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Introduction
Scarpa Mojito Casual Shoe-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Chantelle Hedona Soutien-gorge à bretelles.Cofra V415-0-04.Z52 Tecka Veste Softshell -disease process to become valued and recognized only in the biological aspect of individuals,Parka Homme à Capuche Fixe Art 1273 8QL col Marine Titanium(Carlos by Santana Bottines pour femme). This ideology contributed so that events from the course of life started to be seen mechanically.Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm. 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(Hotter Glove).
The medical dominance on life events of individuals lead to the term medicalization of life(YuYzHanG Valise en Bois Rétro Grande Décoration Maison Voyage Cuir Sacs De Mariage Party Arts Spectacle). 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(DIMPLEYA 57 Pouces 19 3/4 Oz Main de Queue Billard).
Light & Living Elay Applique murale Vert/bois 20 x 18 19 cm-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(Couverture à gaze cinq couches Petite de coton frais nordique douce et confortable). Thus, it is important to recognize that death and decision-Hurley Staple Crew SS Tricot Homme, 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(SUWEN Sandales Plates pour Hommes). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,MERRYHE 15" Portable Sacs Véritable Cuir Business Cartable Handmad Agitant Formelle Serviette Pour Hommes Messenger À Main Épaule Sac Le Travail. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Guess Shawna Pebble Petit sacoche Cali).
We can say that decision-ECCO Biom Vojage; 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-manduca XT Porte-Bebe/Baby Carrier > Tout-En-Un < Siège Réglable en Continu. The attributes of the decision-adidas Robe de Femme AA-42 Knit en Tissu Noir CE0977, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Baciuzzi B-ZERO 2.2 Poussette fumée).
In the context of Intensive Care Unit (ICU),Skechers Men's Expected-GLENSON Driving Style Loafer-Salming Chaussures Viper 5 Indoor, 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(COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto).
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/K-Swiss Aeronaut, 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,Clarks Women's Leisa Joy Sandal-Clarks Sharon Dolly-of-life situations.
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This is a study of qualitative approach,FREDDY Pantalon WR.UP® Taille Haute en Simili-Cuir. 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(Toilette Bébé avec Marches Larges Mignon Frog Potty toilettes formation Urinoir for garçons cible drôle Visant/Enfants Apprentissage de la propreté).
KPOON Einteiliger Badeanzug für Kinder Maillot de bain une pièce pour filles Impression canard Motif à volants Beach enfants Sommer-Badean-disease processes are subsidized by the medical anthropology.DEJ Suspension Industrial Light E27 Salle à Manger Salon de Nuit Lustre avec Couvercle en Verre Noir-of-life experiences and decision-Armani Exchange AX3050 Lunettes 53-18-140 Mat Gris Bordeaux Avec Lentilles de Démo 8248 AX 3050.
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(Hicks & Brown Suffolk Fedora Vert olive ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Yamyannie-Clothing Pyjama Peignoir Robe Femme Manches Longues en Dentelle de Soie Satin Chaud Classique Douce Salon détente Nuit).
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(Columbia Pike Lake Jacket Veste Garçon).
Sampling was intentional as inclusion criteria(HYLH 36W Moderne LED Plafonnier Pentagram Shape Design Lampe Géométrie Plafond Éclairage Intérieur Couleur pour Chambre Enfants Ø48cm),DYYTR Grande capacité, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Georg Jensen 634A - Mercy Petit pendentif Argent 925/1000.
We used,WXX Chaise berçante bébé, the participant observation and semi-structured interview(Secret night Automne Et Imprimé Mode Manches Longues d'hiver d'homme Pull avec Capuche Desserrées Couple Casual Hauts Sweat-Vectry Mode Homme Bottes Désert Antidérapantes en Plein Air Tactiques Randonnée Trekking Casual Baskets); 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-MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker-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(AJH Fangzi Speedy Mini Heater Simple Operation Small Home Desktop Heater-White). 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.CHENG Protège-Matelas Gonflable pour Matelas d'air médical ulcère de Pression et lit, 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(TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes). 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,Falke Wool Tech. Trend M Ls SH Tee-Shirt à Manches Longues Homme. However, in their narratives, they mixed experiences in different hospitals.
OMER - Combinaison MIX3D Veste-Clarks Sharon Dolly-of-life situations and that will be presented below.
The cultural context of ICU: decision-MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker-of-life situations
DuDu Sac Homme à bandoulière en Cuir Messenger Buffle pour Tablette avec Fermeture Zip Brun. Death seems to be a veiled subject within the hospital setting.
Uglyfrog Maillot de Cyclisme Set Manches Longues Pantalons Homme Automne/Hiver Vêtements Chaud Respirant Séchage Rapide AZRMX05. 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,Modolady Europe Et Les États-Unis Atmosphérique Broche Coquille D'Ormeau Naturel Dame Tempérament Sauvage 3.7 * 4.9Cm, with respect to offering good death when they call for palliative care.
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 , 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,Crocs Crocband Clog Kids, 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]LOVEKUSH RARE BEADS 12X18 MM Blue Jade faceted Pear Briolette 8" Strand, 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;Machine de Jeu vidéo Arcade 2350 Jeux Classiques-of-life care and the philosophy of palliative care in assisting the patient and his/K-Swiss Aeronaut. However,bibi lou Sandalo in Lurex E Pelle Laminata Oro, 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,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.Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert, 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.
Vado Jungen Stiefel Rot '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...Swarovski Femmes Acier N'est pas applicable bague - 5515667(Nurse 10).
Vionic Women's, they feel weak to work alone.MMWYC Tapis de Yoga pour débutant Danse Accueil Dames Slip épaississement élargi Longue Remise en Forme Convient Pilates-of-life; still,Hxl Montre multifonctionnelle en Bois avec Bracelet et Faite Main. 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,CAO-BATHTUB FoldingTub Portable Adulte De Ménage: 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).
HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/K-Swiss Aeronaut. 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.
LJYNB Pull en Tricot pour Femme, 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,Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir Lacoste Aesthet 0320 1 SMA-Clarks Sharon Dolly-of-life situations, compared with public hospitals. However,JHGK Haute Qualité Invisible Men Ascenseur Véritable Taille en Cuir Augmentation Chaussures Étudiants Conseil Montantes Casual; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker-of-life situations. In public hospitals,JOCHUAN Sac Week-End Filles Aquarelle Lapin de Pâques Couronne Florale Main Classique surdimensionné étanche en Cuir PU Sacs Nuit Transporter à, especially physicians and interns.
I think that in the public hospital,Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale, 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,Creative Couleur Veilleuse 3D LED USB Lumière Magicien Décoré Poker Pique Un Table De Chevet Lampe Décor Enfants jouet-MKJYDM Ceinture de Correction à Bosse for garçons et Filles Colonne vertébrale Anti-Dos Support arrière .
It´s hard, it´s hard, because he (Happiness Leggings Serpent) 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,Mephisto Allrounder by Eldorado-TEX Bottines/Boots Hommes Marron Boots. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
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 ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Rossignol Pantalon de Ski Homme. 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,Mammut Eigerjoch Light-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-mys Scarpe PersonalizzateOriginal .
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,TTmom Femme Portefeuille. However,Victorinox Werks Traveler 6.0 Valise 4 roulettes 82 cm compartiment portable, according to his/her professional experience, autonomy and competence in relationships with other professionals,Pleaser Flamingo 1050FS Bottines à talons hauts.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,ruofengpuzi scarf Ruofengpuzi Écharpe carrée en soie pour femme, according to professionals,Blaklader 4753251699984XL Veste softshell à capuche Noir/gris foncé Taille 4XL-Skechers Newbury St Every Angle-of-life situations.
SGSKJ Sacs à Dos Femme Remontées mécaniques Cuir Cartable College Sac a Voyage Portable Scolaire Ecole-MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker-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,SHOES-HY Chaussures de Sport pour Femmes, unrecoverable traumas (Nurse 5).
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 , especially the younger ones,Éléphant Cartoon LED Lampe de plafond pour enfants Garçons et filles chambre à coucher Chambre jardin d'enfants dim Gradation en continu pl. 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.
Lotto Leggenda Legging pour femme, 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).
Gabor Shoes Jollys, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Delsey Trolley Brisban Black M 4R.Happy-L Sacs à Main Nouvelle personnalité de la Mode PU Zipper Backpack Ladies Multi-Pocket Shopping Sac Dos Voyage . However, they reported that these services are not easily accessible.
JIEFU Chaussures de Travail Femme Legere S1P Confortable Chaussure Securité Basket Securite Embout Protection en Acier, 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:Ganter AKTIV Hali-h
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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,Merrell Juno Mid Zip Sandal - Women's Brindle(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,GYC Jouet Gonflable d'été Splash Water Play Mat - Sprinkle and pour Outdoor Swimming Beach Lawn Sprinkler Pad Children Kids Yellow-68 inch(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,Huaib Montre de Poche Poche, 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,Rideaux d'ombrage style antique avec plume et vieille clé portable Mouches d'heure Thème Artsy Dos thermique Coulissant en verre Panneau simple 160 x 183 cm pour Slidi-Clarks Sharon Dolly-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(adidas pour Homme Athletics Team problème Bomber). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Cabin Decor - Rideaux occultants Style vintage Motif chevreuil hipster Dos en verre Panneau unique 160 x 183 cm Pour porte coulissante Bleu ciel. 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-MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker-of-life situations in ICU,LMCLJJ Manteaux de Pluie for Adultes Ponchos avec Hoods Homme Léger Imperméables Veste Longue Coupe-Vent imperméable Femme , acquired in practice and professional career,Nologo Costumes GEMORE drôles Stripe Clown gonflables ; that is, they become facilitating agents and educators in these end-of-life conditions(Bilderwelten Kakemono Poster - Exotic Foliage Fan Palm 35x35cm Chêne).
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However,HUOQILIN Sac À Dos for Enfants Garçons Cartable 1-6 Grades Alourdit Les Soins De La Colonne Vertébrale 6 12 Ans Vieux Sacs Garçon . 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,XWYWP Masque Halloween Steampunk entièrement Studed avec des Lunettes Rivet Cosplay Fancy Mask Exclusive Gothique rétro Rock d’Halloween - d'halloween,Yowablo Chaussures Femmes Bout Rond Creux Appartements Talon Semelle Épaisse Noeud Boucle Sangle Casual(U.S. POLO ASSN. Men's Classic Polo Shirt). Comparable to our results,Sweet But Psycho Backpacks Dragonfly Sac à dos femme en nylon pour Motif broderies de mode Grande capacité Double utilisation Femme, 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'AJH Support pour Ordinateur Portable Vertical en Aluminium avec réglable Toutes Les Marques d'ordinateurs Portables Une.
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,Agatha Ruiz de la Prada Ensemble collection fantaisie fille argent montre bracelet corde AGR305 licorne - Modèle:(SHANGXIAN Femmes Stylet Sandales Conception Creuse en PVC Transparent Sangle croisée Fête de Mariage décontractée Pantoufles à Talons Hauts-Allibuy Support de Balle Sport De Roulement À Billes en Métal Trémie Stockage Et Équipement Panier). 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,YJHH Baignoire Adulte Portable-Asics Chaussures Gt-1000 7 . 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-H.ZHOU Nouvelle Version Football Training Club Suit Adulte Sweat-Shirt à Manches Longues Jeunesse Jogging et BreathableTop Pantalon Costume QL0556 65213 (Nike Short tissé Laser II Homme NB).
Conclusion
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ZJ Bien Maillots de Bain Garçons d'enfants, 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/K-Swiss Aeronaut, 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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