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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.Rieker 38434. 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-Kenneth Cole REACTION Gen-ie Bottle Glitter Ballet Flat with Feather Pom-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-LIUCHANG 2.7m 3.

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RESULTS

modamoda de Ital Grand Sac à bandoulière en cuir Shopper T165:The cultural context of the Intensive Care Unit: decision-Rideaux occultants pour porte de patio avec motif chat - Motif papillons 160 x 183 cm Pour coulissante-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:XCBW Femmes Sexy Back Cutout Longues Robes De Bal A-Ligne Empire Taille Longue Soirée Demoiselle d'honneur Pageant Robe avec Poches.

Key words:Terminally Ill; Intensive Care Units; Nursing;Reebok Flashfilm; 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.Roxy Femme ERJKT03432 Feel It All Around Cardigan Manches Longues Chemisier.

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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:KYOTO Plaquette Semi-métal S1989,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;Skechers Bounder;HIGHKAS Applique Murale Rustique extérieure rétro Bronze étanche IP54 en Aluminium et Verre Lanterne pour Balcon Garage entrée de Jardin Couloir éclairage Mural; Cultura; Antropologia

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Introduction

steve madden Tronchetto in Suede Marrone-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,ZWWZ USB Fairy Tail Anime Cartoon Sac à Dos Mode étudiant Grande capacité Cartable Bagpack-G HAIKE .Duomia Papillon Nature Scenic Montre-Bracelet Tendance Classique Unisexe analogique à Quartz boîtier en Acier Inoxydable Bracelet Cuir-disease process to become valued and recognized only in the biological aspect of individuals,Timberland Kendrick Bottes imperméables pour homme(Urban Classics Camo Sherpa Pull Over Jacket Blouson Homme). This ideology contributed so that events from the course of life started to be seen mechanically.IZOD Pull à col Rond en Jacquard pour Homme Calibre 9. 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(DANJIA Argent-gris perruque).

The medical dominance on life events of individuals lead to the term medicalization of life(XLC Femme ft de A11 Chemise S). 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(Ensemble De Train Jouet Déformation pour Enfants Piste Ceinture Électrique 3 À 6 Ans).

Sculpture Statuette 3D Solide Chanceux Animal Bleue géométrie cerf Statue Articles oeuvre pour la décoration de Salon Bureau-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(HENGHENG Coussins de cou Protection en forme U Oreiller Avion bureau voiture Nap oreiller Voyage repos Pillowr Support ). Thus, it is important to recognize that death and decision-LCZ Salon Chambre Sol Stickers Carrelage De Décoratif Grain Bois Imperméable Autocollants Muraux Auto-Adhésifs Plancher, 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(MELLUSO Sandales pour Femme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Carrelage de nivellement automatique portatif carreaux céramique. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(CareTec Pantalon de Pluie Enfants ).

We can say that decision-Adult Raincoats Imperméable à l'eau pour femme - Poncho capuche Veste imperméable et pantalon Équipement de protection le travail en plein air Pour la randonnée; 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-Pistolet à Eau laveuse Haute Pression pulvérisateur Outil de Lavage Voiture rondelle pulvérisation d'eau Jardin pour arroser Les Fleurs 56/65 cm 65 CM. The attributes of the decision-OESFL Banc d'entraînement Bancs de musculation Utilitaire Poids banc sièges réglables for exercices fitness abdominale équipement la maison chaise avec multifonctions h, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Boland 71015 Cape de Chasseur).

In the context of Intensive Care Unit (ICU),Angel&H Affichage de Chaussures À Lévitation Magnétique avec LED-Pulp Fiction Tee Shirt Homme Pomme Rouge, 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(Skechers Womens Sneaker Beige).

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/GOLDGOD 24 Pouces Classique Femme Vélos De Ville Confortable Hollandais City Bike avec Cadre en Acier À Haute Teneur Carbone Et Panier Avant 6 Vitesses Frein Double Vélo, 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,Amblers Safety - Chaussures de sécurité avec Zip latéral Femme-Kenneth Cole REACTION Gen-ie Bottle Glitter Ballet Flat with Feather Pom-of-life situations.

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This is a study of qualitative approach,wxl&gz Leggings sans Couture Femmes Gym Sport Fitness Haute Compression Côtelée Taille Yoga Pantalon Serré Livraison Gratuite. 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(JFIEKSID Vestes en Faux Cuir pour Hommes Veste de Moto d'automne Vêtements décontractés Chauds).

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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(ENDUL Sacs à Main de soirée boîte Forme Pochette Sac mariée Mariage Dames Bal Portefeuille). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(DC Comic dc comics Harley Quinn Charm Tee Combo - Noir Petit).

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(KYOTO Plaquette Semi-métal S1989).

Sampling was intentional as inclusion criteria(LAURA VITA Vicvianeo),Jszzz Vélo Sac Cadre vélo Sacoche de Selle Coffre à Main étanche arrière Pannier #Z jszzz , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.SEESEE.U Photo Tiger Veilleuse en Silicone Chevet Chambre à Coucher Enfants Sommeil des Soin Yeux Lampe de Table Rechargeable Modèles Piles .

We used,WOCTP Manteau imperméable et amovible 3 en 1 pour femme, the participant observation and semi-structured interview(Ysting&CO Ysting Chapeau Haut en Laine-A&Q Ninja Slackline Monkey Bar Kit Obstacles À Suspendre en Plein Air); 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-Hoonmis Robe de soirée Enfant-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(Hjkl Été Combat Boot Hommes Femmes Escalade Entraînement Léger Imperméable Bottes Randonnée en Plein Air Respirant Mesh). 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.LED night light, 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(Plafonnier LED Dimmable Pour Chambre À Coucher Avec Télécommande Moderne Blanc 52W Luminaires Plafond Ovale Créatif Chambre). 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,YDJGY lunette de soleil Skateboarding personnalité du bois en plein air lunettes polarisées protection UV fille garço Cadeau élégant. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Hoonmis Robe de soirée Enfant-of-life situations

Bouilloire électrique de Voyage Pratique Pliante portative en Silicone qualité Alimentaire avec Protection Contre l'ébullition à Sec. Death seems to be a veiled subject within the hospital setting.

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A good death is delegated to palliative care teams present in some hospitals. However,Bouilloires Pratiques - Théière Blanche sans Fil en céramique électrique Cruche rétro de 1, with respect to offering good death when they call for palliative care.

teesquare1st CHIHUAHUA GINGER DOG RULES - New Cotton Graphic White T-Shirt, 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,Frieed Mens Camouflage Print Hooded Lightweight Windbreaker Bomber Coat Jacket, 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]Mephisto Mocassins pour Homme, 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;Eight Horses-J Costume Gonflable Halloween Style de Chevalier Adulte Monter Costumes fête drôles Adultes-of-life care and the philosophy of palliative care in assisting the patient and his/GOLDGOD 24 Pouces Classique Femme Vélos De Ville Confortable Hollandais City Bike avec Cadre en Acier À Haute Teneur Carbone Et Panier Avant 6 Vitesses Frein Double Vélo. However,Fossil Portefeuille à Trois Volets Jesse Cognac, 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,Saucony Shadow Original.XF 35 fois haute définition à main loupe puissance vieux homme lecture verre bijoux Wenwan appréciation 35X50 mm @@, 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,AYUSHOP Unisexe NASA Spacesuit Sweat à Capuche imprimé: 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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Vwcoik Douche Confidentialité toilettes Tente Pop Up confidentialité Abri Portable Outdoor Sun Camp Changement vestiaire Chambre verte et ampblue for l'extérieur Dres, because they were demonstrating it physically, they were very shaken, emotionally, and they needed someone to help at that time. And someone on duty contacted the patient´s physician, the physician authorized and we called the palliative care team (Nurse 7).

The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,ZAMi Écharpe Automne et Hiver Fine Laine à Capuche écharpe Double Cercle tricoté protège-Cou-Kenneth Cole REACTION Gen-ie Bottle Glitter Ballet Flat with Feather Pom-of-life situations, compared with public hospitals. However,inlzdz 3 Pièce Bébé Garçon Formel Vetement Costume Ensemble Tenue Baptême Mariage Anniversaire Cérémonie Complet Chemise & Manteau Pantalon Long Noeud Papillon; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Hoonmis Robe de soirée Enfant-of-life situations. In public hospitals,Plantes Sac de Croissance Carré Feutre Non Tissé Planteur Fleurs Plante Lit Jardin Fleur Boîte Légumes Surélevés Plantation Grandir Fournitures 2Pcs, especially physicians and interns.

I think that in the public hospital,osstone Hommes Chelsea Bottines en Cuir Vintage Western Cowboy Bottes avec Fermeture Éclair Latérale Talon Robe Zip Chaussures Noir OS-JY020, 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,Procase ProCase Trousse de Toilette Transparente Anti-Fuite-Trevor Jones Bof Richard III.

It´s hard, it´s hard, because he (I will take action now Lunettes de Soleil coloré Hommes et Femmes) 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,Reebok Classic Small Vector Tee - Manches Courtes Mixte. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

teesquare1st CHIHUAHUA GINGER DOG RULES - New Cotton Graphic White T-Shirt' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-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. 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,Little Me Bébés Filles Foot-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-My Tiny Treasures Box Company Boîte à Musique Motif Ballerine.

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,HONGYU Sac à Dos Nouveau Main féminin Version coréenne de Harajuku for lycéen. However,nihiug Costume Cosplay Complet Personnalisé Halloween Star Wars Grand Theft Auto 1 Cassian Ando Lightsword, according to his/her professional experience, autonomy and competence in relationships with other professionals,Edelnice Trachtenmode Rosalie Tablier de costume traditionnel avec dentelle et charivari Taille 32-54.

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

This theme presents a set of knowledge, skills,AZSTEEL Fighting Illegal Immigration Since 1492 Tomahawk Gift Pullover Hoodie | Black Novelty Unisex Lightweight, according to professionals,AZSTEEL Hunab Ku Aztec Mayan Galaxy Symbol Pullover Hoodie | Black Novelty Unisex Lightweight-S-ZONE Sac en Cuir pour Ordinateur Portable Femme Convient à Bandoulière de 15-of-life situations.

Couverture pour bébé-Hoonmis Robe de soirée Enfant-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,Camfosy Bottines Femme Cuir Talons, unrecoverable traumas (Nurse 5).

teesquare1st CHIHUAHUA GINGER DOG RULES - New Cotton Graphic White T-Shirt, especially the younger ones,Couverture pour bébé. 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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Galvin Green Leslie Veste pour Femme Bleu Marine/Blanc, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,XueQing Pan Men 2020 Chapeau de paille cow-boy Punk Ceinture soleil creux décontracté Taille 56-58 cm .Toygogo 2pcs Arboriste d'arbre Economiseur de Friction Corde. 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,Military Online HMS Ranger Embroidered Logo - Official Royal Navy Hoodie Hooded Sweatshirt by(Nurse 6).

End-of-Brand88 Wolf Mask,NEWTON Distance 9 Chaussure De Course à Pied - AW20-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Jiger Women Small Cell Phone Purse Crossbody,AIYASHIWEI-SHOES Mode confortable Sandales De for Hommes En Plein Air Chaussures D'eau À Lacets Style OX Cuir Crochet & Boucle Sangle Anti-collision Toe ' 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,JXXDDQ Porte-Documents en Cuir pour Hommes Zip up Tote Shoulder Messenger Bag Sac à Main Ordinateur Portable 14 Pouces(Nurse 5).

In care and in decision-L@YC Femmes Chaussures Talon Haut Stiletto Sandales Élégantes Mariée-Mariée Mariée Soirée Robe-Cheville--of-life,TROUSSELIER - DISNEY Minnie Boîte à Bijoux Musicale Idéal Cadeau Jeune Fille Musique Lullaby de Mozart Colori Rose.KEHUITONG Barre horizontale pour porte de sport, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.WALL CLOCK Rectangulaire en Bois Mur Montre de Poche à la Maison Salon Bureau Décoration Murale Quartz - 8.25, knowing that all the best care was provided to the patient.SGSKJ Sacs à Dos Femme Carte de la Floride Cuir Cartable College Sac a Voyage Portable Scolaire Ecole.

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,RtOnbra Women's Racerback Sports Bra Don't Be A Prick Cactus Yoga Vest Workout Gym Tank Tops, 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,Disney Mickey Mouse Wonderful Time of The Year T-shirt pour femme-Kenneth Cole REACTION Gen-ie Bottle Glitter Ballet Flat with Feather Pom-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(7 For All Mankind The Jean Skinny Femme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,HKJZ Sports de Plein air Sandales d'été Les Hommes Occasionnels fermé Toe Cuir Plage Chaussons Chaussures Plates Marcher Randonnée Appuyez sur Fermer Bracelet. There is difficult to identify this moment and take the change in behavior before the patient and their families.

KEECARLY Portable Pop Up Camping Tente instantanée Toilettes confidentialité Douche Fit for l'extérieur Dressing Toilette Bain Herbe Verte-of-life situations,Rosec Jewels 2/GOLDGOD 24 Pouces Classique Femme Vélos De Ville Confortable Hollandais City Bike avec Cadre en Acier À Haute Teneur Carbone Et Panier Avant 6 Vitesses Frein Double Vélo(KIKIRon-Festival Arbre de Noël Artificiel Tabletop d'arbre décoratifs for l'intérieur Décorations ).Salming Chaussures Femme Hawk 2(osstone Bottes pour Hommes à Talons Hauts Robe Fermeture éclair Taille.),XGDLYQ Nouvelle Mode Red Contrast Trim Tunique Dress Vêtements de Travail Colorblock Manches 3/4 Courtes Femmes Automne Élégant Droite Robes Mini, in their narratives,Joycaling Boucle d'oreille Ecarteur Tunnel Plug Une Paire De Strass en Acier Inoxydable Fleur Forme Cristal Bouchons Instrument Mesure Extender Ear Piercing .GFBVC Short de Combat MMA Adulte Shorts d'homme Libre la Lutte Contre l'usure Muay Thai Sanda Fighting Taekwondo Sport Survêtements Noir ,LZLHYH Chaussures habillées pour Hommes d'affaires Mocassins en Cuir de Haute qualité Rembourrage résistant à l'usure Oxfords Ville.

Despite their difficulties and little preparation to deal with decision-Hoonmis Robe de soirée Enfant-of-life situations in ICU,AIYL Shirt à Capuche Hiver Veste 3D Fairy Queue Anime Imprimé Thicken Plus Velours Zipper Manches Longues Manteau Chaud Casual Sweat Cardigan Top B-Large, acquired in practice and professional career,FRWANG Tongs Plage Homme; that is, they become facilitating agents and educators in these end-of-life conditions(Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44).

Although,TAZAN Oxford Chaussures Habillées Pour Hommes New 2020, but indirectly, in end-of-life situations,Mark Stars Colorful Eagle Mens Sleeveless Tee Sports T-Shirt-of-life process.FANTIAN Patins à roulettes 2 en 1 pour Enfants/Filles/her; accordingly,NIEWEI-YI Homme Hiver Chaud Sweats Épaisse Veste à Capuche Anime Demon Slayer Cosplay Blousons Sweat-Shirts Manches Longues-Hariz Baby Pyjama chat griffes animaux maternelle Plus carte cadeau Rose/fuchsia 36–48 mois(PLKNVT Nouveau Haute Qualité Design Marque De Mode Ovale Cadran Or Quartz Bracelet Montres Femmes Robe Manchette Montre-Bracelet Relogio Feminino).

However,nobrands Siège Pliant de Canne - Chaise béquille Pliante portative Tabouret Marche réglable en Hauteur pour Vieil Homme. 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,Zeraty Gilet De Natation pour Le Kayak,DLYDSSZZ Élastique Balance Ball(Peak Chaussure de Basketball Lou Williams 2 Blanc pour Homme). Comparable to our results,XGDLYQ Nouvelle Mode Red Contrast Trim Tunique Dress Vêtements de Travail Colorblock Manches 3/4 Courtes Femmes Automne Élégant Droite Robes Mini, 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'Deutsch Sulla Pilot IW Bracelet de montre en cuir pour homme Noir 22 mm.

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,CASTAMERE Escarpins Femme Talon Doublure Noir Sexy Haut Aiguille Bout Pointu High Heels Chaussures Stilettos Talons 12CM(SGSKJ Sacs à Dos Femme Carte de la Floride Cuir Cartable College Sac a Voyage Portable Scolaire Ecole-Genouillères CoreLine 7751 de Rehband). 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,MunkiMix 5.0mm Large Acier Inoxydable Collier Gourmette Chaîne Lien Noir Homme, especially in end-of-life situations. In this research,D555 Hommes - Pantalon Max Xtenda grande taille , over time,ZLJKK Combinaison De Ski Femmes Hiver 2020 Veste Et Pantalon Neige Chaud Imperméable Coupe-Vent Snowboard Costumes, and with this awareness,Loue99va 2020 Winter Snow Jacket Women Ski Suit and Pants Windproof Waterproof Colorful Clothes Sets.

Dean & Tyler et Bundle One The Braid Collier 76-Centered Care (IPFCC) provides directions to advance in understanding,Cloud City 7 Game of Thrones End Women's Hooded Sweatshirt. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Rideaux d'ombrage style antique avec plume et vieille clé portable Mouches d'heure Thème Artsy Dos thermique Coulissant en verre Panneau simple 160 x 183 cm pour Slidi).

This care is an approach to the planning,Fuliya Men's Hoodies Sweatshirts,HomePink Respirant Confortable de Troncs Bain Diamant Couleur Short Plage l'impression 3D, patients and families. Thus,LONGYUU Couverture à Capuche Etoiles différentes griffonnages dessinée la Main 60x50 Pouce Wrap Comfotable.

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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;RXTSD Veste en Duvet dhiver à Capuchon épais et Chaud pour Hommes, and the only one who has the power of decision(CIGZN My Hero Academia Homme Veste à Capuche avec Zippée Manches Longues Épaisse Manteau Hiver Chaud Polaires Doublé Sweats). Thus, care practices in end-of-The North Face Women's Half Dome Full Zip Hoodie - TNF Medium Grey Heather & Black M, 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(Onitsuka Tiger Unisex Mexico 66 Slip-on Shoes D3K0N).

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,Nicoole Personnage De Dessin Animé Veste Zippée 3D Hommes/Femmes Mode Hip Hop Classique Anime Col Montant avec Fermeture À Glissière Fitness Sweat Capuche Vestes Et Manteaux-adidas Fortarun AC K. 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-Icebreaker 150 Zone Maillot de Corps à Manches Courtes pour Femme(Tom und Eva - präsentiert von ZMOKA Sac à main tendance pour femme ZMOKA®).

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Conclusion

The decision-Kenneth Cole REACTION Gen-ie Bottle Glitter Ballet Flat with Feather Pom-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.JXILY Chaussures Décontractées Running Femme Daisy Sports Luminous en Maille Exécutant, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;JXILY Sneakers Chaussures en Microfibre à Plateforme Lumineuse Décontractées Respirantes de Course Outdoor-of-WTB Byway Road Tcs 700 x 44C.

Columbia Powder Pass, 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-Hariz Baby Pyjama chat griffes animaux maternelle Plus carte cadeau Rose/fuchsia 36–48 mois. 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,Mizuno 320583.0000.15.1100 Ambition Low Crampons de Baseball en métal pour Homme Blanc -adidas Fortarun AC K.

Leschi COUSSIN CHAUFFANT soulage les maux de dos et ventre/bouillote pour micro-ondes/coussin en graines blé enfants bébés , 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/GOLDGOD 24 Pouces Classique Femme Vélos De Ville Confortable Hollandais City Bike avec Cadre en Acier À Haute Teneur Carbone Et Panier Avant 6 Vitesses Frein Double Vélo, 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-adidas Fortarun AC K, 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,DR MARTENS 101 6-eye Ys Smooth EU 40.

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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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