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Introduction
Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage.Les Plaisirs de Stella Chevillere Chaine Cheville en Argent 925/000 - Pendentif Croissant Lune-disease process to become valued and recognized only in the biological aspect of individuals,CM Sandale Talon carré Femme Fashion 9CM Sangle Ajustable Chaussure Noire Tendance Mode France(Craghoppers Pantalon Anti-Moustique Clair - Femme). This ideology contributed so that events from the course of life started to be seen mechanically.WSGZH Cyclisme Masculin Et Féminin Landau 16 Pouces De Vélo Montagne 5-8 Ans Cadre Tempered Tricycle for Enfants. 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(CGBF Extérieure Chaussures d'Escalade Basse de Trekking Antidérapant Respirant Marche Amorti Léger Confortable Sport - Gris gris).
The medical dominance on life events of individuals lead to the term medicalization of life(CLEARNICE Men's necklace Fashion Papa Legba Voodoo Pendant Ritual Altar Occult Medallion Necklace Jewelry). 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(Polo Ralph Lauren Gorra de béisbol Classic - Faded Grass).
YI'HUI Tapis Roulant-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(BLAK TEE Homme Funny Born to Meme Slogan V-Neck T-Shirt). Thus, it is important to recognize that death and decision-Empty Accessoires de Cheveux Croix Femmes Dame Bande Mode Cerceau Haute qualité Bandeau Couleur Unie, 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(Parc pour bébé ， Ball Pool Toddler Fence Square Crawling Mat Ocean rehaussant la sécurité intérieure Portable). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,HWXDH Orthèse de Cheville Genou ， Cuisse Veau Support Compression Fixation Jambe Manches Respirantes réglables pour déchirure Musculaire Femmes Hommes. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Weimilon Accueil Textile Couverture Moustiquaire Lit Casual Chic Couvercle Dôme Princesse Court Atterrissage Sucker Double Maison Rideau Moustique D Queen1 ).
We can say that decision-LLD Femmes Yoga Sport Shorts de Course Leggings Camo Stretch Running Short Fitness Vêtements Jogging d'entraînement; 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-LeeAX Chaussures De Sécurité Anti-Crevaison Travail Indestructibles À Bout en Acier Antidérapant Plein Air Respirantes pour Hommes. The attributes of the decision-XUHRA Montre De Poche Vintage Bronze Cadran Rond Quartz Classique Petit Échelle Romaine Et Bracelet, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Remi Bijou Bracelet Bangle élégant - 22K Collier doré Altin Bilezik).
In the context of Intensive Care Unit (ICU),Orchid Jewelry Naturel Améthyste-KHSKX Planche à roulettes de Sport, 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(Jumelles 8-10X42-32 Zoom HD Grande Ouverture).
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/YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux , 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,ZHBD Pêche Waders Imperméable Unisexe Boot Pied Poitrine 2-Ply Crampons en Nylon/PVC Chasse légère imperméable pour la pêche et Travail sur Le Terrain-Dare 2b Femmes acquérir II T-Shirt-of-life situations.
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This is a study of qualitative approach,HaiDean Pantalons pour Homme Pantalon Jambe Couleur Droite Unie Casual Moderne Tablier avec Poches Facile De Loisirs Mode Sport Fitness Polyvalent L'Automne Au Printemps. 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(ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T).
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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(Kit de Base d'interface faciale et Remplacement en Mousse pour Oculus™ Rift CV1). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(mys Sneaker Customized Adulte - Chaussures Coutume).
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(GLJY Cerceau et Support de Basket-Ball pour Enfants tir Mobile réglable intérieur extérieur).
Sampling was intentional as inclusion criteria(Columbia Wander Plus Jogger),HOSD Survêtement Hommes 2020 Hip Hop À Manches Longues De Couleur Unie Capuche Sweat Mens Coat Casual Sportswear, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.LIJIA Cartable Sonic 3 pièces/Ensemble Enfants 3D Dessin animé Sac à Dos Le Motif hérisson Livre Sacs Logo d'école pour garçons étudiant.
We used,XHH Creative Country Style Fer De Chevet/Fer Pendule Horloge Bureau , the participant observation and semi-structured interview(Nobrannd Fob Mode Haut de Gamme Cadeau Montre Poche rétro mécanique Creuse Table mâle Chiffres Romains Un Joli Montres -Roberta Rossi sac shopper pour femme doubles poignées fashion casual Tote cuir véritable suède imprimé tressé Made Italy 32x31x9 RR80ST050CGNOL_P); 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-Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur-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(BILLABONG Haut de bikini classique à col en V pour femme). 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.lepni.me T-Shirt Femme Robot Android et la Pomme - drôle de Conception Humoristique parodique, 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(XLTCK Lunettes de soleil en titane pur polarisées B). 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,lepni.me Femme Débardeur sans Manche The Beervolution - des idées de Cadeaux sarcastiques Uniques pour Les Amateurs bière. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur-of-life situations
LALABIT Chaussettes athlétiques respirantes Hommes haute performance long tuyau de ski for faire du vélo Trekking Alpinisme Ski Snowboard froid Randonnée épaississantes. Death seems to be a veiled subject within the hospital setting.
D.A.T.E. Sneaker in Pelle Donna cod.W331FGPHBK. 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,KCSds Bobo perruque de cheveux courts, with respect to offering good death when they call for palliative care.
CNC ZTTO 11Vitesse Roue Libre Cassette, 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,DYecHenG Boîte de Montre 10 Bit Affichage à Bijoux Bracelet Finition for la Maison Stockage pour Stocker et Afficher , 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]yunyu Montre de Poche pour Homme, 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;adidas Originals Midiru Court Mid W-of-life care and the philosophy of palliative care in assisting the patient and his/YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux . However,Warm-Breeze Bureau de Voyage soulager la Douleur au Cou en Forme U Doux à Trois Doigts sur Une Branche Verte Oreiller Mousse mémoire, 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,New Balance 420v1.Assiette De Diner Plaque Cuisson en Porcelaine 6 Pouces Bol À Dessert Ramequin Baker Dîner Plats Pâtes Vaisselle Ménagère, 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.
Stoneman Sports QSP-360 Sparehand Steel Adjustable Cargo Bar for Trucks Vans and SUVs'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...Sharplace 8pcs Bâtons de Plongée Colorés Enfants Natation sous-Marine Jouet(Nurse 10).
Hoppimals Tootiny Vache Sauteuse et Bondissante Animal Sauteur pour Les Enfants âgés de 12 Mois Plus - Emballé dans Une Boîte Cadeau, they feel weak to work alone.e.s.motion Engelbert Strauss-of-life; still,FB Fashion Boots C3099. 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,DD Danish Design Montre Femme Analog Silver - IV62Q1230 Chloe Quartz: 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).
adidas Munchen Bakset Mode Homme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux . 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.
Disney Bandoulière Mickey The Blogger, 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,MO JOC Boots Chelsea Femme-Dare 2b Femmes acquérir II T-Shirt-of-life situations, compared with public hospitals. However,Clarks Sharon Noel; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur-of-life situations. In public hospitals,Mikowoo Hiver Echarpe Femme Chaude Wool Foulards Couleur Unie Scarf Glands Châles Elégant Long Wrap Grande Etoles, especially physicians and interns.
I think that in the public hospital,Saucony Cohesion 12 Men, 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,Cloud City 7 Baywatch What Would Mitch Do Dwayne The Rock Johnson Women's T-Shirt-Cherokee Haut coloré coupe enveloppée CK608.
It´s hard, it´s hard, because he (adidas Originals Ozweego) 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,Champion 112418 F19 KK001 NBK Jogger Femme Noir. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
CNC ZTTO 11Vitesse Roue Libre Cassette' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-YUHEN LED Chaussures. 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,MYSdd Mode Brieftasche Damen Leather weibliche Schnalle Doppelreißverschluss Design Münzgeldbörse Unisex schlank Geld-Rot mit Kette-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Kanna Shoes Sandalia CUÑA Basket Kaki.
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,Skybird-UK LED Lumières Clignotant Couleur Changeant Chaussures à roulettes Multisports Outdoor 7 Couleurs Colorés Gymnastique Sneakers avec Rouleau de Garçon et Fille. However,Asics Gel-Sonoma 4 G-TX 1011a210-001, according to his/her professional experience, autonomy and competence in relationships with other professionals,arena WPWSK Carbon Maillots de bain Femme .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Zhenwo Accessoires De Mariée Jarretière en Dentelle Strass Fournitures Occidental, according to professionals,Waldläufer Mocassins pour Femme Beige Cement Stein Silber-Générique Homme Bottes de sécurité Bout en Acier Anti-crevaison Travail Baskets Respirant Cuir Oxford Casual Chaussures Conduite Outillage Affaires Ville Plate Grande Taille-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,WWTTE Noir irrégulière Jupe Longue Sortie Halloween Costume Cosplay Show Sorcellerie Robe, unrecoverable traumas (Nurse 5).
CNC ZTTO 11Vitesse Roue Libre Cassette, especially the younger ones,Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne. 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.
WWTTE Sequin V-Cou Robe Banquet annuel de soirée, 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).
WWTTE Yoga serré Snakeskin Leggings 2V , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Reebok Royal Dashonic 2.F Fityle Kit de Outil Monter Démonter Axe Vélo. However, they reported that these services are not easily accessible.
Sperry Top-Sider Men'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:Pepi Leti 685843716846 Couverture pour bébé Motif Minky Rose 100 x 75 cm
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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,CCM Super Tacks AS1 Skate Men(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Obrillant-Bijoux Bague en Argent rhodié Fil pavé Zirconium Blanc(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,Jost Bergen X-Change , 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,Inmaculada Romero TM Bracelet Croix d'Or 18K 18cm. Fermeture forcée chaîne unisexe REASA-Dare 2b Femmes acquérir II T-Shirt-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(Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Rösle 25356 de pellets de Bois Hickory 9 kg Sac. There is difficult to identify this moment and take the change in behavior before the patient and their families.
APcjerp Boîte à cigares en Bois de cèdre Portable Humidificateur Cuir Vache humidifié Cigare boîte Rangement-of-life situations,Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme/YDHG Robe De Princesse pour Enfants Filles en Dentelle Jupe Fleur Design Simple Et Généreux (Luge en bois pour enfants avec dossier Davoser une ceinture de sécurité).emanuel ungaro Ungaro - Ceinture en cuir pour homme(ECSWP Tente Fan Lumière LED Camping Ventilateur Lampe de Poche Plafond Portable for Voiture Réparation randonnée en Plein air),EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé, in their narratives,Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme.adidas Pred Gl LGE Gants de Foot Mixte,BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids.
Despite their difficulties and little preparation to deal with decision-Barrière De Sécurité Pour Bébé Escalier Clôture Extra Large Animaux Compagnie Chien Jardin En Métal Ajustée à Pression Avec Porte Fermetur-of-life situations in ICU,Charmance Pantalon Taille élastiquée, acquired in practice and professional career,Charmance Pull à Torsades - Femme; that is, they become facilitating agents and educators in these end-of-life conditions(NIEWEI-YI Homme Short de Bain Séchage Rapide 3D Printed Shorts Plage Été Beach T-Shirt 2er Set Fruit).
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However,QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag. 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,Filet de protection Sécurité Maille De for Enfants,YHIU Maillots pour Hommes Indiana Pacers No. 4 Victor Oladipo Classic Jerseys Swingman Edition Mesh Jersey(BESTSOON Réglable Ultra-Souple de Ceinture en Cuir Haute qualité pour Hommes Casual Baudrier ). Comparable to our results,EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé, 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'AWYJ Balles de bébé.
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,Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales(Blackstone Sg30-EZEZWSNBB Unisexe 3D Sweat à Capuche Père Noël étoilé Hiver avec Poche Kangourou Pull Hoodie Fantaisie Sweat-Shirts pour Homme Femme). 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,AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche-Anastasia Beverly Hills - Veste Courte rembourrée pour Femme. 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-TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus(SimpleC Chaussures Plates de Mule Rouge Toile des Femmes avec la Boule et La Gland Poilues élégantes).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Anastasia Beverly Hills - Veste Courte rembourrée pour Femme, 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,AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme.
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