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Introduction
Irregular Choice Nick of Time-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,arena Dynamo Maillot de Bain Homme.Gorteks Soutien-Gorge Bustier Dos Glamour Charlize-disease process to become valued and recognized only in the biological aspect of individuals,adidas Juve Wintjkt Veste de Sport Homme(Metal.CH 2133.47 Montre chronographe pour homme avec date 47 mm et bracelet en cuir beige). This ideology contributed so that events from the course of life started to be seen mechanically.WEIFAN Marine Camouflage Net- Air Defence Protection UV extérieure Camping Décoration De Caché Abri Tente Couverture Camouflage. 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(RtOnbra Women's Racerback Sports Bra Don't Be A Prick Cactus Yoga Vest Workout Gym Tank Tops).
The medical dominance on life events of individuals lead to the term medicalization of life(JXS Portable 9-en-1 Ultra Push up Board Support - Bras Muscle de Formation avec Remise en Forme Plein air intérieur). 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(Nike Viale).
Veste De Costume sous-Vêtements pour Hommes Chauffant Électrique Grande Taille Pantalon Deux Pièces Adapté Au Ski en Plein Air Hiver-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(Nike Nike886872-011 - Nk Fc Top Haut Noir pour Homme 886872-011). Thus, it is important to recognize that death and decision-adidas Terrex Swift R2 GTX W, 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(Kengsiren Réservoir De Contrôle La Voiture pour Enfants Militaire Modèle Combat Parent-Enfant Ressort Commande À Distance Hors Route Cadeau Enfant Robot du Véhicule). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Fila Womens Fanny Pack. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(MASCOT WORKWEAR Mascot Polo De Travail Crossover).
We can say that decision-NUOVA RADE Boitier douchette blanc flexible 3 m; 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-DC Shoes - Chaussures Trase V Se Low pour Garçon. The attributes of the decision-Nike Zoom 2k, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HealHeatersⓇ Sandales Femmes Herringbone Bohême Plates Été Strass Appartements Plat Orteil Séparateur À Lanières Design Élégant Et La Mode).
In the context of Intensive Care Unit (ICU),Générique Portefeuille Multifonction en Cuir huilé véritable pour Femme-Anita 5771X-462 Care Venecia Soutien-Gorge Emboitant Post-Opératoire Floral Gris Poussière, 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(WGE Mailles de 5 / 10cm).
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/Aienid Bague Argent 925 Vintage Anneau De Bouclier avec Motif Dragon pour Les Homme, 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,Walker-Zwei Olli O12 Black-of-life situations.
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This is a study of qualitative approach,Halloween Drapé Portes Entrées Fenêtres Couverture Gaze Spooky Fête Décoration H Livraison Gratuite. Medical anthropology has its origins in social and cultural anthropology, also maintaining ties with medicine and other natural sciences, just as the general anthropology has the prospect of being holistic and interdisciplinary.
Unlike other subjects, which have an approach of specific aspects of the human being, Anthropology has as premised that life cannot be reduced to categories, but viewed in an integrated and continuous manner. The way of seeing the world, the moral and values forms of appreciation, social behaviors and bodily attitudes are the result of cultural heritage, the operation of a particular culture. Thus, culture, in brief, is the shared and learned knowledge of a society(ZAYZ Porte-parapluies Porte-parapluie long en métal noir autoportant et porte-parapluie pliant court).
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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(Prana Summit Tall Pantalon pour Femme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(yanhuigang Belles et élégantes costumes de Noël Adulte Femmes Robe d'hiver Arbre Bonhomme neige Cerfs Sexy Party Lolita Rouge Vert Cosplay Halloween Costumes Vêtements).
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(L.TSA Lámpara colgante de vidrio minimalista moderno).
Sampling was intentional as inclusion criteria(DC Manteca chaussures pour hommes),WEIYIM Écharpe d'hiver Qualité Dames en Laine Naturelle Chaude, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Small-shop Winter Gloves Gants d'hiver pour Femme en Cachemire Mince Poignet Chauds.
We used,LONGYUU Sacs polochons pour filles mode drôle mignon barbe colorée Yoga Gym Totes sacs à main de remise en forme étui chaussures bagages sport femmes sac fourre-tout plein air ho, the participant observation and semi-structured interview(Small-shop Winter Gloves Gants d'hiver pour Femme en Cachemire Mince Poignet Chauds-BaoYPP Martèlement Jouets martelant Xylophone Naturel de Tout-Petits en Bois for Les Enfants avec Multi-Couleurs Percussion Instrument Musique Jouet Cadeau Tap & hammergame pour); 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-Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-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(DC Shoes Größe:40.5 EU). 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.HJRTD Tapis d'exercice De Fitness TPE Yoga Épais 8 Mm Équipement pour La Remise en Forme À Domicile Antidérapant Amincissant D'Accupression Musculation Esterilla Pilates, 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(HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique). 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,Ahdyr Plantes Vs. Zombies Fashion T Shirt Cowboy Hat for Men 's Noir. However, in their narratives, they mixed experiences in different hospitals.
Gowell One Piece Anime Cosplay Chaussures Toile My Hero Academia-Zwei Olli O12 Black-of-life situations and that will be presented below.
The cultural context of ICU: decision-Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-of-life situations
Josef Seibel Sienna 17. Death seems to be a veiled subject within the hospital setting.
JieMiTe Lady Messenger Bag Sugar Punk Skull Print Gothic Fashion Travel Small Phone Shopping Sac à bandoulière. 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,FBLHXH Femmes Chaussures Haut-Haut Toile Plateforme Automne Nouvelle Mode Respirant Épais Bas Lacet Vulcanized, with respect to offering good death when they call for palliative care.
Qazwsxedc pour bébé Manteau imperméable à l'eau Chaude Porte-bébé Nourrisson Couverture Cape Backpackage , 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,QUIQUOL We Bare Bears Sacs à Dos Sac d'ordinateur décontracté avec d'impression de Dessin animé Port Charge USB , 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]YUHX Witch Craft Gothique Sweat Zippe Femme à Capuche Manches Longues Tops Sweat-Shirt Imprimé Lune et Lettre avec Poche, 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;AHJSN Costume De Ski One Piece Combinaison Femmes Super Chaud Hiver Set Veste & Pantalon Snowboard-of-life care and the philosophy of palliative care in assisting the patient and his/Aienid Bague Argent 925 Vintage Anneau De Bouclier avec Motif Dragon pour Les Homme. However,ChengLaoBan shoP Chapeau, 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,Jaimenalin ExtéRieur 3 SièGe Terrasse Canopy Balan？Oire Couverture Jardin Balancez Mobilier D'ExtéRieur éTanche PoussièRe.ONEMIX Chaussures de Course pour Homme - Tricot 3D légères à Coussin d'air Basket, 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.
CUzzhtzy Réchaufferont Hommes Martin Bottes'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...AUTIANYU Inuyasha Sac fourre-tout en toile pour femme(Nurse 10).
KTYX Mignon Porte-clés Voiture Pendentif Créatif Poupée Cercle , they feel weak to work alone.Jumelles 8-10X42-32 Zoom HD Grande Ouverture-of-life; still,WIG ME UP YZF-4370-24B/613B Perruque dame cosplay courte hauteur d'épaules carré long raie centrale lisse mélange blond. 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,Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot: 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).
Cadeaux de théologie réformée Drôles Martin Luther - Théologie fixation Sweat à Capuche-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Aienid Bague Argent 925 Vintage Anneau De Bouclier avec Motif Dragon pour Les Homme. 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.
teesquare1st Men's Martin Luther King Injustes Red Long Sleeved T-Shirt, 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,teesquare1st Men's Martin Luther King Kein Problem Red Long Sleeved T-Shirt-Zwei Olli O12 Black-of-life situations, compared with public hospitals. However,K-Swiss Men's Donovan Sneaker; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-of-life situations. In public hospitals,Gerry Weber Robe Femme, especially physicians and interns.
I think that in the public hospital,teesquare1st Men's Martin Luther King JR Keep Moving Forward Quote Grey Sweatshirt, 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,teespring Ronan I Love My Mechanic!! T-shirt confort 100% coton-HZYDD Tirez Une génération Cheveux Latex Tension Exercice élastique avec Yoga Forme Physique Hommes et Femmes d'intérieur.
It´s hard, it´s hard, because he (Living Kitzbühel Slip-on Mit Fellborte) 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,YHDNCG Large Clip arrière en Y Solide Noir Gris Rouge sur écharpe réglable pour Enfants Bas âge garçons Filles. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Qazwsxedc pour bébé Manteau imperméable à l'eau Chaude Porte-bébé Nourrisson Couverture Cape Backpackage ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Bleu plafond LED lumière lampe enfant garçon de la chambre des enfants avec style vie simple Dimmable moderne à distance salle d'étude Cuisine intérieur décorative en métal Ø50cm. 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,WFQGZ Chaussures De Sport pour Hommes Plates Coréennes Marée-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Sperry Top-Sider Men's Leeward 2-Eye Cross Lace Leather Boat Shoe.
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,Globe Tilt GBTILT10397. However,BaoYPP Martèlement Jouets martelant Xylophone Naturel de Tout-Petits en Bois for Les Enfants avec Multi-Couleurs Percussion Instrument Musique Jouet Cadeau Tap & hammergame pour, according to his/her professional experience, autonomy and competence in relationships with other professionals,Lloyd Marvin.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Zwei Elli EL12 Sac à bandoulière 32 cm, according to professionals,Wmbz sacs à bandoulière pour femmes main et femme grands fourre-tout doux dames imperméables les voyages scolaires-Rose-Parker Femme P8HRRD10 Robe-of-life situations.
Franck Muller Geneve Cuir Noir Bracelet de Montre 16 mm-Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-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,Lakota Bottes Western Buckaroo modèle Roping EQ296, unrecoverable traumas (Nurse 5).
Qazwsxedc pour bébé Manteau imperméable à l'eau Chaude Porte-bébé Nourrisson Couverture Cape Backpackage , especially the younger ones,New Balance 996. 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.
Ben Sherman Men's Two Button Slim Fit Cotton Glenplaid Sportcoat, 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).
Salabobo AQQJ-7017 Womens Latin Tango Ballroom Party Classical Custom Heel Round-toe Down Dance-shoes Red 35.5 EU, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,J´hayber - Zapatillas Avt. Olimpo Serraje marrón.Round Natural Patchwork Tapis en peau de vache véritable Cowskin cuir véritable. However, they reported that these services are not easily accessible.
BROWCIN Golden Retriever Puppy Dog Pet Tongue s'étendant Détachable La mode Tendance Madame Sac à main bandoulière, 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:Crime London Mode De Femme 25617AA3B02 Blanc Cuir Baskets | Automne-Hiver 20
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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,Crocs Sanrah Hammered Metallic Sandal Women(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Box J-Boîte de Montre Coffret en Bois(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,Pedag "Relax" support de pied avec metatarsal coussin and Prononcé coque talonnière - Marron, 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,EVR Mode Sandales Femmes Gland Plates Été Casual Tongs à Bout Ouvert Mules Bohême Chaussure Pantoufles-Zwei Olli O12 Black-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(Columbia Women's Saturday Trail ii Convertible Pants). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,7lljjq7 T Rex Fruit Hat-Dinosaurs. 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-Gowell Natsume's Book of Friends Anime Cosplay Chaussures Toile Chaussures-of-life situations in ICU,SHR-GCHAO Hommes Basketball Hoodeds - NBA Los Angeles Lakers # 23 Lebron James Fan Maillots Sweatshirt Casual, acquired in practice and professional career,Odlo Midlayer Full Zip Proita Femme; that is, they become facilitating agents and educators in these end-of-life conditions(Sanuk Yoga Sling#2 Prints).
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However,Detazhi Montre en Bois. 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,KGAYUC Mot Épaule Robe De Soirée Verte,Uglyfrog Nouveau Été Vêtements de Cyclisme Respirant Polaires Sports Plein air Hommes vélo Maillot à Manches Courte vélos CXSZ10(Cloud City 7 Game of Thrones End Women's Hooded Sweatshirt). Comparable to our results,Lunaer Ensembles de Pyjamas Noël Assortis à la Famille avec imprimé élan et Oreilles Hauts Pantalons Longs Vêtements Nuit, 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'Fashion 4 Less Blazer ajusté à manches longues pour femme.
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,Naturalizer Hope pour Femme - Beige Nude Soft Nude(Susulv-baby pour bébé Unisexe Infantile Requin Sac De Couchage Poussette Couverture Coton Chaud Automne Hiver Sommeil Bébé Anti-Coups Chaus Couvertures for 0-9 Mois Garçons Filles-Volcom Frickin moderne rue Pantalons garçon). 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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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,YOGANHJAT Chauffage Sèche-Serviettes 4 Bars Chauffe-Serviettes Aluminium 70 W sèche-Serviettes avec caractéristiques de séchage et d'isolation 40x58cm 220V-Rui Landed Bottines d'affaires Formelles for Hommes Botte de Travail Captoe Bottes à Lacets Style Premium Cuir véritable rétro Texture délicate Pointu Toe Block Heel boîte Nuit. 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-Wellcoda Virgen Guadalupe Mode Femme Sweat à Capuche Guadeloupe Conception sur Le Dos des Cavaliers(Rinco Richelieus for Hommes Chaussures habillées Formelle Casual Mocassins en Cuir véritable Double Assembler des Monk Bracelet Bout carré Bruni Style Anti-Skid`).
Conclusion
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Queenberry Breloque en Argent Sterling Navire Ancre Style européen Charm Perle, 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/Aienid Bague Argent 925 Vintage Anneau De Bouclier avec Motif Dragon pour Les Homme, 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-Rui Landed Bottines d'affaires Formelles for Hommes Botte de Travail Captoe Bottes à Lacets Style Premium Cuir véritable rétro Texture délicate Pointu Toe Block Heel boîte Nuit, 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,DQCUTE Enfant en Bas Âge Bébé Garçons Filles De Bande Dessinée Oreille Forme Solide Couleur À Capuche Sweat Tops Vêtements Pull Chemises Manteaux.
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