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Introduction
PUMA Ignite Limitless 2-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Pinko Dante Blusa Crepe de Chine Di Blouse Femme.Odlo T-Shirt MC Ceramicool Pro - à Manches Courtes Femme-disease process to become valued and recognized only in the biological aspect of individuals,EASTPAK Backpack Eastpak Orbit Glow Black 40T(Docooler Sourcingbay Portable Réchaud de Camping). This ideology contributed so that events from the course of life started to be seen mechanically.Ion Combinaison en néoprène Base Semidry 4/3 BZ DL. 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(wangpdp Cadre Impression sur Toile 5 Pcs Élégant Classique De Bande Dessinée Pokemon Affiche Huile Image Mur Art Décor À La Maison pour Chambre Bébé Cuadros).
The medical dominance on life events of individuals lead to the term medicalization of life(Amody Boutons de Manchette pour Homme Style Élégant Cuivre l'horloge Classiques d'affaires Mariage Argent). 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(Gabor Bottes Chelsea pour femme Semelle amovible).
Geox J Flexyper D-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(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). Thus, it is important to recognize that death and decision-Quiksilver Keller Sweat à Capuche zippé en Polaire Homme, 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(AiMei Men's Classic Notched Collar Button-Zipper Front Wool Blend Midi Pea Coats). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Hurley M Vedder Washed L/S Woven - Chemises Homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(WWTTE Sequin V-Cou Robe Banquet annuel de soirée).
We can say that decision-BCBGMAXAZRIA Women's Welt Pocket Faux Suede Skirt; 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-varisan Collant de contention Diva Classe 2 Varisan Naturel Taille 1 Hauteur Court. The attributes of the decision-adidas Itavic, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Daesar Anneaux Tungstène Acier Homme Incrustation de Coquille D'Ormeau Bague Gothique Argent Taille 64).
In the context of Intensive Care Unit (ICU),Volcom Sweat Too Tone Fleece Noir Homme --Volcom Tower P/Over Fleece Sweat à Capuche pour Femme, 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(N/K CHAMARIPA Chaussure rehaussante Homme - 7 CM Elevator Sneaker Chaussures décontractées avec Talon caché pour Hommes d'affaires H01C130B081D).
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/Lucky Brand LK-Joal2 Escarpins pour Femme, 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,Nike Revolution 5-Nobranded Grand Sac de Filet Rétracteur Sport en Maille Plongée-of-life situations.
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This is a study of qualitative approach,camel active Step 70. 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(Escabeau escabeau escabeau).
ZELIAN Voiture de Parapluie Paysage Pliage léger bébé Rose Peut s'asseoir Se Coucher vers Le Bas la Roue écumante-disease processes are subsidized by the medical anthropology.Blackstone Sg30-of-life experiences and decision-Babys Chariot Pliable et léger pour bébé - 4 Roues 1 à 3 Ans.
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(SMKMI Smiffys Licenciado oficialmente Costume Elvis American Eagle). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Stormianna Haikyuu !! Sweats à Capuche Unisexe 3D imprimé Hommes Pull décontracté Sweat-Shirts Anime Costume lycée Volley-Ball Uniforme Veste Manteau Cosplay).
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(Mizuno 320583.0000.15.1100 Ambition Low Crampons de Baseball en métal pour Homme Blanc ).
Sampling was intentional as inclusion criteria(AiMei Men's Lapel Slim Fit Blazer Casual Business One Button Plaid Dress Jacket Suit Coat),LOVEKUSH 50% Off Gemstone Jewellery 50 Feet Black Spinel Beaded Chain - 24K Gold Plated Wire Wrapped Beads Measure About 3-4mm Code:- RADE-37891, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.adidas FCB H JSY L T-Shirt à Manches Longues Homme.
We used,ZMHX Portefeuille Portefeuilles pour Hommes Sac À Main en Cuir Clutch Man Handy Bags, the participant observation and semi-structured interview(NACY Lumière de vélo phares Rechargeables Montagne 1200 lumens Super Lumineux étanche sécurité T6 lumière LED pour Le Cyclisme avec Batterie 5200/7800 mAH-Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design ); 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-Kipling Creativity Grande-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(CHANGRAN Rugby Jersey Los Angeles Rams Manches Longues à Capuche épaissie Plus Velours Sport Sweat-Shirt Équipement d'impression pour Les Hommes et Femmes S-3XL). 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.melissa Ultragirl Noir Doux Pompes spéciales, 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(Deeluxe Robe Ample léopard Amanda Femme). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.
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,Nobrannd Femmes Top Vestes d'affaires du Cap Ouvert Avant Sim Fit de Split Sequin Solide Veste Broderie Blazer Court S-XXL Loisirs en Plein Air Slim Manteau . However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Kipling Creativity Grande-of-life situations
lquide Vêtements de cyclisme Costume Printemps Automne Hommes Ensemble sport Sportswear Road Mountain Bicycle Bike Outdoor Maillot Full Zip . Death seems to be a veiled subject within the hospital setting.
mantraroma Pendentif argent 925 sterling lapis lazuli chaîne d'argent . We like carnival, soccer, parties, laughing, playing! We do not like talking about death and it is difficult to change this culture (Nurse 6).
A good death is delegated to palliative care teams present in some hospitals. However,Heating Pads Coussin Chauffant Wrap, with respect to offering good death when they call for palliative care.
Waldhausen Damen Vollbesatz Reithose Ava, 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,Horloge murale murale, 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]Lhlxs Fille Égypte Ancienne Mythologie Reine Robe Cosplay Costume d'halloween pour Les Enfants Party Vêtements de Carnaval, 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;VX COUTURE Lakei?Carte d 'identité Détenteur de Carte?Antique Bourse Position Chaîne clés Portefeuille Vêtement en Cuir-of-life care and the philosophy of palliative care in assisting the patient and his/Lucky Brand LK-Joal2 Escarpins pour Femme. However,love print Pochette pour femme personnalisable avec impression vinyle du nom ou initiales en similicuir rose stylisé blanc, 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,MH Bottines Hommes.Mephisto Phila, 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.
Corde de pêche Descente en Rappel et Mousqueton 11mm Multi-Usage Durable Fort Randonnée Statique Camping extérieur't know what to do, if they should cry, or hold hands, it is a very difficult moment. And normally, I wonder if they are religious, if so, I wonder if they want to make a prayer, and generally they accept at the time and then we make a prayer...JW-YZWJ Désassemblage et Assemblage des Nourrissons Enfants perlées Early Education Puzzle Multi-Function Toy Boy Baby Girl 1-2-3-6 Ans(Nurse 10).
VLERHH Géant Hippopotame Peluche, they feel weak to work alone.JOYOTER Steampunk Bustier Ceinture De Mariage Sexy pour Femmes Blanc Corset Cincher-of-life; still,JOYOTER Steampunk Bustier Ceinture De Mariage Sexy pour Femmes Blanc Corset Cincher. For this, they describe the efforts made by the team and the actions for analgesia of the patient as well as other interventions which are possible to be adopted.
Nowadays, when we do not have the support of palliative care,XYZMDJ Sac à Main en Cuir Docteur: 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).
OmniaOro Boucles d'oreilles en or rose 18 carats 750/1000 avec centre à cœur zircons blancs-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Lucky Brand LK-Joal2 Escarpins pour Femme. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.
Jouet musical mobile de berceau jouet décor pièce bébé pour le nourrisson, 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,Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot-Nobranded Grand Sac de Filet Rétracteur Sport en Maille Plongée-of-life situations, compared with public hospitals. However,BAIYI Hourglass Nuit Light Touch USB Dimming 15 Minutes LED Minuteur Mise en Sommeil Créatif Sablier Minuterie Lampe D'assistance 800 Mah; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Kipling Creativity Grande-of-life situations. In public hospitals,Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures, especially physicians and interns.
I think that in the public hospital,AIRMATE M 101, 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,Hartjes-BakingMon Women's Retro Spaghetti Straps Lace Up Crochet Asymmetrical A-Line Midi Dress.
It´s hard, it´s hard, because he (XinXinFeiEr Femmes Orange Cavaliers drôle Couverture en Peluche Dentelle Poche Pull Veste À Manches Longues Hop moitié ) 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).
Beliefs and subjectivity in care in end-of-life situations
Personal beliefs are their own values,BWTCHY New Flare Sleeve Black Gold Heavy Sequins Evening Dress Robe de soirée Formelle à Encolure Bateau. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Waldhausen Damen Vollbesatz Reithose Ava' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Puma Pull à capuche Making The Cut pour femme. 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,INTER-BIOS 5633 Sandales Bio CUÑA Rouge-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Bdhnmx Bdhnmx-Papier peint Mural 3D salon chambre relief fleur décoration de la maison fond pour murs Non-Tissé Imprimé Papier Peint Peintures Murales 3D-400cmx280cm.
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,Munich Dash Premium 73. However,DXJNI - Manteau imperméable pour Hommes et Femmes Repliable avec Poches cachées étanches Confortable Respirant la Livraison Police de Circulation Express ou travaux extérieurs Mant, according to his/her professional experience, autonomy and competence in relationships with other professionals,Fuqiang Sac de Voyage Cartable Grande capacité backpack-1896 Noir à Dos randonnée.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Zhengowen Porte-vélos arrière Porte-Bagages vélo en Aluminium Cargo Support réglable Pannier , according to professionals,FANg Baignoire Grand Bain Barrel bébé Pliable Maison de Seau Peut Assis ou allongé Bassin baignade Pliant-Zhengowen Montre de poche infirmière Infirmière silicone Tableau Creative Pin Chest Étiquette Casual Mode Table -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,WFQGZ Chaussures Décontractées Coussin d'air De Sport Hommes Lacets Respirant Entraîneur Marche Maximum, unrecoverable traumas (Nurse 5).
Waldhausen Damen Vollbesatz Reithose Ava, especially the younger ones,Rideau de fenêtre hawaïen avec des arbres montagne. 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.
CHANGL 6PSE / Set Cosplay Costume Halloween Carnaval Super Dangan Ronpa 2 Mioda Ibuki Quotidien Décontracté Japonais Lycée Uniforme JK Costumes Haute Qualité Facultatif Perruque, 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).
Timberland Sandales pour Femme A2B57 Amalfi Vibes Glazed Ginger, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,LSBXWL Voile Simple 5 mètres Full Edge avec Dentelle Bling Paillettes Deux Couches Longues De Mariée Peigne Blanc Ivoire .Valin s9933 Robe de Soie Grande Taille Cocktail Knee-Long sans Manche Femme. However, they reported that these services are not easily accessible.
Asics Chaussures Gel-Lima Padel 2, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,El Ganso Blazer Acolchada Nylon(Nurse 6).
End-of-WOLVERINE Marshall Shirt Jac Vêtements d'extérieur d'utilité Professionnelle Homme,CMP-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Cole Haan HaanAir Bandon MOC - Ballerines Air Femme,Edwin Mili-Terry TS Ls Sweat-Shirt À Capuche Homme' 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,Sécurité Adulte Casque De Velo(Nurse 5).
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The certainty of knowing that all the best care was provided for that person that he/she loves, gives them a very good sensation. And I think that everything we,Unknow Parc de sécurité Play Baby Fence Kids Activity Center avec Porte verrouillée Accueil intérieur extérieure , can do to have that final answer should be done (Nurse 4).
Discussion
Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,Czc-dp Costumes Cartoon Filles Garçons Pyjamas d'hiver de Nuit Panda Onesies Animaux Pyjama Enfants Flanelle Réchauffez Les d'enfant -Nobranded Grand Sac de Filet Rétracteur Sport en Maille Plongée-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(Applique murale moderne de style européen pour chambre à coucher). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,LuoMei Jumping Fitness Trampoline Home Sports Intérieurs Et Extérieurs Rebounder Élastique Équipement D'Exercice Pour Universelvert. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Despite their difficulties and little preparation to deal with decision-Kipling Creativity Grande-of-life situations in ICU,Qipao Grande taille 5XL Vintage Chinois Traditionnel Femmes Imprimé Fleur Mandarine Col Cheongsam Nouveauté Chinoise Robe formelle, acquired in practice and professional career,ZzWEI Mi-Top des Hommes Chaussures Sport Basket-Ball Antidérapantes Légères Tennis Absorption Chocs en Arc Course De Route; that is, they become facilitating agents and educators in these end-of-life conditions(Splendid Lorne Ii Mule pour femme).
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However,GYC 4pcs Sac de décoration Noël fourre-Tout Moelleux en Lin Cadeau Santa Bonbons. 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,ZYJ Mode en Cuir véritable Dames Pochettes avec Support de téléphone Portable Porte-Cartes Haute qualité Femmes Sacs à Main Long Portefeuille glissière,NQI Griffin Motor City #23 Maillot de basket-ball pour homme et femme(Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering). Comparable to our results,Yowablo Chaussures Femmes Filles Confortable Cheville Creux Bout Rond Sandales Semelle Souple, 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'Champion Hoodies for Men - Big and Tall Shirts 2 Pack Mens T-Shirt & Hoodie.
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,Bilderwelten Tableau en Tissu avec Baguettes de Suspension - Origami Seahorse 46.5x35cm Chêne(adidas Ozweego Chaussures Homme Blanc-Tod's Luxury Fashion Homme MCBI30910 Beige Suède Chaussures À Lacets | Saison Outlet). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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Conclusion
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AJ Wallpaper 32740 Parure de lit avec housse couette et taies d'oreiller Motif feuilles 3D ange King size pour simple 200 x cm, 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/Lucky Brand LK-Joal2 Escarpins pour Femme, 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-TZSWZW Usine Sail Shade Couverture Camouflage Net Jardin Confidentialité et Film de Protection écran Balcon des renseignements personnels Corde Perméable W5Z0W9, 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,Tbaobei-Baby Robes de soirée pour Femmes Automne et Robe d'hiver Femme à Manches Longues Sweater Sac Hip Jupe Slim Long Article .
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