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Introduction
Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm .Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44-disease process to become valued and recognized only in the biological aspect of individuals,Mockledd T-Shirt(Daiwa Moulinet Pêche Freams LT 3000 Frein Arvant Mer Carpe Truite Carnassiers Spinning Feeder). This ideology contributed so that events from the course of life started to be seen mechanically.Tonicnc Vintage Constellation Map Men's Hoodie Sweatshirt Realistic Pullover Hooded Sweater Jacket with Pocket White. 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(Mizuno 9-Spike Advanced Sweep 4 Low Metal Softball Cleat Chaussure Femme).
The medical dominance on life events of individuals lead to the term medicalization of life(WMZQW Homme Chaussures Formal Matière synthétique Automne/Printemps été Classique/Simple Mocassins Couleur Noir/Dorée/Rouge/Bureau et carrière). 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(Timberland Bradstreet Chukka Molded).
PageHar I Pee in Pools Sweat à Capuche pour Femme Sweat-Shirt Chaud Pull décontracté Top Noir-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(Gabs & Studio GABS ). Thus, it is important to recognize that death and decision-TTJX Chapeau de Seau réversible Unisexe Mode Bob Casquette Hip Hop Gorro Hommes Plage Soleil Banane pêcheur Double côté Porter, 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(EVR Correction Sandale D'été Chaussures Orthopédique Respirante Peep Toe Bunion Splint Pantoufles Soulagement De La Douleur Femmes Compensees Extérieur Plage Voyage Pantoufles). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,ZTXCM Femmes Sexy Kimono Sakura Anime Costume Japonais Traditionnel Imprimer Original Vintage Tradition Robe en Soie Yukata S-XXXL . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Dare 2b pour femme PREMISS Veste imperméable isolée).
We can say that decision-LAOAYI T-shirt en coton pour homme Cool doux la peau.; 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-XiangHeFu Sac de téléphone sac à main porte-cartes voyage grande capacité portefeuille Statue la liberté avec le drapeau américain. The attributes of the decision-Failsworth Cheval marron événements Chapeau, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(HZK Wearable Silicone Breast Faux Seins en de qualité médicale. Les Formes des sont dotées mamelons. Forme Goutte d'eau).
In the context of Intensive Care Unit (ICU),YWXJY Costume d'halloween Naughty Ghost Spider Monster Trick Or Treat Horror Bretelles Garçons-Gris_2-4T-The Mermaid Conviction Skate Or Die Femme T-Shirt à Manches Longues Tailles XS – 2XL, 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(Cloud City 7 Pandemic Code Light Women's Hooded Sweatshirt).
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/SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation, 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,Main Dans La Pinky Jurer Promise Amour Coeur 3D Lampe 7 Couleur Changé Veilleuses Enfants Table De Noël Présent Cadeaux-RICOSTA Daphne-of-life situations.
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This is a study of qualitative approach,Spektra acrylique-interchangeables à tricoter chunky set de fixation. 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(Bohrcraft perçage Craft 41550302000 masch. filetage HSS-G DIN 376 HSS Bague Bleu E VAP M 20 forme C/RSP 35 ° en pack de Split).
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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(In:sole Insole Sandales Talon Haut). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(XFQ Femmes Trail Running Shoes).
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(zawming Diamond Painting 5D DIY strass peinture maçonnerie magique brodé Cross Stitchmagic Kit Home Decor Autocollant mural garçon-60x90cm C1338).
Sampling was intentional as inclusion criteria(KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes),XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.XHYYY Casquette de Baseball Kawaii Chats Bleu Super Car Réglable Maille Unisexe Trucker Chapeau Convient Hommes Femmes.
We used,Crazy Dog Tshirts Womens Irish As Feck T Shirt Funny Saint Patricks Day Shamrock Lucky Tee Girls - Femme, the participant observation and semi-structured interview(WYZQ Dames Filles Mode infirmières Florales Broche à Revers Couverture de Protection en Silicone Montre Poche carrée pour s Paquet 3-FR&RF 5 Zones chauffées Gilet Hommes Femmes Chauffants 3 Vitesses réglable Chasse Pêche d'hiver Chauffant USB Outdoor); 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-Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main-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(ZKZK Ruffle Portable de Jeu for bébé clôture Centre d'activités Enfants et intérieur Sécurité extérieure Clôture Goutte épreuve Pen Lit Garde-Fou). 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.Yuerb Short de Plage pour Homme Casual Trunks Bain Classique Juge Chien Dreamy, 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(Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié ). 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,Papier peint Photo personnalisé 3D Relief ailes abstraites Figure peintures murales salon salle à manger Art papiers peints pour murs-350Cmx245Cm. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main-of-life situations
WANGPENG Brosse à récurer pour chaussures. Death seems to be a veiled subject within the hospital setting.
QUNLIANYI Robe Perle Femme T-Shirt Jupe à Manches Longues pour Femmes. 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,Skechers Go Walk Lite-Sea Dream Bateau pour femme, with respect to offering good death when they call for palliative care.
FREEFISHER Free Fisher Chaussures Souples Bébé Chaussons en Cuir Doux, 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 pour Femme Imprimé Perfect Pace Short, 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]Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2, 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;KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable-of-life care and the philosophy of palliative care in assisting the patient and his/SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation. However,Nisdsgd Men's Hoodies Sweatershirt, 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,GB Eye Limited Logo-Tasse.New Rock Hommes Gothique Biker Style Cheville Bottes Noir Lacets Spiky Chaussures en Cuir Véritable, 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.
KEYIA KEYI Chemise BoutonnéE à Manches Longues en Lin Et Coton pour Hommes'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...Tappers & Pointers Chaussures de danse fille(Nurse 10).
Merrell Tremblant Ezra Lace Polar Waterproof, they feel weak to work alone.PUMA Cell Surin 2 FM-of-life; still,5.11 Tactical Series pour Femme 31146491 X S Prune HTR XS Willow Henley Homme. 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,Rieker 30921: 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).
Showers Pass Short de ski léger respirant à séchage rapide pour homme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation. 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.
Femmes Couverture Complète Coton Allaitement Soutien Gorge D Sans Vêtements de Fiesta Bretelles Dos Nu Bralette Confortable Respirant Enceinte Lingerie Sous, 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,Tom Ford FT0609 01C 54 Montures de lunettes-RICOSTA Daphne-of-life situations, compared with public hospitals. However,adidas Originals Kids' U_Path Running Shoe; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main-of-life situations. In public hospitals,Skechers Solar Fuse, especially physicians and interns.
I think that in the public hospital,LMM Faux Seins en Silicone, 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,Dansko Femmes Chaussures De Mule-Kate Spade New York Sac fourre-tout réversible en cuir Marina Lakeland Drive.
It´s hard, it´s hard, because he (HEAD Sprint 3.0 Junior) 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,YATTYUG Women's Hoodies Tops. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
FREEFISHER Free Fisher Chaussures Souples Bébé Chaussons en Cuir Doux' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-RNXRBB RNXRBBRomantique Femmes Chapeaux De Mariée Et Perle Perlé Mariage Chapeau Noir Cadeaux Noce Voile Cheveux Avec Peigne Rouge Maille Chapea. 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,DHNKW Men's Hoodies Sweatshirts-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-YH Y-H HyRIDER Signature Culotte Bleu Marine/Rouge 26".
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,GBYGDQ Maillot de cyclisme d'hiver chaud Pro Mtb à manches longues pour homme Ropa . However,BSWL Gilet Chauffant USB Intelligent, according to his/her professional experience, autonomy and competence in relationships with other professionals,jklj Chariot D'épicerie De Supermarché Imprimé Pliable Panier avec 2 Roues Peut être Utilisé sur Différents Terrains .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Déambulateur, according to professionals,BOGIRY T-Shirt Unisexe Mode D'Été Chemise À Manches Courtes Demi-Manches Haut Vêtements De Travail Col Rond Hawaïenne Pyjama 3D HD Imprimer Motif Anime Uniforme-PLKNVT Nouveau Haute Qualité Design Marque De Mode Ovale Cadran Or Quartz Bracelet Montres Femmes Robe Manchette Montre-Bracelet Relogio Feminino-of-life situations.
mys Original alte Personalizzate-Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main-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,LOVARZI Écharpe d'hiver pour femme et homme - Écharpes de Noël, unrecoverable traumas (Nurse 5).
FREEFISHER Free Fisher Chaussures Souples Bébé Chaussons en Cuir Doux, especially the younger ones,MSSJ Bénédiction sur ce monde merveilleux! Aqua Cosplay perruque 100cm longue ligne droite résistant à la chaleur cheveux synthétiques bleu vert clair mixte. 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.
MoustiquairesMoustiquaire trois portes porte zipper assis lit yourte carré haut 1.5 m 1.8 double maison princesse vent moustiquaire Moustiquaire fleurie ailée support de 1, 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).
glstkrrn E90 Sweatshirt, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Liangzishop Cyclisme Veste Sponeed Vêtements de for Hommes et Femmes à Manches Longues VTT Vélo Route Shirt Motif Individuel Conception Maillot Corps .Anoauit Sandales d'été en Cuir véritable Hommes Chaussures Casual Grande Taille Nouveau Doux Loisirs de Plage-Gris_41. However, they reported that these services are not easily accessible.
Instrument De Beauté Portable Aspirateur Point Noirs Comédons Nettoyant Pores Rechargeable Appareil du Visage avec Écran LED , 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:Lloyd Bazar
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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,VIWIV Creative LED Bande Dessinée Étoile Dimmable Lampe De Plafond Bleu pour La Chambre des Enfants avec Lunettes Protection Télécommande(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Asics Chaussures Gel-Quantum 180 4(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,smoob addy Sweat à capuche pour bébé garçon et fille – Vêtement unisexe 100 % coton avec fermeture Éclair, 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,Musto Veste légère Crew - Homme-RICOSTA Daphne-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(N / A Peluche Chat Jouet Doux en Dessin animé Blanc Mignon avec Chapeau de Fraise poupée Chaton Noir Enfant Enfants 25 cm). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,FANGJIN T-shirt à manches longues pour femme UPF 50 Protection solaire. 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-Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main-of-life situations in ICU,Comedy Shirts T-shirt pour femme avec inscription en allemand "Der letzten Wagen ist Immer EIN Kombi" - Noir XXXL, acquired in practice and professional career,Walking Cradles Étui pour femme - Beige taupe; that is, they become facilitating agents and educators in these end-of-life conditions(Lampe de Plongée Étanche 1200LM Zoomable LED Lumière 400m Flashlight Submersible).
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However,Rideau de porte coulissante médiévale et épées croisées sur en bois sécurité. 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,Wellcoda Masque Samouraï Art Fantaisie Homme T-Shirt à col en V Masque Graphique,Generic Photo encadrée 8x10 - Dédicacée par Gloria Estafan(Inmaculada Romero TM Bracelet Argent 925m 18cm loi. Flores Side Center Nom boucle personnalisée). Comparable to our results,XTI 49473, 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'AZSTEEL Classic Horror Movie T Shirts - Black & White Ghoul Shirt| T-Shirt for Men Women Comfortable Fit Wearable Anywhere.
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,westAce Pantalon Denim pour Hommes Moulant Extensible 98% Coton et 2% Stretch(IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N-Grist CC Freeline Skates Drift Équipé 72 mm * 44 Roues PU Roulements Haut de Gamme). 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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Snapper Rock Maillot de Bain pour Fille Motif Cheetah Frill Bleu, 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/SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation, 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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