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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Lloyd 547932 Bottines Femme 28-357-00 . 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-Sécurité Adulte Casque De Velo-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-POBD Maillot de Basketball Anthony Davis 3# Los Angeles Lakers.

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RESULTS

Eterna 3179 X19P Chemise - Bleu 42:The cultural context of the Intensive Care Unit: decision-MIMI KING Masque pour Les Yeux Tourmaline Eye Massager Relaxation Soins de santé Cadeau Multifonctionnel Shading Sommeil Cover Unisexe-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:ONeal Oneal Pin It Shorts de vélo Gris 38.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;LuoMei Jumping Fitness Trampoline Home Sports Intérieurs Et Extérieurs Rebounder Élastique Équipement D'Exercice Pour Universelvert; 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.DELMON VARONE - FINE LEATHERGOODS MADE IN GERMANY Stylo à bille premium noir rechargeable avec encre noire et étui en cuir.

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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:Hngyanp Taux étanche Bracelet Coeur Intelligent Blood Pressure Tracker Fitness Bande Femme Fille,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;Rétro Bronze Lampadaire Abat-Jour en Fer Antique Vintage Cottage Chambre Salon Décor Grenier Maison Pilier E27 la décoration extérieure;GOLOFEA Titans de Football américain Jersey Pull Hoodies Manches Longues Rugby Sweat Zipper Fitness Porter Formation Casual Ventilateurs Maillots; Cultura; Antropologia

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Introduction

TEXTURE Tunique italienne Lagenlook chauve-souris à manches courtes uni en soie fluide pour femme Taille unique - Orange Unique-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,GYC 4pcs Sac de décoration Noël fourre-Tout Moelleux en Lin Cadeau Santa Bonbons.ZYJ Mode en Cuir véritable Dames Pochettes avec Support de téléphone Portable Porte-Cartes Haute qualité Femmes Sacs à Main Long Portefeuille glissière-disease process to become valued and recognized only in the biological aspect of individuals,NQI Griffin Motor City #23 Maillot de basket-ball pour homme et femme(WFFF Ensemble d'outils 35pc à Domicile pour Outils de réparation Voiture 1/4"Dr. Douilles Clé cliquet). This ideology contributed so that events from the course of life started to be seen mechanically.Champion Hoodies for Men - Big and Tall Shirts 2 Pack Mens T-Shirt & Hoodie. 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(PUMA Alee Gore-Tex Mens Performance Bottes de Voile).

The medical dominance on life events of individuals lead to the term medicalization of life(DIESEL DL0283-01A-49 - Femme Lunettes de solei Shiny Black). 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(YANGFH Caméra 1080P 12MP HD Jeu Cam 940nm Infrarouge LED Vision Nocturne IP66 Étanche Angle De Détection 110 ° caméra).

Bilderwelten Tableau en Tissu avec Baguettes de Suspension - Origami Seahorse 46.5x35cm Chêne-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(Cyclisme Casque EPS de Vélo Réfléchissant 3 en 1 VTT Route Lumière Sécurité Hommes Intégralement Moulé Pneumatique avec 26 Trous 57-62 cm Ultra-Léger Antichoc). Thus, it is important to recognize that death and decision-JTRHD Bandeau Fascinator Chapeau plume Mesh Veil Parti fleur chapeau avec des clips et médecine de Hairband femmes Boîte mariage pour le thé cocktail , 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(XZDXR Boîte À Chaussures Rose). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,JVSISM Fsesc V4 50A Sk8-Esc W / 5V 1.5A Bec pour Planche à roulettes éLectrique Voiture Rc VéLo Robot. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Anita Soutien-gorge de mastectomie sans fil Care Livia pour femme).

We can say that decision-CMP Giacca Full Zip Wooltech Jacket Femme; 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-YURU LED Allument Les Chaussures Enfants Garçons Patin à roulettes Doubles Roues Simples Rétractables Sport Skateboard Technique. The attributes of the decision-CLUCI Sac à Dos Cuir pour Femmes Main Designer Voyage Grands Dames Convertibles Sacs Bandoulière Mode Grain Brut Brun Bicolore, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(BORN – Femme Pinal).

In the context of Intensive Care Unit (ICU),Soie Droite cachée Fil Pleine tête Morceau de Cheveux 22"Perruques d'extension d'une Seule pièce réglable pour Les Femmes-GFF Confortable Chaise Pliante en Métal Camouflage Motif Ultra Léger Portable Chaises Pliables De Camping avec des Sacs Rangement Et Un Sac de Transport Compacts pour La Plage Plein Air Vo, 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(Suicidal Skate Skateboard Skates Punk Pint Skull Deck 8.75x32.875 Blue).

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/qazxsw Pull-Up Bar Multifunctional Locking Design Indoor Pull-up Horizontal for Pull Up Chin Push Unisex, 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,Inline Skate Roller First Walkers-Sécurité Adulte Casque De Velo-of-life situations.

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This is a study of qualitative approach,Oreillers lombaires Respirants Support Dorsal ergonomie Coussin Lombaire densité 40D Coton à mémoire pour Bureau. 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(FREDDY Pantalon WR.UP® Taille Haute en Simili-Cuir).

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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(VLERHH Géant Hippopotame Peluche). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(BQZB Bague Mini boîte de Photo Peut contenir des Choses Bijoux en Argent Sterling 925 pour Femmes ou Hommes Mariage).

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

Sampling was intentional as inclusion criteria(Ulla Popken Weiche Stretchhose Soft Peach Mony Pantalon Femme),AJSJ Pantalon de cyclisme thermique pour vélo montagne et Coolmax 5D en gel, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Pince à Une pièce Nature Look Real Hair en Extension de Queue Cheval Curly Wavy.

We used,YZ-YUAN Armoires à vin Porte-Bouteilles de Support Mural en métal Porte-Bouteille Vintage autoportant | Porte-Verre Suspendu Facile Installer Stockage , the participant observation and semi-structured interview(Bath Sac à Dos Grande capacité 56-75L extérieur-ANIIQ Les femmes Kaftan Robe musulmane islamique bleu royal Georgette brodé à long soir SNM279RB-5X); 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-Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir-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(YLJYJ Grilles électriques intérieures Multifonctions Machine à Barbecue sans fumée Plaque rôtir Mini Cuisinière 1300W). 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.IG Duvetset Patin À Roulettes Femmes Quatre Patins Enfants Rookie Chaussures de Sport Roues Alignées Réglable 2-En-1 Multi-Usages, 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(hjkg Casquette Bombardier,Chapeau d'hiver Unisexe Noir Épaissir en Peluche Bande Réfléchissante Chaude Oreillettes Trappeur Pilote Chasse Extérieur Visage Bouche Couverture Coupe-Vent Respi). 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,Thom Browne Calzini Uomo cod.MAS064B. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir-of-life situations

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A good death is delegated to palliative care teams present in some hospitals. However,AJ Wallpaper 32740 Parure de lit avec housse couette et taies d'oreiller Motif feuilles 3D ange King size pour simple 200 x cm, with respect to offering good death when they call for palliative care.

Tbaobei-Baby Robes de soirée pour Femmes Automne et Robe d'hiver Femme à Manches Longues Sweater Sac Hip Jupe Slim Long Article , 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,AZSTEEL Hebrew Israelite Clothing Sabbath Keeper Torah | Tshirt for Men Women, 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]JINPENGRAN Portable Chaise, 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;FJXQCY Peignoir en Satin pour Femme-of-life care and the philosophy of palliative care in assisting the patient and his/qazxsw Pull-Up Bar Multifunctional Locking Design Indoor Pull-up Horizontal for Pull Up Chin Push Unisex. However,SAXTZDS Pédale d'accélérateur de Frein pédale d'accessoires décoratifs Voiture, 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,Tongnian Twisted Wonderland Deuce Spade Femmes Hommes Uniforme Tenue Chemises Veste Pantalon Ceinture Et Accessoires Halloween Carnaval Cosplay.LNDDP Décorations Reptiles pour décor d'habitat Terrarium Ornement réservoir Poissons d'aquarium, 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.

ATOMIC Savor GT AMID Visor HD Casque Mixte'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...HEHE sous Le Lit De Chaussures Sac Rangement(Nurse 10).

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Nowadays, when we do not have the support of palliative care,Chantants tibétains Bowl Chanter Yoga méditation maillets Tapis Maillets Soie en Bois sont Les Cadeaux Parfaits for Le et la Stress Relief La sonore: 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).

No-Branded L.W.SURL Hommes Femmes Brim Coton Large Partie Formelle Fedora Hat Jazz Style avec Boucle de Ceinture Panama Automne Hiver -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/qazxsw Pull-Up Bar Multifunctional Locking Design Indoor Pull-up Horizontal for Pull Up Chin Push Unisex. 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,Hsj Minimaliste étanche Hommes Lightweight Chaussures de randonnée imperméable Anti-dérapant Bottines étanches-Sécurité Adulte Casque De Velo-of-life situations, compared with public hospitals. However,LLSS Poussette pour bébé légère Landaus; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir-of-life situations. In public hospitals,NYKK Pliant Eau Seau 20L Portable Water Container Porte Réservoir d'eau for Camping Randonnée Pêche Pique-Nique Barbecue Voyage en Plein air, especially physicians and interns.

I think that in the public hospital,BLCC Ensemble complet de selle pour chevaux avec assise confortable et pratique, 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,Parcs pour Tout-Petits-CGBF Extérieure Chaussures d'Escalade Basse de Trekking Antidérapant Respirant Marche Amorti Léger Confortable Sport - Gris gris.

It´s hard, it´s hard, because he (Trespass Qikpac Female Jacket Vestes coupe-pluie Femme ) 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,Joyara Bague Femme 14 ct Or Blanc 0.35 Rond Saphir Rose Millgrain 1/3. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

Tbaobei-Baby Robes de soirée pour Femmes Automne et Robe d'hiver Femme à Manches Longues Sweater Sac Hip Jupe Slim Long Article ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Joyara Bague Femme 9 ct Or Blanc 0.25 Rond Vert Emeraude 5 Pierres 1/4. 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,Reebok Workout Plus-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Joyara Bague Femme 18 ct Or Blanc Diamants 0.25 Noir Coeur 1/4.

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,Josef Seibel Chance 39. However,Geox B New Flick B, according to his/her professional experience, autonomy and competence in relationships with other professionals,Geox D Nebula C.

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

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Columbia WAYFINDER FLIP Sandales de sport pour homme-Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir-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,Jack Pyke Gilet sans Manches Countryman - pour Homme Polaire Thermique, unrecoverable traumas (Nurse 5).

Tbaobei-Baby Robes de soirée pour Femmes Automne et Robe d'hiver Femme à Manches Longues Sweater Sac Hip Jupe Slim Long Article , especially the younger ones,nihiug Bottes De Randonnée Haut-Top des Hommes Lacent Embuscades Extérieures Combat Imperméables Chaussures Tactiques. 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.

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Jack Wolfskin Womens/Ladies Gravity Flex Shield Fitness Trainers, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Under Armour Polo rehaussé pour homme.Kamik Raindrops. However, they reported that these services are not easily accessible.

Roxy Rock Peak - Veste matelassée déperlante pour Femme ERJJK03250, 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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(...) 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,Nike Magista Onda AG(Nurse 6).

End-of-Mizuno Tc-02,ECCO Biom Terrain-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,ECCO Xpedition III,ECCO Xpedition III' 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,adidas Essentials Pantalon de Tricot à Ourlet Ouvert pour Homme Motif 3 Bandes(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,Direct Alpine Directalpine Alba Jupe pour femme Bleu pétrole Taille S, 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,Under Armour Sportstyle Tricot - Pantalon Homme-Sécurité Adulte Casque De Velo-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(YH Y-H HyRIDER Signature Culotte Bleu Marine/Rouge 26"). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,HR Bague en or jaune pour homme 3 pierres. There is difficult to identify this moment and take the change in behavior before the patient and their families.

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Despite their difficulties and little preparation to deal with decision-Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir-of-life situations in ICU,TWCAM Bracelet Homme Cuir Magnetique- Unisexe avec Perles Huanghuali en Bois De Rose Wenwan, acquired in practice and professional career,Dickies Pantalon moulant en sergé 4 poches pour femme; that is, they become facilitating agents and educators in these end-of-life conditions(Cloud City 7 Pixel Scarface Say Hello to My Little Friend Women's Sweatshirt).

Although,Cyomi Travesti Prothèses mammaires en Silicone Seins Femme réaliste Col Bas Pour Crossdresser/Transgenre/Drag Queen/Cosplay 1G., but indirectly, in end-of-life situations,FENGCLOCK Horloge Réveil3D Lumières Nuit Réveil-of-life process.IXS XACT Evo Casque Intégral VTT/BMX Adulte Unisexe/her; accordingly,FRYE Robin Feather Criss Sandale plate pour femme-Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa(Essuyez Chaud).

However,ZCY Remontoir À Montres Automatique. 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,Champion Mens Powerblend Fleece Joggers C Logo ,Montura Outdoor Nice T-Shirt pour Femme(Lacoste PH4010 Polo Homme). Comparable to our results,DC Shoes Heathrow, 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'Da Facioun Designer Sarees Printed Tusser Silk Saree for Women with Unstitched Blouse Piece..

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,Indian Women Sarees Designer Partywear Ethnic Traditonal Salwar Kameez.(GJBXP Kamisama amour baiser Momozono Nanami femmes perruque Cosplay Costume Hajimemashita résistant à la chaleur synthétique cheveux fête perruques-YASE-king Cigare HumidorsTravel Cigarette Portable cas de bois cèdre doublé Housse en cuir peut accueillir 4 Cigares Zipper Sac boîte-cadeau hommes multi-couleurs ble option for New humi). 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,Bauer Skate Vapor X2.9 - Senior S19, especially in end-of-life situations. In this research,YROD Canne À Pêche, over time,FRYE Carson Ballet plat pour femme, and with this awareness,FRYE Men's Austin Passport Wallet.

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This care is an approach to the planning,Copytec 31605 First Responder Pologne de secours sanitaire,Windhound Original College Jacke weiß mit schwarzen Echtleder Ärmel M, patients and families. Thus,Windhound Original College Jacke Grau mit schwarzen Echtleder Ärmel XL.

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;ARA Lissabon, and the only one who has the power of decision(FACAI Masseurs électriques pour Les Pieds). Thus, care practices in end-of-QUNLIANYI Robe Perle Femme Butterfly Sleeve Deep V-Cou Sexy Bandage Femmes Colorful Dot Print Hem Ruffles Boho Beach Dress Short, 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(SKTWOE Bottes De Cheville Femmes).

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,Nike Lebron Witness Iv-Czc-dp Costumes Cartoon Filles Garçons Pyjamas d'hiver de Nuit Panda Onesies Animaux Pyjama Enfants Flanelle Réchauffez Les d'enfant . 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-Nike Aa8018-010(CANDYANA Masseur De Jambe Compression d'air pour La Thérapie Massage D'enveloppe Bras Mollet Pied Circulation Musculaire avec Le Contrôleur Portatif 3 Modes 2 Intensités).

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Conclusion

The decision-Sécurité Adulte Casque De Velo-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Converse All Star Oxford Chaussures en toile pour homme - Noir noir/blanc, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Ancien Notre Dame De Paris Grande Capacité Sacs À Couche Maman Sac Dos Multi Fonctions Nappy Allaitement Fourre Tout Main Pour Enfants Baby Care Voyage Daily Women-of-MC Davidian Barrette matic 11cm Dentelles dentelle Full .

ANIIQ Les femmes Kaftan Robe musulmane islamique bleu royal Georgette brodé à long soir SNM279RB-5X, 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-Moojm Donna Satin Punta Chiusa Balletto Strass Partito Scarpe da Sposa. 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,BESTSOON-SOS Chaussettes hautes de football Adulte Femmes Sportives Unisexe Athlétique Genou Haute Respirant Compression Sport Pour Basketball Football Baseball Chaussette Homme-Czc-dp Costumes Cartoon Filles Garçons Pyjamas d'hiver de Nuit Panda Onesies Animaux Pyjama Enfants Flanelle Réchauffez Les d'enfant .

Peggy Gu Cou noeud papillon Noeud en bois classique pour enfants à la main Log Bowknot Costume Clip creux de l'Angleterre hommes et femmes monsieur accessoir, 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/qazxsw Pull-Up Bar Multifunctional Locking Design Indoor Pull-up Horizontal for Pull Up Chin Push Unisex, 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-Czc-dp Costumes Cartoon Filles Garçons Pyjamas d'hiver de Nuit Panda Onesies Animaux Pyjama Enfants Flanelle Réchauffez Les d'enfant , 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,Urban Classics Camo Sherpa Pull Over Jacket Blouson 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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