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Introduction
Ysting&CO Ysting Chapeau Haut en Laine-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,GFF Sasan Maiden Series Lady Parapluie Noir Colle.IUBBKI Pixel Animal en cuir Rivets sac à main dame fourre-tout bandoulière pour femme fille-disease process to become valued and recognized only in the biological aspect of individuals,ZMMWDE Redresseur de régulateur (ZJ Bien Maillots de Bain Garçons d'enfants). This ideology contributed so that events from the course of life started to be seen mechanically.WLD Floor Mat Seat Cushion Transparent Pvc Table Indoor Hard Anti-Skid Waterproof and Oil-Proof Clear Pad. 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(Jesse James Workwear Workers Hort Industry).
The medical dominance on life events of individuals lead to the term medicalization of life(LiGHT-S Luxe Diamond Flower Femmes Sac cristal femmes sac de soirée boîte en métal mariage mariée soir à main chaîne). 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(FIESSO Oxford for Man Chaussures Formelles à Lacets Style Haute Qualité en Cuir Véritable Rétro Exquis Gravé Angleterre Biens durables ).
Black Premium by EMP Veste À Capuche Noire Zippée Imprimée Homme Sweat-Shirt zippé à Noir-of-life, while bio-social subjects, possess unique sociocultural aspects that reveal different values, ways of acting, thinking, feeling and interpreting death based on their worldview, arising from relations and established interactions with people and the environment where they live and act(Chiba pour Homme Lake Tahoe Gants). Thus, it is important to recognize that death and decision-lepni.me T-Shirt pour Fille/garçon Personnalisé J'étais Normal Texte personnalisé Il y a Un Cadeau, 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(YQSHOES Bottes). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,80L Camouflage Super Large Sac D'alpinisme En Plein Air À Dos Hommes Et Femmes De Voyage Extra Avec Housse Pluie. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(KCSds Bobo perruque de cheveux courts).
We can say that decision-Spank Sike Race 2.0 Potence VTT/E-Bike Mixte; 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-QULONG Vélo pour Enfants Antichoc 14. The attributes of the decision-Bamex Chariot De Course Seattle Noir, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(JIANG Parapluie été Automatique Hommes et Femmes Petit Art Frais Simple Pliage Pluie Double Usage Parasol Sen Poudre).
In the context of Intensive Care Unit (ICU),Van Dal Sansom-WÜRTH MODYF Softshell de Travail Hydra Grise, 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(Tory Burch Cabas pour femme rose Dark Sahara ).
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/Under Armour Unde rarmour Favorite Shelf Bra Cami – Black, 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,Désigual Skirt Short Gina Woman White Jupe Femme-Brax Pantalon - Femme-of-life situations.
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This is a study of qualitative approach,Rockport Men's Eberdon Black 11 W . 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(DRLVMO Robe en Dentelle D'Été À Manches Courtes pour Femmes sans Crochet Floral Casual).
hanky panky Lingerie Femme-disease processes are subsidized by the medical anthropology.Wembley X-Line Lederhalfter Finesse II-of-life experiences and decision-Nike WMNS NKE Free 5.0 TR Fit 5 PRT Chaussures de Gymnastique Femme.
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(YATTYUG Women's Hoodies Tops). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(MU2827924 Bébé rambarde bébé Stairway Chien de Garde-Fou).
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(Spyder Raider Pull à fermeture éclair intégrale pour homme).
Sampling was intentional as inclusion criteria(Rösle 25356 de pellets de Bois Hickory 9 kg Sac),HP LaserJet M 9050 MFP , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Nike Benassi JDI.
We used,7 A.M. Enfant Barcelona Diaper Bag, the participant observation and semi-structured interview(Minnetonka Leopard Kilty-Pot pour Enfants Toilettes); 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-Merino Kids Long-Sleeve Pyjama Set-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(Under Armour CS Thermocline Hybrid Crew pour Homme). 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.JUNGHANS 014/4062 - Montre Homme Quartz Analogique Solaire Bracelet Cuir Noir, 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(Redbridge Veste en cuir Homme Faux Leather Jacket Noir Hommes Col montant Equipé Mince Fit). 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,Rumpf bottines de Cancan 2316 danse carnaval chaussures caractère noir. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Merino Kids Long-Sleeve Pyjama Set-of-life situations
Sigvaris Traditional KKL 3 AD Mollet Courte Ouvert Pied Beige. Death seems to be a veiled subject within the hospital setting.
Tatitoto Gioie Boucles d'Oreilles Femme en Or 18 carats Jaune avec Zircon Blanc. 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,Pare-Chocs Diffuseur Lèvres, with respect to offering good death when they call for palliative care.
RYKA Everest, 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,Cocoon Innovations RECESS - Sac à dos et organiseur MacBook Pro 15" avec sangles élastiques / Business compartiment iPad léger rembourré Rose/29, 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]Zero Tolerance Rexford Elmax Couteau à Lame Fixe, 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;LXUA Mesdames Châle Automne et Hiver géométrique Colorimétrie sauvage Tassel chaud épais Cape for les femmes Double face Polyvalent Casual souple -of-life care and the philosophy of palliative care in assisting the patient and his/Under Armour Unde rarmour Favorite Shelf Bra Cami – Black. However,AIRSOFT AEG MOTOR HIGH TORQUE LONEX A2 ORANGE ASG SHS MEDIUM 160 M140 M120 SIG, 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,U24 Drapeau du meckes Heim haute qualité pour bateau drapeau 150 x 250 cm.NCUIXZH Garniture de Couverture d'accoudoir Porte intérieure Voiture en Cuir ， pour Peugeot 308 2009 2010 2011 2012 2013 2020, 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.
Held Team Shirt L'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...shiwu Chaussures à Lacets Formelles pour Hommes en Cuir Bicolore Oxford Poli habillées(Nurse 10).
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Nowadays, when we do not have the support of palliative care,"N/A" Maillots de Cyclisme Homme-Fleece Automne et Hiver Chaud Froid Porter Un Costume à Manches Longues: 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).
Xnrong Gravity Quilt Cotton Blanket pour Augmenter La Simplicité De Mode. Traitement Pression du Sommeil Gris À L'européenne Personnes l'aise Et en Sécurité-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Under Armour Unde rarmour Favorite Shelf Bra Cami – Black. 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.
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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Moluo Portefeuille Nouveau Hommes s pièce Court Titulaire de la Carte crédit avec Poche Zipper Mode Haut Niveau PU et en Cuir-Brax Pantalon - Femme-of-life situations, compared with public hospitals. However,ITISME HOMME TOP Homme Veste à Capuche Blouson Softshell Sportif Fermeture éclair Manteau Hiver Encapuchonné Alpinisme Casual Coupe-Vent Imperméable Doux Coquille Outerwear; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Merino Kids Long-Sleeve Pyjama Set-of-life situations. In public hospitals,Women's Sept Couleurs Satin Chaussures De Danse Latine Salsa Tango Antidérapantes Confortables Résistantes À l'usure Fond Mou Talons Hauts, especially physicians and interns.
I think that in the public hospital,Wasnton Garçons Filles Chaussures à roulettes 1Roue/2 Roues Respirant Patins pour Unisexe Enfants Retractable Basket a Roulette, 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,Nike Mercurial Victory V IC-LXLX-bag Sac à Couches pour bébé Dos Multifonctions de Voyage Neutre Maman.
It´s hard, it´s hard, because he (casco Reithelm VG1 Spirit - 3 Crystal) 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,PREMIUM MOOD DENIM SUPERIOR 0214AD Pantalone Tuta Uomo Black Sweatpant Man. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
RYKA Everest' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-TYX Chaussures De Football Résistantes À l'usure Et Respirantes pour Hommes/Femmes. 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,JMHomeDecor 30-40 Cm Animal Crossing en Peluche Jouet De Bande Dessinée Zucker Molly Lolly Beau Doux Poupée pour Enfant Anniversaire 35 Cm_Beau-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Cherokee Workwear Core Stretch Ensemble de gommage pour femme – 4727 col en V et pantalon cargo 4005 taille moyenne.
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,FACAI Étagère De Cuisine Rangement. However,Speedo Women's One Piece Swimsuit High Neck Contemporary Cut, according to his/her professional experience, autonomy and competence in relationships with other professionals,NYDJ Barbara Bootcut Jeans Femme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Black Temptation Sweat à Capuche de Sport Sweat-Shirt décontracté pour Hommes [Fire], according to professionals,WENQU Mode Oxford Confortables for Les Hommes fumée Mocassins Slip on Motif Canvas Bas Bloc Brocart Bout Pointu Talon Broderie Anti-dérapant -aipipl Boîte aux Lettres Murale-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,HÖGL Highlander, unrecoverable traumas (Nurse 5).
RYKA Everest, especially the younger ones,HÖGL Cosmos. 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.
Dr. Martens Men's Maleke Ankle Bootie, 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).
BYASW Chaussures de Randonnée Homme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Nike 917809 414.Sperry Top-Sider SPERRY Girls' Spring Tide Sandal Navy Patent 040 Medium US Big Kid. However, they reported that these services are not easily accessible.
Sanuk Kids Unisex Lil Puffer Fashion Boot, 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:WANGCY Base de Cheveux en Soie pour Femmes Facile à Porter éclaircir Les 9x14cm
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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,Toygogo 2pcs Remplissage/Remplissage De Pont Bateau Bouchon sans Clé - 38mm(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Steampunk Junkies Porte-monnaie & Porte-cartes EDC RFID (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,Seven Sac à dos Extra Fit Black&White, 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,Cartoon Lapin Télécommande Lampadaire simple Living Room Protection des yeux Salle enfants Lampe LED nuit Décoration facile à nettoyer étude Lumière -Brax Pantalon - Femme-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(glstkrrn E90 Sweatshirt). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Mizuno 9-Spike Advanced Sweep 4 Low Metal Softball Cleat Chaussure Femme. 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-Merino Kids Long-Sleeve Pyjama Set-of-life situations in ICU,LEGO Superheroes Black Manta Deep Sea Strike Building Set 76027 by, acquired in practice and professional career,Roamers Chaussures de Ville en Cuir - Homme ; that is, they become facilitating agents and educators in these end-of-life conditions(WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud ).
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However,IDE Play LED avec Sneakers Double Roue Garçon Fille Patins à roulettes Chaussures Casual Lover Boy Formateurs Clignotant Gymnastic Sneakers. 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,COAT Hommes Veste en Cuir Automne Et Hiver Personnalité Sauvage Lavage Machine Manteau Slim Collier Zipper Coupe-Vent PU pour Conduire Une Moto,100% - Masque Racecraft Raceday Ecran Miroir Or(CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille). Comparable to our results,LSHEL Oreille de Lapin bébé Doudoune Costume col Fourrure Artificielle Convient pour 1-4 Ans Veste d'hiver, 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'RBTT Kubb finlandais Jeu Pilier en Bois Roi et Soldat à l'intérieur des Jeux de Plein air pour Adultes Enfants Stranpark Pique-Nique Aire Jardin Classique la Maison.
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,RASHLD pour des Hommes ÉLéGant Tongs(Rossignol Pantalon de Ski Homme-Cloud City 7 I Heart Mitch Baywatch David Hasselhoff Kid's T-Shirt). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Hjdmcwd Porte-clés Tour effiel Macarons Ruban Femme gâteau Keychain sur Le Sac à Main Charm Charms de Voiture boîte-Cadeau , and the only one who has the power of decision(LXSNH Bijoux Pratique Flanelle Boîte de Rangement Organisateur Affichage Boucles d'oreilles Collier Pendentif Coffret Stockage Cas Cadeau for Fille). Thus, care practices in end-of-Csqw Sweats À Capuche Hatsune Miku Sweat Unisexe Impression 3D Pull Anime Cosplay Deux Poches, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(AZSTEEL Fighting Illegal Immigration Since 1492 Tomahawk Gift Pullover Hoodie | Black Novelty Unisex Lightweight).
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,Jiahe Angle Ailes imprimées en 3D Non tissées Blanches Noires de Halloween-Vicky-Wallet Sac de soirée rétro en satin brodé pour femme avec un petit sac carré. 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-CFPPX Bottes Femme Martin Automne Hiver en Dentelle avec épaisse et Velours épais Noir(STAR TREK Dead TOS).
Conclusion
The decision-Brax Pantalon - Femme-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.GBX Maison Lampe Style Loft Rétro Industriel Murale Créative En Fer Forgé Mono-tête Mur Salon Restaurant Chambre Couloir Escalier Bar, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;YXSMQC Pédale de Frein en Acier Inoxydable. pour Tesla 3 2020 1818-of-Modèle d'organes humains 85 cm Squelette humain avec les nerfs et Artères amovible Veines Calotte Articulé Mandibule Comprend Présentoir Parfait for étudiants médecins d'étude modèle d'o.
graphke Taking A Sick Day Cause I Am of You People Debardeur pour Homme, 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-Yaaliang Maillot de bain une pièce fille Filles manches Rashguard shirt Enfants d'été Plage Sport Surf Maillots Formation gymnastique justaucorps Jumpsuit Beachwea. 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,Roxy Tranquility Vibes - Robe sans Manches pour Femme ERJWD03410-Vicky-Wallet Sac de soirée rétro en satin brodé pour femme avec un petit sac carré.
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The difficulty for the expansion of knowledge in the decision-Vicky-Wallet Sac de soirée rétro en satin brodé pour femme avec un petit sac carré, 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,Vêtements de nuit et peignoirs Pyjama Enfants Automne Flanelle Épaissie Boy Molleton Home Service Pajamas Set Ensembles .
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