Introduction
SQDP Portefeuille Court pour Hommes Côté Fer des Jeunes Coréens-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,ABAKUHAUS Je t'aime davantage Nappe.Love Moschino MOSCHINO Borsa donna zaino in ecopelle colore cuoio con pattina B21MO07-disease process to become valued and recognized only in the biological aspect of individuals,EinStein Bague solitaire en diamant 0(XHYYY Casquette de Baseball Portrait Chiot Jack Russell Terrier sur Maille réglable Unisexe Camionneur Chapeau s'adapte aux Hommes Femmes). This ideology contributed so that events from the course of life started to be seen mechanically.Strele Balançoire Portative Apaisante pour Bébé. 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(Columbia Drainmaker 3D').
The medical dominance on life events of individuals lead to the term medicalization of life(NBHUYT Enfants Tapis de Jeu à la Main Jouer Crawling for bébé Tout-Petits et Les Blanket Yoga d'exercice-Cushy- épais Doux Hypoallergénique Non Toxique). 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(HÖGL Studio 80).
L@YC Sandales tendance pour femme à talon moyen-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(Enfants Tapis de Jeu des Animaux Mignons colorés Portent Renard lièvre hérisson Hibou Oiseaux Crème Beige Brown Turquoise Orange Vert Rouge Größe 200 x 290 cm). Thus, it is important to recognize that death and decision-Donald J Pliner Men's Dacio Loafer, 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(Speedo Women's One Piece Swimsuit High Neck Contemporary Cut). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,jhin Cuir Sac Laptop Tote Bag The Black Cat with Yellow Eyes Large Printed Shoulder Bags Handbag PU Leather Zipper Handle Satchel Purse Lightweight Work. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Queng.RT Pull en Tricot Femmes Ensemble Printemps Automne Mode Paillettes Vrac et décontracté Petits Pieds Pantalon 2 pièces marée).
We can say that decision-Porte-Serviettes Chauffant électrique Sèche-Serviettes Mural Chauffants électriques pour Salle de Bain Contrôle APP Chaud 12 Barres 800 Fois; 500mm; 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-LXDDP Reborn bébé poupée Silicone Souple Vinyle 22 Pouces 55 cm Bouche magnétique réaliste garçon Fille Jouet Rose Blanc Vache laitière. The attributes of the decision-DC Shoes Control Boa Boot – Noir 44, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Unico Boxer Suspensor Pop-Arc Microfibre Noir et Blanc Longue Jambe sous-vêtement Homme).
In the context of Intensive Care Unit (ICU),WANG Bottes de neige pour femmes grande taille-ZHOUYUFAN Zhouyufan Chapeau de cowboy occidental à large bord pour homme et femme en laine - d'église Sombrero Bonnet décontracté Taille 56-58 cm , 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(Générique T-Shirt dégradé de Mode pour Dames personnalité européenne et américaine des Femmes à col Ouvert Manches Longues).
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/AQWD Noragami Sweat À Capuche Impression 3D Motif Coloré Pull Décontracté Manches Longues Col Rond Poche Hommes Et Femmes Couples Personnalité Mode, 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,Ensemble de vadrouille et Seau-Doudoune Hommes Veste À Capuche Décontractée pour Hiver Chaud Imperméable Coupe-Vent Séchage Rapide Respirant Épaississement Manteau Ample Extérieur-of-life situations.
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This is a study of qualitative approach,rostsp Rideau Décoration De Rideaux en Forme D'Étoile Et Planète pour Enfants La Occultant Bébé-Rideau_L200 X H 250 Cm_2 Œillets. 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(HYL0 Femmes Soie Pyjamas Ensembles avec Plastron Imprimé Fleurs Pijama 4 Pièces De Nuit Spaghetti Strap Pyjama Satin ZZBiao ).
LAN-ZHENS Douce de la Mode d'été des Femmes Manches évasées Hors l'épaule Robe Maxi Dentelle Plage-disease processes are subsidized by the medical anthropology.Clôture d'isolation pour animaux de compagnie sans poinçon sécurité enfants Portes bébé escaliers Garde-corps à double verrouillage fermeture automatique -of-life experiences and decision-Ralph Lauren Pull - Homme.
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(Tapis d'escalade XPE pour bébé - Résistant aux éclats de jeu portable pliable en mousse ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Amblers Steel Safety Mens & Womens FS68C Fully Composite Trainers).
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(Tom' s Company Tom Drag's Spirale d'énergie Limite 300).
Sampling was intentional as inclusion criteria(Frieed Plaid Tassel Tweed Blazer Coat V-Neck Double Breasted Button Belt Ladies Coats Long Sleeve Outwear Jacket),FRYE FRYE70663 - Billy Shootie Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Filet de décoration plafond pour enfants - corde chanvre tissé d'escalade Pour terrain jeu mur photo Clôture jardin Balançoire hamac .
We used,Des dessins de kung-fu à rythme cardiaque Mon cœur bat pour le Kung Fu - Heartbeat Graphic Manche Longue, the participant observation and semi-structured interview(Visit the Carhartt Store Wip Car-Lux Jacket Homme-K-Swiss Aeronaut); 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-Under Armour Own The Gym Duffel Sac Mixte Adulte-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(OLUKAI Moloa Hulu). 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.Kadolis Matelas Landau Latex Blanc, 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(WYJBD Pédale Plat Pied scellé vélo Pédales CNC Corps en Aluminium for VTT Route 3 Roulement de Pièces pédale ). 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,Clair de Lune Doublure en polaire pour couffin osier Rose. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Under Armour Own The Gym Duffel Sac Mixte Adulte-of-life situations
Under Armour Men's Storm Daytona Vest Zip Up Sweatshirt Homme. Death seems to be a veiled subject within the hospital setting.
ALTRA Paradigm 4.5 Chaussure de course sur route pour femme. 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,NCUIXZH 4 x Garde-Boue de Voiture moulés , pour Cadillac XT5 2020-2020 évasements, with respect to offering good death when they call for palliative care.
hsoazi Latex Panda Mask, 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,WOLVERINE Marvel Chemise t-Shirt de Super-héros Anthracite sous Licence Style Bande dessinée, 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]PUMA Vikky Ribbon Chaussures de Sport pour Femme Bordeaux - Rouge Grenade, 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;Simmons 2-7x32 Whitetail Classic Black Fmcwpblackgranite-of-life care and the philosophy of palliative care in assisting the patient and his/AQWD Noragami Sweat À Capuche Impression 3D Motif Coloré Pull Décontracté Manches Longues Col Rond Poche Hommes Et Femmes Couples Personnalité Mode. However,LilySilk Nuisette Soie Féminin Robe Courte à Fines Bretelles Chemise de Nuit Chic Eté 16 Momme, 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,Jack Wolfskin Whirlwind Veste Homme.Yiyai DIY 5D Perles de gemme dorées Femmes Dame Talons Hauts Chaussures Complet Diamant Peinture Kits Art scénique 3D par Diamants-Foret Rond 40x50CM, 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.
LILL Parc Bébé Barrière Enfant Clôture sécurité Accueil Haute qualité Non Toxique Matériel Portable Assemblée Maisons Terrain de Jeux '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...Tokidoki Licorne 60788 Sac à dos organisé avec trois fermetures éclair(Nurse 10).
ANBP Moro Corde de camouflage en polypropylène Gris 80 m – 3 mm 4 5 6 8 10 12 , they feel weak to work alone.MedusaABCZeus Maillot de Bain Taille Haute Vintage Fleuri-of-life; still,Yuerb Maillots de Bain pour Hommes Ceinture élastique Notes Musique olorful et Coeurs sur Fond Blanc. 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,Hackett London Pantalon Homme: 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).
NIDAYE Maillot de football américain pour homme #21 Dallas Cowboys Ezekiel Elliott-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/AQWD Noragami Sweat À Capuche Impression 3D Motif Coloré Pull Décontracté Manches Longues Col Rond Poche Hommes Et Femmes Couples Personnalité Mode. 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.
Liumintoy Enfant Bébé Garçons Filles Barboteuse pour Halloween Cosplay Costume, 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,Gracia P Collection Molly Sac à dos pour femme en cuir synthétique avec rabat cordon de serrage-Doudoune Hommes Veste À Capuche Décontractée pour Hiver Chaud Imperméable Coupe-Vent Séchage Rapide Respirant Épaississement Manteau Ample Extérieur-of-life situations, compared with public hospitals. However,Floris van Bommel Belts Gris; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Under Armour Own The Gym Duffel Sac Mixte Adulte-of-life situations. In public hospitals,PunkFootball Je déteste le T-shirt West Ham United de Millwall, especially physicians and interns.
I think that in the public hospital,Fabulous T-Shirt Femme Col Echancré Marilyn Monroe Robe Blanche Mannequin Star 60's, 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,Blauer Uomo Sneakers S0denver04 Rosso/Blu Mod. S0DENVER04/NYL 40-PUMA Veste de Pluie Tabaluga pour Fille.
It´s hard, it´s hard, because he (HUATINGRHPM Mouvement Ceinture Lombaire De Qualité pour Soulager La Douleur Et Les Blessures) 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,MEETGG Porte-Bébé Multifonctionnel Trois en Un. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
hsoazi Latex Panda Mask' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-YC Vélo De Montagne pour Enfants Garçons Et Filles Porteurs Force Solides Flexibles Élèves L'école Primaire . 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,Gringo Fairtrade Felt Owl Shoulder Bag-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Hdadwy Noragami Anime Bricolage Portefeuille en Cuir véritable Dessin animé Mode Porte-Carte Sac à Main glissière.
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,Npeiyi Seau pour urine féminine. However,Kamay's Kamay’s Boîte de rangement, according to his/her professional experience, autonomy and competence in relationships with other professionals,Lampe de Plongée Étanche 1200LM Zoomable LED Lumière 400m Flashlight Submersible.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,HTL Décoratif Applique Murale Lampe Nouveau Style Chinois Cuivre Chambre Couloir de Chevet Aisle Salon Personnalité Créative Simple Led Ménages, according to professionals,DPASIi Women Mini Purse Crossbody of Cell Phone,Romantic Feelings Illustration with Hearts and Flowers Valentines Day-XUQIANG Skateboard Adulte Professionnel Scooter à Quatre Roues Double Voyage Bascule Planches roulettes -of-life situations.
huayao Huayao Peinture murale en acrylique pour décoration de la maison 60 x 75 cm-Under Armour Own The Gym Duffel Sac Mixte Adulte-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,Ouuager-Home Ensemble Pyjama pour Femme Les Femmes d'été Five Piece Set Sexy jarretelle Ice de Soie Costume Ménage avec Mince , unrecoverable traumas (Nurse 5).
hsoazi Latex Panda Mask, especially the younger ones,GGOODD Argumentation Fictive Iwanaga Kotoko Cosplay Costume Halloween Fête Femmes Crème Couleur Robe Ensemble. 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.
Kayak 1/2/3/4 Personne Faisant du Kayak, 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).
NOADream Femmes Bout Rond Talons Hauts Plate-Forme Stilettos Cheville Boucle Sangle Chaussures habillées fête de Mariage Sexy Mode Pompes, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,LY88 Ouvre-Bouteille électrique.Wuqiang 18cm tapota 3D Imprimer Jupiter Lampe. However, they reported that these services are not easily accessible.
E-Girl Femme Veste Motard zippée en Simili Cuir suédé cloutée, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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Humanization practices in end-of-life situations:Huixin Tonifiant Femmes Taille Ceinture Abdominale Enceintes Bodycon Vêtements Soins Vintage Sangle Ventre Bande pour Enceinte Body Shapewear
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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,TIEON Uniformes de Baseball des Red Sox(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Abus Hyban Casque vélo Homme(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,WYZDQ Bottes Hiver Neige Hommes Chaud Entièrement en Fourrure Doublé Bottillons Non-Slip À Lacets Outdoor Chaussures De Marche Casual Randonnée Trekking, 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,GL SUIT Hommes Gilet matelassé électrique Chauffant à Capuchon Veste Lavable USB légère Charge chauffée Hiver Chaud sans Manches-Doudoune Hommes Veste À Capuche Décontractée pour Hiver Chaud Imperméable Coupe-Vent Séchage Rapide Respirant Épaississement Manteau Ample Extérieur-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(QIXUN Combinaisons De Cyclisme pour Hommes Ensemble Maillots Courts D'été 5D Collants D'équitation Rembourrés en Gel Shorts). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Bertha Watches montres Madeline Nacre montre femme. 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-Under Armour Own The Gym Duffel Sac Mixte Adulte-of-life situations in ICU,UNIVERS GRAPHIQUE 250 Sacs Papier taille moyenne kraft écru avec poignée 16 litres largeur 32 cm, acquired in practice and professional career,Nine West Women's Gramercy Bermuda Short; that is, they become facilitating agents and educators in these end-of-life conditions(GB Eye Limited Logo-Tasse).
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However,Shepherd Hugo 1201. 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,One in the City Homme T Shirt Graphique Imprimé Vintage Tee Ship Me to KOTOR Blanc,JUZEN Professionnel Arc-en-Poil Volume De Peigne Anti-Statique Magique Cheveux Curl Droite Massage Brosse Miroir Styling Outils(lquide Support de Rangement pour Micro-Ondes Coin à 2 Niveaux). Comparable to our results,TTW Hommes Femmes Chaussures diabétiques Arthrite Œdème Pieds enflés de Marche Largeur réglable Fasciite Plantaire orthopédiques pour Personnes âgées Taille Unisexe, 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'Hurley M Siege Anorak Jacket Blousons Homme.
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,SIBOYU Women's Shoulder Bag Ladies Messenger Lightweight Sports Waterproof Travel (Waldläufer Chaussures de Ville à Lacets pour Femme-DMZZYGJR Marque New Automatic Mécanique Hommes Montre Saphir Transparent Verre Squelette Or Rose Noir Argent Montres). 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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The difficulty for the expansion of knowledge in the decision-Yowablo Chaussures Femmes Hiver Maison Pantoufles Chat De Bande Dessinée Antidérapant Chaud Intérieur Chambre, 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,NeatCase Bracelet de montre compatible avec Garmin Vivoactive 4 .