title: Nurses' autonomy in end-of-life situations in intensive care units.
abstract: BACKGROUND
  The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident.
  
  
  OBJECTIVE
  To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units.
  
  
  METHODS
  Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study.
  
  
  METHODS
  Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making.
  
  
  METHODS
  Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized.
  
  
  RESULTS
  The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals.
  
  
  CONCLUSIONS
  Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process.
authors.affiliation: Universidade Federal do Paraná, Brazil; University of Tuiuti do Paraná, Brazil pagnine@brturbo.com.br.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Paganini
authors.affiliation: University of São Paulo, Brazil.
authors.forename: Regina Szylit
authors.initials: RS
authors.lastname: Bousso
mesh_terms: D001938:Brazil; D064648:Critical Care Nursing; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital / Q000523:psychology*; D017009:Professional Autonomy; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology*
keywords: Decision-making; end-of-life care; grounded theory; intensive care; life support systems; nurse; professional autonomy; qualitative research