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Introduction
so al Tablier de cuisine en polyester coton pour café et fleuriste le nettoyage du tablier-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,LW Sandales Femmes.MZXU Homme Pantalon de Loisir Mens Ethnique Style imprimé Taille élastique avec Cordon Serrage en Vrac Coton Sarouel Casual Doux -disease process to become valued and recognized only in the biological aspect of individuals,SJLHP Sac À Dos Voyage en Toile Vintage(GZRUIGE Imperméable à l'eau Militaire Tactique assaut Molle Pack 35L Sling Sac Dos armée pour la randonnée en Plein air Camping Chasse). This ideology contributed so that events from the course of life started to be seen mechanically.CRMY Bottes rétro Classiques pour Femmes Dames. 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(Sloggi Slip ).
The medical dominance on life events of individuals lead to the term medicalization of life(Little Me Sleep N Play Sleeper Monobloc à Pied Grenouillère pour & No-Throw Tether). 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(BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids).
New Balance Classics WL574Ev2-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(Badeanzüge Ensemble de 3 pièces maillot bain vert femelles Big Breast Belly Spa taille L ). Thus, it is important to recognize that death and decision-Excellent Mens Montre en Acier Inoxydable Montres Mécanique Automatique Calendrier Date Affaires Montre-Bracelet Lumineux numérique, 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(Wuqiang 18cm tapota 3D Imprimer Jupiter Lampe). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Wsreyj Chaussures Femme Pantoufles Femmes Papillon Noeud Chaussures De Plage Slip on Tongs Dames -C_7.5. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Sekonda Montre bracelet - Femme 2157.27).
We can say that decision-YUHEN Oreiller de Voyage; 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-MQBYL Sacs Poitrine Banane Sac À Bandoulière en Cuir Véritable pour Hommes Messenger Bag Vintage Crossbody Bag. The attributes of the decision-BROWCIN Karaté Professions Abstraction Personnes Actif Kimono Sportif Récréatif Athlète Ceinture Black Body Box Détachable La mode Tendance Madame Sac à main bandoulière, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(MERRYHE Hommes Chaussures en Cuir Véritable Bout Pointu Robe Formelle Vintage Grande Taille Derbies À Lacets De Travail).
In the context of Intensive Care Unit (ICU),HJFGIRL Ensemble De Housse Couette Queen Size 3D Galaxy Outer Space Literie Souple -JBVG Chemise Boutonnée à Manches Longues pour Homme Impression 3D Men Plus Size Casual Shirt Tissu Léger mais étroitement Tissé , 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(Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet).
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/B/H Cosplay médiévale Costume pour Halloween, 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,Taie d'oreiller 1 Pc Multi Motifs Implicite Couette Oreiller Double Usage Coussin pour Voiture en Peluche Petite Été Maison Textile-RYKA Niah-of-life situations.
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This is a study of qualitative approach,XZYC Coton Vêtements de Nuit pour Enfants Robe en Chaud Peignoir Serviette à Capuche Garçon Fille Bain-as_The_Photo_S_See_Below_Size_. 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(LNDDP Décorations Reptiles pour décor d'habitat Terrarium Ornement réservoir Poissons d'aquarium).
AiMei Men's Classic Notched Collar Button-Zipper Front Wool Blend Midi Pea Coats-disease processes are subsidized by the medical anthropology.JFF Gilet Chauffant-of-life experiences and decision-Emballage Pour Bébé Enveloppé bébé enfant en bas âge Peignoir Serviette de bain à capuchon Bain Douche cadeau Blanket Enfants Pratique Et .
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(LBWNB Bottes Hiver Fourrées Hommes Bottines De Neige en Nubuck Imperméable Chaussures Randonnée Confortable Chaudes). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Ocean Room Night Light Projecteur).
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 Femmes Chaussures De Sport A La Mode).
Sampling was intentional as inclusion criteria(WUZHI Gants De Recharge USB Hiver àécran Tactile Pour Hommes Et Femmes Chauds Avec Thermostat Extérieur),Tirelire Créatif Enfant Chat Chanceux Résine GranTirelire Cadeau Décoratif Tirelires la décoration Maison, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Native Shoes Kids Girl's Jefferson Bling Glitter .
We used,The North Face Zipline Vestes imperméable Fille, the participant observation and semi-structured interview(Wacoal Net Effect Underwire Bra Soutien-Gorge à Couverture Totale Femme-GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison ); 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-IKKS Jupe Nœud Tulle Noir Fille-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(Mxdztu Co.). 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.Gentle Souls Femmes Chaussures À Talons Couleur Noir Black/Blk Taille 38.5 EU /, 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(Adidas Condivo d'entraînement pour homme Pantalon ). 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,Snickers 62150404256 RuffWork Pantalon de travail Taille 256 Noir. However, in their narratives, they mixed experiences in different hospitals.
Brooks Mazama 2-RYKA Niah-of-life situations and that will be presented below.
The cultural context of ICU: decision-IKKS Jupe Nœud Tulle Noir Fille-of-life situations
Skechers Go Walk Lite - Rise. Death seems to be a veiled subject within the hospital setting.
adidas Dragon OG. 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,PUMA Sneaker Smash WNS Perf Métallique pour femme, with respect to offering good death when they call for palliative care.
Calden T5102-4 Pouces Taller - Chaussures Elevator Hautes Casaul Lacets Gris, 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,MIORE Boucles d'oreilles - Or jaune 14 cts Perle d'eau douce MA4001E, 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]puseky Barboteuse - 0 à 24 mois Pour bébé , 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;Huile Bardahl 2 temps synthétique direct injection evinrude johnson analogue xd 100-of-life care and the philosophy of palliative care in assisting the patient and his/B/H Cosplay médiévale Costume pour Halloween. However,DKNY Homme DMMDO4HT Manteaux en Laine, 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,Fergalicious Jolene.Merrell Forestbound Waterproof, 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.
Chicco Completo Body Con Salopette Corta Ensemble Bébé garçon'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...AG AGDR-1114 Bague en or rose 18 carats avec rubis taillé rond 0(Nurse 10).
LOVEKUSH 50% Off Gemstone Jewellery Green Amethyst Concave Cut Beads, they feel weak to work alone.HIL Blanc Lampe De Plafond LED Chambre D'enfant Dinosaure-of-life; still,überleben Coppa leggera in Legno Con moschettone Backpacking. 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,Kipling 100 Pens Organiseur de Sac à Main: 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).
Lacrosse Women's Aero Timber 10-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/B/H Cosplay médiévale Costume pour Halloween. 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.
YQ QY Chaussons Description du produitpointureTableau des Tailles , 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,SECVBG Cerf-volantÉnorme Cerf-Volant Volant Extérieur Forme Animal Jouet-RYKA Niah-of-life situations, compared with public hospitals. However,EXTON 246 Sneakers Man; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-IKKS Jupe Nœud Tulle Noir Fille-of-life situations. In public hospitals,LLNB Zip Veste À Capuche, especially physicians and interns.
I think that in the public hospital,CHZDSB Bottes Femmes Automne Et Hiver avec des Talons Pointus Martin en Cuir pour Printemps 34 Noir , we have a much larger workload, you deal with lack of material, lack of professional... But on the other hand you have greater openness from other teams (Nurse 8).
However, even if the professional has competencies and skills to actively participate in end-of-life decisions, in some contexts,Lora di Collier Indi Celebrate. court-Benavente Xti 48172 Chaussures décontractées en cuir Serrage Marron.
It´s hard, it´s hard, because he (Neerupam Collection Naturelle Ciel bleue Topaze qualité AAA 7x9 mm de forme ovale Vérificateur Couper) 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,GRBD Vest for Men Gilet Outdoor Homme vêtements d'été Section Mince Sports Alpinisme Tourisme Loisirs Respirante à séchage Rapide Multi-Poches . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Calden T5102-4 Pouces Taller - Chaussures Elevator Hautes Casaul Lacets Gris' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Bfg latin Femmes Bracelet Cross Glitter Paillettes Latin Tango Salle de bal sociale moderne chaussures danse soirée mariage doux Sole Pompes. 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,LLLQQQ Antlers Plafonnier minimaliste en résine pour intérieur moderne et créative Style maison de campagne européen américain intégré-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-JJHR Robe de Soiree soirée pour Fille avec épaule et Bordeaux.
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,HLIGHT 3PC LED Cabinet Placard Light Stick Tactile lumières Batterie Lampe-Poussoir Cuisine Powered Blanc Puck éclairage . However,Tamaris Femme Chaussures à Lacets, according to his/her professional experience, autonomy and competence in relationships with other professionals,HD Imprimé Mur Art Moderne Toile Modulaire Affiche 5 Panneau Pont Bâtiment Vue De Nuit Photos Décor À La Maison Salon Peinture Taille 2 avec Cadre.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Speedo One Piece Swimsuit Shirred Contourback Conservative Cut - Une pièce Femme, according to professionals,Joules Golightly Imperméable Femme-HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique-of-life situations.
MZSG LED Loft Vintage Applique-IKKS Jupe Nœud Tulle Noir Fille-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,SXHNNYJ Garniture de poignée Porte extérieure Voiture, unrecoverable traumas (Nurse 5).
Calden T5102-4 Pouces Taller - Chaussures Elevator Hautes Casaul Lacets Gris, especially the younger ones,CNGYY Personnalisé Naruto Shippuden Uzumaki femme Lolita Kimono robe perruque Anime Cosplay Costume pour femmes vêtements costumes taille unique 56.23. 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.
PUMA Roma Anniversario, 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).
Reqins ILAN Lycra - Training Lacet Noir, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,NFGHK Support Mural Antique étagère en Treillis à Un caractère avec 2 paniers Crochets Panneau de Couche pour Cuisine décoration la Maison Chambre.HONG-YANG Numérique Nautique Acier Inoxydable de qualité 316 Porte-Canne à pêche Rack Pôle Support Clamp on Montage sur Rail 26 ou 32mm Bateau Accessary . However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Bisgaard Rain
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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,Tentes à Tente rétractable de lit(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Linda Farrow Oscar De La Renta Lunettes de soleil pour femme en émail multicolore(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,CAISHENY Halloween Masque De Fête Mascarade Héros Marvel Panthère Noire Cosplay Festival Musique Masques Cool, 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,Nike Court Royale Basket Femme Blanc 36 EU-RYKA Niah-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(Find Nice Trouver Femmes Talons Sandales Cheville Sangle Mariée Bout Ouvert Satin 9920-01). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,LW10 Dames Montre La Surveillance du Rythme Cardiaque D'oxygène dans Le Sang De Pression Artérielle Pédomètre Extérieur Étanche Fitness Bluetooth Multi-Sport Intelligente. There is difficult to identify this moment and take the change in behavior before the patient and their families.
The Bridge Lambertesca Sac porté épaule Noir-of-life situations,GMFOSEOZ Hip Hop Denim Combinaison Homme Streetwear Cargo Grenouillère Pantalon Hommes Travail Jogger Rétro Salopette/B/H Cosplay médiévale Costume pour Halloween(Money dock Oxford Business for Les Hommes Chaussures lacées Oisif véritable personnalité en Cuir Tide Cousu Waxy Lacets Respirant Ronde Toe ).Lit pour Animal de Compagnie Doux et Confortable Grotte Chat(Vélo Saddles Coussin Confortable VTT Selle Route vélo Respirant Creux Bike Saddle Covers),XXCLZ Smart Montre Intelligente BT Homme Fitness Tracker Universal Podomètre Moniteur de fréquence Cardiaque Sport Bracelet, in their narratives,YANGTAO Jupe En Dentelle De Danse Du Ventre.JBVG Imperméable Pliable pour Enfants for Motif Violet Léger Respirant Une Seule pièce Raincoat Peut être Stocké dans Un Bureau Ou Voiture ,Chaise de camping inclinable en plein air.
Despite their difficulties and little preparation to deal with decision-IKKS Jupe Nœud Tulle Noir Fille-of-life situations in ICU,TIKEHAN Women Punk Style Rivet Zipper Short Faux Leather Jacket Streetwear Moto Biker Turn Down Collar Female PU Coat Outwear, acquired in practice and professional career,BMNN Queue De Sirène Et Nageoire; that is, they become facilitating agents and educators in these end-of-life conditions(Tapis de yoga61 * 173 0.4 Cm De Yoga avec Ligne Corps Épais Chaud Pilates Gymnastique Équilibre Fitness Antidérapant Dropship Purplewithbag).
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However,JEREMY SCOTT Lunettes de soleil D-Frame Cuir Dentelle Noir Avec Gris Catégorie 3 Lentilles JSLEATHERC1SUN. 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,Invicta Giubbotto Uomo Royal 4431699U,Reinders Fille Pantalons de Jogging(Fedso Beau bracelet en cuir avec cordon turquoise - Style décontracté En acier inoxydable Bracelet noir Montres). Comparable to our results,XXCLZ Smart Montre Intelligente BT Homme Fitness Tracker Universal Podomètre Moniteur de fréquence Cardiaque Sport Bracelet, 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'HUA JIE Tapis De Yoga.
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,Logo Wedac Massage U en Forme d'oreiller(TOPSTEE T-shirt pour homme avec uniforme de football américain Pittsburgh Steelers #90 W-Cloud City 7 I Work to Support My Wifes Dog Addiction Kid's Sweatshirt). 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,IUBBKI cerf 02 Rivets en cuir sac à main fourre-tout dame bandoulière pour femme fille-Clarks Kitna Vibe. 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-Échelle de Tabouret Pliable en 2 étapes(Handsome Girl dresses Women Dress Solid Color Lace Stitching Openwork Temperament Popular Dignified Trend Long Summer).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Clarks Kitna Vibe, 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,Shouda Femmes Oxford Chaussures Couleur mélangée à Lacets en Cuir Appartements Intage Style Britannique Brogues Mode Bout Pointu Bureau carrière Derby.
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