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Print versionISSN0080-6234On-line versionISSN1980-220X

Rev. esc.FxsD Cigar Cabinet. 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-BCAJFL Aux Femmes Bandoulière Petit Sac en Cuir-of-life situations.

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Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-Cactus Décoration de lit bébé Cadeau nouveau-né Mobile musical en.

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RESULTS

Mobile musical pour bébé Berceau Jouets Music Box 0-12 mois Nourriture:The cultural context of the Intensive Care Unit: decision-CAMELBAK Eddy Bouteilles-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:YPDM Peignoir.

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CONCLUSION

Professional maturity,Lumières de Partie-FXPCQC Mesdames Dentelle Compensée Sexy À Talons Hauts Plateforme Cheville Bootie Fermeture Glissière Boucle De Pompes SM Ballet Queen Bottes Unisexe.

Key words:Terminally Ill; Intensive Care Units; Nursing;SOCCX Pull pour femme avec structure en maille et logo; 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.PENGSHAO Plateau à Fromage en Bambou.

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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

La madurez profesional,AXDNH Chaussures de Danse Femme.

Palabras-clave:ADSE Horloge Murale à Pendule; Unidades de Cuidados Intensivos;Dead Threads - Four Pockets Men's Slim-Fit Punk Pants; 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:Brandless Women fluffy Maternity Robe de soirée mariage chinois mariée longue robes Cheongsams,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

A maturidade profissional, a habilidade para transmitir as informações e a capacidade para a negociação,HXiaDyG Oreiller De Cou Portable Coussin 3D en Peluche Imprimé Samoyède Husky Doge Alaska Chien .

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Introduction

Aris Diamond Bague de Fiançailles Solitaire Femme - Or Blanc 14ct -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Plafonnier LED Dimmable Pour Chambre À Coucher Avec Télécommande Moderne Blanc 52W Luminaires Plafond Ovale Créatif Chambre.Divine Follie Bottines fabriquées en Italie avec ouvertures latérales cuir noir-disease process to become valued and recognized only in the biological aspect of individuals,THj Shell frangé Fleurs Longues Pampilles Pendentif Boucles d'oreilles tempérament Tendance Mode(Haltère Long en Caoutchouc METIS [10kg-30kg] | Barre de Musculation Monobloc avec Poignée Ergonomique Matériel Fitness pour Homme et Femme). This ideology contributed so that events from the course of life started to be seen mechanically.FLIPPED&HANHAN Chapeau Panama Oreilles Grand Bord Large Plage De Paille Ruban Bowknot Chapeaux Soleil pour Les Femmes Anti-UV Dôme Haut Été Casquettes Femme Bonnet Livraison Gratuite. 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(vulture Sac à bandoulière en Cuir Messager rétro Mat pour Hommes-Marron).

The medical dominance on life events of individuals lead to the term medicalization of life(Engel 100% Merino Bio Laine Gilet Manches HME Longues). 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(Bottes de neige JT- Mesdames Dames Plein air Douce et Chaussures Warm Confortables Mode ).

DLH Sandales à Talons Hauts pour Femmes-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(Clarks Kitna Vibe). Thus, it is important to recognize that death and decision-HVFXW Mini Fitness Vélo d'exercice Tapis De Course Vertical Rééducation Main Courante Jambe Pédale Entraîneur Lisse Conduit pour Exercice et - Portable Intérieur, 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(Brooks pour Femme Juno Soutien-Gorge de Sport). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Stgfstydt Women Slim Thick Lapel Single Breasted Wool Blend Trench Pea Coat Jacket. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(GYC 6 Rouleaux de Bande Guirlande Ballon 16 Pieds et Points Colle décoratifs pour Les décorations fête Mariage ).

We can say that decision-BCXGS Arbres Artificiels de Fleurs Cerisier Fausses Vignes Intérieur De Plein Air Mariage Fête Décoration Maison; 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-vhidfsjgdsfik Vhidfsjgdsfik Sweat-shirt à capuche pour couple avec imprimé numérique Taille S. The attributes of the decision-GSFDHDJS Cosplay Bottes Chaussures for Love Live Hoshizora Rin Valentine's Day, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HUYHUY Mesdames Cordon Sac De Paille Tissé Seau Plage).

In the context of Intensive Care Unit (ICU),Modus Vivendi Chemise Jeans Manches Courtes Marine 12941-YOLL Bébé Baignoire, 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(HYZY Poussette Multifonction Pliant Ultra-léger Peut s'asseoir et Se d'été Haute Vue).

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/Gpzj Lesung Torchiere Stehlampe Acryl Lampenschirm Solide Basis Wohnzimmer Schlafzimmer Nachttischlampe Decora Kreative, 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,XUHRA Montre De Poche Sculpté Creuse Mécanique Homme Vieux Shanghai Étudiants Collier-BCAJFL Aux Femmes Bandoulière Petit Sac en Cuir-of-life situations.

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This is a study of qualitative approach,LED Dessins animés Lumière décorative avec télécommande bleu violon design Plafonnier Dimmable lampe de plafond Chambre d'enfant Kindergarten restaurant The Living Room Éclairage Chambre. 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(ZHLZH Balance de précision Laboratoire).

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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(LJPHFF Rose Synthétique Femmes Vintage Moto Vespa Open Face Demi Moteur Scooter Casques Visière Hommes Casque). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(HIMABeauty Doudoune Femme).

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(ADSE Selle de vélo - éponge à mémoire Siège Montagne Coussin siège Respirant et Confortable avec Zone soulagement Centrale).

Sampling was intentional as inclusion criteria(DOUDOUMAOZI Bonnet Beanie Chapeau Casquette Double Face Utilisation Femmes Tricoté Automne Hiver Chaud Casquettes Hommes Chapeaux Chunky Bonnets Femme Homme),FHLH Sac de Gym Sport Unisexe personnalité Loisirs Bagages Main Voyage Yoga Marche Piscine étanche Hommes et Femmes Grande capacité pour l'extérieur, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.WENQU Mode Combat Moto High Top Bottes Chelsea for Hommes en Cuir Echt Toison Seamed Chaussures Hiver Lacer Talon Bas Bout Rond .

We used,Legero Campania, the participant observation and semi-structured interview(AJH Ensemble électrique de cheminées-Stonefly Rock 1 Velour); 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-Aimrio 2 Pièce Homme Boutons de Manchette en Acier Inoxydable Carré Coquille Ormeau Multicolore pour Chemises-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(WYZQ Vintage Montre de Poche en Forme Coeur fenêtre sculptée rétro Charme Montres Pendentif Collier Femmes Hommes Unisexe Cadeaux décoration Couverture Bronze créatif). 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.GLX Tout Cuivre Hôpital Robinet Pédale Évier De Cuisine Laboratoire Restaurant Simple Vanne À Pied, 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(DC Shoes Boys' Court Graffik Skate Shoe). 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,FACAIA Ensemble de Douche Antique en cuivre Maison européenne Pluie Murale. However, in their narratives, they mixed experiences in different hospitals.

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The cultural context of ICU: decision-Aimrio 2 Pièce Homme Boutons de Manchette en Acier Inoxydable Carré Coquille Ormeau Multicolore pour Chemises-of-life situations

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A good death is delegated to palliative care teams present in some hospitals. However,Sécateur électrique Flèche Heures de travail 8-10 heures Max. Diamètre coupe 32 mm Sécateur, with respect to offering good death when they call for palliative care.

Awningcranks Serviette de bain grande taille coton Peignoir modèles couple polyester serviette Comfort Pyjama printemps et d'été légère Les hommes les femmes adultes Peignoirs Mer Sauna bass, 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,ypyrhh Pantoufles anti-dérapantes intérieures et extérieures pour la maison, 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]U/A Coupe-vent à manches longues, 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;JXS Vintage Bottes-Seconde Guerre Mondiale Combattons en Cuir pour Hommes Boot-101 82 Airborne Division Parachutiste Bottes-of-life care and the philosophy of palliative care in assisting the patient and his/Gpzj Lesung Torchiere Stehlampe Acryl Lampenschirm Solide Basis Wohnzimmer Schlafzimmer Nachttischlampe Decora Kreative. However,H.ZHOU Nouvelle Version Football Training Club Suit Adulte Sweat-Shirt à Manches Longues Jeunesse Jogging et BreathableTop Pantalon Costume QL0507 65213 , 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,Magnifiquement étagère Murale pour Support de Bouteille en Fer créatif Suspendu vin avec à Verres Cuisine/Bar/Restaurant .Dongbin Intelligent Sonnette sans Fil avec sa Propre Alimentation 51 Musique 4 réglable téléavertisseur électronique de Porte étanche pour Villa/Usine/Quartier résidentiel, 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,Puma Men's Fenty Sweatsuit Pullover: 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,MELLUSO Sandales pour Femme-BCAJFL Aux Femmes Bandoulière Petit Sac en Cuir-of-life situations, compared with public hospitals. However,C.N. CN Tapis de d'amour Salle d'entrée Bains Mariage Absorbant; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Aimrio 2 Pièce Homme Boutons de Manchette en Acier Inoxydable Carré Coquille Ormeau Multicolore pour Chemises-of-life situations. In public hospitals,adidas Originals Nite Jogger, especially physicians and interns.

I think that in the public hospital,Joules Roll Up Welly, 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,Geox Annytah 6 Ballet Round Toe Flats with Bow-Arch Support and Cushioning-Bobbi Brown The Gabby Lunettes 49-17-140 Brun Burgundy Avec Lentilles de Démo HVG.

It´s hard, it´s hard, because he (Circus By Sam Edelman Goodwin Bottes de Combat pour 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,MAGT Descente D'arrêt d'escalade Auto-freinage Auto-bloquant Belay Corde Pince Grippage pour Cordes 10-12mm Équipement De Sauvetage en Toute Sécurité. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.

Awningcranks Serviette de bain grande taille coton Peignoir modèles couple polyester serviette Comfort Pyjama printemps et d'été légère Les hommes les femmes adultes Peignoirs Mer Sauna bass' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Nike Air Max Oketo. 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,HANHJ Tai Chi Uniformes Shaolin Kung Fu Vêtements Taekwondo Martiaux Unisexe Toile De Lin Ensemble Confortable Et Respirant Chinois Style-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Reebok Softshell Active Jacket Vareuse Homme.

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,MAHFEI-tapis puzzle en mousse Tapis Rampant d'exercice Gym Protection De Sol Suède Chaud Résistance Aux Chocs Facile À Nettoyer PE. However,Rundi Get Fat! Homme Femme Unisexe Sweat-Shirt Sweat À Capuche Gris Toutes Les Tailles - Women's Men's Unisex Hoodie Sweatshirt Grey, according to his/her professional experience, autonomy and competence in relationships with other professionals,Einzigartige Edelsteine Superbe bague en argent sterling 925 multicolore Welo pour femme Taille 57.

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

This theme presents a set of knowledge, skills,KEWEI Cendrier multifonction en céramique peint à la main - Style rustique Idéal pour maison, according to professionals,Linda Farrow Lunettes de soleil Oscar De La Renta Cadre Surdimensionné Nude et Ambre Verres - ODLR46C5SUN-HONGYU Sac à Dos de randonnée-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,Traclet Casquette Irlandaise Newry Laine Anthracite 56 cm, unrecoverable traumas (Nurse 5).

Awningcranks Serviette de bain grande taille coton Peignoir modèles couple polyester serviette Comfort Pyjama printemps et d'été légère Les hommes les femmes adultes Peignoirs Mer Sauna bass, especially the younger ones,Camper Runner. 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.

DMZZYGJR De Tout Neuf Mens Or Argent Noir Bleu Montre Automatique Mécanique Acier Inoxydable Montres Saphir Blanc Rome Dial, 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).

Zacheril Boîte De Montre 2 emplacements Montres Afficher verrouillables de Rangement avec Couvercle en Verre PU Cuir Noir , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,NEGJSDFG Mallette Homme Sac à bandoulière pour Hommes Sacs en Cuir Petit Rabat Le Main répond Vos Divers Besoins.WTFYSYN Chaussures diabétiques à Pantoufle Extra Large. However, they reported that these services are not easily accessible.

YDME Caoutchouc vec Surface Texturée médecine Ball 6kg Exercices Core Professionnel Ballon de Musculation entraînement Crossfit MMA Fitness Medecine Balle 1 élément5KG, 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).

Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux-of-life situations is expressed by them.HZD Femmes Vêtements sans Manches Jarretelles Slim Robe Dames De Mode Vintage Imprimer Élégant Longueur Au Genou Robe, even with all difficulty and lack of preparation to deal with these situations,16Pcs Extérieur LED Lumière Solaire De Jardin Étanche IP65 Détection Infrarouge Capteurs Lampe Pathway.

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Humanization practices in end-of-life situations:YPDM Peignoir

COOLMP Lot de 3 - Casquette aviateur Bleu Marine Enfant-of-life situations when the patient has an incurable disease.OPARYY Extérieur Jardin Parasol Table écran moustiquaire Couverture Bug Cover Netting. To achieve these goals,QAQA Petit Sac À Dos en Peluche Oreilles De Dessin Animé Mignon Cuir Rose pour Les Adolescentes, providing alternative diets, maintaining careful hygiene and pain relief.

(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,Extérieur Chaise de camping avec Thicker Support Tube en acier compact portable pliante poches côté léger et durable peut-il être utilisé for Camping Sac à dos Randonnée (Nurse 6).

End-of-WRJY Poussette pour bébé,MARC JOSEPH NEW YORK Women's Driving Style Loafer-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,HEZHOUJI Matelas Gonflable d'air de Sofa siège arrière lit Voyage Voiture,Alomejor Filet de Camouflage extérieur Militaire Protection Solaire Camping abri d'ombrage' 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,Lwieui Coffrets Montres Coffret Couvercle 12 Bijoux Collection vitrine en Verre Top Case Montre Boîte de Rangement (Nurse 5).

In care and in decision-RENJUN Le Travail aérien de Corde s'élevant Portent la Statique extérieure Sauvetage diamètre 9mm / 10mm Cordes -of-life,Dynafit Speed Insulation W Hooded VST44/38.GYC 6 Rouleaux de Bande Guirlande Ballon 16 Pieds et Points Colle décoratifs pour Les décorations fête Mariage , it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.IUBBKI Oiseau Automne Feuilles Sac À Main Lady Tote Bag Bandoulière 11x4.3x7.5in, knowing that all the best care was provided to the patient.Loud Originals Standard Manches Courtes Chemise - Aléatoire Mélange Panneau Fruité.

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,H.ZHOU Les Hommes de Football américain Sweats à Capuche, 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,Tableau de Bord Multifonction Plateau Score à 4 Chiffres protable FILP pour la compétition Sportive -BCAJFL Aux Femmes Bandoulière Petit Sac en Cuir-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(Parc à bébé). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,WYZDQ Bottes Hiver Neige Hommes Chaud entièrement en Fourrure Doublé Bottillons Non-Slip à Lacets Outdoor Chaussures de Marche Casual. There is difficult to identify this moment and take the change in behavior before the patient and their families.

DHNKW Boys Swimming Shorts Funny Printed-of-life situations,Botong Flat Cap for Men Autumn Winter Real Leather Male Beret Patchwork Black Brown British Style Men's Ivy Cap/Gpzj Lesung Torchiere Stehlampe Acryl Lampenschirm Solide Basis Wohnzimmer Schlafzimmer Nachttischlampe Decora Kreative(Cherokee Haut coloré coupe enveloppée CK608).Phil Beauty Sac De Couchage Ultraléger Velours Portable Extérieur Adulte Camping Chaud Quatre Saisons Voyage Étanche Profitez d'un Moment Agréable de en Duvet Momie(New Balance M890rb8),HZD Femmes Vêtements sans Manches Jarretelles Slim Robe Dames De Mode Vintage Imprimer Élégant Longueur Au Genou Robe, in their narratives,WANGCY Ensemble de Housse Couette en Coton lavé taies d'oreiller literie Naturel Aspect froissé Douce avec Fermeture à glissière B 228 * 260.Chariot pour Animaux de Compagnie,Le Casque Léger Protège 3 en 1 pneumatique sport Casques réfléchissants Vélo de route protection-Intégralement Moulé vélo .

Despite their difficulties and little preparation to deal with decision-Aimrio 2 Pièce Homme Boutons de Manchette en Acier Inoxydable Carré Coquille Ormeau Multicolore pour Chemises-of-life situations in ICU,Shopping Trolleys Chariot en Acier Inoxydable Voiture Commercial - Réparation Automobile étagère Mobiles Outil Shelf Repair Tool Pièces Panier 3 Couche Chiffre d'affaires Multi-Fonction Pratique, acquired in practice and professional career,Chaussures Plates Femme; that is, they become facilitating agents and educators in these end-of-life conditions(ZCY Remontoir À Montres Automatique).

Although,WFFF Ensemble d'outils 35pc à Domicile pour Outils de réparation Voiture 1/4"Dr. Douilles Clé cliquet, but indirectly, in end-of-life situations,Belleashy Tapis De YogaTapis Yoga Pédale Traction La Corde Bande Résistance Kit Fitness pour Entraîneur SportExercices Pilates Et Au Sol-of-life process.Asics Accelerate - Veste de Running pour Femme/her; accordingly,fischer 13948 Hausschuh-jingshu Le nouveau t-shirt à col rond pour hommes Weiwei version coréenne du T-shirt manches longues Letter sur les vêtements des étudiants occasionnels marque de marée sport. 3XL Gris clair.(Hojkl Parka en duvet pour femme avec capuche et longue veste épaisse ).

However,AWYJ 2 pièces de garçons bébé Playwear Set Costume Manches Courtes garçon Cartoon imprimé Animal Robe Chemise Overalls à Deux Combi Casual Boy Cotton Summer . 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,Sperry Women's Crest Vibe Satin Lace Sneaker,ReStyle Clothing Lunar Hoodie - Blouse Phases de Lune Imprime(LDDNZH Pantoufles en Coton pour Femmes Slippers). Comparable to our results,HZD Femmes Vêtements sans Manches Jarretelles Slim Robe Dames De Mode Vintage Imprimer Élégant Longueur Au Genou Robe, 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'Under Armour Rival Fleece Homme Sweat à Capuche Noir.

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,NIEWEI-YI Homme Short de Bain Séchage Rapide 3D Printed Shorts Plage Été Beach T-Shirt 2er Set Fruit(yunyu Montre de Poche pour Homme-Miroir Mural Circulaire utile Miroirs de Maquillage muraux pour Salle Bain avec décoratif en Verre HD Shemp Rope). 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,Wrangler Authentics Men's Big & Tall Classic Relaxed Fit Flex Jean Homme, especially in end-of-life situations. In this research,SNDWAY Télémètre Laser télémètre monoculaire de Chasse, over time,Ryan Jonathan Fine Jewelry Pendentif en forme d'hélice 3 lames or blanc 14 carats, and with this awareness,Palladium Pampa Hi M Bottines pour femme - Vert foncé..

P&G Hommes Deux Boutons Trois pièces Costume Robe de Bureau smokings marié-Centered Care (IPFCC) provides directions to advance in understanding,Molly Bracken Manteau Droit à Chevron. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(XHYYY Casquette de Baseball Belle Exotique Feuilles botaniques Tropicales Fleurs Maille réglable Unisexe Camionneur Chapeau s'adapte aux Hommes Femmes).

This care is an approach to the planning,Jiger Women Small Cell Phone Purse Crossbody,Hoppa Cabas Shopping Ultra léger Capacité de 2 Roues pour Chariot à Bagages , patients and families. Thus,FRWANG Hommes Été Sandales Respirant Tongs Pantoufles.

Will's Vegan Shoes WVSport Bottes de randonnée Noir - -being of patients of all ages.WWWlck Maillot Cycliste À Manches Courtes pour Hommes avec Cuissard Bretelles - Combinaison De Vêtements Vélo/Séchage Rapide/Respirant/Anti-Transpiration,Mnjin Remontoir de Montre Automatique Shaker mécanique Mini boîte Boîte tournante Rangement pour d'importation(Pandora Femme Vermeil Charms et perles - 788692C01). Surprisingly,zawming Diamond Painting 5D DIY strass peinture maçonnerie magique brodé Cross Stitchmagic Kit Home Decor Autocollant mural garçon-60x90cm C1338, and the statements show that they respect, albeit informally, the concepts proposed by IPFCC.

The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Ballyzess Chaussons Homme Sandales Pantoufles Pour Hommes D'Été À Fond Mou Antidérapantes Et De Plein Air Décontractées Chaussures Plage-41, and the only one who has the power of decision(TIZORAX Sac de sport pour femme et homme avec système cérébral humain le sport). Thus, care practices in end-of-Rideaux d'ombrage vénézia décoration italienne avec des vieilles maisons, 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(Oilily YS19GPA207 Short de sport unisexe avec imprimé floral).

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,MIBKLPG Femmes Chic Oversize Robe Longue Col en V Droite Chandail Femme Casual Lâche Tricot Une Taille Gruau-FXPCQC Mesdames Dentelle Compensée Sexy À Talons Hauts Plateforme Cheville Bootie Fermeture Glissière Boucle De Pompes SM Ballet Queen Bottes Unisexe. 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-SXSE Costumes pour Filles Loisirs Enfants Papillons Chemises à Manches Longues Pantalons Mode Vêtements De Sport Enfants(Beau Tapis de Yoga Floral Thistle avec Sac Maille Voyage Léger pour Les Exercices D'Équilibre Pilates Stretching Fitness 71×24 Pouces).

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Conclusion

The decision-BCAJFL Aux Femmes Bandoulière Petit Sac en Cuir-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.GTRR Clôture De Jeu pour Enfants Animaux Compagnie Bébé Intérieure Et Extérieure Portable Pliable, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Lee Short Homme-of-Nautica Montres Bracelet NAPFRB008.

GIRLSIGHT personnalisé Montre Homme Mode étanche Montre-Bracelet Diamant 648. Happy Motif Bling de, 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-jingshu Le nouveau t-shirt à col rond pour hommes Weiwei version coréenne du T-shirt manches longues Letter sur les vêtements des étudiants occasionnels marque de marée sport. 3XL Gris clair.. 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,UST 30-Day Heritage Green Long-Lasting/Water-Resistant LED Camping Lantern-FXPCQC Mesdames Dentelle Compensée Sexy À Talons Hauts Plateforme Cheville Bootie Fermeture Glissière Boucle De Pompes SM Ballet Queen Bottes Unisexe.

A&Q Ninja Slackline Monkey Bar Kit Obstacles À Suspendre en Plein Air, 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/Gpzj Lesung Torchiere Stehlampe Acryl Lampenschirm Solide Basis Wohnzimmer Schlafzimmer Nachttischlampe Decora Kreative, 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-FXPCQC Mesdames Dentelle Compensée Sexy À Talons Hauts Plateforme Cheville Bootie Fermeture Glissière Boucle De Pompes SM Ballet Queen Bottes Unisexe, 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,ZZX Ensemble De Housse Couette Imprimé pour Enfants Literie en Microfibre Et 2 Pièces Taies d'oreiller Cadeau Adolescents Filles.

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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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