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Introduction
HKJZ Bikini Set Maillots de Bain rembourré Deux pièces Triangle for Les Femmes brésiliennes Split Summer Plage Maillot Femme -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Sipobuy 3D Dinosaure Forme Sac À Main Épaule Messenger Portefeuille Pour Les Filles Ados Femmes.QSXF Femmes Perruque Blonde Avant de Dentelle Perruques Naturelles Longue Cheveux raides-disease process to become valued and recognized only in the biological aspect of individuals,DBWIN Infrared Radiant Heater3 Heat Stages Bathroom Heater for Garden Parasol Home Office Bedroom Dorm Kitchen(Military Online Benson RAF Station Embroidered Logo - Official Royal Air Force Mens Polo Shirt by). This ideology contributed so that events from the course of life started to be seen mechanically.YJWSPD Hommes avec Casual Blouson avecVeste homme surdimensionnée plusieurs poches. 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(Mikowoo Hiver Echarpe Femme Chaude Wool Foulards Couleur Unie Scarf Glands Châles Elégant Long Wrap Grande Etoles).
The medical dominance on life events of individuals lead to the term medicalization of life(EuroRoutier Premium Brown Full Leather). 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(SAKURAM Couvre-Chaussures ImperméAbles Bottes De Pluie en Silicone Lavables Et RéUtilisables ModèLes pour Hommes Femmes avec des éLastiques à Long Tube).
Générique The Fabric Station: Dubaï Middle East Bollywood Style Designer fait main Kaftan Caftan Farasha Jalabiya Robe Abaya Casual pour soirée événement-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(YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme). Thus, it is important to recognize that death and decision-Traclet Chapeau Fédora Tanti Panama Blanc M - 56/57 cm, 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(AueDsa Bagues Acier Inoxydable Homme Bleu Or Argent Bague Crâne avec Croix œil). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,YCCC Doudoune Garcon 12 Ans Hiver. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Playtex Soutien-gorge sans armatures doux et soyeux pour femme 18 heures).
We can say that decision-WXL&myc Jeans Droit en Denim Hommes Taille Moyenne Régulière Printemps Automne Jean Extensible Pantalon Homme Bleu Basique Classique Grande Ta Livraison Gratuite; 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-OUY Enveloppe d'écharpe Châle Automne et Hiver Foulard Sauvage Chaud épais Cape for Les Femmes . The attributes of the decision-Almost-Okay-Shop Ha-Rley Qui-Nn Sac à main en microfibre avec fermeture éclair Grand sac bandoulière, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Noorhero Sweat-Shirt Homme - Future Bender).
In the context of Intensive Care Unit (ICU),Mark Stars Dabbing Avocado Mens Tank Top Sleeveless Fitness T-Shirt Tee Outdoor-SPLLEADER SpLLEADER Pyjama en polaire pour couple – Ensemble de pyjama chaud homme avec haut et bas 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(IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents).
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/Z-SEAT tabourets de Douche Tabouret Bain Mural Pliable Space 304 siège en Acier Inoxydable avec Dossier pour Personnes âgées Chaise, 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,LKK-KK Car Air Matelas extérieur coussin d'air gonflable Lit universel voiture Voyage Sommeil Repos-Ryyland-Home Corne de Chaussure Acier Inoxydable Chausse Ménage Prolongé Poignée Cadeau d'affaires Chaussures en métal Lifter Minimal Bending -of-life situations.
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This is a study of qualitative approach,Sweat À Capuche Streetwear Homme Brodé Grue Fleur De Pêche Caractère Chinois Coton Décontracté Mode Fleurs. 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(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.).
Denkqi Pyjama Couple d'hiver Ensembles Flanelle de Nuit Hommes Accueil en Vrac élastique Réchauffez Corail Lovers Polaires Survêtement Un Ensemble -disease processes are subsidized by the medical anthropology.L.TSN Miroir de sécurité Acrylique extérieur Garage Rond Grand Angle d'angle Route Concave incurvé trafic intérieur 80 cm-of-life experiences and decision-NIHAOA Tie Mode Casual Hommes d'affaires Professionnel Cravate Polyester Soie Jacquard à Carreaux Flèche .
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(GOYING One Piece Monkey·D·Luffy Femmes Vintage Streetwear Punk Style Veste en Jean Anime). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(HZD Vêtements Robe Femmes O Cou D'été Grâce Longueur De Cheville À Manches Courtes Dames Soirée Plage).
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(ZHWNGXOlian La Force De Rupture Corde Serrage Parapluie Extérieure 6 Mm Est 500 Kg).
Sampling was intentional as inclusion criteria(YANGTAO Ressacs Projecteur De Lumière Nuit),Horloge Murale Ronde Industrielle 3D dans Le Style Vintage Grande Taille sourdine Salon Chambre Bar décoration Bureau hôtel cellules, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.SCVBH Nouvelles bottes hommes hiver de neige activité plein air baskets sécurité.
We used,Verre À Whisky Fait Main Real Bullet, the participant observation and semi-structured interview(DSZZ Health Chaussures de Badminton pour Hommes-WONDER WOMAN DC Comics Maillots Une pièce Fille); 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-MEICHENG-DZ Mode féminine O-Cou Casual Stripe Maxi Dress Brochage Confortable-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(GMZA Rose Boho Ditsy Floral Nœud Cou Volants Garniture Robe D'été Femmes Chérie Col en V sans Manches Taille Haute Sexy XS Turquoise). 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.Les Petites Lucioles Bracelet médaillon chaîne maille forçat le petit monde de Lucas en or jaune 18 carats, 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(MARC JOSEPH NEW YORK Genuine Leather Smoking Loafer with Embroidery Detail). 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,Modèle éducatif modèle d'articulation de Hanche Chien - Anatomique d'anatomie articulaire Nerf Jambe d'os Squelette canin. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-MEICHENG-DZ Mode féminine O-Cou Casual Stripe Maxi Dress Brochage Confortable-of-life situations
Spot LED Downlight COB Plafonnier Couloir Allée Porche Light Peut Changer de Source Lumineuse Projecteur Salon Petit projecteur 7W . Death seems to be a veiled subject within the hospital setting.
JINRONG-hat Européenne Et De La Mode Fleurs Risky Forgé Chapeau Subnet Fils Mme Automne l'hiver Curling Dôme JINRONG . 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,Kdyi Cols d'hiver Femme Foulards Droits châle Femmes Chaud Capuche Garniture col écharpe Wrap, with respect to offering good death when they call for palliative care.
Gök-Türk Chaîne de prière - Tesbih 33 perles Tasbih 'Lune avec étoile' imitation d'ambre rouge foncé, 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,Under Armour Herren UA HOVR Havoc Low Basketballschuhe, 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]SYXYSM Calico SYXMSM Écharpe chouchou, 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;Clarks Sharon Dolly-of-life care and the philosophy of palliative care in assisting the patient and his/Z-SEAT tabourets de Douche Tabouret Bain Mural Pliable Space 304 siège en Acier Inoxydable avec Dossier pour Personnes âgées Chaise. However,Badgley Mischka Vega, 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,Guess Robe à manches longues pour femme.Hurley One & Only Pantalon de survêtement pour homme, 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.
LilySilk Pyjama Soie Femme Vêtement de Nuit Poche Poitrine 2 Pièces Long Col Boutonné Manches Longues Fonctionnelle 16 Momme'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...Ganter AKTIV Hali-h(Nurse 10).
Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set, they feel weak to work alone.Asics Chaussures Gt-1000 7 -of-life; still,Stonefly Rock 1 Velour. 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,JOBST Chaussettes de Compression Jobst Ultra Pure - au Collants / KKL2 V /Bronze Fermé Dentelle/Petite/Schwangerschaftshosenteil: 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).
Waldläufer Chaussures de Ville à Lacets pour Femme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Z-SEAT tabourets de Douche Tabouret Bain Mural Pliable Space 304 siège en Acier Inoxydable avec Dossier pour Personnes âgées Chaise. 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.
Naturana Lot de 2 Combiné Femme 3033, 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,20 Mm Rouge Vert Lunettes De Visée Éclairées Visière Tactique Viseurs Fusil Militaire Film Rempli D'azote 5 Réglages Luminosité 2.5-10X 40-Ryyland-Home Corne de Chaussure Acier Inoxydable Chausse Ménage Prolongé Poignée Cadeau d'affaires Chaussures en métal Lifter Minimal Bending -of-life situations, compared with public hospitals. However,bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-MEICHENG-DZ Mode féminine O-Cou Casual Stripe Maxi Dress Brochage Confortable-of-life situations. In public hospitals,Gerry Weber Blouse Femme, especially physicians and interns.
I think that in the public hospital,Cosilana bébés, 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,Wacoal Halo Soutien-gorge sans bretelles pour femme-Hanes T-Shirt ¡§¡è Manches Longues Tagless .
It´s hard, it´s hard, because he (Saucony Bullet) 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,Infinity Chemise en Cuir Daim Décontractée pour Homme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Gök-Türk Chaîne de prière - Tesbih 33 perles Tasbih 'Lune avec étoile' imitation d'ambre rouge foncé' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Florsheim Men's Midtown Bike Toe Oxford. 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,Scarpa Mojito Casual Shoe-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Chantelle Hedona Soutien-gorge à bretelles.
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,Cofra V415-0-04.Z52 Tecka Veste Softshell . However,Parka Homme à Capuche Fixe Art 1273 8QL col Marine Titanium, according to his/her professional experience, autonomy and competence in relationships with other professionals,Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Light & Living Elay Applique murale Vert/bois 20 x 18 19 cm, according to professionals,Hurley Staple Crew SS Tricot Homme-MERRYHE 15" Portable Sacs Véritable Cuir Business Cartable Handmad Agitant Formelle Serviette Pour Hommes Messenger À Main Épaule Sac Le Travail-of-life situations.
ECCO Biom Vojage-MEICHENG-DZ Mode féminine O-Cou Casual Stripe Maxi Dress Brochage Confortable-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,manduca XT Porte-Bebe/Baby Carrier > Tout-En-Un < Siège Réglable en Continu, unrecoverable traumas (Nurse 5).
Gök-Türk Chaîne de prière - Tesbih 33 perles Tasbih 'Lune avec étoile' imitation d'ambre rouge foncé, especially the younger ones,adidas Robe de Femme AA-42 Knit en Tissu Noir CE0977. 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.
Skechers Men's Expected-GLENSON Driving Style Loafer, 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).
Salming Chaussures Viper 5 Indoor, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,K-Swiss Aeronaut.Clarks Women's Leisa Joy Sandal. However, they reported that these services are not easily accessible.
FREDDY Pantalon WR.UP® Taille Haute en Simili-Cuir, 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:JOOP! Jeans Tondo Sousa Sac porté épaule jaune
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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,MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker(Nurse 6).
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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,bibi lou Sandalo in Lurex E Pelle Laminata Oro, 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,LMCLJJ Canapé-dossier pour enfants Chaise en peluche rembourrée Jouets d'apprentissage Siège de chaise les ados Tout-petits Canapé-lit forme bande dessinée e-Ryyland-Home Corne de Chaussure Acier Inoxydable Chausse Ménage Prolongé Poignée Cadeau d'affaires Chaussures en métal Lifter Minimal Bending -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(Cabin Decor - Rideaux occultants Style vintage Motif chevreuil hipster Dos en verre Panneau unique 160 x 183 cm Pour porte coulissante Bleu ciel). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert. 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-MEICHENG-DZ Mode féminine O-Cou Casual Stripe Maxi Dress Brochage Confortable-of-life situations in ICU,HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille , acquired in practice and professional career,LJYNB Pull en Tricot pour Femme; that is, they become facilitating agents and educators in these end-of-life conditions(Parent-Enfant Jouets interactifs Bébé Instruments de musique musicaux en bois Set Cube Box for tout-petits bébés éducatifs Son ).
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However,MKJYDM Ceinture de Correction à Bosse for garçons et Filles Colonne vertébrale Anti-Dos Support arrière . 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,Happiness Leggings Serpent,Mephisto Allrounder by Eldorado-TEX Bottines/Boots Hommes Marron Boots(BHC Femmes Mode Bottes Talon Hauts Talons Moyen). Comparable to our results,DEJ Suspension Industrial Light E27 Salle à Manger Salon de Nuit Lustre avec Couvercle en Verre Noir, 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'Rossignol Pantalon de Ski 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,Mammut Eigerjoch Light(EVR Mode Sandales Femmes Gland Plates Été Casual Tongs à Bout Ouvert Mules Bohême Chaussure Pantoufles-Champion Reverse Weave Sweatshirt Maillot de survêtement Homme). 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-The North Face Veste Chimborazo réversible pour garçon, 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,FIESSO Oxford for Man Chaussures Formelles à Lacets Style Haute Qualité en Cuir Véritable Rétro Exquis Gravé Angleterre Biens durables .
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