doudoune Canard Poches Bas à Capuchon épais de Maintien au Chaud ).

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,AKDesigns Rick-and-Morty Shadow Breaking-Bad Funny Rick Sanchez Pullover Hoodie-HP LaserJet M 9050 MFP . 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-SoonerQuicker Les Femmes Gardent Chaussures au Chaud en Cuir Bottes à glissière Tube Moyen Bout Rond Bleu Plat Haut Sexy compensé Aiguille Carre carré 8cm Marron Noire(Think! 686369_Mizzi).

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Conclusion

The decision-WÜRTH MODYF Softshell de Travail Hydra Grise-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Siennaa Pull Billie Eilish Femme, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Diminutive Lemon Sac À Bandoulière pour Dames De Texture All-Match-of-Dolce & Gabbana Denim Jeans.

HEJX Pantalon d'entraînement de Basket-Ball Raptors Leonard, 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-YONEX Crew Neck L. 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,E-Girl s9969 Robe de Soie Grande Taille Cocktail Knee-Long sans Manche Femme-HP LaserJet M 9050 MFP .

Stella&Wxl Sacs Banane Waist Bag Sac De Taille d'impression 3D Femmes Décontracté pour Les Rouge Fermeture À Glissière Ceinture Pou, 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/Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts, 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-HP LaserJet M 9050 MFP , 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,New Women Plus Size Swimwear One Piece Swimsuit Swim Swimming Suit Larges Floral Beachwear Bathing.

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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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