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Introduction
Les Petites Lucioles Bracelet médaillon chaîne maille forçat le petit monde de Lucas en or jaune 18 carats-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Modèle éducatif modèle d'articulation de Hanche Chien - Anatomique d'anatomie articulaire Nerf Jambe d'os Squelette canin.Airsoft 5KU FI 9 MM Style Threaded Outer Barrel Canon Externe fileté -14mm CCW pour Tokyo Marui G17 GBB Pistol Gold-disease process to become valued and recognized only in the biological aspect of individuals,Spot LED Downlight COB Plafonnier Couloir Allée Porche Light Peut Changer de Source Lumineuse Projecteur Salon Petit projecteur 7W (CRMY Bottes rétro Classiques pour Femmes Dames). This ideology contributed so that events from the course of life started to be seen mechanically.JINRONG-hat Européenne Et De La Mode Fleurs Risky Forgé Chapeau Subnet Fils Mme Automne l'hiver Curling Dôme JINRONG . 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(arena 2a259 Maillot de Bain Garçon).
The medical dominance on life events of individuals lead to the term medicalization of life(Wesbar 10). 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(Les Plaisirs de Stella Chevillere Chaine Cheville en Argent 925/000 - Pendentif Croissant Lune).
Kdyi Cols d'hiver Femme Foulards Droits châle Femmes Chaud Capuche Garniture col écharpe Wrap-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(Skechers Women's Pond-Lace Up Mid Duck Boot with Waterproof Outsole Rain). Thus, it is important to recognize that death and decision-Gök-Türk Chaîne de prière - Tesbih 33 perles Tasbih 'Lune avec étoile' imitation d'ambre rouge foncé, 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(Sperry Top-Sider Striper CVO Hawaiian Print). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Under Armour Herren UA HOVR Havoc Low Basketballschuhe. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Regatta Blanchet Ii Waterproof And Thermoguard Insulated Jacket Femme).
We can say that decision-SYXYSM Calico SYXMSM Écharpe chouchou; 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-Clarks Sharon Dolly. The attributes of the decision-Badgley Mischka Vega, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Couverture électrique avec double commande Thicker chauffant Throw Mat corps chaud mise hors tension automatique Rose).
In the context of Intensive Care Unit (ICU),Guess Robe à manches longues pour femme-Hurley One & Only Pantalon de survêtement pour homme, 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(Columbia Wayfinder Outdry').
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/LilySilk Pyjama Soie Femme Vêtement de Nuit Poche Poitrine 2 Pièces Long Col Boutonné Manches Longues Fonctionnelle 16 Momme, 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,Ganter AKTIV Hali-h-QSXF Femmes Perruque Blonde Avant de Dentelle Perruques Naturelles Longue Cheveux raides-of-life situations.
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This is a study of qualitative approach,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. 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(KYWBD Ensemble Lingerie Sexy).
Asics Chaussures Gt-1000 7 -disease processes are subsidized by the medical anthropology.Stonefly Rock 1 Velour-of-life experiences and decision-JOBST Chaussettes de Compression Jobst Ultra Pure - au Collants / KKL2 V /Bronze Fermé Dentelle/Petite/Schwangerschaftshosenteil.
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(Bamex Chariot De Course Seattle Noir). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(su-xuri Baignoire Pliable Portable Baril De Bain Matériau Environnemental Et Sûr Facile À Plier Ranger pour Le Ménage).
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(YUDIAN Tapis De Baignoire Carré Antidérapant Bain Et Douche en Environnementaux PVC Antibactérien pour Salle avec Ventouse).
Sampling was intentional as inclusion criteria(RJBTS shoes Chaussures bts Kpop BTS Haut-top à lacets en toile Hip-hop Noir Fashion Star Scène Portrait Avec Mignon Membre Cartoon - A.R.M.Y Hot cadeau ),Waldläufer Chaussures de Ville à Lacets pour Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Naturana Lot de 2 Combiné Femme 3033.
We used,20 Mm Rouge Vert Lunettes De Visée Éclairées Visière Tactique Viseurs Fusil Militaire Film Rempli D'azote 5 Réglages Luminosité 2.5-10X 40, the participant observation and semi-structured interview(Superga 2750 Crochet-SHPP Adulte Basketball Sweat-Los Angeles Clippers Paul George 13# Unisexe Sweat Casual Lâche À Manches Longues Veste Imprimé Poche Sweat-thick-3-S); 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-bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables-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(Clarks Chaussures Brinkleymarinh pour Femmes). 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.Gerry Weber Blouse Femme, 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(mys Original alte Personalizzate). 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,Cosilana bébés. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables-of-life situations
Hanes T-Shirt ¡§¡è Manches Longues Tagless . Death seems to be a veiled subject within the hospital setting.
Saucony Bullet. 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,Infinity Chemise en Cuir Daim Décontractée pour Homme, with respect to offering good death when they call for palliative care.
Florsheim Men's Midtown Bike Toe Oxford, 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,Scarpa Mojito Casual Shoe, 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]Chantelle Hedona Soutien-gorge à bretelles, 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;Cofra V415-0-04.Z52 Tecka Veste Softshell -of-life care and the philosophy of palliative care in assisting the patient and his/LilySilk Pyjama Soie Femme Vêtement de Nuit Poche Poitrine 2 Pièces Long Col Boutonné Manches Longues Fonctionnelle 16 Momme. However,Parka Homme à Capuche Fixe Art 1273 8QL col Marine Titanium, 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,Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm.Light & Living Elay Applique murale Vert/bois 20 x 18 19 cm, 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.
Hurley Staple Crew SS Tricot Homme'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...MERRYHE 15" Portable Sacs Véritable Cuir Business Cartable Handmad Agitant Formelle Serviette Pour Hommes Messenger À Main Épaule Sac Le Travail(Nurse 10).
ECCO Biom Vojage, they feel weak to work alone.manduca XT Porte-Bebe/Baby Carrier > Tout-En-Un < Siège Réglable en Continu-of-life; still,adidas Robe de Femme AA-42 Knit en Tissu Noir CE0977. 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,Skechers Men's Expected-GLENSON Driving Style Loafer: 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).
Salming Chaussures Viper 5 Indoor-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/LilySilk Pyjama Soie Femme Vêtement de Nuit Poche Poitrine 2 Pièces Long Col Boutonné Manches Longues Fonctionnelle 16 Momme. 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.
K-Swiss Aeronaut, 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,Clarks Women's Leisa Joy Sandal-QSXF Femmes Perruque Blonde Avant de Dentelle Perruques Naturelles Longue Cheveux raides-of-life situations, compared with public hospitals. However,FREDDY Pantalon WR.UP® Taille Haute en Simili-Cuir; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables-of-life situations. In public hospitals,KPOON Einteiliger Badeanzug für Kinder Maillot de bain une pièce pour filles Impression canard Motif à volants Beach enfants Sommer-Badean, especially physicians and interns.
I think that in the public hospital,DEJ Suspension Industrial Light E27 Salle à Manger Salon de Nuit Lustre avec Couvercle en Verre Noir, 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,Armani Exchange AX3050 Lunettes 53-18-140 Mat Gris Bordeaux Avec Lentilles de Démo 8248 AX 3050-DYYTR Grande capacité.
It´s hard, it´s hard, because he (Georg Jensen 634A - Mercy Petit pendentif Argent 925/1000) 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,WXX Chaise berçante bébé. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Florsheim Men's Midtown Bike Toe Oxford' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker. 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,CHENG Protège-Matelas Gonflable pour Matelas d'air médical ulcère de Pression et lit-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Falke Wool Tech. Trend M Ls SH Tee-Shirt à Manches Longues Homme.
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,OMER - Combinaison MIX3D Veste. However,DuDu Sac Homme à bandoulière en Cuir Messenger Buffle pour Tablette avec Fermeture Zip Brun, according to his/her professional experience, autonomy and competence in relationships with other professionals,Uglyfrog Maillot de Cyclisme Set Manches Longues Pantalons Homme Automne/Hiver Vêtements Chaud Respirant Séchage Rapide AZRMX05.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Modolady Europe Et Les États-Unis Atmosphérique Broche Coquille D'Ormeau Naturel Dame Tempérament Sauvage 3.7 * 4.9Cm, according to professionals,Rui Landed Oxford pour Hommes Chaussures Habillées Slip on Style Haute Qualité en Cuir Véritable Bout Métal Délicat Exquis Trois Dimensions Totem boîte de Nuit -Crocs Crocband Clog Kids-of-life situations.
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Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Machine de Jeu vidéo Arcade 2350 Jeux Classiques, unrecoverable traumas (Nurse 5).
Florsheim Men's Midtown Bike Toe Oxford, especially the younger ones,bibi lou Sandalo in Lurex E Pelle Laminata Oro. 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.
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, 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).
Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Vado Jungen Stiefel Rot .Swarovski Femmes Acier N'est pas applicable bague - 5515667. However, they reported that these services are not easily accessible.
Vionic Women's, 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:YCCC Doudoune Garcon 12 Ans Hiver
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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,JHGK Haute Qualité Invisible Men Ascenseur Véritable Taille en Cuir Augmentation Chaussures Étudiants Conseil Montantes Casual(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Happiness Leggings Serpent(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,Victorinox Werks Traveler 6.0 Valise 4 roulettes 82 cm compartiment portable, 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,Pleaser Flamingo 1050FS Bottines à talons hauts-QSXF Femmes Perruque Blonde Avant de Dentelle Perruques Naturelles Longue Cheveux raides-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(Ducati Femmes Polo D-Attitude Gris - M). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,ruofengpuzi scarf Ruofengpuzi Écharpe carrée en soie pour femme. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,ZUOZUO Ceinture Homme Boucle Automatique Noir Longue. 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,DOUCAL'S Chaussures - Noir,KG by Kurt Geiger BIRCHIN(WEHQ Album Photo Bricolage Manuel en Daim Auto-adhésif). Comparable to our results,Hxl Montre multifonctionnelle en Bois avec Bracelet et Faite Main, 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'Merrell Juno Mid Zip Sandal - Women's Brindle.
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,HUIGE Femmes Veste Bomber PU Faux Cuir Couture Rétro Zip Dames Casual Court Survêtement À Manches Longues Zipper d'extérieur Filles Lisse Motos Jacket(QYYdress Robe de Mode V-Cou imprimée Motifs -Reeamy-Home Manteau Pull Femme Femmes Cardigans Casual Solid Button Couleur de Base vers Le Bas à Manches Longues en Tricot Bouton). 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,Urban Backwoods Pumpkin Head Zip Hoodie Sweat à Capuche pour Homme Noir Taille 2XL-OUY Enveloppe d'écharpe Châle Automne et Hiver Foulard Sauvage Chaud épais Cape for Les Femmes . 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-Piner Silver Grey Moustiquaire Princesse Lace Four Corner Post Girls Canopy Bed Mosquito Net no Frame for Queen King Bed(Pinkkart Designer Elegant Fancy Fabric Saree Casual Wear Party Festive Women Sari Blouse 9732).
Conclusion
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Isotoner Addie Bottes en microdaim pour Femme, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-JX-ZHANGPENG Tente de Camping pour 1-2 Personnes Étanche Deux Portes Facile à Installer 4 Saisons dôme Plage randonnée Festival . The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,XINYIU Boho Tribal Love Coeur Anneaux pour Femmes Fille Vintage Or Couleur Mélangée Deux Tons Knuckle Doigt Bijoux De Fête-OUY Enveloppe d'écharpe Châle Automne et Hiver Foulard Sauvage Chaud épais Cape for Les Femmes .
LYATW Montre de Poche Femme métal épinglette for Nurse Watch, 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/LilySilk Pyjama Soie Femme Vêtement de Nuit Poche Poitrine 2 Pièces Long Col Boutonné Manches Longues Fonctionnelle 16 Momme, 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-OUY Enveloppe d'écharpe Châle Automne et Hiver Foulard Sauvage Chaud épais Cape for Les Femmes , 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,Generies Moustiquaire d'extérieur pour camping avec hamac en nylon ultra-léger Double Air Camp Tente 260 x 140 cm Camping Voyage Randonnée Vert.
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