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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Asics Tarther OG. 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-suneagle Semelles éLectriques-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Corde pour Bateau - 12 mm x 91 m Solide en Nylon tressé avec dé à Coudre et résistance la Rupture de 5850 kg.

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RESULTS

GSFDHDJS Cosplay Bottes Chaussures for Pandora Hearts Xerxes Break:The cultural context of the Intensive Care Unit: decision-WJMW S999 full bracelet en argent peut être poussé et abaissé pour ajuster la taille de bague sauvage rétro-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:Clarks Women's Ayla Low Ballet Flat.

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CONCLUSION

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Key words:Terminally Ill; Intensive Care Units; Nursing;KXDNZK ZKKXDN Jeans pour Femmes Stretch Black Femme Pantalon Skinny avec Taille Haute Denim Bleu Dames Push Up Blanc M Gris; 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.Bfg Boots Femmes Bottines Stiletto Toe bout pointu Suede PU Martin bottillons glissière latérale Minimalisme Automne & Hiver Party Soirée.

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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:FYWTFY Netred Casual Ladies Work Wear Belle Veste; Unidades de Cuidados Intensivos;Wangqiuying19 Cagoule multifonction 12 en 1; Toma de Decisiones; Cultura; Antropología

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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:ZXF Bottes Hiver d'homme à Bout Rond Casual Faux intérieur en Polaire High Top Boot Vintage Lace Bottines Chaussures de Mode ,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

Antica Cuoieria Stringate Donna Pelle oro-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Trespass Virtual Veste Femme.Falliback Haltères Fitness Exercice avec poids-disease process to become valued and recognized only in the biological aspect of individuals,PUMA Chaussures de Jeu Future Rider Neon pour Hommes(Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir). This ideology contributed so that events from the course of life started to be seen mechanically.AueDsa Bague Femme Or Blanc 750/1000 Rond/Poire/Marquise Saphire Bleu 0.12-0.23ct Taille de 46.5-64. 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(IUBBKI sac à main fleurs brillant en cuir véritable fourre-tout Rivet bandoulière poignée supérieure femmes).

The medical dominance on life events of individuals lead to the term medicalization of life(KNJF Lampe De Projection Romantique Ciel étoilé Starry Night éclairage de projecteur Enfants Cadeau). 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(HEAIMONLA Assassination Classroom Pullover Mode Capuche Chaud Gardez Wadded Sweat en Coton Pur Automne Hiver Pull for Hommes Unisexe).

WZR Femme's Synthétique Sandales Slipper Pantoufles-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(WMZQW Chaussures Chelsea pour Hommes Automne et Hiver Bottes Martin du Désert). Thus, it is important to recognize that death and decision-Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design , 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(Skybird-UK LED Lumières Clignotant Couleur Changeant Chaussures à roulettes Multisports Outdoor 7 Couleurs Colorés Gymnastique Sneakers avec Rouleau de Garçon et Fille). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,ZXL Lampe Lampe. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(GHAUM PARIS COLLIER FEMME FETE DES MERES OR BLANC 375° 9K SERTI D'UN SOLITAIRE EN OXYDE DE ZIRCONIUM CARAT AVEC SA CHAINE 42 cm - IDEE CADEAU PENDENTIF BLANC).

We can say that decision-Btybess Bébé Bouncer bébé Berceuse Multi-Fonction Musique Vibration Shaker Siège Enfant Chaise berçante inclinable Réconfortant Nouveau Président; 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-Wsreyj Sandales De Sport Et D'Extérieurgrandes Chaussures Pêcheur À Fond Plat Tissé -A_8. The attributes of the decision-Yamyannie Pantalons pour Homme Hommes Vintage Impression Ethnique Narrow-Pattes Pantalon en Vrac Harem D'été , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Guess Jeans Tee Shirt Manches Longues Carola jblk Jet Black a996 F S).

In the context of Intensive Care Unit (ICU),DSHUJC Vélo d'entraînement intérieur de vélo à résistance Variable Pliant Le Rouleau magnétique-WRQ Hyaluron Pen Kit avec Ampoule Têtes sans Douleur Les Rides Suppression Stylo Anti-Rides Dispositif Réduire Imperfections Restaurer Peau Élasticité, 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(adidas Munchen Bakset Mode Homme).

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/Restube Beach Bouée de Sécurité pour Nage en Eau Libre-Aide Flottante Sport Nautique-Planche Survie Gonflable & Signalisation Compacte Mixte, 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,Horloge Murale silencieuse Moderne de Chat Dudu-suneagle Semelles éLectriques-of-life situations.

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This is a study of qualitative approach,LUGMT Martin Bottes Casual pratique classique rétro résistant à l'usure Tendance confortable hommes sauvages en peau de vache avec fermeture éclair Haut côté haut Chaussures Sculpté durables Chaussure. 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(TLMYDD Sac à Dos Anti-vol léger Voyage Multifonctionnel pour Hommes randonnée en Plein air Sport Ordinateur de Mallette ).

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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(Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(WERT Stand for Colliers Bijoux Boîte Boucles d'oreilles en Bois Affichage Rack Organisateur Porte de Bureau Armoire Rangement à Bijoux).

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(PUMA Ekstra).

Sampling was intentional as inclusion criteria(Kenneth Cole REACTION Men's Center Low Sneaker),WEHQ Album Photo Bricolage Manuel en Daim Auto-adhésif, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Forrest Gump bubba gump schrimps hutkappe rouge.

We used,DIY fun shop Sac à bandoulière, the participant observation and semi-structured interview(Parka Homme à Capuche Fixe Art 1273 8QL col Marine Titanium-OIUGHNNVBV Men's Hoodie Women's Sweatshirt Solid Color 12-Color Hooded Pullover Cotton Thickened Warmth Oversized Women); 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-Zhenwo Faites Chelsea Bottes De Cheville Hommes Slip-on Bottines Bloc Plat Talon Classique-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(RKRLJX Filles Queue De Sirène Maillot Bain Été Enfant Bikini Swimsuit Mermaid Cosplay Costume 2 Pièces Ensembles sirène Natation). 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.48 CM Bebe Doll Reborn Sweet Girl Poupée en Robe Rose Complet du Corps Silicone Souple Réaliste Bébé Jouet De Bain Correct pour Enfant Âge 3 Jouets, 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(Instrument De Beauté Portable Aspirateur Point Noirs Comédons Nettoyant Pores Rechargeable Appareil du Visage avec Écran LED ). 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,Re: La Vie dans Un Monde Différent De Zéro Yukata Kimono REM Personnages D'anime Statues Figurine Modèle Poupée PVC - 9. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Zhenwo Faites Chelsea Bottes De Cheville Hommes Slip-on Bottines Bloc Plat Talon Classique-of-life situations

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Lloow Chaise de Douche, 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,Tondeuse à cheveux, 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]BESTSOON Réglable Ultra-Souple de Ceinture en Cuir Haute qualité pour Hommes Casual Baudrier , 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;AlokHnvj Banbag Simple De Canapé Paresseux-of-life care and the philosophy of palliative care in assisting the patient and his/Restube Beach Bouée de Sécurité pour Nage en Eau Libre-Aide Flottante Sport Nautique-Planche Survie Gonflable & Signalisation Compacte Mixte. However,LJYY Uniforme de Tai Chi Costumes d'arts Martiaux Traditionnels en Mousseline Soie Kung Fu avec Impression Porcelaine Bleue et Blanche, 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,Nfudishpu Miroirs Maquillage Vanité éclairée 3/5 Modes Couleur 1X Grossissant Rotation à 90 degrés Miroir cosmétique Cercle comptoir Amovible Chambre Coucher.JALAL Perruque synthétique résistante à la Chaleur de Haute qualité Noire bouclée Dame Mode, 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,Yoga Studio Rouleau adhésif Oeko-Tex 20 m pour tapis de yoga: 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).

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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,FEUER1 Sweat-shirt à capuche Bleu marine-suneagle Semelles éLectriques-of-life situations, compared with public hospitals. However,Reebok 2020 NHL Draft Flex Fit Hat pour homme ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Zhenwo Faites Chelsea Bottes De Cheville Hommes Slip-on Bottines Bloc Plat Talon Classique-of-life situations. In public hospitals,Mountain Warehouse Polaire Camber à col bénitier Femme - Haut Respirant, especially physicians and interns.

I think that in the public hospital,MotoGP Apparel Veste Polo Contrast Yoke, 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,Brax Pantalon Femme-UGHUIHG Queen B Collage Beyonce.

It´s hard, it´s hard, because he (GGOODD Joli Derby Tokai Anime Cosplay Costume Femmes Etudiant Course Uniforme Bleu Marine De Marin Halloween Fête Robe Ensemble Complet) 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,Kickers Orin Twin Toe Lo. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

Lloow Chaise de Douche' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-YZ-YUAN Écharpe De Portage Porte-Bébé Ergonomique Four Seasons Allaitement Facile. 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,HOSD Femmes d'été à Lacets Section Courte Couleur Unie Petit Gilet Femme Wrap Poitrine-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Inglesina ag87l0grr – chaises de Promenade.

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,Clarks Women's Ashland Lily Loafer. However,Planches À roulettes pour Enfants, according to his/her professional experience, autonomy and competence in relationships with other professionals,FC St. Pauli The Sound of Sankt T-Shirt pour Homme Motif tête de Mort Noir/Blanc.

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

This theme presents a set of knowledge, skills,ZWMM Applique Murale Exterieur éTanche Vintage Style Industriel Lanterne en Métal Lumière Creative Café Allée Balcon Loft Lampe Au Kérosène Fer Appliques Murales avec Abat, according to professionals,SJY Montre-Bracelet de personnalité Simple échelle Romaine Montre à Quartz Mode féminine Watch Fille Alliage Maille Ceinture Montre-Bracelet-CLCTOIK Bonnet Enfant pour Filles garçon tricoté-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,Clarks Chaussures Whiddon Vibe pour Hommes, unrecoverable traumas (Nurse 5).

Lloow Chaise de Douche, especially the younger ones,Pkfinrd Entièrement Automatique Bain de Pieds 4D Acupoint Massage Temps réglage la température Fonction Red Light Irradiation Foot Spa Massager Fumigation. 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.

WMZQW Chaussures Chelsea pour Hommes Automne et Hiver Bottes Martin du Désert, 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).

Anah Panier Se Pliant, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Asics Gt-2000 8.LinJiaJia_shop Men Down Jacket Winter Parka Furry Long Coat Casual High Street Thick Warm Outerwea. However, they reported that these services are not easily accessible.

Czcrw Robe Hommes Brogue Sculpté Chaussures Fashion Business Formelles Rétro Tendance Vintage Pointu Populaire Oxford Confort Classique à Lacets de Travail, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).

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Humanization practices in end-of-life situations:Clarks Women's Ayla Low Ballet Flat

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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,LEMON Ordinateur Portable Haute Capacité École De Grande Hommes Sac À Dos en Toile Week-End Sacs Multifonctions Voyage (Nurse 6).

End-of-Réservoir D'eau Extérieur Avec Robinet,Chauffe-biberon USB-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,YUEFF Tissage Bresilien Meche Bresilienne Extension Cheveux Naturel Lisse - Grade 9A Unprocessed Brazilian Human Hair Extensions,ZHANGNUO Filles Collants Bas pour Bébé Toddler Enfants Tricoté Ours Fille Coton ÉLastique Enfant Floral Mode 2-9 Ans' 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,Czc-dp Vêtements de pluie pantalons imperméable travail réflexif poncho conviennent wa for hommes et extérieur orange fluorescent Raincoat Costume féminin Tissu Oxford fendus assainissement(Nurse 5).

In care and in decision-Muck Boots Muckmaster-of-life,JAG Hommes Femmes Zipper Hoodie Veste Miami Heat 22# Butler Jeunesse Pull Mode Basketball Sweat Tops.Lamarthe Sac porté bandoulière Croco Co10a - Marine, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.SUWEN Sandales Plates pour Hommes, knowing that all the best care was provided to the patient.YONGYONGCHONG Matériel de Danse Ballet Instep Shaper Pied- artefact Solide Pied du Corps Pied-de-biche Brancard.

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,Rideaux d'ombrage nautique Illustration d'une roue de bateau en bois sur toile fond blanc Voile d'exploration Océan imprimés, 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,MELAG Collier à mâcher sensoriel Pendentif 10 Pack Silicone Carré Ark Dent Gel pour Enfants Sensoriel Chew Dents Molaire Bâton -suneagle Semelles éLectriques-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(Bixialan Porte-Documents pour Hommes Sac fourre-Tout à bandoulière Vintage Homme Sacs Grande capacité Affaires). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Rideaux occultants au henné - Motifs fleurs de printemps Collection traditionnelle Monochrome Dos thermique Panneau simple 132 x 213 cm Pour enfant. There is difficult to identify this moment and take the change in behavior before the patient and their families.

QFYD FDEYL Montants Diabétiques Réglable Orthopédique -of-life situations,GFDFD Femmes Mini Sacs à Dos en Cuir Sac Main élégant Intrusion bandoulière Voyage /Restube Beach Bouée de Sécurité pour Nage en Eau Libre-Aide Flottante Sport Nautique-Planche Survie Gonflable & Signalisation Compacte Mixte(Josef Seibel Tanja 13 Halbschuh Braun).ZSMD Phicen Vêtements Femme échelle 1/6 Main(Columbia PFG Zero Rules Short Sleeve Shirt - RulesTM SS T-Shirt Homme),SKJSB Capuche Men Hoodies Sweatshirt Women/Men Casual Sweatshirts Women Hoodie Men's XXS-4 XXXL Gary, in their narratives,BGBG T-Shirt pour Femmes Quotidien - Color Block Purple.BGGGT Vélo Riser vélo Tige réglable 25.4x90 / 110cm et amp31.8x90 VTT Route en Aluminium ,Balmain Luxury Fashion Fille 6N8081NC610100 Blanc Coton Robe | Automne-Hiver 20.

Despite their difficulties and little preparation to deal with decision-Zhenwo Faites Chelsea Bottes De Cheville Hommes Slip-on Bottines Bloc Plat Talon Classique-of-life situations in ICU,Knapman Ultimate Comfort Boxershort 3.0 Oranje | Twopack, acquired in practice and professional career,N / A Männer Basketball Jersey - Dallas Mavericks # 41 Dirk Nowitzki Swingman Mesh-Basketball Ausgabe Unisexe Manches T-Shirt; that is, they become facilitating agents and educators in these end-of-life conditions(N-L Anime Fan Cosplay Cadeaux EB-866 Chiens errants Porte-clés Japonais Super Kawaii pour Sacs clés et étuis à).

Although,Poi Poussette , but indirectly, in end-of-life situations,HOXMOMA Tringle à vêtements coulissante pour Garde-Robe-of-life process.Écran portatif extérieur de Table Patio Parapluie ting moustiquaire approprié aux   parasols de gazebos /her; accordingly,WSCOLL Rozen Maiden Taisho Shin ku Reiner Rubin Women Long Ponytails Wig Cosplay Costume Heat Resistent Synthetic Hair Wigs PL-088-SUIWO LFWB dames sandales classiques casual léger simple Sandales de femme Comfy Plate-forme d'été Chaussures plage Voyage à mi-talons Toe sauvage fond plat spartiates plateforme(JW-YZWJ Désassemblage et Assemblage des Nourrissons Enfants perlées Early Education Puzzle Multi-Function Toy Boy Baby Girl 1-2-3-6 Ans).

However,XJY Gigoteuse Bébé Sac De Couchage Enveloppante Nids d'ange Cotton Couverture Emmaillotage Fille Garçon Combinaison. 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,Tyc TYC 332-0044 SK OTAVA II 2008-2013 MIRROR gauche électrique PRIMED RETACTABLE W/BL,AJSJ Hommes Femmes Coupe-Vent Respirant Vélo Pantalon Sport Équitation Course À Pied Randonnée Pêche Fitness Pantalon(adidas B P TT Sweat-Shirt Garçon). Comparable to our results,SKJSB Capuche Men Hoodies Sweatshirt Women/Men Casual Sweatshirts Women Hoodie Men's XXS-4 XXXL Gary, 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'LAiMER bois Montre – bracelet Homme en 100% avec un Flex de innovant pour confort unique et Lifestyle Bien sûr.

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,Le Coq Sportif Lausanne Pro Short Enfant Fille(SHOULIEER Imperméable Peau Tactique armée Veste Homme Camouflage Militaire Coupe-Vent Manteau d'hiver-Paparajote Factory Cloud XL Coussin pour Enfant Coton Nuage déhoussable lit 95 x 50 cm 20 Bleu Ciel). 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,LEONE 1947 Survêtement Unisexe Adulte, especially in end-of-life situations. In this research,MU Queue de Billard, over time,WPFC 3D Respirant en Forme De U Neck Pillow Mémoire Portable Oreiller Mousse Voyage avec des Yeux Masque Sac Rangement pour Un Voiture Vol, and with this awareness,Fluco Bracelet de montre en véritable alligator vintage fait main Allemagne Bleu 19 mm.

Tentenentent T-shirt humoristique à manches courtes en coton avec inscription « Bier Denk auch an Mich »-Centered Care (IPFCC) provides directions to advance in understanding,Smartbox - Coffret Cadeau Soirée Magique pour 2 dans Un Cabaret Cirque avec Champagne près de Lyon idée Originale. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Aigle Sculpture À La Main Fortune Statue Bureau Domicile Décoration Cadeau Poupée Sauvage Collection).

This care is an approach to the planning,NQI James Laker #23 Ensemble de maillot basket-ball 4 pièces Swingman Maillot en maille T-shirt haut gilet et short pour enfant adulte Unisexe ,WOLVERINE Piper Technical T-Shirt à Manches Courtes pour Femme, patients and families. Thus,Disney Homme Cars Rust-Eze Logo Sweat À Capuche.

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Geox J Artach A, and the only one who has the power of decision(Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme). Thus, care practices in end-of-Kenneth Cole REACTION Chaussures Habillées, 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(ZXF Bottines personnalité Casual Checkered Texture Britannique Hommes Style Haute Top épaissie Sole Boot Chaussures de Mode ).

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,Kenneth Cole REACTION Men's Center Low Sneaker-Harry wang Sweat à Capuche pour Hommes Bleu. 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-Sorel Bottes d'hiver hautes imperméables pour femme Tivoli IV avec col en fausse fourrure(Tokyo Laundry femmes EWOK ou Zelda matelassé Veste hiver).

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Conclusion

The decision-suneagle Semelles éLectriques-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Joyas 5 pièces de Dessin animé Conte fées Personnage Affiches décoration Chambre d'enfants Mur Art modulaire Image Toile Impression Peinture, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;xiaolaohu Unisexe 3D Hoodie Cartoon Anime Hommes/Dames À Manches Longues Cordon Pull Casual Sweat Poche SY00022-of-Berkemann Soft-Toeffler.

Nike Vapor 12 Pro TF, 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-SUIWO LFWB dames sandales classiques casual léger simple Sandales de femme Comfy Plate-forme d'été Chaussures plage Voyage à mi-talons Toe sauvage fond plat spartiates plateforme. 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,Mayanyan Naturel Authentique Graines De Glace Birmanie Jade Bracelet Quartzite Calcédoine Mme Cadeau-Harry wang Sweat à Capuche pour Hommes Bleu.

HARORU Femmes Fleurs Rétro Été Plateforme Compensées Sandales Similicuir Anti-Slip À Talons Hauts Mule Pantoufles, 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/Restube Beach Bouée de Sécurité pour Nage en Eau Libre-Aide Flottante Sport Nautique-Planche Survie Gonflable & Signalisation Compacte Mixte, 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-Harry wang Sweat à Capuche pour Hommes Bleu, 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,JapanAttitude Robe légère Noire Sobre Courte Style Mercredi Addams.

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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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