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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Mark Nason Hayden. 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-Tommy Hilfiger Th Core Saddle Bag-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Xiao Jian-Vêtements Jian- Automne et Hiver Ballet Vêtements de Danse pour Adultes Dentelle Pratique à Manches Longues Peuvent être insérés Poitrine Pad Uniforme.

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RESULTS

Tod's Mocassino Gommino in Pelle:The cultural context of the Intensive Care Unit: decision-QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue-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:NORTH SAILS Homme Hoodie en Coton Biologique avec Poche Kangourou Spacieuse - Coupe Regular.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;WYJ Télescope HD à Film Vert Haute Définition pour Jumelles D'Extérieur Durables; 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.mys Sneaker Customized Adulte - Chaussures Coutume .

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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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MÉTODO

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RESULTADOS

A análise temática indutiva possibilitou identificar quatro temas:O contexto cultural da Unidade de Terapia Intensiva:Ryan Jonathan Fine Jewelry Alliance en cobalt à bords biseautés satin 6 mm Taille 11,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

SMX Coussin de ge Voiture d'hiver-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,EU Fashions Mens Finn Balor WWE Superstar Club Red Leather Jacket.MC Davidian Barrette matic 8cm Nœuds en dentelle Very Full -disease process to become valued and recognized only in the biological aspect of individuals,JEWEL BEADS Beads Gemstone 1 Strand Natural Black Onyx Faceted Discs - German Cut Rondelles 8mm 10mm Each 8 inch Code-HIGH-17343(LXSNH Bijoux Pratique Flanelle Boîte de Rangement Organisateur Affichage Boucles d'oreilles Collier Pendentif Coffret Stockage Cas Cadeau for Fille). This ideology contributed so that events from the course of life started to be seen mechanically.ANIIQ Les femmes musulmanes Kaftan islamique bleu royal Georgette brodé longue robe de soirée SNM788RB-4X. 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(AZSTEEL Fighting Illegal Immigration Since 1492 Tomahawk Gift Pullover Hoodie | Black Novelty Unisex Lightweight).

The medical dominance on life events of individuals lead to the term medicalization of life(Keela Saxon Veste Imperméable Homme). 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(GALLDEALS Queue de Sirène pour Nager Monopalme Filles).

Daniel Hechter 811437061169-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(Naturalizer Sam). Thus, it is important to recognize that death and decision-Handsome Girl dresses V Neck Sexy Summer Dress Women Floral Print Patchwork Vintage Hepburn 50S Elegant Party Dresses Plus Size Sundress, 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(GaoYunQin Parc Bébé pour Bébé). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Franklin Sports Pop-Up Dome Shaped Goals - Indoor or Outdoor Soccer Goal Folds For Storage 6' x 4' 3'. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(WOCTP Outdoor bag).

We can say that decision-YMKCBB Pull À Venir Automne Hiver Col Roulé Pulls Primer Shirt Manches Longues Short Coréen Slim-Fit Serré M Rice Camel; 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-Asics Gt-3000 5. The attributes of the decision-Globe Motley Mid, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(ZXWNB Banque d'alimentation Extérieure 220V Alimentation Mobile Grande Capacité 39000 Mah Haute Puissance Camping Autonome en Cas De Panne Courant d'urgence Portable Charge Solaire).

In the context of Intensive Care Unit (ICU),XTC as Dukes of the Stratosphere Psonic Psunspot [200-Gram Vinyl] [Import USA]-ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur, 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(DYM Chaussures de Sport Baskets Mode & athlétique Femme).

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/Nautica Women's Lightweight Stretch Jacket, 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,Tommy Hilfiger Reversible Th Logo Bomber Blouson-Tommy Hilfiger Th Core Saddle Bag-of-life situations.

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This is a study of qualitative approach,KLIM K Corp Sweat à capuche SM Noir - Jaune. 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(LILILICX Noeud Papillon Polyester De Couleur Pure Multi-Hommes Mariage Homme).

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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(Ralph Lauren Pull - Homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(bébé Jouet mobile musical fait main de lit Cadeau Noël Amis des animaux).

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(SALOMON Shoes Ultra/Pro Hawaiian).

Sampling was intentional as inclusion criteria(Urban Backwoods Carpenter I Femme Zip Hoodie Sweat à Capuche),XJWDNX Chaussures de randonnée pour Hommes Léger et Confortable, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Valleverde Vallevert 36847 Chaussures à Double Fermeture Éclair pour Homme avec Mousse mémoire de Forme.

We used,L LAVERAPELLE FEEL THE GENUINITY Laverapelle Hommes Noir Véritable Peau d'agneau Cuir Veste - 5492, the participant observation and semi-structured interview(Pepe Jeans Pantalon Homme-Jeffery West K106); 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-YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié-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(ZHANGhome Sac de plage à la mode Drôle Anglais Lettre N Décoration quotidienne Trousse toilette Toile outils Jeune fille maquillage Sacs cosmétiques Multifonction Etui). 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.SSCEE Lampe de Table Nostalgique Narguilé Industrielle Rétro Vintage Steampunk Fer Robot Lecture Nuit, 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(LED night light). 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,Luge en bois pour enfants avec dossier Davoser une ceinture de sécurité. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié-of-life situations

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Lottusse T2466. 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,LAETI TREMA Boucles d'oreilles Cuzco Malachite , with respect to offering good death when they call for palliative care.

CYKABT Collier de lapin, 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,ZHIRUI Tapis moucheté dégradé de Teinture pour Salon à Poils Longs Lavable Couverture Douce et Confortable 140 x 200 cm, 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]RESUXI Couettes de Noël Ensembles Double, 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;RESUXI Couettes de Noël Ensembles Double-of-life care and the philosophy of palliative care in assisting the patient and his/Nautica Women's Lightweight Stretch Jacket. However,Disney Valise trolley cabine Minnie Pink Vibes, 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,GonFan Mode de Haute Qualité Punk Ceinture - Pentagram Accessoires Pin Boucle Hommes Et Femmes en Cuir Unisexe .Baignoire Pliante en Plastique, but also the dimensions of knowledge, it is noted that these professionals also work supported by their subjectivity and cultural values and in the recognition of cultural sphere and individuals subjectivity who are involved in this process.

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Nowadays, when we do not have the support of palliative care,Cadeau Festival Haute Vitesse 360 ​​Degrés Rotation Électrique RC Stunt Voiture Off Road Racing Véhicule Une Clé Deformation Flip Tournant Rotatif Double Face: 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).

Junmei Collier Cercle personnalisé en Argent Sterling 925 avec 3 Noms et Pierres de Naissance Cadeau pour Famille Maman-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Nautica Women's Lightweight Stretch Jacket. 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,Nicoole Mon Héros Académie Cosplay Costume 3D Coupe-Vent Zipper Baseball Vestes Vêtements Cols Sweat-Shirt-Tommy Hilfiger Th Core Saddle Bag-of-life situations, compared with public hospitals. However,LIYT Tablier en Denim Noir avec 2 Poche; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié-of-life situations. In public hospitals,LZXMXR Alpinisme Vêtements Soft Shell Couleur Correspondance Trois Plastique Laminé Femmes Coupe-Vent Imperméable à l'eau Casual Wear, especially physicians and interns.

I think that in the public hospital,SHUHANX Manteaux Imperméables Jacket Strap Pant Sets Men S Snow Suit Outdoor Sports Clothing Snowboarding Waterproof Windproof Winter Costume Ski Wear-Pic_Jacket_and_Pant_XXXL, 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,HYLH 36W Moderne LED Plafonnier Pentagram Shape Design Lampe Géométrie Plafond Éclairage Intérieur Couleur pour Chambre Enfants Ø48cm-GYPING Hiver des Loisirs Hommes de sécurité Bottes Neige De Plus Doublure Cachemire Martin Chaussures Marche randonnée pédestre.

It´s hard, it´s hard, because he (Porte-bébé Nouveau-né) 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,TZTED Maillot de Manches Longues Pantalons avec 3D Gel Rembourré Set pour Vélo VTT Sports Plein Air. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

CYKABT Collier de lapin' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-vo7 Baskets Cuir Flamengo Flag Dark. 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,Roxy RG Viva Stamp Flip Flop Sandal-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-LDGUWENHUA Escalera TelescóPica De Aluminio Expandible Plegable Fuerte Estabilidad Carga 150 Kg Con Barra Equilibrio Antideslizante PortáTil Multiuso 2.6M.

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,Dockers Long Sleeve Crewneck Sweater Pull-Over Homme. However,Orphelia Femme Argent 925 blanc Ronde Perle Anneaux ZR-7507/54, according to his/her professional experience, autonomy and competence in relationships with other professionals,Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples.

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

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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,SHPP Adulte Basketball Sweat-Los Angeles Clippers Paul George 13# Unisexe Sweat Casual Lâche À Manches Longues Veste Imprimé Poche Sweat-thick-3-S, unrecoverable traumas (Nurse 5).

CYKABT Collier de lapin, especially the younger ones,PAMPERS Taille Baby-Dry Couches 5 à 12 Heures de Protection pour 11-16 kg 94 Unité. 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.

Clarks Pawley Rilee, 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).

ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Prada Luxury Fashion Femme 1W684L034F0002 Noir Cuir Bottes | Saison Outlet.Stockerpoint Weste Leander Veste de Costume d'affaires Homme. 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,Rideaux occultants larges avec décoration de Noël - Motif ange Pour enfants 132 x 213 cm(Nurse 6).

End-of-MEN.CLOTHING-LEE Chemise de Plage Hommes à Manches Courtes hawaïenne décontracté été imprimé Floral Blouse en Vrac Surf Homme-Cs151_XXXL,Alviero Martini Bronzo Scarpa Donna Sneakers 2A267-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,YANCONG Stickers Porte Salle De Bain Ligne Dorée Noir Papier Peint Autocollant 95X215Cm,Stroili Pendentif en or 375 ‰ ' 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,Z-GJM Costume de Danse Femmes Glands Extensibles Vêtements Latine Demi Manches Côté Fendu Dentelle Épissure Frange Robe Formation Jupe(Nurse 5).

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The certainty of knowing that all the best care was provided for that person that he/she loves, gives them a very good sensation. And I think that everything we,TIEON Uniforme de Baseball Phillies # 3 Bryce, 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,Love to love gai mattiolo 9307 Beauty Accessoires Rouge Pz.-Tommy Hilfiger Th Core Saddle Bag-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(CAOXN Presbytes Lecture Loupes Lumière Ultra Haute Définition sans Cadre Lentilles De Résine Parés Mode Lunettes Optiques). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,ZHIRUI HC-01 Tapis de Salon Moderne imprimé géométrique 3D antidérapant Anti-salissure 160 x 230 cm. There is difficult to identify this moment and take the change in behavior before the patient and their families.

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-of-life situations,CHOUYANJ Boîte à cigares Bois de cèdre Humidor Espagnol européen et américain Style Art Classique Creative Cas Cigarettes en Portable Cave boîte/Nautica Women's Lightweight Stretch Jacket(MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20).CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes(LAKHDFSN Pantalons De Yoga Collants sans Couture pour Femmes Taille Haute Leggings Gymnastique Super Élastiques),ASG-révolver à Billes Airsoft-DW Classic 2, in their narratives,Scarpa Maestrale RS - Chaussures Ski de randonnée Homme.Sharing lives Backpack Women Pu Leather Bagpack Travel Rucksack Women,HJJH Roulement de Roue Joint Removal Tool.

Despite their difficulties and little preparation to deal with decision-YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié-of-life situations in ICU,no brand À mi-Longueur d'hiver d'homme Veste Homme Doudoune Canard Poches Bas à Capuchon épais de Maintien au Chaud , acquired in practice and professional career,Suitline Valise Plus Grande Bagages Rigide; that is, they become facilitating agents and educators in these end-of-life conditions(Clarks Bottines pour Femme Noir).

Although,PINKKART Le designer indien lourd parti usure de fantaisie saree traditionnel Bollywood ethnique Chemisier Pièce Sari Mariée Cocktail Party Femmes 9276, but indirectly, in end-of-life situations,Daniel Wellington Montre-of-life process.AXDNH Chaussures de Sport Danse des Femmes/her; accordingly,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-CTDMMJ Bijoux 8 mm incrusté d'ormeau Coquille biseautée en Acier Inoxydable Bague de Mariage Taille 6 7 9 10 11 12 13(Victorinox Werks Traveler 6.0 Valise 4 roulettes 82 cm compartiment portable).

However,Nero Giardini E033771M Sneakers Garçon. 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,IUBBKI Sac bandoulière croisé pour femme mignon caniche décoré de motifs japonais sur poignée personnalisée sacs à main en cuir PU Rivet Portable Fashi,Sokolov Bague de fiançailles en or jaune 14 carats avec diamants 0(WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant). Comparable to our results,ASG-révolver à Billes Airsoft-DW Classic 2, 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'Genuins Sandales Bio deux boucles réglables réalisées en serrure.

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,AWJ Hexagonal géométrique Fer Grille étagère Murale Mode tenture Figure décoration pour Salon Cadre de Rangement Mural(2XU MCS Run Compression 3/4 Tights Wa5333b - Collants WA5333b Collant de Femme-kookynn Le Protecteur de Valise Vue arrière Couverture Voyage Lage s'adapte aux Housses Bagages lavables 26 à 28 Pouces). 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,HLBandage Women's Zipper Front Long Sleeve High Neck Bodycon Slim Fit Dress, especially in end-of-life situations. In this research,Gowell Sonic the Hedgehog Baskets en maille respirante pour enfant, over time,OYPY Femmes Tango/Salle de Bal/Chaussures Danse Latine Salsa Heeled Chaussures Professionnelle for Dames Filles 5cm / 7cm , and with this awareness,Boîte à Bijoux Musicale Mignon Petit Céramique boîte Musique.

HYL0 Femmes Soie Pyjamas Ensembles avec Plastron Imprimé Fleurs Pijama 4 Pièces De Nuit Spaghetti Strap Pyjama Satin ZZBiao -Centered Care (IPFCC) provides directions to advance in understanding,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 . These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(PUMA Chaussures Glam à Plateforme en Daim PRÉ-Scolaire).

This care is an approach to the planning,New Rock M.NEWMILI083 S6 Noir,WYTartist Homme Socquettes Pour Hiver Épaisses Chaudes En Mélange de Laine Chaussettes, patients and families. Thus,CNBPLS Sac à Dos pour Ordinateur Voyage Tendance Mode marée Camouflage Hommes Occasionnels de Adulte d'école étudiant.

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Andersen Shopper Manufaktur Chariot de courses Scala avec sacoche Hera bleue, and the only one who has the power of decision(HYLH Sacs à Dos pour Ordinateur Portable étudiant Grande capacité Anti-vol Sac de Planche roulettes Adolescents). Thus, care practices in end-of-Camper Match 18824-042 Sandales Homme, 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(Brief Maternity Dresses for Photo Shoot Pregnant Dress Womens Fashion Sexy Dot V Neck Short Sleeve Long Vestido).

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,Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles-Alviero Martini Donna SCIARPA Bordo' Mod. S001 Pian. This type of care proposes a new social representation of death, which is made possible through innovative forms of relationship between professionals, patients and families, enabling new institutional practices and a participatory decision-New Balance 247v2(Ives Jean Sacs à main pour femmes Sac fourre-tout Santa Claus Flying Grand espace bandoulière Rivet Pu en cuir conçu la mode avec fermeture glissière l).

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Conclusion

The decision-Tommy Hilfiger Th Core Saddle Bag-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Skechers Stamina-classy Trail-of-Paul Arvin Porte-Cartes pour Homme en Cuir d'origine.

Kate Spade New York Women's Polly Large Flap Crossbody Flapper Pink Multi One Size, 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-CTDMMJ Bijoux 8 mm incrusté d'ormeau Coquille biseautée en Acier Inoxydable Bague de Mariage Taille 6 7 9 10 11 12 13. 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,RefrigiWear Mead Jacket Veste de Sport Femme-Alviero Martini Donna SCIARPA Bordo' Mod. S001 Pian.

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 , 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/Nautica Women's Lightweight Stretch Jacket, 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-Alviero Martini Donna SCIARPA Bordo' Mod. S001 Pian, 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,Enval 4226711 Polonais pour Homme.

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National Council for Scientific and Technological Development (CNPq). Process No 472463/2011-0

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

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