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Introduction
Holley 34504 Carburetor Accelerator Pump-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,ROTHCO M-65 Camo Field pour Homme.CMP 38Z1726 Parka Fix Hood pour Femme-disease process to become valued and recognized only in the biological aspect of individuals,PUMA RS-x Winterized(CuteRose Baby Grils Infantile Boys Lightly Hoode Down Coat Jacket). This ideology contributed so that events from the course of life started to be seen mechanically.Brandit Sweatshirt à capuche Homme. 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(Gabor Shoes Casual).
The medical dominance on life events of individuals lead to the term medicalization of life(FACAIA Individuality Educational Model Garden Decorative Statue). 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(Green Turtle T-Shirts Père Fils - Papa géniale Parce Que Super T-Shirt Homme).
Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles-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(Timberland Chaussures - Grantly Chukka A12IA brown). Thus, it is important to recognize that death and decision-The 1 for U 100% Coton Peignoir/Peignoir Rosalind, 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(Napapijri Serber Ls T-Shirt Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,HUAQINEI Guirlande Lumineuse Chaîne De Musique À Distance LED Imperméable Lumières Décoration Noël Convient pour Halloween Salon Fête. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Pinko Dante Blusa Crepe de Chine Di Blouse Femme).
We can say that decision-LybMjG Maillot Cyclisme Pro; 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-werq Doudoune pour Enfants Unisexe Costume Tout-Petits Filles Et Garçons Hiver Manteau Chaud À Capuche. The attributes of the decision-Carhartt Gilliam Vest Gilet Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Ice Peak Icepeak Parka Leona).
In the context of Intensive Care Unit (ICU),LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique-Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe, 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(WYFX Smart Fingerprint Wallet).
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/Sanuk Yoga Bliss, 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,Under Armour Curry IV Sandale pour homme-WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe-of-life situations.
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This is a study of qualitative approach,Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir. 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(Salewa Pedroc Hybrid 2 DST/PTX W Veste Femme).
Guess lea03 femme guess flazl2-disease processes are subsidized by the medical anthropology.Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large-of-life experiences and decision-HKM 9109 Bottes d'équitation Gijón.
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(Hngyanp Taux étanche Bracelet Coeur Intelligent Blood Pressure Tracker Fitness Bande Femme Fille). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Decoy - Ys 23 Big BL 10/0).
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(RONGXIE Nouveau Populaire Mode Casual Femmes Chaussures De Toile Graffiti Vulcanize Respirant Mignonnes Baskets Blanches).
Sampling was intentional as inclusion criteria(MULIZHE Nanatsu No Taizai 3D Couleur Impression T-Shirt à Manches Courtes Dessin animé Couple Sport réunion Respirant Vacances garçon Fille Cadeau),Pandora Femme Argent Boutons d'oreilles - 290721CZ, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713].
We used,J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN, the participant observation and semi-structured interview(LIANGJIE Écharpe en laine pour femmes-W&XY Bottes d'hiver de la mode des hommes haut en peluche coton antid¨¦rapant ext¨¦rieur chaussures ); 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-Onitsuka Tiger Mexico 66-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(Salming Femmes Distance D5 Chaussure De Running sans Stabilisateurs Chaussures Noir - Blanc). 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.Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe, 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(IUBBKI Sac bandoulière croisé pour femme mignon caniche décoré de motifs japonais sur poignée personnalisée sacs à main en cuir PU Rivet Portable Fashi). 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,Suitline Valise Plus Grande Bagages Rigide. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Onitsuka Tiger Mexico 66-of-life situations
Pierre Cardin Lyon Long Life Chino Pantalon Homme. Death seems to be a veiled subject within the hospital setting.
adidas Supernova de Course pour Femme à Manches Longues Tee. 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,Montane Ineo Pro Women's Pantalon, with respect to offering good death when they call for palliative care.
Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle, 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,Manfrotto Travel Backpack Sac à dos Gris, 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]Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini Noir, 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;Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro-of-life care and the philosophy of palliative care in assisting the patient and his/Sanuk Yoga Bliss. However,Hexagona Sacoche en cuir de vachette RÉPUBLIQUE, 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,X-Bionic O100093 - Cuissards de vélo Femme.YUHT Album Photo Hybride interstitiel, 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.
YULIN-L YYL Imperméables pour Enfants'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...DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles (Nurse 10).
Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck, they feel weak to work alone.Wilvorst - Veston Uni Bébé -of-life; still,Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support. 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,adidas Ultimafusion: 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).
GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Sanuk Yoga Bliss. 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.
good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine, 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,Guess Bla Moritz-WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe-of-life situations, compared with public hospitals. However,Haggar Cool 18 Pro Stretch Madras Short pour Homme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Onitsuka Tiger Mexico 66-of-life situations. In public hospitals,YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe, especially physicians and interns.
I think that in the public hospital,Tosca Blu Bottes Mary, 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,BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute-WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud .
It´s hard, it´s hard, because he (Radio Portable multifonctionnelle) 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,Spyder Raider Pull à fermeture éclair intégrale 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.
Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Palladium Pampa Boots White. 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,Apalis Sticker Mural Squirricorn on The Branch-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk.
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,Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband. However,ALPHA INDUSTRIES Blouson - Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Kamik Snowvalley.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Nike Viale, according to professionals,American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003-Fun Costumes Deluxe King of Hearts Fancy Dress Costume Small-of-life situations.
Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main-Onitsuka Tiger Mexico 66-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,Green Burry Greenburry , unrecoverable traumas (Nurse 5).
Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle, especially the younger ones,Under Armour Men's UA Yard Low St Sneaker. 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.
New Balance H754 , 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).
WOOLRICH Laureldale Pull à col roulé pour femme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,German Wear Chaussures de Ville à Lacets pour Homme Noir.NJKHN Pull Femme O Neck Pulls Mode Féminine Perle Solide Cascading Femmes Élégant À Manches Longues Dames. However, they reported that these services are not easily accessible.
PUMA Suede Classic , 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:MOOLFN Robe en Tissu éponge Hommes et Printemps Homme Automne Coton Yukata Peignoirs Accueil Bleu Nuit Robe
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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,Bisgaard Dora(Nurse 6).
End-of-Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche ,Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,PALLADIUM-EU Pampa Sport Cuff Wpn,Trippen Road Brown' 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,Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme(Nurse 5).
In care and in decision-Madden Girl Femmes Bottes-of-life,Columbia Wander Plus Jogger.gracosy Sabots Femmes Cuir, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Brass Monkeys Haut Thermique - Homme, knowing that all the best care was provided to the patient.Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7.
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,Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris, 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,TONI CS-Jenny Business-WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe-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(MEETGG Porte-Bébé Multifonctionnel Trois en Un). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Nike Flex Trainer 9. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Adidas Condivo d'entraînement pour homme Pantalon . 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,Oliver Peoples BERNARDO OV 5189/S,WFQGZ Chaussures De Sport pour Hommes Bas(HADDRELLS OF CAMBRIDGE Haddrell's of Cambridge | Miel de Manuka UMF 20 MGO 850 Nouvelle-Zélande Naturels De Première Qualité 250 grammes). Comparable to our results,Fabulicious Flair, 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'Aura Cacia Ginger/Mint Mist aromathérapie.
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,Hush Puppies H18800(Haltère Fitness Yoga Hexagonal Dumbbell Formation Unisexe Paire 5kg Violet Bleu -Dll Hommes Enfants Basketball Jersey Ensembles Survêtements Uniformes Respirant Filles vêtements de Sport). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu, and the only one who has the power of decision(Stgfstydt Women Slim Thick Lapel Single Breasted Wool Blend Trench Pea Coat Jacket). Thus, care practices in end-of-no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable , creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(ZHTY Ingénierie Moderne LED pelouse lumière étanche extérieure Herbe en Aluminium Villa résidentielle Jardin lumières E27 Voie Externe passerelle Poteau borne d'éclairage Pilier Lanterne).
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,Flyye épaule Étui System Panel MOLLE Ranger Vert-G&F Hommes Gynécomastie Gilet Contrôle Ventre Body Shaper avec Ceinture Hauts Shorts 2 Pièces . 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-ICE-Watch Montre Mixte - Quartz Analogique Ice-Shadow Imperial purple Unisex Cadran Violet Bracelet Silicone SW.IMP.U.S.12(N / A Unisexe Basketball Maillots Cleveland Cavaliers Set- # 13 Tristan Thompson Fan klassischer Jersey Swingman Ärmel Top und Shorts).
Conclusion
The decision-WJFXG Lampe de Plafond Moderne G4 Base cuivre Verre Cristal Plafonnier LED Dimming Chambre Salon Cuisine Salle à Manger décorative Intérieur Lampe-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Hammer Folding Panier-of-SFOXL Homme Chaussures de Sécurité.
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Supra Breaker, 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/Sanuk Yoga Bliss, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
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