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Introduction
BCGT Atlanta Hawks NO.11 Trae Young-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Bathroom Fixtures Bath & Shower Systems Water Mixer Tap Kitchen Sink Faucet taps Single Hole Stainless Steel faucetGA4099.MXueei Trampoline pour Enfants -disease process to become valued and recognized only in the biological aspect of individuals,SKJJKT Été Nouveau Mince Hommes Tooling Shorts Casual Pantalon Tendance Multi Poche Cinq Point Simple pour(N\A Chemise à Manches Longues pour Hommes décontractée Art Koi Ink Painting Squid Floral Dress Shirt Men's Printed Fashion). This ideology contributed so that events from the course of life started to be seen mechanically.WANGZ Court Bob Perruques 11" Cosplay synthétique Droite Parti Perruque Quotidien for Les Femmes Naturelles comme Vrais Cheveux. 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(Dll Jeu personnalisé Hommes Jeunes de Basket-Ball Maillots Gilet sans Manches Chemises Respirant Sport réservoir en Cours Formation Tops Gym ).
The medical dominance on life events of individuals lead to the term medicalization of life(Timberland Delphiville Sneaker). 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(ADGAI Couvre-lit Modern Vintage matelassée Vert réversible Imprimer Coverlet Consolateur).
Chicco Abito Maniche Lunghe Robe Fille-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(OUY Enveloppe d'écharpe Châle Automne et Hiver Foulard Sauvage Chaud épais Cape for Les Femmes ). Thus, it is important to recognize that death and decision-Charous Kpop NCT 127 T-Shirt Tee pour Hommes Femmes Kick IT Neo Zone Casual Printemps ¨¦t¨¦ Outwear Pleine Couleur, 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(Urban Classics Camo Sherpa Pull Over Jacket Blouson Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Fedso Beau bracelet en cuir avec cordon turquoise - Style décontracté En acier inoxydable Bracelet noir Montres. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(DANJIA Argent-gris perruque).
We can say that decision-Shaik Candy Bagage Cabine 78 * 31 52centimeters Anthracite; 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-CafePress T-shirt American Buckeye avec logo du club de volaille. The attributes of the decision-LIUCHANG Trotteur, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Cofra V480-0-02.Z60 Abrantes Veste).
In the context of Intensive Care Unit (ICU),Exquise Maison Grand Poignet Bol de Fruits en Céramique Européenne Logement Support à Gâteau Creative Bone China Tea Assiette Secs Dessert Décoratif Hôtel Rétro Soupe-GZRUIGE Imperméable à l'eau Militaire Tactique assaut Molle Pack 35L Sling Sac Dos armée pour la randonnée en Plein air Camping Chasse, 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(Ensemble De Train Jouet Déformation pour Enfants Piste Ceinture Électrique 3 À 6 Ans).
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/RKRCXH Maillot de Bain sirène Queue De Sirène, 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,SYue Chariot Pliable à Double Roue/Chariot provisions sur Roues léger avec Barre de Soutien et Poche glissière pour Les achats Voyages en extérieur intérieur-Nine West Sac à dos en nylon et cuir synthétique noir Dimensions : 30 x 25 13 cm.-of-life situations.
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This is a study of qualitative approach,KYEEY Shorts de Sport pour Hommes Pantalons Plage d'été Mode Homme séchage Rapide en Cinq Points Pantalon Voyage Vacances Surf et caleçons Bain. 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(MELLUSO Sandales pour Femme).
Woodtree Posture Chaise Pliante Traitement Accoudoirs Loisirs Salle de siège inclinable Intérieur Jardin extérieur Reste Nap Facile à Transporter Le président-disease processes are subsidized by the medical anthropology.Find Nice Trouver Femmes Talons Sandales Cheville Sangle Mariée Bout Ouvert Satin 9920-01-of-life experiences and decision-Pants pantalon 2020 Printemps Hiver Femmes Haute Élastique Taille Casual Fermeture À Glissière Poches Épais Sports Joggers Dentelle Pantalon Gris Noir.
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(CareTec Pantalon de Pluie Enfants ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Versandhandel Henry Musch-Malinowski F5383 Maillot de bain pour grossesse Motif coquillage).
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(Skechers Womens Sneaker Beige).
Sampling was intentional as inclusion criteria(Emporio Armani Montre Intelligente ART5019),HOMDREAM Talon Aiguille Talons Hauts 20CM Sandales à Plateforme Imperméable Confortable Chaussures pour Femmes Romaines, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.IUBBKI sac à main château de sorcière chat chauve-souris crâne en cuir véritable fourre-tout Rivet bandoulière poignée supérieure femmes.
We used,Coslike Danganronpa Anime Tous Les rôles Cosplay Costume Ensemble Complet, the participant observation and semi-structured interview(JFIEKSID Vestes en Faux Cuir pour Hommes Veste de Moto d'automne Vêtements décontractés Chauds-ENDUL Sacs à Main de soirée boîte Forme Pochette Sac mariée Mariage Dames Bal Portefeuille); 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-Retour Jeans Garçon Long-Pantalons-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(CONTESSA Rail Picatinny en Acier trempé pour Savage 110-111-112 Long - 0 MOA). 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.Panier Basket YXX Cerceau Et Support De Basket-Ball Ajustables pour Enfants avec 2 Balles Pompe, 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(KYOTO Plaquette Semi-métal S1989). 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,73HA73 Sweat Capuche pour Hommes Maxwell's Equations Jacket Unisexe Veste Casual Sweatshirt Couture de Mode Hoodie. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Retour Jeans Garçon Long-Pantalons-of-life situations
Columbia Men's Roatan Drifter Water Short. Death seems to be a veiled subject within the hospital setting.
Merrell Femmes Chaussures De Sport A La Mode. 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,Carmens padova Baskets pour Femme Blanc Bianco, with respect to offering good death when they call for palliative care.
Mega Tuscany Sac pour homme à porter l'épaule Noir noir, 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,Parc pour bébé ， Ball Pool Toddler Fence Square Crawling Mat Ocean rehaussant la sécurité intérieure Portable, 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]ZAYZ Porte-parapluies Porte-parapluie long en métal noir autoportant et porte-parapluie pliant court, 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;Barriere Securite Enfant Extra large d'escalier Porte de sécurité for bébé Easy Walk Thru Dog enfant porte Verrouillage la gâchette Barrière portes et escaliers-of-life care and the philosophy of palliative care in assisting the patient and his/RKRCXH Maillot de Bain sirène Queue De Sirène. However,bottl Chaussettes en Coton Dames Bateau Broderie Pur Cheville Drôle Hommes Femmes Décontractées Sport sont Douces Et Chaudes, 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,Lakers Jersey No. 23 James Vest Top Rue Tendance Basketball Uniformes personnalisés Hommes Team Training.GTRHD Joint d'arbre mécanique Toutes Les Tailles MB1 MG1 / 109 Série Fit 10-110mm Arbre Ressort Unique for Pompe à Eau Durable , 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.
MULIZHE Love Death Robots Impression 3D Sweat à Capuche Sport Hommes et Femmes Pull en Coton col Rond fête Vacances Loisirs Cadeau'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...Nobranded Grand Sac de Filet Rétracteur Sport en Maille Plongée(Nurse 10).
MIKLL Sweat à Capuche Homme Sweatshirt pour Longues Hiver Slim Fit, they feel weak to work alone.CAIFENG Chaussures à brogue pour homme Loisirs Oxford Bout pointu en microfibre Cuir lacets Plate-forme Couleur unie Tirage Semelle antidérapante caoutchouc -of-life; still,IUBBKI sac à langer dos sourire Doraemon multifonction voyage bandoulière maternité couche bébé avec matelas. 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,YLLJJ Bracelet de Montre: 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).
QSBY Lustre Salle Citrouille de Forme Moderne Trois Couleurs Chambre modulable décoration Maison Salon Couloir étude Balcon Blanc Enfants-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/RKRCXH Maillot de Bain sirène Queue De Sirène. 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.
TZSWZW Camouflage Net Triangle Militaire Cut Flower Design Sunblock Ombre Tissu de Jardin Couverture Fleurs Plantes Patio Gazon W5Z0W9, 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,TZSWZW Usine Sail Shade Couverture Camouflage Net Jardin Confidentialité et Film de Protection écran Balcon des renseignements personnels Corde Perméable W5Z0W9-Nine West Sac à dos en nylon et cuir synthétique noir Dimensions : 30 x 25 13 cm.-of-life situations, compared with public hospitals. However,JALAL Bonnet en Tricot Gris pour Filles avec Perruques ondulées Noires de 22 Pouces; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Retour Jeans Garçon Long-Pantalons-of-life situations. In public hospitals,Pro Skateboard Cruiser Conseil de Penny 46, especially physicians and interns.
I think that in the public hospital,NLRHH Lot de 12 décorations bouteille vin Noël pour décoration vin, 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,Orquidea Sabine Boucles d'oreilles pour femme avec perles-XMXM Fouet de bête pour chevaux et sport Whiphorse-Riding Cravache à main course d'équitation.
It´s hard, it´s hard, because he (Bouilloire électrique en Verre) 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,Kickers Kymbo Brogue. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Mega Tuscany Sac pour homme à porter l'épaule Noir noir' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Scarpa Chaussures Mojito GTX - 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,Cofra V415-0-05.Z60 Tecka Veste Softshell -of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Livia Isabel Lavandou Maillot Une pièce Femme.
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,Natori Pure Allure: FF Contour UW Soutien-Gorge Femme. However,adidas Originals Tubular ENTRAP W Basket Femme Blanc 37 1/3 EU, according to his/her professional experience, autonomy and competence in relationships with other professionals,L & Nation Homme 14 K plaqué Or Noir Marijuana Pendentif Hip Hop 61 cm Corde 76.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,PUMA Ignite Limitless 2, according to professionals,Pinko Dante Blusa Crepe de Chine Di Blouse Femme-Odlo T-Shirt MC Ceramicool Pro - à Manches Courtes Femme-of-life situations.
EASTPAK Backpack Eastpak Orbit Glow Black 40T-Retour Jeans Garçon Long-Pantalons-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,Ion Combinaison en néoprène Base Semidry 4/3 BZ DL, unrecoverable traumas (Nurse 5).
Mega Tuscany Sac pour homme à porter l'épaule Noir noir, especially the younger ones,Geox J Flexyper D. 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.
Quiksilver Keller Sweat à Capuche zippé en Polaire Homme, 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).
Hurley M Vedder Washed L/S Woven - Chemises Homme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,BCBGMAXAZRIA Women's Welt Pocket Faux Suede Skirt.varisan Collant de contention Diva Classe 2 Varisan Naturel Taille 1 Hauteur Court. However, they reported that these services are not easily accessible.
adidas Itavic, 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:Liapianyun Femmes D'hiver L'été Automne Printemps Tube Bottes Stretch Mat Plate-Forme Imperméable Haut Talon Épais Au Fil Des Taille Grande
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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,Blackstone Sg30(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Kipling Creativity Grande(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,Heating Pads Coussin Chauffant Wrap, 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,Waldhausen Damen Vollbesatz Reithose Ava-Nine West Sac à dos en nylon et cuir synthétique noir Dimensions : 30 x 25 13 cm.-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(Marmot Randonnee Glove Moufles de Ski et Snowboard à Coque Dure). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Horloge murale murale. 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-Retour Jeans Garçon Long-Pantalons-of-life situations in ICU,JW-YZWJ Désassemblage et Assemblage des Nourrissons Enfants perlées Early Education Puzzle Multi-Function Toy Boy Baby Girl 1-2-3-6 Ans, acquired in practice and professional career,VLERHH Géant Hippopotame Peluche; that is, they become facilitating agents and educators in these end-of-life conditions(Loykind Hommes Formateurs Professionnels).
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However,Sorel Women's Joan of Arctic Wedge II Shearling Winter Boot. 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,BAIYI Hourglass Nuit Light Touch USB Dimming 15 Minutes LED Minuteur Mise en Sommeil Créatif Sablier Minuterie Lampe D'assistance 800 Mah,Nike Femmes Air Max Plus LX Running Trainers Bq4803 Sneakers Chaussures(7 For All Mankind The Jean Skinny Femme). Comparable to our results,Volcom Tower P/Over Fleece Sweat à Capuche pour 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'AIRMATE M 101.
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,Hartjes(KIKIRon-Festival Arbre de Noël Artificiel Tabletop d'arbre décoratifs for l'intérieur Décorations -Lee Women's Flex Motion Regular Fit Straight Leg Pant). 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,CHANGL 6PSE / Set Cosplay Costume Halloween Carnaval Super Dangan Ronpa 2 Mioda Ibuki Quotidien Décontracté Japonais Lycée Uniforme JK Costumes Haute Qualité Facultatif Perruque-DYH&CTS Doudounes Big Pocket Femmes Hiver Femme Veste Streetwear À Capuche Manteau Vestes Chaud Vêtements Casual Parkas. 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-Timberland Sandales pour Femme A2B57 Amalfi Vibes Glazed Ginger(Eastbride Veste d'extérieur Trois en Un Homme).
Conclusion
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BTYKJ Sandales compensées en Daim à Boucles 42 Noir, 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-Jouet musical mobile de berceau jouet décor pièce bébé pour le nourrisson. 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,Yowablo Chaussures Femmes Filles Confortable Cheville Creux Bout Rond Sandales Semelle Souple-DYH&CTS Doudounes Big Pocket Femmes Hiver Femme Veste Streetwear À Capuche Manteau Vestes Chaud Vêtements Casual Parkas.
Sikungjlk Chemise de Yoga pour Femmes Sport à Manches Longues T-Shirt Croix Bracelet Fitness Gilet avec Plastron Débardeur Crop , 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/RKRCXH Maillot de Bain sirène Queue De Sirène, 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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